A review of the current literature on aetiology and measurement methods of halitosis

Highly Selective and Reversible Detection of Simulated Breath Hydrogen Sulfide Using Fe-Doped CuO Hollow Spheres: Enhanced Surface Redox Reaction by Multi-Valent Catalysts

The precise and reversible detection of hydrogen sulfide (H2 S) at high humidity condition, a malodorous and harmful volatile sulfur compound, is essential for the self-assessment of oral diseases, halitosis, and asthma. However, the selective and reversible detection of trace concentrations of H2 S (≈0.1 ppm) in high humidity conditions (exhaled breath) is challenging because of irreversible H2 S adsorption/desorption at the surface of chemiresistors. The study reports the synthesis of Fe-doped CuO hollow spheres as H2 S gas-sensing materials via spray pyrolysis. 4 at.% of Fe-doped CuO hollow spheres exhibit high selectivity (response ratio ≥ 34.4) over interference gas (ethanol, 1 ppm) and reversible sensing characteristics (100% recovery) to 0.1 ppm of H2 S under high humidity (relative humidity 80%) at 175 °C. The effect of multi-valent transition metal ion doping into CuO on sensor reversibility is confirmed through the enhancement of recovery kinetics by doping 4 at.% of Ti- or Nb ions into CuO sensors. Mechanistic details of these excellent H2 S sensing characteristics are also investigated by analyzing the redox reactions and the catalytic activity change of the Fe-doped CuO sensing materials. The selective and reversible detection of H2 S using the Fe-doped CuO sensor suggested in this work opens a new possibility for halitosis self-monitoring.

Tongue feature dataset construction and real-time detection

BACKGROUND

Tongue diagnosis in traditional Chinese medicine (TCM) provides clinically important, objective evidence from direct observation of specific features that assist with diagnosis. However, the current interpretation of tongue features requires a significant amount of manpower and time. TCM physicians may have different interpretations of features displayed by the same tongue. An automated interpretation system that interprets tongue features would expedite the interpretation process and yield more consistent results.

MATERIALS AND METHODS

This study applied deep learning visualization to tongue diagnosis. After collecting tongue images and corresponding interpretation reports by TCM physicians in a single teaching hospital, various tongue features such as fissures, tooth marks, and different types of coatings were annotated manually with rectangles. These annotated data and images were used to train a deep learning object detection model. Upon completion of training, the position of each tongue feature was dynamically marked.

RESULTS

A large high-quality manually annotated tongue feature dataset was constructed and analyzed. A detection model was trained with average precision (AP) 47.67%, 58.94%, 71.25% and 59.78% for fissures, tooth marks, thick and yellow coatings, respectively. At over 40 frames per second on a NVIDIA GeForce GTX 1060, the model was capable of detecting tongue features from any viewpoint in real time.

CONCLUSIONS/SIGNIFICANCE

This study constructed a tongue feature dataset and trained a deep learning object detection model to locate tongue features in real time. The model provided interpretability and intuitiveness that are often lacking in general neural network models and implies good feasibility for clinical application.

Preliminary investigation of a combined herbal extract of Aruncus dioicus, Cirsium nipponicum, and Ocimum basilicum for halitosis

BACKGROUND

Halitosis, the unpleasant odor in the oral cavity, has garnered increased attention and concern due to the growing significance of social interaction. SGE-107, a blend of 3 botanical drugs-Korean goat's beard, Cirsium tanakae, and Basil-with caffeic acid as its indicator component. This study aims to investigate the efficacy of SGE-107 in treating halitosis in patients with mild gastrointestinal symptoms.

METHODS

We enrolled 25 participants with oral malodor and dyspeptic symptoms. We assessed the severity of halitosis using the visual analog scale. Throughout a 4-week period of administering SGE-107, we evaluated both objective and subjective parameters, including the halitosis-associated life-quality test, the Korean gastrointestinal symptom rating scale, levels of volatile sulfur compounds, salivary flow rate, oral moisture, tongue index, Winkel tongue coating index, and tongue temperature.

RESULTS

After the intervention period, both the visual analog scale (5.88 ± 1.03 vs 2.38 ± 0.93, P < .001) and the scores of the halitosis-associated life-quality test (31.21 ± 11.78 vs 13.83 ± 6.38, P < .001) showed significant reductions. The proportion of participants with abnormal levels of methyl mercaptan (a volatile sulfur compound) also significantly decreased (17, 70.8% vs 9, 37.5%, P = .039). Furthermore, there were significant improvements in reflux, constipation, diarrhea, and the total scores on the Korean gastrointestinal symptom rating scale. Throughout the study period, only 2 participants experienced mild adverse events.

CONCLUSION

SGE-107 appears to be a safe and effective treatment for halitosis-associated with gastrointestinal symptoms; nevertheless, the limited sample size necessitates further large-scale randomized, controlled studies to confirm our findings.

In vitro gastrointestinal gas monitoring with carbon nanotube sensors

In vitro simulators of the human gastrointestinal (GI) tract are remarkable technological platforms for studying the impact of food on the gut microbiota, enabling continuous and real-time monitoring of key biomarkers. However, comprehensive real-time monitoring of gaseous biomarkers in these systems is required with a cost-effective approach, which has been challenging to perform experimentally to date. In this work, we demonstrate the integration and in-line use of carbon nanotube (CNT)-based chemiresitive gas sensors coated with a thin polydimethylsiloxane (PDMS) membrane for the continuous monitoring of gases within the Simulator of the Human Microbial Ecosystem (SHIME). The findings demonstrate the ability of the gas sensor to continuously monitor the different phases of gas production in this harsh, anaerobic, highly humid, and acidic environment for a long exposure time (16 h) without saturation. This establishes our sensor platform as an effective tool for real-time monitoring of gaseous biomarkers in in vitro systems like SHIME.

The effect of mastic mouthwash on halitosis and oral hygiene in orthodontic patients: a randomized clinical trial

BACKGROUND/OBJECTIVES

The aim of this trial was to investigate the effect of mastic mouthwash on halitosis using as a proxy the levels of the Volatile Sulfur Compounds (VSCs), and the effect on plaque and gingival indices in adolescents undergoing orthodontic treatment with fixed conventional labial appliances.

SUBJECTS/METHODS

The study was a double-blinded, placebo-controlled, parallel-group, randomized clinical trial. Thirty patients with fixed orthodontic appliances were randomly allocated at a 1:1 ratio, to either the mastic-mouthwash or the placebo-mouthwash group. Eligibility criteria included ages between 13 and 18, active orthodontic treatment with fixed appliances, good general health, and total initial VSCs levels above 150 ppb. The primary outcome was the objective hydrogen sulfide (H2S) level, measured with the Oral ChromaTM device. The secondary outcomes were (1.) the methyl-mercaptan (CH3SH) and (2.) dimethyl sulfide [(CH3)2S] levels, measured with the same device, (3.) the subjective perception of the own malodour via questionnaires, and (4.) the oral hygiene assessed with the use of the Modified Silness and Löe Plaque Index (PI-M) and the Silness and Löe Gingival Index (GI) at baseline (T0) and after 2 weeks (T1). Stratified randomization by gender was used, and allocation was concealed with opaque numbered sealed envelopes.

RESULTS

H2S level dropped from 221.00 ppb (T0) to 125.00 ppb (T1), and the difference between treatment groups was statistically significant in favour of the mastic group (coef: 72.34, 95% CI: 8.48, 136.27, P = 0.03). The levels of the other VSCs, the subjective measurements of oral malodour, and the oral hygiene indices did not differ between treatment arms.

LIMITATIONS

The objective organoleptic assessment by a calibrated examiner was not performed.

CONCLUSIONS/IMPLICATIONS

Mastic mouthwashes could be an alternative treatment for adolescent patients suffering from halitosis during orthodontic treatment with fixed appliances.

REGISTRATION

The trial was registered at ClinicalTrials.gov (identifier: NCT05647369).

ORGANOLEPTIC AND HALITOMETRIC ASSESSMENTS DO NOT CORRELATE WELL IN INTRA-ORAL HALITOSIS: A SYSTEMATIC REVIEW AND META-ANALYSIS

BACKGROUND

The gold standard method for diagnosing oral halitosis is the subjective organoleptic measurement. Device-supported methods are also widespread worldwide. The challenges and safety concerns around performing organoleptic measurements during pandemics and the diversity of measuring device alternatives raised our clinical question: which halitometer is the most suitable for diagnosing halitosis?

METHODS

This systematic review was registered in PROSPERO (ID CRD42022320024). The search was performed on March 23, 2022 in the following electronic databases: MEDLINE, Embase, Scopus, Web of Science, and CENTRAL. Adult populations with or without halitosis were included, and patients with systemic diseases were excluded. Organoleptic (subjective) measurement and the device-supported (objective) methods were compared; the primary outcome was the correlation coefficient, and the secondary was the specificity and sensitivity of the devices. QUADAS-2 and QUADAS-C were used to evaluate the risk of bias in the studies. Random-effects meta analyses were performed on the outcomes, and the secondary outcomes were plotted on a common ROC plot.

RESULTS

A total of 1231 records were found in the 5 databases. After the selection process, 76 articles were eligible for the systematic review, and 14,635 patients were involved in the qualitative analysis. The pooled Spearman's correlation coefficient (c.c.) for sulfide monitors was 0.65; 95% CIs: [0.53-0.74]; I2 = 95%, P < .01. The pooled Spearman's c.c. for portable gas chromatographs was 0.69; 95% CIs: [0.63-0.74]; I2 = 12%, P < .01. The pooled Spearman's c.c. for gas chromatographs was 0.76; 95% CIs: [0.67-0.83]; I2 = 0%, P < .01.

DISCUSSION

None of the most commonly used halitometers proved to be significantly superior to the others. Halimeter and OralChroma measurements did not correlate well with the organoleptic level of oral halitosis in adults. Therefore, better halitometers need to be developed as an alternative to organoleptic measurements.

Pathways between verbal bullying and oral conditions among school children

PURPOSE

To investigate the direct and indirect pathways between verbal bullying and adverse oral conditions among school-aged children.

METHODS

A cross-sectional survey was conducted with 8- to 10-year-old children, enrolled in public schools in Southern Brazil. Verbal bullying was collected by self-reports. Independent variables included sociodemographic characteristics (sex, age, household income, and caregivers' educational level) and oral conditions (anterior open bite, anterior teeth crowding, upper anterior diastema, large overjet, untreated dental caries, and PUFA index). The pathways between verbal bullying and the independent variables were analysed through structural equation modelling.

RESULTS

1369 children were included. The prevalence of verbal bullying was 26.2% (95% confidence interval [CI] 23.9-28.6%). Verbal bullying was directly influenced by large overjet (standard coefficient [SC] 0.13, P < 0.01), untreated dental caries (SC 0.63, P = 0.01) and PUFA index (SC 0.75, P = 0.02). Sex (SC - 0.005, P = .04) and age (SC - 0.006, P < 0.01) indirectly influenced verbal bullying via untreated dental caries.

CONCLUSIONS

Verbal bullying was directly influenced by large overjet, untreated dental caries and PUFA index. Sex and age indirectly impacted verbal bullying through untreated dental caries.

Daily use of chlorine dioxide effectively treats halitosis: A meta-analysis of randomised controlled trials

OBJECTIVES

We aimed to conduct a systematic review on published data in order to investigate the efficacy of mouthwash products containing chlorine dioxide in halitosis.

STUDY DESIGN

Systematic review and meta-analysis.

METHODS

Our search was conducted on 14th October 2021. We searched the following electronic databases: MEDLINE, Embase, Scopus, Web of Science, and CENTRAL. We analysed data on adults with halitosis, included only randomised controlled trials and excluded in vitro and animal studies. The interventional groups used chlorine dioxide, and the comparator groups used a placebo or other mouthwash. Our primary outcomes were changes in organoleptic test scores (OLS) and Volatile Sulfur Compound (VSC) levels from baseline to the last available follow-up.

RESULTS

We found 325 articles in databases. After the selection process, ten articles were eligible for qualitative synthesis, and 7 RCTs with 234 patients were involved in the meta-analysis. Our findings showed a significant improvement in the parameters of the chlorine dioxide group compared to the placebo group in OLS one-day data (mean difference (MD): -0.82; 95% confidence intervals (95% CIs): [-1.04 --0.6]; heterogeneity: I2 = 0%, p = 0.67); and one-week OLS data (MD: -0.24; 95% CIs: [-0.41 --0.07]; I2 = 0%, p = 0.52); and also changes in H2S one-day data (standardised mean difference (SMD): -1.81; 95% CIs: [-2.52 --1.10]); I2 = 73.4%, p = 0.02).

CONCLUSION

Our data indicate that chlorine dioxide mouthwash may be a good supportive therapy in oral halitosis without known side effects.

A comprehensive review of the application of probiotics and postbiotics in oral health

Oral diseases are among the most common diseases around the world that people usually suffer from during their lifetime. Tooth decay is a multifactorial disease, and the composition of oral microbiota is a critical factor in its development. Also, Streptococcus mutans is considered the most important caries-causing species. It is expected that probiotics, as they adjust the intestinal microbiota and reduce the number of pathogenic bacteria in the human intestine, can exert their health-giving effects, especially the anti-pathogenic effect, in the oral cavity, which is part of the human gastrointestinal tract. Therefore, numerous in vitro and in vivo studies have been conducted on the role of probiotics in the prevention of tooth decay. In this review, while investigating the effect of different strains of probiotics Lactobacillus and Bifidobacteria on oral diseases, including dental caries, candida yeast infections, periodontal diseases, and halitosis, we have also discussed postbiotics as novel non-living biological compounds derived from probiotics.

Relationship between Hormonal Changes and Self-Perceived Halitosis in Females: A Cross-Sectional Study

Halitosis is a growing concern for patients seeking dental treatment. Women experience hormonal changes throughout different phases of their life. These changes may affect volatile organic compound (VOC) production and can be linked to halitosis. The aim of this study was to evaluate the effect of hormonal changes on self-perceived halitosis in a sample of females using a self-administered questionnaire. This study used a cross-sectional observational design. The questionnaire was distributed electronically through Google forms. A total of 1089 participants completed the questionnaire. Almost 50% of participants were below the age of 25; and 12% were of menopausal age (defined as 45 years and older). Most participants reported having regular menstrual cycles (63.5%) while only 20% reported having hormonal disturbances. Almost 62% of the sample reported that they notice halitosis on themselves with 27.6% indicating their perception of halitosis occurred at different times of the month. Around 12% of the sample thought that a relationship between halitosis and their menstrual cycle existed with 4.6% reporting halitosis during menstruation. The present study found that regularity of menstrual cycle and hormonal disturbances can affect females' self-perceived halitosis and the prevalence of oral health symptoms.

The tongue biofilm metatranscriptome identifies metabolic pathways associated with the presence or absence of halitosis

Intra-oral halitosis usually results from the production of volatile sulfur compounds, such as methyl mercaptan and hydrogen sulfide, by the tongue microbiota. There are currently no reports on the microbial gene-expression profiles of the tongue microbiota in halitosis. In this study, we performed RNAseq of tongue coating samples from individuals with and without halitosis. The activity of Streptococcus (including S. parasanguinis), Veillonella (including V. dispar) and Rothia (including R. mucilaginosa) was associated with halitosis-free individuals while Prevotella (including P. shahi), Fusobacterium (including F. nucleatum) and Leptotrichia were associated with halitosis. Interestingly, the metatranscriptome of patients that only had halitosis levels of methyl mercaptan was similar to that of halitosis-free individuals. Finally, gene expression profiles showed a significant over-expression of genes involved in L-cysteine and L-homocysteine synthesis, as well as nitrate reduction genes, in halitosis-free individuals and an over-expression of genes responsible for cysteine degradation into hydrogen sulfide in halitosis patients.

Nanometric Surface-Selective Regulation of Au/In2O3 Nanofibers as an Exhaled H2S Chemiresistor for Periodontitis Diagnosis

As one of the most prevalent diseases in the world, timely early intervention for periodontitis is a great challenge because the indicator is imperceptible. The exhaled H₂S is considered to be a promising biomarker for fast and invasive periodontitis screening; however, the high-performance H₂S gas sensor with excellent selectivity and sensitivity which is applicable to the oral cavity remains technically challenging. Herein, a self-assembled monolayer (SAM)-functionalized Au/In₂O₃ nanofiber (NF) sensor for H₂S exhalation analysis was developed to flexibly and effectively modulate the selectivity of the sensor. Through optimizing the specific binding capacity to H₂S by systematic adjustment with terminal groups and alkyl chains of SAMs, the sensing performance of the SAM-functionalized Au/In₂O₃ NF sensor is greatly enhanced. In the optimal (Au/In₂O₃-MPTES) sensor, the functionalization of the MPTES molecule could achieve significant response enhancement because of the stronger interaction between the sulfhydryl group at the end of the MPTES and H₂S. Density functional theory simulation supports the proposed selective sensing mechanism via the analysis of adsorption energy and charge density distribution. The sensor exhibited a high response to H₂S (1505.3-10 ppm) at an operating temperature of 100 °C with a low practical detection limit of 10 ppb and 13-145 fold enhanced selectivity. Furthermore, the Au/In₂O₃-MPTES sensor was successfully applied to distinguish the breath of healthy individuals and patients with severe periodontitis. This study provides novel design insights for the development of highly selective gas sensors for clinical aids in the diagnosis and detection of oral diseases such as periodontitis.

Prevalence of halitosis among young adults in Dunedin, New Zealand

OBJECTIVES

To investigate the prevalence of halitosis in young adults.

METHODS

Young adults (n = 372; mean age = 21.0 ± 2.6 years old, range = 18-30 years) in Dunedin, New Zealand were recruited into the cross sectional study after providing informed consent. The prevalence of halitosis was determined using both objective measurements (parts per billion [ppb] volatile sulphur compounds [VSCs] in the exhaled air) and subjective measurements (self-reported halitosis questionnaire, tongue coating index, and organoleptic assessment).

RESULTS

VSC measurements indicated that the prevalence of halitosis (values ≥ 140 ppb) was 31.2%; 25.6% of participants self-reported halitosis. The organoleptic assessment revealed that 14.3% of the participants had a score of ≥2. A positive correlation was found between the VSC measurements and organoleptic assessment (p < 0.05). No significant relationship was found between self-reported halitosis and either organoleptic assessment or VSC measurements. Self-reported dry mouth, smoking, oral hygiene index, DMFT index, and tongue coating score were significantly associated with the organoleptic assessment (p < 0.05). The self-reported dry mouth, mouth breathing and tongue coating score were significantly associated with the VSC scores (p < 0.05).

CONCLUSION

Halitosis, as represented by VSC, was found in 31.2% of the participants. VSC scores and organoleptic assessment were positively correlated. There was no significant relationship between self-reported halitosis and either organoleptic assessment or VSC measurements.

Au@Ag Nanorods-PDMS Wearable Mouthguard as a Visualized Detection Platform for Screening Dental Caries and Periodontal Diseases

The development of easy-to-use, low-cost, and visualized detection platforms for screening human dental caries and periodontal diseases is in urgent demand. In this work, a Au@Ag nanorods-poly(dimethylsiloxane) (Au@Ag NRs-PDMS) wearable mouthguard, which can visualize the tooth lesion sites through the color change of it at the corresponding locations, is presented. The Au@Ag NRs-PDMS composite exhibits a distinct color response to hydrogen sulfide (H₂ S) gas generated by bacterial decay at the lesion sites. Moreover, the Au@Ag NRs-PDMS mouthguard is demonstrated to own desired mechanical properties, excellent chemical stability, as well as good biocompatibility, and can accurately locate the lesion sites in human oral cavity. These findings suggest that the mouthguard has the potential to be utilized on a large scale to help people self-monitor their oral health in daily life, and treat oral diseases locally.

Halitosis, what experiences and methods apply Dutch dental hygienists

OBJECTIVES

The aim of this research is to gain more insight in the methods and experiences of dental hygienists in the Netherlands regarding the treatment of patients with halitosis.

MATERIAL AND METHODS

A total of 92 dental hygienists completed the questionnaire (consisting of 19 questions on personal and professional characteristics, clinical observation and treatment of halitosis, the referral of patients with halitosis, the presence and usefulness of a protocol). The questionnaire was distributed using a social media platform for dental professionals in oral health care from all over the Netherlands.

RESULTS

83.4% of 90 dental hygienists had paid attention to the patient's breath but only 37.8% of dental hygienists always informed the patient. Reasons for not informing patients were the fear of the patient's possible reaction or because other oral health problems were more important. Of the included dental hygienists 67.8% had never referred a patient for treatment of halitosis. 86.7% of the dental hygienists stated there was no protocol for diagnosis and treatment of patients with halitosis. However, 90.0% of the dental hygienists acknowledged a protocol would be useful.

CONCLUSIONS

The majority of the dental hygienists in the Netherlands had paid attention to the patient's breath, but only a small group of dental hygienists informed their patients about halitosis. In dental practices halitosis is an underestimated problem. During the coronavirus pandemic people are more aware with the smell of their breath. Dental hygienists indicated scaling and root planning and/or providing information and instruction by patients with a bad breath.

Next-Generation Digital Biomarkers for Tuberculosis and Antibiotic Stewardship: Perspective on Novel Molecular Digital Biomarkers in Sweat, Saliva, and Exhaled Breath

The internet of health care things enables a remote connection between health care professionals and patients wearing smart biosensors. Wearable smart devices are potentially affordable, sensitive, specific, user-friendly, rapid, robust, lab-independent, and deliverable to the end user for point-of-care testing. The datasets derived from these devices are known as digital biomarkers. They represent a novel patient-centered approach to collecting longitudinal, context-derived health insights. Adding automated, analytical smartphone applications will enable their use in high-, middle-, and low-income countries. So far, digital biomarkers have been focused primarily on accelerometer data and heart rate due to well-established sensors originating from the consumer market. Novel emerging smart biosensors will detect biomarkers (or compounds) independent of a lab and noninvasively in sweat, saliva, and exhaled breath. These molecular digital biomarkers are a promising novel approach to reduce the burden from 2 major infectious diseases with urgent unmet needs: tuberculosis and infections with multidrug resistant pathogens. Active tuberculosis (aTbc) is one of the deadliest diseases from an infectious agent. However, a simple and reliable test for its detection is still missing. Furthermore, inappropriate antimicrobial use leads to the development of antimicrobial resistance, which is associated with high mortality and health care costs. From this perspective, we discuss the innovative approach of a noninvasive and lab-independent collection of novel biomarkers to detect aTbc, which at the same time may additionally serve as a scalable therapeutic drug monitoring approach for antibiotics. These molecular digital biomarkers are next-generation digital biomarkers and have the potential to shape the future of infectious diseases.

Identification of Salivary Microorganisms and Metabolites Associated with Halitosis

Halitosis is mainly caused by the action of oral microbes. The purpose of this study was to investigate the differences in salivary microbes and metabolites between subjects with and without halitosis. Of the 52 participants, 22 were classified into the halitosis group by the volatile sulfur compound analysis on breath samples. The 16S rRNA gene amplicon sequencing and metabolomics approaches were used to investigate the difference in microbes and metabolites in saliva of the control and halitosis groups. The profiles of microbiota and metabolites were relatively different between the halitosis and control groups. The relative abundances of Prevotella, Alloprevotella, and Megasphaera were significantly higher in the halitosis group. In contrast, the relative abundances of Streptococcus, Rothia, and Haemophilus were considerably higher in the control group. The levels of 5-aminovaleric acid and n-acetylornithine were significantly higher in the halitosis group. The correlation between identified metabolites and microbiota reveals that Alloprevotella and Prevotella might be related to the cadaverine and putrescine pathways that cause halitosis. This study could provide insight into the mechanisms of halitosis.

Highly Sensitive and Selective NiO/WO3 Composite Nanoparticles in Detecting H2S Biomarker of Halitosis

Indirectly monitoring halitosis via the detection of hydrogen sulfide (H₂S) biomarkers using gas sensors is a newly emerging technique. However, such H₂S sensors are required with critically high selectivity and sensitivity, as well as a ppb-level detection limit, which remains technologically challenging. To address such issues, here, we have developed highly sensitive and selective H₂S sensors with NiO/WO₃ nanoparticles (NPs), which have been synthesized by firstly hydrolyzing WO₃ NPs and subsequently decorating with NiO NPs in a hydrothermal process. Theoretically, the NiO/WO₃ NPs assist in forming a thicker electron depletion layer, adsorbing more oxygen species O₂^- to oxidize H₂S and finally release more electrons. Beneficially, 2.1 wt % NiO/WO₃ NPs show high sensitivity to H₂S (R_a/R_g = 15031 ± 1370 @ 10 ppm, 100 °C), which is 42.6-fold higher than that of the pristine WO₃ NPs (R_a/R_g = 353 ± 5.6 @ 10 ppm, 100 °C). Further, the H₂S sensor shows ppb-level detection limit (R_a/R_g = 4.95 ± 2.9 @ 0.05 ppm, 100 °C) and high selectivity. Practically, NiO/WO₃ NP sensor prototype has been employed to detect the simulated exhaled halitosis compared with that of gas chromatography, revealing a close concentration of H₂S. Our investigation offers an experimental base in future intelligent medical applications.

Recent Advances in Ammonia Gas Sensors Based on Carbon Nanomaterials

This review paper is devoted to an extended analysis of ammonia gas sensors based on carbon nanomaterials. It provides a detailed comparison of various types of active materials used for the detection of ammonia, e.g., carbon nanotubes, carbon nanofibers, graphene, graphene oxide, and related materials. Different parameters that can affect the performance of chemiresistive gas sensors are discussed. The paper also gives a comparison of the sensing characteristics (response, response time, recovery time, operating temperature) of gas sensors based on carbon nanomaterials. The results of our tests on ammonia gas sensors using various techniques are analyzed. The problems related to the recovery of sensors using various approaches are also considered. Finally, the impact of relative humidity on the sensing behavior of carbon nanomaterials of various different natures was estimated.

Volatile sulphur compounds in people with chronic kidney disease and the impact on quality of life

The objectives are to identify volatile sulphur compounds (VSCs) in individuals with Chronic Kidney Disease (CKD) and to relate quality of life and oral health. A case-control study with 32 individuals with CKD in haemodialysis in the study group (SG) and 32 healthy individuals in the control group (CG) was performed. The VSCs were identified by gas chromatograph before (BC) and after cysteine (AC) mouthwash and an organoleptic test. For oral health assessment, oral health index was used. For quality of life, the Oral Health Impact Profile (OHIP-14) and Medical Outcomes Study 36-Item Short Form Health Survery (SF-36) were used. The hydrogen sulphide AC, methyl mercaptan AC, tongue coating, dry mouth, plaque index, and DMFT were significantly higher in the SG. VSCs did not negatively affected the impact of oral health on the quality of life in the SG but did in the CG. As for the impact of general health on quality of life, methyl mercaptan BC and AC worsened overall health in vitality and mental health, respectively. Individuals with CKD have more halitosis than healthy individuals, and it is more related to methyl mercaptan. The halitosis worsened the general quality of life of individuals with CKD. The diagnosis and identification of the origin of halitosis is important to prevent one more factor that it worsened the global quality of life of patients with CKD.

Effects of Labrador Tea, Peppermint, and Winter Savory Essential Oils on Fusobacterium nucleatum

Bad breath or halitosis is an oral condition caused by volatile sulfur compounds (VSC) produced by bacteria found in the dental and tongue biofilms. Fusobacterium nucleatum is a Gram-negative anaerobic bacterium that has been strongly associated with halitosis. In this study, essential oils (EO) from three plants, Labrador tea (Rhododendron groenlandicum [Oeder] Kron & Judd), peppermint (Mentha x piperita L.), and winter savory (Satureja montana L.), were investigated for their effects on growth, biofilm formation and killing, and VSC production by F. nucleatum. Moreover, their biocompatibility with oral keratinocytes was investigated. Using a broth microdilution assay, winter savory EO and to a lesser extent Labrador tea and peppermint EO showed antibacterial activity against F. nucleatum. A treatment of pre-formed biofilms of F. nucleatum with EO also significantly decreased bacterial viability as determined by a luminescence assay monitoring adenosine triphosphate production. The EO were found to permeabilize the bacterial cell membrane, suggesting that it represents the target of the tested EO. The three EO under investigation were able to dose-dependently reduce VSC production by F. nucleatum. Lastly, no significant loss of cell viability was observed when oral keratinocytes were treated with the EO at concentrations effective against F. nucleatum. This study supports the potential of Labrador tea, peppermint, and winter savory EO as promising agents to control halitosis and promote oral health.

Synergistic Effects of PdOx-CuOx Loadings on Methyl Mercaptan Sensing of Porous WO3 Microspheres Prepared by Ultrasonic Spray Pyrolysis

In this work, PdO_x-CuO_x co-loaded porous WO₃ microspheres were synthesized with varying loading levels by ultrasonic spray pyrolysis (USP) using polymethyl methacrylate (PMMA) microspheres as a vehicle template. The as-prepared sensing materials and their fabricated sensor properties were characterized by X-ray analysis, nitrogen adsorption, and electron microscopy. The gas-sensing properties were studied toward methyl mercaptan (CH₃SH), hydrogen sulfide (H₂S), dimethyl sulfide (CH₃SCH₃), nitric oxide (NO), nitrogen dioxide (NO₂), methane (CH₄), ethanol (C₂H₅OH), and acetone (C₃H₆O) at 0.5 ppm under atmospheric conditions with different operating temperatures ranging from 100 to 400 °C. The results showed that the CH₃SH response of USP-made WO₃ microspheres was collaboratively enhanced by the creation of pores in the microsphere and co-loading of CuO_x and PdO_x at low operating temperatures (≤200 °C). More importantly, the CH₃SH selectivity against H₂S was significantly improved and high selectivity against CH₃SCH₃, NO, NO₂, CH₄, C₂H₅OH, and CH₃COCH₃ were upheld by the incorporation of PdO_x to CuO_x-loaded WO₃ sensors. Therefore, the co-loading of PdO_x-CuO_x on porous WO₃ structures could be promising strategies to achieve highly selective and sensitive CH₃SH sensors, which would be practically useful for specific applications including biomedical and periodontal diagnoses.

Microbiome variations in preschool children with halitosis

OBJECTIVE

To assess the bacterial characteristics associated with intra-oral halitosis among Chinese preschool children.

METHODS

An epidemiological study was conducted among 273 preschool children (aged 3-4 years) in Shanghai, China, followed by the collection of 16 samples from the tongue coating of caries-free healthy and halitosis participants. The characterization of associated microbial communities was performed using 16S rRNA gene sequencing on the MiSeq.

RESULTS

Halitosis was observed in 13.2% of the preschool children. No significant difference in terms of microbial diversity (p > .05) was detected in the control and halitosis groups. The dominant bacterial genera observed in both groups included Prevotella, Veillonella, Streptococcus, Neisseria, Actinomyces, Haemophilus, and Leptotrichia. The relative proportions of thirteen species (including Leptotrichia sp. HMT_417, Prevotella Pallens, and Alloprevotella rava) were significantly higher in the halitosis group compared with the control group, whereas the distribution of seventeen species from genera Streptococcus, Gemella, and Kingella showed a higher abundance in the control group. Further investigation of interactions among species demonstrated obvious differences in two groups, indicating that various microorganisms interact to produce halitosis in preschool children.

CONCLUSIONS

Overall, halitosis is associated with multi-microbial mutual interactions. The oral flora microorganisms may exert potentiating or inhibiting effects on each other.

The Role of Oral Microbiota in Intra-Oral Halitosis

Halitosis is a common ailment concerning 15% to 60% of the human population. Halitosis can be divided into extra-oral halitosis (EOH) and intra-oral halitosis (IOH). The IOH is formed by volatile compounds, which are produced mainly by anaerobic bacteria. To these odorous substances belong volatile sulfur compounds (VSCs), aromatic compounds, amines, short-chain fatty or organic acids, alcohols, aliphatic compounds, aldehydes, and ketones. The most important VSCs are hydrogen sulfide, dimethyl sulfide, dimethyl disulfide, and methyl mercaptan. VSCs can be toxic for human cells even at low concentrations. The oral bacteria most related to halitosis are Actinomyces spp., Bacteroides spp., Dialister spp., Eubacterium spp., Fusobacterium spp., Leptotrichia spp., Peptostreptococcus spp., Porphyromonas spp., Prevotella spp., Selenomonas spp., Solobacterium spp., Tannerella forsythia, and Veillonella spp. Most bacteria that cause halitosis are responsible for periodontitis, but they can also affect the development of oral and digestive tract cancers. Malodorous agents responsible for carcinogenesis are hydrogen sulfide and acetaldehyde.

Oral disorders associated with the experience of verbal bullying among Brazilian school-aged children: A case-control study

BACKGROUND

Dental features have been considered a potential target of verbal bullying (VB) among school-aged children. The authors conducted a study to investigate the association between the presence of oral disorders and the occurrence of VB among 8- through 10-year-old school-aged children.

METHODS

The study included 445 school-aged children 8 through 10 years old. VB was verified by a specific validated question from the Child Perceptions Questionnaire 8-10 index. Oral disorders such as untreated caries, fluorosis, clinical consequences of untreated caries, and malocclusion were evaluated. The Pearson χ² test and bivariate and multivariate conditional logistic regression analyses were used for statistical analysis.

RESULTS

A total of 390 school-aged children completed the study. The results of the multivariate logistic regression model showed that a severe malocclusion (odds ratio [OR], 2.29; 95% confidence interval [CI], 1.03 to 5.10), a greater maxillary misalignment (OR, 2.23; 95% CI, 1.05 to 4.73), and the presence of a tooth with pulp exposure (OR, 2.93; 95% CI, 1.58 to 5.45) were significantly associated with the occurrence of VB.

CONCLUSION

Children aged 8 through 10 years with a severe malocclusion, larger maxillary misalignment, or the presence of pulp exposure had increased odds of experiencing VB compared with children without those oral health conditions.

PRACTICAL IMPLICATIONS

Once oral disorders involved in VB are identified, appropriate approaches should be used to address this issue. With this course of action, oral health care professionals may use the treatment and preventive care to eliminate potential factors for peer aggression.

The Underestimated Problem of Intra-Oral Halitosis in Dental Practice: An Expert Consensus Review

Approximately 90% of halitosis cases originate within the oral cavity (intra-oral halitosis). With a focus on intra-oral halitosis, this narrative review article provides a current summary of the epidemiology, diagnosis and management of halitosis and discusses practical considerations for healthcare professionals (HCPs), including dentists, dental hygienists, general practitioners, community pharmacists, nurses and medical specialists. MEDLINE and PubMed were searched up to 31 December 2019. Additional information was sourced from reference lists of relevant published literature. Full-text articles which reported on the epidemiology, diagnosis and management of halitosis were considered for inclusion. Halitosis affects substantial numbers of individuals globally and is an underestimated problem in dental practice. Current estimates of the prevalence of halitosis, in addition to diagnostic methods and management considerations for halitosis, are discussed. Although not a life-threatening condition, halitosis has a significant impact on patients’ quality of life and can result in psychological consequences including social, professional and affective limitations. Using a simple step-wise approach for diagnosis and treatment, dentists and dental hygienists are ideally placed to respond to an initial consultation for halitosis.

Exploring residential care aide experiences with oral malodour in long-term care

Aim

To determine what experiences do residential care aides (RCAs) have with individuals living with oral malodour in a long-term care (LTC) facility?

Design

Study investigation was done using an interpretive qualitative approach paired with a social constructivism interpretive framework.

Methods

The study was conducted in May of 2015 through face-to-face interviews with RCAs, which were recorded and transcribed verbatim, observations of RCAs in their work environment, as well as RCA personal logs of their daily experiences with odour during caregiving. Thereafter, data were analysed and coded for emerging themes.

Results

Five major themes were identified after grouping the codes: 1) attitudes and behaviours when caring for residents with malodour; 2)RCA knowledge of oral malodour; 3) level of job satisfaction among RCAs that care for residents with malodour; 4) culture and malodour; and 5) challenges of care giving compounded by malodour. These themes depict the overall experiences of study participants.

Oral Health Status of Chinese Children With Autism Spectrum Disorders

OBJECTIVES

To assess and compare the oral health status of children with and without autism spectrum disorders (ASD) in China.

METHODS

This study recruited 144 children with ASD and 228 unrelated children with typical development (TD) aged 3-16 years from China. Data were collected using parent-reported questionnaires. Oral problems (oral symptoms and habits), oral health measures (oral hygiene practice and dental care experience), and the impact on the child's quality of life (based on a modified version of the Parental-Caregiver Perception Questionnaire) were assessed and compared between the two groups.

RESULTS

Children with ASD had worse oral health status than children with TD. Oral symptoms were more prevalent in the ASD group, especially halitosis (p < 0.001), food impaction (p < 0.001), and oral lesions (p < 0.001), than the TD group. The rate of damaging oral habits, including mouth breathing (p < 0.001) and object biting (p < 0.05), was also high in the ASD group. Compared with the TD group, more children with ASD did not brush their teeth independently and frequently (p < 0.001), had difficulty accessing dental care (p < 0.01), and reported unpleasant dental experiences (p < 0.001). The presence of ASD was associated with decreased oral health-related quality of life (p < 0.001) in these children and their families.

CONCLUSION

Oral problems such as halitosis and bad oral habits are more prevalent among children with ASD. These children also lack oral hygiene practice and dental visits. This situation negatively impacts their quality of life, and must be brought to the attention of their treating dentists.

Rapid and accurate determination of trace volatile sulfur compounds in human halitosis by an adaptable active sampling system coupling with gas chromatography

Halitosis with the main components of trace volatile sulfur compounds widely affects the quality of life. In this study, an adaptable active sampling system with two sample-collection modes of direct injection and solid-phase microextraction was developed for the rapid and precise determination of trace volatile sulfur compounds in human halitosis coupled with gas chromatography-flame photometric detection. The active sampling system was well designed and produced for efficiently sampling and precisely determining trace volatile targets in halitosis under the optimized sampling and detection conditions. The analytical method established was successfully applied for the determination of trace targets in halitosis. The limits of detection of H₂ S, CH₃ SH, and CH₃ SCH₃ by direct injection were 0.0140-23.0 μg/L with good recoveries ranging from 82.2 to 118% and satisfactory relative standard deviations of 0.4-9.5% (n = 3), respectively. The limit of detections of CH₃ SH and CH₃ SCH₃ by solid-phase microextraction were 2.03 and 0.186 × 10^-3  μg/L with good recoveries ranging from 98.3 to 108% and relative standard deviations of 5.9-9.0% (n = 3). Trace volatile targets in positive real samples could be actually found and quantified by combination of direct injection and solid-phase microextraction. This method was reliable and efficient for the determination of trace volatile sulfur compounds in halitosis.

Interventions for managing halitosis

BACKGROUND

Halitosis or bad breath is a symptom in which a noticeably unpleasant breath odour is present due to an underlying oral or systemic disease. 50% to 60% of the world population has experienced this problem which can lead to social stigma and loss of self-confidence. Multiple interventions have been tried to control halitosis ranging from mouthwashes and toothpastes to lasers. This new Cochrane Review incorporates Cochrane Reviews previously published on tongue scraping and mouthrinses for halitosis.

OBJECTIVES

The objectives of this review were to assess the effects of various interventions used to control halitosis due to oral diseases only. We excluded studies including patients with halitosis secondary to systemic disease and halitosis-masking interventions.

SEARCH METHODS

Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 8 April 2019), the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 3) in the Cochrane Library (searched 8 April 2019), MEDLINE Ovid (1946 to 8 April 2019), and Embase Ovid (1980 to 8 April 2019). We also searched LILACS BIREME (1982 to 19 April 2019), the National Database of Indian Medical Journals (1985 to 19 April 2019), OpenGrey (1992 to 19 April 2019), and CINAHL EBSCO (1937 to 19 April 2019). The US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov (8 April 2019), the World Health Organization International Clinical Trials Registry Platform (8 April 2019), the ISRCTN Registry (19 April 2019), the Clinical Trials Registry - India (19 April 2019), were searched for ongoing trials. We also searched the cross-references of included studies and systematic reviews published on the topic. No restrictions were placed on the language or date of publication when searching the electronic databases.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) which involved adults over the age of 16, and any intervention for managing halitosis compared to another or placebo, or no intervention. The active interventions or controls were administered over a minimum of one week and with no upper time limit. We excluded quasi-randomised trials, trials comparing the results for less than one week follow-up, and studies including advanced periodontitis.

DATA COLLECTION AND ANALYSIS

Two pairs of review authors independently selected trials, extracted data, and assessed risk of bias. We estimated mean differences (MDs) for continuous data, with 95% confidence intervals (CIs). We assessed the certainty of the evidence using the GRADE approach.

MAIN RESULTS

We included 44 trials in the review with 1809 participants comparing an intervention with a placebo or a control. The age of participants ranged from 17 to 77 years. Most of the trials reported on short-term follow-up (ranging from one week to four weeks). Only one trial reported long-term follow-up (three months). Three studies were at low overall risk of bias, 16 at high overall risk of bias, and the remaining 25 at unclear overall risk of bias. We compared different types of interventions which were categorised as mechanical debridement, chewing gums, systemic deodorising agents, topical agents, toothpastes, mouthrinse/mouthwash, tablets, and combination methods. Mechanical debridement: for mechanical tongue cleaning versus no tongue cleaning, the evidence was very uncertain for the outcome dentist-reported organoleptic test (OLT) scores (MD -0.20, 95% CI -0.34 to -0.07; 2 trials, 46 participants; very low-certainty evidence). No data were reported for patient-reported OLT score or adverse events. Chewing gums: for 0.6% eucalyptus chewing gum versus placebo chewing gum, the evidence was very uncertain for the outcome dentist-reported OLT scores (MD -0.10, 95% CI -0.31 to 0.11; 1 trial, 65 participants; very low-certainty evidence). No data were reported for patient-reported OLT score or adverse events. Systemic deodorising agents: for 1000 mg champignon versus placebo, the evidence was very uncertain for the outcome patient-reported visual analogue scale (VAS) scores (MD -1.07, 95% CI -14.51 to 12.37; 1 trial, 40 participants; very low-certainty evidence). No data were reported for dentist-reported OLT score or adverse events. Topical agents: for hinokitiol gel versus placebo gel, the evidence was very uncertain for the outcome dentist-reported OLT scores (MD -0.27, 95% CI -1.26 to 0.72; 1 trial, 18 participants; very low-certainty evidence). No data were reported for patient-reported OLT score or adverse events. Toothpastes: for 0.3% triclosan toothpaste versus control toothpaste, the evidence was very uncertain for the outcome dentist-reported OLT scores (MD -3.48, 95% CI -3.77 to -3.19; 1 trial, 81 participants; very low-certainty evidence). No data were reported for patient-reported OLT score or adverse events. Mouthrinse/mouthwash: for mouthwash containing chlorhexidine and zinc acetate versus placebo mouthwash, the evidence was very uncertain for the outcome dentist-reported OLT scores (MD -0.20, 95% CI -0.58 to 0.18; 1 trial, 44 participants; very low-certainty evidence). No data were reported for patient-reported OLT score or adverse events. Tablets: no data were reported on key outcomes for this comparison. Combination methods: for brushing plus cetylpyridium mouthwash versus brushing, the evidence was uncertain for the outcome dentist-reported OLT scores (MD -0.48, 95% CI -0.72 to -0.24; 1 trial, 70 participants; low-certainty evidence). No data were reported for patient-reported OLT score or adverse events.

AUTHORS' CONCLUSIONS

We found low- to very low-certainty evidence to support the effectiveness of interventions for managing halitosis compared to placebo or control for the OLT and patient-reported outcomes tested. We were unable to draw any conclusions regarding the superiority of any intervention or concentration. Well-planned RCTs need to be conducted by standardising the interventions and concentrations.

The Effect of Zinc Lactate added Tablets on Volatile Sulfur-containing Compounds in the Oral Cavity

Background:

Oral malodor is defined as breath that is offensive to others and its prevalence is around 35%.

Objective:

A controlled clinical double-blinded study was conducted to assess the efficacy of sugar-free tablets containing zinc lactate on oral Volatile Sulfur-containing Compounds (VSC) versus placebo tablets.

Methods:

All participants, who met the inclusion criteria, had to score a level of VSC ≥75 ppb at the basal measurement. Subjects were randomly assigned to one of the groups. The test tablet (0.7g) contained 0.255 mg of zinc lactate; the control tablet was identical but without the active agent. The OralChroma2© device was utilized to evaluate VSC. The levels were recorded at baseline, after sucking two tablets in succession and after 1 hour and 2 hours. Data were analyzed with SPSS and significance was set at α=0.05.

Results:

186 subjects completed the trial. The mean reduction from baseline at the end of tablets sucking was, respectively, 43% (p <0.001) in the control and 67% (p <0.001) in the test group, after 1 hour, it was 6% in the control (p=NS) and 25% (p <0.001) in the test group, after 2 hours, it was 3% in the control (p=NS) and 12% (p <0.001) in the test group. The comparison between the two groups after baseline adjustment showed a statistically significant difference for reductions at the end of the sucking period (p <0.001), after 1 hour (p <0.001) and after 2 hours (p <0.05).

Conclusion:

Tablets containing zinc lactate can statistically reduce the oral VSC levels immediately and for over 2 hours.

Halitosis: prevalence, risk factors, sources, measurement and treatment - a review of the literature

Halitosis, an offensive breath odour, has multiple sources and negative impacts on people's social interactions and quality of life. It is important for health care professionals, including general physicians and dental professionals, to understand its aetiology and risk factors in order to diagnose and treat patients appropriately. In this study, we have reviewed the current literature on halitosis regarding its prevalence, classification, risk factors, sources, measurement and treatment.

Targeted polymerase chain reaction-based expression of putative halitogenic bacteria and volatile sulphur compound analysis among halitosis patients at a tertiary hospital in Nigeria

Halitosis (bad breath) can be a cause of anxiety, depression and psychosocial stress, with pathological changes in the oral microbiota playing an important role in its development. Despite its prevalence, studies on the microbiology of halitosis are rare in Nigeria. This study determines the presence of five putative periodontal pathogens viz: Actinobacillus actinomycetemcomitans, Fusobacterium nucleatum, Porphyromonas gingivalis, Prevotella intermedia and Treponema denticola on the tongue dorsa of halitosis and non-halitosis patients using a 16S rDNA-directed polymerase chain reaction assay. Furthermore, an association of these bacteria with oral malodour [as assessed by volatile sulphur compounds (VSC) measurements] with a portable sulphide monitor, the Halimeter (Interscan Corp, Chatsworth, California), was performed. The results showed that the prevalence of halitosis in this environment as defined by VSC level above 160 ppb is 14.9%. Halitosis is affected by gender with males having it more than the females. Males also tend to present more with self-reported complaints of halitosis than females. Age does not appear to contribute to the incidence of halitosis. Fusobacterium nucleatum, P. gingivalis, P. intermedia are responsible for increased production of VSCs in halitosis patients while A. actinomycetemcomitans and T. denticola appear to play no part in the production of VSCs. Evaluation of halitogenic bacteria and VSCs may potentially become a surrogate biomarker for monitoring halitosis. Targeted assessment of putative halitogenic bacteria may provide a rapid point-of-care diagnostic tool for halitosis.

The prevalence of halitosis (oral malodor) and associated factors among dental students and interns, Lahore, Pakistan

Objective

To evaluate the prevalence of halitosis and the factors associated with it among dental students and interns in Lahore, Pakistan.

Methods

A cross-sectional study design was chosen, and a sample of dental students and interns was collected from seven dental colleges in Lahore, Pakistan. A total of 833 participants were approached in person as convenient sample population. A self-reported questionnaire was administered and informed consent was obtained. The associations between oral malodor and different variables of the study were explored using analytical statistics (Chi-square test and logistic regression analysis). Statistical significance was determined using a 95% confidence interval (CI).

Results

Six hundred and fifteen participants (aged 19-27 years) completed the survey with a response rate of 73.8%. The prevalence of self-reported halitosis was 75.1%. More female (51.4%) than male students (23.7%) reported oral malodor, and most participants (61%) reported early morning halitosis. Thirteen percent of respondents had examination for oral malodor by a dentist and 37.6% treated the condition with self-medication. Binary logistic regression model showed that male gender (odds ratio [OR] =0.44, CI = 0.22-0.87), daily use of dental floss (OR = 0.28, CI = 0.13-0.58), and drinking tea with mint (OR = 0.44, CI = 0.22-0.89) were significantly associated with oral malodor. The participants with tongue coating had higher odds (OR = 2.75, CI = 1.13-6.69) of having oral malodor than those without tongue coating, and the association was statistically significant.

Conclusions

The study identified high prevalence of oral malodor among dental students and interns. They should receive appropriate diagnosis and management of the condition from dentist. The regular use of dental floss and removal of tongue coating can significantly reduce halitosis.

Impact of the halitosis on QoL in overweight and obese patients: Based on six years of experience in two centers in sulaimani governorate, Kurdistan Region/Iraq, and case series study

BACKGROUND/OBJECTIVES

The patients who are overweight and obese, are under stress of excess body weight, embarrassed, one may imagine the impact of halitosis on this group of patients, this is an attempt to evaluate this extra impact, and which aspect of quality of life will be affect in the overweight and obese.

SUBJECTS/METHODS

A prospective case series study including 885 overweight or obese patients, they were consulting for advice, diet and or drugs and various bariatric operations. A group of normal weight patients with halitosis, matched in age group and gender were enrolled as a control group for comparison. Patients who have either oral causes of the condition or pseudo halitosis or halite-phobia or were using drugs like phenytoin, cyclosporine or calcium channel blockers, isosorbide di-nitrate, Chloral hydrate, Nitrites and Nitrates, Dimethyl sulphoxide, Disulphiram, cytotoxic agents, Phenothiazine were excluded.

INTERVENTIONS/METHODS

The work conducted over a period of 6 years from February 1st, 2012 to March 1st, 2018. Prospective evaluation of the type and etiology of halitosis was done by using organoleptic measurement, which is not a slandered but evaluated by a group of academic colleagues. The patients were advised to avoid eating odiferous foods for 48 hours before the assessment and both the patient and the examiner should refrain from drinking coffee, tea or juice, smoking and using scented cosmetics before the assessment.

RESULTS

Halitosis in the overweight and obese patients magnifies the negative aspects of quality of life: avoidance, narrow social circle (P Value = 0.3415, 95% confidence interval = 11.43924-29.67085), avoidance of sex by partner (P Value = 0.0143, 95% confidence interval = 04.11537-17.08480), low self-esteem (P Value = 0.0100, 95% confidence interval = 10.66794-28.44776), teasing by others and negative thoughts (P Value = 0.4013, 95% confidence interval = 11.43924-29.67085). While obesity was not a cause of avoidance of to be kissed by partner in obese patients, but was a direct cause for this avoidance in obese patients with halitosis (P Value = 0.0143, 95% confidence interval = 04.11537-17.08480). Halitosis in normal weight patients affects the quality of life remarkably but not to the extent of halitosis in overweight and obese patients, especially social life and self-esteem which will suffer most.

CONCLUSIONS

The quality of life of overweight and obese, especially emotional and social aspects was significantly disturbed by halitosis more than normal weight subjects with halitosis.

Effectiveness of novel herbal dentifrice in control of plaque, gingivitis, and halitosis - Randomized controlled trial

Background and aim

Plaque is a common etiological factor for common oral conditions like gingivitis, periodontitis, dental caries and halitosis. We aimed to evaluate the efficacy of a novel herbal dentifrice in control of plaque, gingivitis, and halitosis in comparison to control dentifrice.

Experimental procedure

We conducted a randomized controlled, single center, double-blinded parallel arm clinical trial. Participants were randomly distributed with commercially available herbal dentifrice or control dentifrice. Assessments of plaque, gingivitis, halitosis, unstimulated saliva pH were done at baseline and at one month by a trained and calibrated periodontist. All the participants were given new toothbrushes one week before the start of the study. They were asked to brush with the designated dentifrices for 2–4 min, twice daily for one month.

Results and conclusion

A total of 79 participants were recruited for this study, out of which 75 participants completed the follow-up. Inter-group comparisons of all the variables at baseline showed no significant differences in the mean plaque index, gingival index, halitosis and pH between test and control groups respectively. Intra-group comparisons showed a significant decrease in mean plaque, gingival and halitosis at follow-up than at baseline in both test and control groups. No significant differences between test and control groups were seen in the mean plaque index (P = 0.792), gingival index (P = 0.292), halitosis (P = 0.266), pH (P = 0.742) at follow-up after adjusting the respective baseline scores. The novel herbal dentifrice could be a suitable alternative for the control of plaque, gingivitis, and halitosis.

•

Significant decrease in clinical indices at follow-up than baseline in both groups.

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Significant increase in salivary pH at follow-up than baseline in both groups.

•

No significant differences were seen clinical indices between test and control.

A Miniaturized Amperometric Hydrogen Sulfide Sensor Applicable for Bad Breath Monitoring

Bad breath or halitosis affects a majority of the population from time to time, causing personal discomfort and social embarrassment. Here, we report on a miniaturized, microelectromechanical systems (MEMS)-based, amperometric hydrogen sulfide (H₂S) sensor that potentially allows bad breath quantification through a small handheld device. The sensor is designed to detect H₂S gas in the order of parts-per-billion (ppb) and has a measured sensitivity of 0.65 nA/ppb with a response time of 21 s. The sensor was found to be selective to NO and NH₃ gases, which are normally present in the oral breath of adults. The ppb-level detection capability of the integrated sensor, combined with its relatively fast response and high sensitivity to H₂S, makes the sensor potentially applicable for oral breath monitoring.

Effect of rapid maxillary expansion on halitosis

INTRODUCTION

The objective of this study was to evaluate the effect of rapid maxillary expansion (RME) on halitosis.

METHODS

Thirty children (11-15 years old) were randomly divided into RME and control groups. The RME group consisted of 15 children treated with hyrax appliances, and the control group included 15 children without treatment. Halitosis was evaluated with the halimeter and the organoleptic method. Plaque index and gingival index scores were recorded. Acoustic rhinometry was used to measure the nasal volume. Measurements were obtained at 2 times: before RME, and after retention at 4 months. The Wilcoxon signed rank test and the paired t test were used for intragroup comparisons, and the Mann-Whitney U test and the Student t test were used for intergroup comparisons.

RESULTS

Halitosis (halimeter and organoleptic values) decreased significantly in the RME group (P <0.001). Insignificant changes of halitosis were observed in the control group. Intragroup and intergroup comparisons showed no statistically significant differences for the plaque index. Gingival index values were significantly decreased with RME (P ≤0.05). Nasal cavity volume increased significantly in the RME group (P <0.01).

CONCLUSIONS

RME was shown to lower halitosis values. RME could be a treatment option for patients with maxillary transverse deficiency and halitosis.

Prevalence and risk factors of halitosis in Japanese school children

BACKGROUND

Little data are available regarding halitosis in Japanese children. The aim of the current study was to investigate the prevalence and risk factors associated with halitosis in Japanese elementary and junior high school children.

METHODS

The subjects consisted of 520 elementary (1st-6th grade: boys, n = 284; girls, n = 236) and 248 junior high (7th-9th grade: boys, n = 136; girls, n = 112) school children aged 6-15 years in Saitama Prefecture, Japan. A self-administered questionnaire survey; halitosis measurement using an organoleptic assessment method; and clinical oral examination were conducted.

RESULTS

Overall, 44.9% of subjects had halitosis. The proportion of boys with halitosis was 43.6% and that of girls was 46.6%. On logistic regression analysis, grade and tongue coating were significant predictors of halitosis. The 7th-9th graders were significantly more likely to have halitosis than 1st-3rd graders (OR, 1.83; P = 0.007). Subjects with area of tongue coating score 2 or 3 were 5.51-fold more likely to present with halitosis (P < 0.001) than those with area of tongue coating score 0 or 1. Similarly, subjects with thickness of tongue coating score 2 or 3 were 3.28-fold more likely to have halitosis than those with thickness of tongue coating score 0 or 1 (P < 0.001).

CONCLUSIONS

Halitosis in the school children is not a rare condition; instead, its occurrence is relatively high. Therefore, inclusion of a halitosis prevention and management component in school oral health programs would lead to the promotion of overall oral health.

Assessment of Volatile Sulfur Compounds in Adult and Pediatric Chronic Tonsillitis Patients Receiving Tonsillectomy

OBJECTIVES

To study the volatile sulfur compound (VSC) concentration profile in chronic tonsillitis patients before and after tonsillectomy, and to evaluate the difference between adult and pediatric (children and adolescents) patients.

METHODS

Thirty adult patients (older than 20 years old) and 30 pediatric patients (younger than 20 years old) who were assigned to get tonsillectomy due to chronic tonsillitis were enrolled in this prospective nonrandomized clinical study. The concentrations of the three main VSCs related to halitosis (hydrogen sulfide, methyl mercaptan, and dimethyl sulfide) were assessed in each patient using a portable chromatograph (Oral Chroma^TM) at 1 day before operation, postoperative 1 day, 1 week, and 2 weeks.

RESULTS

Average concentration of hydrogen sulfide, methyl mercaptan, and dimethyl sulfide preoperatively were 99.5 ppb, 24.6 ppb, and 9.45 ppb in adult patients, and 97.4 ppb, 26 ppb, and 10.5 ppb in pediatric patients, respectively. The concentrations of the three VSCs in both groups were highest in first day after surgery, and decreased signigicantly after 2 weeks compared to preoperative values (P<0.001). There was no significant difference of the concentration of the three VSCs between adult and pediatric patients in any time point.

CONCLUSION

The concentrations of hydrogen sulfide, methyl mercaptan, and dimethyl sulfide decreased significantly after tonsillectomy in chronic tonsillitis patients. The concentrations of the three VSCs were not significantly different between pediatric and adult patients before and after tonsillectomy.

A Current Approach to Halitosis and Oral Malodor- A Mini Review

BACKGROUND

Halitosis, in other words, oral malodor is an important multifactorial health problem affecting the psychological and social life of individuals and is the most common reason for referral to dentists after dental caries and periodontal diseases.

OBJECTIVE

The objective of this review was to present and discuss conventional and recently introduced information about the types, causes, detection and treatment methods of halitosis.

METHODS

An expanded literature review was conducted which targeted all articles published in peer-reviewed journals relating to the topic of halitosis. Only articles written in Turkish and English languages were considered. The review itself began with a search of relevant subject headings such as 'halitosis, oral malodor, volatile sulfur compounds in PubMed/Medline, Scopus, Google Scholar and Tubitak Ulakbim databases. A hand search of references was also performed.

RESULTS

When search results are combined, the total number of relevant literature was found to be 4646 abstracts and 978 full-text articles. Abstracts, editorial letters were not included and about half of full-text articles were not related to dental practice. Among the remaining 124 full-text articles, duplicated articles and articles written other than Turkish and English languages were removed and 54 full-text articles were used for this review.

DISCUSSION

According to the reviewed articles, both conventional and new methods were introduced in the management of halitosis. However, conventional methods seem to be more effective and widely used in the diagnosis and treatment of halitosis.

CONCLUSION

As being first line professionals, dentists must analyze and treat oral problems which may be responsible for the patient's malodor, and should inform the patient about halitosis causes and oral hygiene procedures (tooth flossing, tongue cleaning, appropriate mouthwash and toothpaste selection and use) and if the problem persists, they should consult to a medical specialist.

Halitosis in children with adenoid hypertrophy

This paper attempts to identify the sources and evaluate the prevalence of halitosis in children with adenoid hypertrophy. The study included pediatric patients admitted for adenoidectomy due to obstructive symptoms. Patients with possibly other causes of halitosis, were excluded from the study. Halitosis was detected in 30 out of 136 children (22.1%). The effect of adenoid hypertrophy on halitosis was confirmed by the significant reduction in the organoleptic score rated according to the Rosenberg scale (on average by 2°) and the levels of volatile sulfur compounds (on average 84 ppb) post-adenoidectomy, as compared to pre-surgery results. In total, we reported a statistically significant decrease in the abovementioned values in 90% of patients with halitosis. It was found that in patients with halitosis, as compared to patients with no oral malodor, anaerobic bacteria and Staphylococcus aureus were more frequently observed in the adenoid tissue. Streptococcus oralis strains were more commonly reported in the material taken during adenoidectomy in children without oral malodor.

Genuine halitosis in patients with dental and laryngological etiologies of mouth odor: severity and role of oral hygiene behaviors

The aims of the study were to determine the severity of halitosis and the association between oral hygiene practices and the severity of malodor in patients with dental and laryngological etiologies of genuine halitosis. Thirty-five laryngological and 40 dental patients with halitosis completed a structured interview and underwent laryngological and dental examinations. Halitosis was assessed using organoleptic and halimeter tests. Greater halitosis severity in laryngological patients was associated with worse clinical status of the palatine tonsils, less frequent toothbrushing, less frequent use of tongue cleaners, fewer daily meals, and increased use of mouthrinses. Among dental patients, more severe halitosis was associated with worse clinical status of the periodontium, more tongue coating, less saliva secretion, and less frequent use of dental floss, interdental toothbrushes, and tongue cleaners. Oral hygiene was found to be a key moderator of the relationship between status of the periodontium or tonsils and severity of halitosis. The severity of halitosis in laryngological patients and dental patients is essentially similar; however, oral hygiene routines are associated with different effects in each group. Consequently, individual recommendations for patients with halitosis should be adjusted for the underlying disease and emphasize the role of effective specific hygiene behaviors.

Quality and readability of internet-based information on halitosis

OBJECTIVE

To evaluate quality and readability of Internet-based information on halitosis.

STUDY DESIGN

An Internet search through 3 engines (Google, Yahoo, and Bing) was done with the terms ("bad breath," "halitosis," "oral malodor," "foul breath," "mouth malodor," "breath malodor," "fetor ex ore," "fetor oris," "ozostomia," and "stomatodysodia"). The first 50 websites from each engine resulting from each search term were screened. Included websites were evaluated using Health on the Net (HON) criteria, Journal of American Medical Association (JAMA) benchmarks, DISCERN, Ensuring Quality Information for Patients (EQIP), Flesch Reading Ease (FRE) score, and Flesch-Kincaid Grade level.

RESULTS

A total of 101 websites were included. HON, DISCERN, EQIP, and FRE score were 42.9%, 37.6%, 37.4%, and 51.9% of the maximum score, respectively. Fewer than 50% of sites displayed attribution, disclosure, and currency according to JAMA benchmarks. HON score, DISCERN score, and EQIP score had significant correlation with each other and were significantly higher in sites displaying the HON seal.

CONCLUSION

The current quality and readability of informative websites on halitosis are generally low and poorly organized. Clinicians should be able to assess the Internet-based information on halitosis, as well as give accurate advice and guide patients concerning this issue.

Hierarchical and Hollow Fe2O3 Nanoboxes Derived from Metal-Organic Frameworks with Excellent Sensitivity to H2S

Hierarchical and hollow porous Fe₂O₃ nanoboxes (with an average edge length of ∼500 nm) were derived from metal-organic frameworks (MOFs) and the gas sensing characteristics were investigated. Sensors based on Fe₂O₃ nanoboxes exhibited a response (resistance ratio) of 1.23 to 0.25 ppm (ppm) hydrogen sulfide (H₂S) at 200 °C, the response/recovery speed is fast and the selectivity to H₂S is excellent. Remarkably, the sensor showed fully reversible response to 5 ppm of H₂S at 50 °C, demonstrating its promise for operating at near room temperature, which is favorable for medical diagnosis and indoor/outdoor environment monitoring. The excellent performance of the Fe₂O₃ nanoboxes can be ascribed to the unique morphology with high specific surface area (SSA) and porous nanostructure.

Evaluation of the Efficacy of G32 (Commercially Available Ayurvedic Preparation) in Reducing Halitosis - A Randomized Controlled Trial

INTRODUCTION

Oral malodour is a social malady affecting people of all the age groups. Effective management of oral malodour is the key to improve the quality of life of such people.

AIM

To evaluate the effectiveness of ayurvedic medication, G32 in controlling oral malodour and comparing the effects with Chlorhexidine (CHX).

MATERIALS AND METHODS

This was a single blind randomized controlled trial with parallel study design conducted at a hospital in the city of Udupi in Southern India. A total of 40 patients suffering with oral malodour, aged 17-35 years, were included in this trial. After inclusion into the study, the subjects were examined twice, with a one-week interval between both examinations. Volatile Sulphur Compounds (VSCs), gingival, plaque and tongue coating scores were assessed at both examinations. Subjects were randomly allocated to G32 group - ayurvedic formulation (intervention group) and CHX group (control group), and were provided with the respective formulations enough to be used twice daily for a period of one week. The difference between the mean scores of VSCs, plaque, and gingivitis and tongue coating were compared within the intervention and control groups, respectively, using paired t-test.

RESULTS

Both test and control groups showed a significant reduction in VSCs, plaque and gingivitis levels. The percentage reductions in VSCs, plaque and gingivitis were found to be similar among the two groups. There was no significant difference between the preintervention and postintervention scores in both the groups.

CONCLUSION

G32, an ayurvedic medication, can be an effective tool to deal with oral malodour.

Mesoporous SnO2 Nanotubes via Electrospinning-Etching Route: Highly Sensitive and Selective Detection of H2S Molecule

We report the facile synthesis of thin-walled SnO₂ nanotubes (NTs) with numerous clustered pores (pore radius 6.56 nm) and high surface area (125.63 m²/g) via selective etching of core (SiO₂) region in SiO₂-SnO₂ composite nanofibers (NFs), in which SnO₂ phase preferentially occupies the shell while SiO₂ is concentrated in the center of the composite NFs. The SiO₂-etched SnO₂ NTs are composed of ultrasmall crystallites (∼6 nm in size) originating from crystal growth inhibition by small SiO₂ domains, which are partially segregated in the polycrystalline SnO₂ shell during calcination. These features account for efficacious diffusion and innumerable active sites, which maximize interaction between background gas (air) and analyte gas (H₂S). Evaluation of gas-sensing performance of the porous SnO₂ NTs before and after decorating the exterior and interior walls with Pt nanoparticles (NPs) reveals exceptional selectivity and superior response (R_a/R_g) of 154.8 and 89.3 to 5 and 1 ppm of H₂S, respectively. Excellent gas-sensing characteristics are attributed to the porous topography, nanosized crystallites, high surface area, and the catalytic activity of Pt/PtO_x NPs.