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Canine oral malodor may be the first indication that a serious disease process is occurring in the oral cavity. Various methods for detecting oral malodor have been used in humans, and some of these are suitable for collecting data in the dog. Oral malodor often responds favorably to improved oral hygiene, administered first by a trained professional and followed with adequate home care.
This study investigated the oral health awareness of aesthetic problems among adolescents. In 2002, a questionnaire survey on oral malodor and teeth stains was conducted at a junior and senior high school for males in Tokyo. The subjects were 783 students. The following results were obtained. (1) The rate of students who were concerned about other persons' oral malodor was significantly higher for the students in the senior high school than in the junior high school. The attitudes toward oral malodor varied depending on whether the target was family or friends. (2) Forty percent of junior high school students and first-year senior high school students answered that they had been conscious about their oral malodor. The rate was 60% for second- and third-year senior high school students. There was a significant difference between the two groups. (3) Thirty-five percent of the students who were conscious about their oral malodor felt some difficulties in daily life such as communication with other persons. (4) Fifty percent of the students replied that they had been conscious about their teeth stains. However, most of them felt no difficulties in daily life. From these results, it was revealed that almost half of the junior and senior high school students had been concerned about oral malodor and teeth stains. It is necessary to provide adequate dental health education on oral malodor and teeth stains for students through school oral health promotion activities as well as in dental clinics.
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Microleakage can occur at the abutment-implant (A-I) interface in osseointegrated implants and may cause malodor and inflammation of peri-implant tissues. The degree of microleakage at the A-I interface of 5 implant systems was comparatively assessed at varying closing torques. Using colored tracing probes driven by a 2-atm pressure system, the interface microleakage of Brånemark, Sulzer Calcitek, 3i, ITI, and Steri-Oss implants was determined spectrophotometrically. Microleakage through the A-I interface occurred in all systems, with variability between systems, samples, and closing torques. As closing torque increased from 10 Ncm to 20 Ncm to manufacturers' recommended closing torques, microleakage decreased significantly (P < .005) for all systems. Analysis of variance showed significant interaction between closing torques and the time course of microleakage, and between systems and the time course of microleakage (P < .001). The results indicate that fluids and small molecules are capable of passing through the interface of all the A-I assemblies studied. Presumably in an in situ situation, fluids containing bacterial byproducts and nutrients required for bacterial growth may pass through the interface gap, contributing in part to clinically observed malodor and peri-implantitis.
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Two recent cases of psychiatric disorders, presenting primarily with physical symptoms are described, which suggest that both psychotic and psychoneurotic disorders can present with somatic symptoms for which no adequate physical cause could be defined. It is emphasised that such cases require specialist psychiatric evaluation and assessment for the appropriate management to be initiated. Recent studies have stressed the frequency with which psychiatric illness or psychological distress is presented in most African patients as somatic illness, especially in depressive illness, psychotic disorders and psychoneurotic disorders (1). Two such cases of different diagnoses are presented here.
PURPOSE: This study examined and compared levels of salivary bacteria which produced volatile sulfur compounds (VSC) in young children with and without oral malodor. METHODS: Clinic populations of children aged two to seven years, whose parents presented with an unsolicited major complaint of oral malodor in their child (OM+), or aged-matched controls in whom oral malodor was not detected by parents (OM-), were investigated. Saliva specimens were cultured anaerobically on media that differentiated VSC+ bacteria. These were quantified and identified. Levels in OM+ and OM- children were compared and statistically analyzed. RESULTS: OM+ children harbored significantly higher levels of VSC+ isolates in saliva than OM- children (OM+ = 44% of total viable counts, TVC; OM- = 24% of TVC; P = 0.0083). Types of recovered bacterial species did not differ in the two groups, but levels of Prevotella oralis were significantly higher in OM+ children (P = 0.0001). Veillonella species followed by P. oralis were the predominant VSC+ isolates recovered in both populations. CONCLUSIONS: VSC+ salivary bacteria may differ both in type and quantity in young children with and without parent-perceived oral malodor.
The efficacy of a chlorine dioxide-containing mouthrinse in reducing oral malodor was compared to that of a water control in randomized, double-blind crossover study in 12 male and female subjects. Entrance criteria required a score of < or = 1 (slightly unpleasant/stale) on a 7-point ordinal odor pleasantness scale at both screening and baseline. On the test mornings, subjects refrained from oral hygiene and rinsed with 15 mL of either mouthrinse or water (one occasion each), under supervision for a timed 30-second interval. Three trained, previously calibrated sensory judges independently evaluated mouth odor pleasantness and intensity. Odor pleasantness scores (7-point scale) and odor intensity scores (5-point scale) from the three sensory judges were analyzed using an Analysis of Variance. The average score of all the judges was analyzed for each time point. The mean (+/- SD) mouth odor pleasantness in the chlorine dioxide group improved from -1.25 +/- 0.29 at baseline to -0.72 +/- 0.31 at 0.5 hour, -0.81 +/- 0.26 at 1 hour, -0.61 +/- 0.45 at 2 hours, and -0.61 +/- 0.55 at 4 hours post-rinsing (delta = 0.53, 0.44, 0.64, and 0.64, respectively). In the control group, the mean (+/- SD) mouth odor pleasantness improved from -1.06 +/- 0.40 at baseline to -0.94 +/- 0.58 at 0.5 hour, and to -0.97 +/- 0.46 at 1 hour, then deteriorated from -1.06 +/- 0.40 at baseline to -1.11 +/- 0.38 at 2 hours, and -1.08 +/- 0.61 at 4 hours post-rinsing (delta = 0.11, 0.08, -0.06, and -0.03, respectively). The mean (+/- SD) mouth odor intensity in the chlorine dioxide group improved from 1.14 +/- 0.17 at baseline to 0.92 +/- 0.35 at 0.5 hour, 1.06 +/- 0.24 at 1 hour, 0.83 +/- 0.44 at 2 hours, and 0.81 +/- 0.44 at 4 hours post-rinsing (delta = -0.22, -0.08, -0.31, and -0.33, respectively). In the control group, the mean (+/- SD) mouth odor intensity improved from 1.11 +/- 0.26 at baseline to 0.97 +/- 0.44 at 0.5 hour and 1.03 +/- 0.33 at 1 hour, then deteriorated from 1.11 +/- 0.26 at baseline to 1.17 +/- 0.39 at 2 hours, and 1.19 +/- 0.52 at 4 hours post-rinsing (delta = -0.14, -0.08, 0.06, and 0.08, respectively). Analyses of Variance showed that improvement in mouth odor pleasantness compared to baseline for the chlorine dioxide-containing mouthrinse versus the water control was statistically significant (p < 0.05) at all post-rinsing evaluations. For the reduction in mouth odor intensity, there was a statistically significant difference favoring the oral rinse at 2 and 4 hours post-rinsing. Thus, this study demonstrates that a one-time use of a chlorine dioxide-containing mouthrinse significantly improves mouth odor pleasantness and reduces mouth odor intensity for at least 4 hours.
This randomized and controlled, examiner blind, parallel group study was undertaken to evaluate the efficacy of three commercial dentifrices on breath malodor. A total of 384 healthy adult subjects with oral malodor were randomized to one of four brushing groups, using either an antimicrobial dentifrice containing 0.45% stannous fluoride, an antitartar dentifrice containing 0.243% sodium fluoride and 5% pyrophosphate, an antimicrobial dentifrice containing 0.24% sodium fluoride and 0.30% triclosan/copolymer, or bottled distilled water which served as the negative experimental control. Breath quality was evaluated over a five-day period by second-person organoleptic grading and measurement of volatile sulfur levels. Following treatment, adjusted mean organoleptic scores and volatile sulfur levels were lowest for the stannous fluoride dentifrice group, with this group exhibiting superior breath quality compared to the negative control at three hours after a single brushing, and again at all cumulative use time points. While all test dentifrices showed some activity, only stannous fluoride had a second-person breath benefit. Breath effects for the other two dentifrices were limited to reductions in volatile sulfur levels at hours 99 and 104 for the antitartar sodium fluoride pyrophosphate dentifrice, and at hour 99 only for the antimicrobial sodium fluoride triclosan/copolymer dentifrice. This research establishes the comparative breath efficacy of three commercial dentifrices in a study model that may prove relevant for other dentifrice clinical trials.
Chronic oral malodor is a serious concern for about one-fifth of the North American population, and a field of emerging research interest. The present three studies, one involving gas chromatography and two employing odor judge assessment, examined the efficacy of baking soda and other toothpastes in reducing breath odor. The most common cause of oral malodor is elevated levels of volatile sulfur compounds (VSC's), primarily hydrogen sulfide (H2S) and methyl mercaptan (CH3SH), in the breath. Gas chromatography, an accurate means of measuring breath VSC, was employed to evaluate the breath levels of VSC in 11 men after brushing with baking soda-containing dentifrices with or without the addition of Zn++. Dentifrices with either Zn++ or a concentration of baking soda 20% or greater significantly reduced VSC levels. The addition of Zn++ to baking soda dentifrices enhanced the anti-odor effects. In the first organoleptic study, dentifrices containing 20% baking soda and 30% baking soda demonstrated significantly greater ability to reduce breath odor than a standard sodium fluoride/silica dentifrice. The subjects' baseline mouth odor evaluations, initially rated as strong, declined after brushing with the baking soda toothpastes to a barely detectable level at one hour, then rising to a faint level at two hours and moderate levels at three hours. In the second organoleptic study, a dentifrice containing 65% baking soda demonstrated significantly greater ability to reduce breath odor than a standard sodium fluoride/silica tartar control dentifrice, but did not differ significantly from a standard dentifrice containing 0.76% sodium monofluorophosphate in a dicalcium phosphate dihydrate base. The results of these studies indicate that dentifrices containing 20% or more baking soda can confer a significant odor-reducing benefit for time periods up to three hours.
Gas chromatography and a flame photometric detection system measured directly from mouth air the sulfur volatiles associated with malodor. Statistically significant reductions in the hydrogen sulfide and methyl mercaptan levels were observed with use of the test rinse vs a placebo rinse. The method appears potentially useful in objective clinical evaluation of mouth odor.
OBJECTIVE: Chewing gum may act as a masking or a therapeutic agent against the different chemical compounds that are responsible for oral malodor. An open-label exploratory study investigated the effect of mastication and aromatic components of chewing gum on reducing oral volatile sulfur compounds. METHOD AND MATERIALS: Twelve dental students (5 males and 7 females) acted as their own controls. Toothbrushing stopped 12 hours before observations. Measurements included organoleptic and volatile sulfur compound scores and the pH of the anterior and posterior zones of the dorsal tongue. Measurements were made at 9 AM and 12 PM on 1 day for 3 successive weeks; week 1, no gum (control); week 2, test gum; week 3, unsweetened gum base. This open-label study was then completed by an observer-blind study, according to the same schedule; the recorded measurement was the plaque index. RESULTS: The pH, volatile sulfur compounds, and organoleptic scores were similar for all groups. The pH was more basic in the posterior part than in the anterior zone of the dorsal tongue, irrespective of time and presence or absence of chewing gum. In addition, the volatile sulfur compound score rose transiently immediately after the test gum, and the organoleptic score fell in the first hour only after the test gum. The two chewing gum groups seemed to have a greater reduction in plaque index than did the control (no gum) group. CONCLUSION: Chewing gum may have a valuable mechanical role in cleaning dental surfaces, and the test gum may temporarily control bad breath. After 3 hours, similar volatile sulfur compound scores were observed for subjects who chewed either test or unsweetened gum base and control subjects.
OBJECTIVE: In an initial study, subjects complaining of bad breath were generally unable to score the level of their own oral malodor in an objective fashion. Subjects were taught several techniques for self-measurement of bad breath. One year following the initial consultation, subjects were recalled to determine whether their ability to assess their own oral malodor had improved. METHOD AND MATERIALS: In the study, subjects were blinded to their own scores 1 year earlier, to the odor-judge scores, and to the results of the clinical laboratory tests. Thirty-two of 43 subjects in the original study who presented with a complaint of oral malodor agreed to participate in the follow-up study. Odor-judge scores and self-assessments of oral malodor (whole-mouth odor, tongue odor, and saliva odor) were compared with one another as well as with clinical parameters. RESULTS: Objective improvements were noted in both oral health parameters and malodor levels of subjects. Despite this, self-assessments generally remained unrelated to objective parameters (odor-judge scores, clinical indices, and laboratory tests). Self-assessments were all significantly correlated with one another, and also were significantly associated with corresponding self-estimates made 1 year earlier. CONCLUSION: Subjects with a complaint of oral malodor remain largely unable to score their own bad breath in an objective fashion. In addition, they are not capable of sensing reductions in oral malodor 1 year following the original assessment, even though, from a clinical standpoint, improvements have taken place.
OBJECTIVE: The purpose of this study was to detect the relative contribution of Porphyromonas gingivalis, Fusobacterium nucleatum, and Prevotella intermedia in the production of oral malodor. METHOD AND MATERIALS: The volatile sulfur compounds produced by these bacteria in vitro were measured semiquantitatively by a portable sulfide monitor. RESULTS: Samples from the tongue, tonsils, and pharynx showed a significantly higher production (550 ppb) of volatile sulfur compounds during the first 6 hours after anaerobic incubation in broths (brain-heart infusion, Columbia, and Trypticase Soy) than after incubation in agar media (300 ppb) (P < 0.001). After 24 hours, values in broths and agars leveled off at 350 ppb (P = 0.3) and remained constant during the next 6 days. Measurement of separate pure cultures showed that maximal volatile sulfur compound production was reached 6 hours after incubation (450 ppb for the 3 bacteria). Higher volatile sulfur compound values were measured in brain-heart infusion. When measurements of mixed cultures of the 3 pathogens were performed every 15 minutes, the maximal value was reached after only 30 minutes of incubation (nearly 500 ppb). CONCLUSION: The in vitro volatile sulfur compound production of oral samples is preferably measured in broths. Maximal sulfur production from mixed cultures is reached after 30 minutes of incubation. Samples should always be inoculated at the same dilution.
Bacterial putrefaction is the central metabolic process involved in oral malodor and can easily be modeled in the salivary sediment system developed from centrifuged whole saliva. Methods used in this system for examining malodor have included measurement of (1) head space (gaseous-phase) and liquid-phase odors, organoleptically; (2) volatile sulfur compounds, by means of an electrochemical sensory instrument; (3) pH, Po2, and oxidation-reduction potential with appropriate respective electrodes; (4) the malodorous compounds indole and skatole, colorimetrically; (5) substrate levels and their effects; and (6) bacterial numbers and types. The simplicity of the system permits other analyses to be easily added, if needed, and the influence of factors and agents that affect oral malodor to be assessed. Addition of odorigenic or non-odorigenic pure cultures to the mixed bacterial flora of the system enables modification of the microflora composition and high- and low-odor-production microflora to be simulated and compared. Modeling validity has been enhanced by the use of complementary in vivo methods, such as a method used to measure the ability or potential of an oral microbial flora to produce malodor. The method involves in vivo challenge testing with cysteine, an amino acid, and measuring the hydrogen sulfide produced. Oral malodor is a multifactorial condition and models enable its systematic study and the quantitative testing of antimalodor agents.