Halitosis in children with adenoid hypertrophy

Comparative study between photodynamic therapy and the use of probiotics in the reduction of halitosis in mouth breathing children: Study protocol for a randomized controlled clinical trial

INTRODUCTION

Halitosis is a term that defines any odor or foul smell the emanates from the oral cavity, the origin of which may be local or systemic. One of the causes of local or oral halitosis is low salivary flow and dry mouth, which is also one of the complaints of individuals with the mouth-breathing habit. The aim of this study is to determine the effectiveness of antimicrobial photodynamic therapy (aPDT) and the use of probiotics for the treatment of halitosis in mouth-breathing children.

METHODS

Fifty-two children between 7 and 12 years of age with a diagnosis of mouth breathing and halitosis determined through an interview and clinical examination will be selected. The participants will be divided into 4 groups: Group 1-treatment with brushing, dental floss and tongue scraper; Group 2-brushing, dental floss and aPDT applied to the dorsum and middle third of the tongue; Group 3-brushing, dental floss and probiotics; Group 4-brushing, dental floss, aPDT and probiotics. The use of a breath meter and microbiological analysis of the tongue coating will be performed before, immediately after treatment and 7 days after treatment. The quantitative analysis will involve counts of colony-forming bacteria per milliliter and real-time polymerase chain reaction. The normality of the data will be determined using the Shapiro-Wilk test. Parametric data will be submitted to analysis of variance and nonparametric data will be compared using the Kruskal-Wallis test. The results of each treatment in the different periods of the study will be compared using the Wilcoxon test.

DISCUSSION

Due to the low level of evidence, studies are needed to determine whether treatment with aPDT using annatto as the photosensitizer and blue led as the light source is effective at diminishing halitosis in mouth-breathing children.

Adverse events of coblation or microdebrider in pediatric adenoidectomy: A retrospective analysis in 468 patients

Objective

Childhood obstructive sleep apnea hypopnea syndrome (OSAHS) is a common clinical disease that can cause serious complications if not treated in time. Adenoidectomy with or without tonsillectomy is the most important first line surgical treatment of obstructive sleep apnea in children. The aim of this study was to compare the differences between these two surgical procedures for adenoidectomy in terms of operation time, intraoperative blood loss, proportion of patients experiencing postoperative delayed hemorrhage, and incidence of adverse events.

Study Design

Retrospective analysis.

Methods

We performed a retrospective systematic analysis of patient data using the in-house electronic patient records and considered a 2-year period from 2016 to 2017. In total, 468 patients who underwent adenoidectomy under nasal endoscopy with coblation or microdebrider were identified.

Results

The coblation adenoidectomy technique was associated with significantly reduced blood loss and operation time. However, incidence of fever, neck pain, and halitosis were significantly lower in the microdebrider adenoidectomy group (p < .01). The difference in the postoperative primary and secondary hemorrhage between the two groups was not statistically significant (p > .05).

Conclusion

Coblation adenoidectomy had a significantly higher incidence of adverse events such as halitosis, neck pain, and fever. Therefore, otorhinolaryngologists should consider the differences in adverse events when selecting use of coblation adenoidectomy for pediatric patients.

Level of Evidence

IV.

Influences of Airway Obstruction Caused by Adenoid Hypertrophy on Growth and Development of Craniomaxillofacial Structure and Respiratory Function in Children

Adenoid hypertrophy (AH) is a common disease in otorhinolaryngology. Children with chronic snoring and hypoxia are susceptible to long-term nasal obstruction, while long-term open-mouth breathing may cause craniofacial bone development disorders and dull facial expressions, the so-called adenoid face. The purpose of this work is to analyze the influence of AH-induced airway obstruction (AO) on the growth and development of craniomaxillofacial structure and respiratory function (RF) in children. The clinical data of 56 AH children (observation group) and 42 healthy children with physical examination (control group) who visited the Hebei Eye Hospital during the same period were retrospectively analyzed. All children received acoustic rhinometry and X-ray cephalometric measurements. The upper airway structure, sleep disorder score, and A/N value of nasopharyngeal lateral X-ray images were compared between cases and controls. For AH children, sleep tests were also performed to assess their RF. X-ray cephalometric measurements of facial morphology showed obvious vertical growth, mandibular retrognathia, and enlarged mandibular angle in AH children. AH mainly affects the size of the nasopharyngeal and oropharyngeal airway. AH children presented with higher nasal airway resistance (5.11 ± 1.95 cmH₂O/L min) and lower nasopharyngeal volume (NPV) (16.86 ± 3.93 cm³) than controls. Of the AH children, 45 had abnormal RF, including 4 with obstructive sleep apnea syndrome. The A/N value of nasopharyngeal lateral X-ray images was significantly higher in AH children than in controls. Besides, worse sleep quality was found in AH children. The above differences were all of statistical significance. The above indicates that AH can affect the size of the nasopharyngeal and oropharyngeal airway, change children's respiratory mode and RF, increase nasal resistance, and decrease NPV, resulting in upper respiratory tract stenosis, as well as craniomaxillofacial and oral malformations, which affects children's normal growth and development.

The aetiology and associations of halitosis: a systematic review

INTRODUCTION

Halitosis is a term that refers to an unpleasant or foul odour originating from the oral cavity that can be caused by either intra-oral or extra-oral factors. Despite the fact that halitosis has multifactorial aetiology, intra-oral factors play a significant role in the majority of cases.

AIM

This systematic review assesses halitosis's intra-oral and extra-oral associations.

METHODS

An electronic search through MEDLINE (PubMed), Google Scholar, and the Wiley Online Library was conducted to identify relevant manuscripts. A keywords-based search was performed, using the terms "halitosis," "bad-breath," and "oral malodour causes and aetiology." Articles published from January 2014 to December 2020 were included. We selected studies evaluating the intra-oral and extra-oral factors that induce oral malodour, as well as the factors associated with systemic diseases.

RESULTS

Eighty to ninety percent of halitosis is caused by intra-oral factors, with coated tongue, periodontal diseases, and poor oral hygiene practices being the principal factors. Ten to twenty percent of halitosis is induced by extra-oral factors associated with systemic diseases.

CONCLUSIONS

Multiple factors can cause halitosis, but most of the aetiology is intra-oral. Increased medical awareness is needed to determine the actual pathophysiological process of oral malodour in otherwise healthy individuals.

Effect of adenoid hypertrophy on the upper airway and craniomaxillofacial region

BACKGROUND

In recent years, annual incidences of adenoid hypertrophy (AH), a highly common tissue lesion in children, have increased. Currently, research on AH has focused on its obstruction of nasal cavity function, and little has been written on its influence on the upper airway's bone structure. For this reason, our present study seeks to determine the influence of AH on both the morphological development characteristics of the upper airway and the craniofacial features in children, with the goal being to offer more choices for diagnosing and treating the condition in the future.

METHODS

From June 2019 to December 2020 in Department of Orthodontics, Beijing Stomatological Hospital, Capital Medical University, 38 children with AH admitted to the Department of Otolaryngology [research group (RG)] and 35 children [control group (CG)] who underwent orthodontic treatment over the same time span were selected as the research objects. X-ray examination of the lateral position of the head, observation of the maxillofacial structure, and detection of the children's height, growth factors, and sleep status, and analysis of the differences between the two groups.

RESULTS

The height of RG, insulin-like growth factor-1 (IGF-1) as well as insulin-like growth factor binding protein-3 (IGFBP-3) were all lower than CG (P<0.05), the upper airway became narrower, and the malocclusion was aggravated (P<0.05). Cephalometric measurement showed that the angle between the subspinale and sella at nasion (SNA angle) and the angle between the subspinale and supraemental at nasion (ANB angle) of RG children decreased, and the angle between the supraemental and sella at nasion (SNB angle) increased (P<0.05). In addition, the sleep quality of RG was significantly lower than that of CG (P<0.05).

CONCLUSIONS

AH can change a child's breathing mode and function by giving rise to upper airway stenosis, and by inducing deformities of their craniomaxillofacial region and oral cavity, thus disrupting their normal growth and development.

Comparative Evaluation of the Effects of Adenotonsillar Hypertrophy on Oral Health in Children

We aimed to investigate the oral health of children in terms of the presence of dental caries, periodontal health, halitosis, and dentofacial changes in patients who had adenotonsillar hypertrophy related to mouth breathing and compared these findings with nasal breathing healthy and adenotonsillectomy-operated children. The patient group comprised 40 mouth-breathing children who were diagnosed with adenotonsillar hypertrophy, while the control group consisted of 40 nasal breathing children who had no adenotonsillar hypertrophy. Forty children who had undergone an adenotonsillectomy operation at least 1 year prior to the study were included in the treatment group. Oral examinations of all children were conducted, and the parents were asked about medical and dental anamnesis, demographic parameters, toothbrushing and nutrition habits, oral health-related quality of life (OHRQoL), and symptoms of their children. Demographic parameters, toothbrushing and nutrition habits, and the presence of bad oral habits did not differ between groups (p > 0.05). Adenotonsillectomy is associated with a remarkable improvement in symptoms; however, some symptoms persist in a small number of children. The salivary flow rate, dmft/s, DMFT/S index, plaque, and gingival index scores did not differ between groups (p > 0.05). The patient group showed higher rates of halitosis when compared with the treatment and control groups (p < 0.001). Mouth breathing due to adenotonsillar hypertrophy caused various dentofacial changes and an increase in Class II division 1 malocclusion (p < 0.001). It was shown that adenotonsillar hypertrophy does not negatively affect OHRQoL, it could be a risk factor for dental caries, periodontal diseases, and halitosis, but by ensuring adequate oral health care, it is possible to maintain oral health in children with adenotonsillar hypertrophy. Also, it is recommended that orthodontic treatment should start as soon as possible if it is required. In this context, otorhinolaryngologists, pedodontists, and orthodontists should work as a team in the treatment of children with adenotonsillar hypertrophy.