The effect of professional tooth cleaning or non-surgical periodontal therapy on oral halitosis in patients with periodontal diseases. A systematic review

OBJECTIVE

The aim of this systematic review was to give the best available evidence on the impact of professional tooth cleaning (PTC) and scaling and root planing (SRP) on oral halitosis in patients with periodontal diseases.

MATERIAL AND METHODS

Three databases were screened for relevant studies. Only randomized controlled trials (RCTs) or controlled clinical trials (CCT) were included. The primary outcome in all included studies was volatile sulphur compounds (VSC) measured by Halimeter or OralChroma and organoleptic scores as secondary outcome. Only studies investigating healthy adults except for periodontitis or gingivitis were included. The considered intervention strategies were professional tooth cleaning and non-surgical periodontal treatment. For both strategies, additional oral hygiene instructions (OHI) were possible. Two independent reviewers performed the study selection and quality assessment.

SEARCH RESULTS

After abstract and title screening and subsequent full-text reading of potential papers, a placebo-controlled RCT could not be found. However, eight studies or particular arms used PTC or SRP as sole interventions and were included in this review. All trials or study arms included showed a positive effect on VSC levels or organoleptic scores after intervention.

CONCLUSIONS

Based on best available evidence, PTC and SRP in combination with oral hygiene instructions reduced VSC values in patients with oral halitosis and/or periodontal diseases, independent of tongue cleaning and the use of mouth rinses.

Isolation and Identification of Nonoral Pathogenic Bacteria in the Oral Cavity of Patients with Removable Dentures

Aims and Objectives:

Dentures in the oral cavity may act as a reservoir of microorganisms, which may be related to systemic infections. The aim of this study was to investigate the nonoral pathogenic bacteria in the oral cavity of patients with removable dentures in Shiraz, Southern Iran.

Materials and Methods:

The bacterial flora of saliva samples from 50 men and 50 women with removable dentures and 100 age- and sex-matched controls with normal dentate were compared using culture, Gram staining, and API20E Kit methods. All data were analyzed using SPSS software.

Results:

Except for Enterobacter cloacae isolate (P = 0.03), there was no significant difference between both groups for the presence of Escherichia coli, Klebsiella pneumoniae, nonfermenting Gram-negative bacilli, Raoultella ornithinolytica, Raoultella planticola, Kluyvera spp., and Enterobacter aerogenes. No significant correlation was noticed between age and presence of bacteria in the oral cavity. The Gram-negative rod bacteria were more in males, but the difference was not significant. When a total of Gram-negative rods were considered, there was a significant difference between case and control groups (P = 0.004).

Conclusions:

Based on our findings that nonoral pathogenic bacteria are detected from the saliva of the denture wearers, general and oral health measures in patients with removable dentures should be adopted to decrease the risk of cross infection.

Proteases, actinidin, papain and trypsin reduce oral biofilm on the tongue in elderly subjects and in vitro

OBJECTIVE

Dental plaque is a causative factor for oral disease and a potential reservoir for respiratory infection in the elderly. Therefore, there is a critical need for the development of effective methods to remove oral biofilm. The objective of this study was to investigate the effect of proteases on oral biofilm formation andremoval.

DESIGN

The in vivo effect of actinidin, a cysteine protease, on the removal of tongue coating was assessed after orally taking a protease tablet. Effects of the proteases trypsin, papain and actinidin on Actinomyces monospecies biofilm and multispecies biofilm that was reconstructed using a plaque sample from the tongue coating were investigated using the microtiter plate method. Antimicrobial tests and limited proteolysis of fimbrial shaft proteins were also performed to clarify underlying mechanisms of oral biofilm removal.

RESULTS

Tablets containing actinidin removed tongue coating in elderly subjects. Oral Actinomyces biofilm was significantly reduced by the proteases papain, actinidin and trypsin. Papain and trypsin effectively digested the major fimbrial proteins, FimP and FimA, from Actinomyces. Actinidin, papain and trypsin reduced multispecies biofilm that was reconstructed in vitro. Papain and trypsin inhibited formation of multispecies biofilm in vitro.

CONCLUSIONS

This study shows that proteases reduced oral biofilm in vivo in elderly subjects and in vitro, and suggests that protease digests fimbriae and inhibits biofilm formation.

Comparison of oral malodors before and after nonsurgical periodontal therapy in chronic periodontitis patients

Background/purpose

Periodontal diseases have been considered as a source of oral malodor or halitosis. Improvement of oral malodor in chronic periodontitis patients has recently been observed after nonsurgical periodontal therapy in combination with tongue cleaning and/or chlorhexidine mouth rinsing. The present study, however, evaluated the impact of nonsurgical periodontal therapy alone on the oral malodor in chronic periodontitis patients by comparing the intraoral concentrations of volatile sulfur compounds (VSCs) before and after nonsurgical therapy.

Materials and methods

Using a sulfide monitor, the total VSCs in exhaled breath were measured in 80 patients with chronic periodontitis prior to and 1 month after nonsurgical periodontal therapy (re-evaluation phase). Malodor was defined as a VSC score > 75 parts per billion (ppb) and > 110 ppb, respectively.

Results

Significantly lower level of VSCs was recorded at periodontal re-evaluation (55 ± 9.7 ppb) than before treatment (89 ± 16.3 ppb). Before treatment, 27 (34%) patients were considered to have malodor, defined as VSCs > 75 ppb. After treatment, 16 patients (20%) had VSC scores > 75 ppb, including 10 of 27 patients with baseline VSC scores > 75 ppb and six of 53 patients with baseline scores ≤ 75 ppb. The risk of malodor differed significantly before and after treatment (P = 0.035, McNemar's test). However, when malodor was defined as VSCs > 110 ppb, the difference in risk showed only borderline significance (P = 0.077).

Conclusion

On the basis of our findings, we suggest that nonsurgical periodontal therapy has a mild impact on oral malodor.

Understanding the Potential of WO₃ Based Sensors for Breath Analysis

Tungsten trioxide is the second most commonly used semiconducting metal oxide in gas sensors. Semiconducting metal oxide (SMOX)-based sensors are small, robust, inexpensive and sensitive, making them highly attractive for handheld portable medical diagnostic detectors. WO₃ is reported to show high sensor responses to several biomarkers found in breath, e.g., acetone, ammonia, carbon monoxide, hydrogen sulfide, toluene, and nitric oxide. Modern material science allows WO₃ samples to be tailored to address certain sensing needs. Utilizing recent advances in breath sampling it will be possible in the future to test WO₃-based sensors in application conditions and to compare the sensing results to those obtained using more expensive analytical methods.

Light activated antimicrobial agents can inactivate oral malodour causing bacteria

Oral malodour is a common condition which affects a large proportion of the population, resulting in social, emotional and psychological stress. Certain oral bacteria form a coating called a biofilm on the tongue dorsum and degrade organic compounds releasing volatile sulfur compounds that are malodourous. Current chemical treatments for oral malodour such as mouthwashes containing chlorhexidine or essential oils, are not sufficiently effective at reducing the bacterial load on the tongue. One potential alternative to current chemical treatments for oral malodour is the use of light activated antimicrobial agents (LAAAs), which display no toxicity or antimicrobial activity in the dark, but when exposed to light of a specific wavelength produce reactive oxygen species which induce damage to target cells in a process known as photodynamic inactivation. This study aimed to determine whether oral malodour causing bacteria were susceptible to lethal photosensitization. Five bacterial species that are causative agents of oral malodour were highly sensitive to lethal photosensitization and were efficiently killed by methylene blue in conjunction with 665 nm laser light. Between 4.5-5 log₁₀ reductions in the number of viable bacteria were achieved with 20 µM methylene blue and 14.53 J cm^-2 laser light for Porphyromonas gingivalis, Prevotella intermedia, Peptostreptococcus anaerobius and Solobacterium moorei. The number of viable cells fell below the limit of detection in the case of Fusobacterium nucleatum. These findings demonstrate that methylene blue in combination with 665 nm laser light is effective at killing bacteria associated with oral malodour, suggesting photodynamic therapy could be a viable treatment option for oral malodour.

Minimally invasive periodontal therapy for general practitioners

There remains a high prevalence of mild-to-moderate forms of periodontal diseases in both developed and developing countries. Although many periodontal specialty practices currently place strong emphasis on implant surgery, periodontal plastic surgery and esthetics, general dentists and hygienists have often assumed more responsibility than periodontal specialty practices for the diagnosis, treatment, assessment and maintenance, and possible referral, of their patients. To address these current trends and challenges, this volume of Periodontology 2000 presents a series of topics on the basic biological principles of periodontal disease, as well as on approaches to diagnosis, treatment planning and treatment, in what is called 'conservative' or 'noninvasive' periodontal therapy. These topics include risk assessment of the periodontal condition; reduction, elimination and/or control of etiologies and risk factors, including mechanical, antimicrobial and host-modulation approaches; considerations for evaluation of clinical outcomes based on treatment approaches; and selected topics in laser therapy, halitosis and gingival recession.