Oral malodour among adolescents and its association with health behaviour and oral health status

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.

Quality and Reliability of Halitosis Videos on YouTube as a Source of Information

Halitosis is a common condition that adversely affects quality of life. Through YouTube, people access oral health information. This study aimed to analyze the quality and comprehensiveness of the content, and reliability of halitosis videos hosted on YouTube. In total, 300 videos were collected based on three search keywords, and the number of likes, dislikes, views, duration, interaction index, viewing rate, and source category. Subsequently, the video score, which represents the content quality and comprehensiveness was used to categorize videos as poor, good, and excellent. DISCERN score was used to assess video reliability. Of the 105 videos analyzed, 68 (64.8%) were uploaded by personal users. In general, videos were categorized as poor and have low reliability. Videos sourced from healthcare professionals showed the highest quality, comprehensiveness of the content, and reliability (p < 0.05). There was no difference in the number of viewers for video duration less than or more than 4 min (p > 0.05). YouTube users prefer low-quality videos over high-quality ones, indicating that viewers cannot differentiate between reliable and potentially biased content. It is critical to enable viewers to critically assimilate information hosted on YouTube to make effective oral healthcare decisions.

Self-reported halitosis and oral health related quality of life in adolescent students from a suburban community in Nigeria

Background

Halitosis is an important cause of impaired quality of life in adolescents. Little is known about the prevalence of self-reported halitosis in adolescents in Nigeria and the extent to which self-reported halitosis impairs their oral health related quality of life.

Objectives

To determine the prevalence and impact of self-reported halitosis on the oral health related quality of life of adolescent students in a suburban community in Nigeria.

Methods

An analytical cross-sectional study. Pre-tested self-administered pro-forma was used to obtain the adolescents' demographic data and their self-perception of halitosis. The Oral Health Impact Profile (OHIP-14) was used to assess the adolescents' OHRQoL. The Mann-Whitney U test was used to compare the median OHIP-14 scores between adolescents who reported halitosis and those who did not. The level of significance was set at p < 0.05. Ethics approval for this study was obtained from the Health Research and Ethics Committee of the Lagos University Teaching Hospital.

Results

A total of 361 adolescents aged 10 – 19 years (mean age 14.1 ± 1.79 years) took part in the study. Of these, 32.7% (n=118) had self-reported halitosis. The median OHIP-14 score among adolescents with self-reported halitosis was 3 (0–9) while those who did not report halitosis had a median OHIP-14 score of 0 (0 – 5). This difference was statistically significant (p < 0.0001).

Conclusion

Self-reported halitosis significantly impaired the oral health related quality of life of the adolescents.

Characterization of oral bacteria in the tongue coating of patients with halitosis using 16S rRNA analysis

There are many studies on the relationship between the tongue coating and halitosis, but few have evaluated the bacterial community present in the tongue coating. This study identified bacteria in the tongue coating in individuals with and without halitosis using 16S rRNA analysis. Forty subjects (mean age, 46.1 ± 15.8 years) who visited the halitosis clinic at the University Dental Hospital between 2016 and 2017 were divided into halitosis (n = 32) and non-halitosis (n = 8) groups according to results from an organoleptic test (OT). Additional measurements via gas chromatography (GC) and the Breathtron® instrument confirmed the groupings as the H₂S, CH₃SH, (CH₃)₂S, and total volatile sulphur compounds (VSC) levels were significantly higher in the halitosis group than in the non-halitosis group. Bacterial diversity was higher in the halitosis group; the median (quartile) values of the Shannon index were 4.46 (4.21, 4.67) in the halitosis group and 3.80 (3.45, 4.30) in the non-halitosis group. Additionally, the median (quartile) values of the Chao-1 index were 84.0 (77.2, 95.0) in the halitosis group and 71.3 (65.0, 81.5) in the non-halitosis group. These differences in bacterial composition and diversity may further the understanding of causes and treatments for halitosis.

Effects of tongue cleaning on Ayurvedic digestive power and oral health-related quality of life: A randomized cross-over study

OBJECTIVES

The effect of tongue cleaning on digestive power is mentioned in Ayurvedic information sources. However, no study has yet evaluated this. We aimed to evaluate the effects of tongue cleaning on digestive power from Ayurvedic viewpoint, and on oral health-related quality of life (OHRQoL) in healthy adults.

DESIGN

Randomized cross-over.

INTERVENTIONS

We recruited healthy adults aged 20-60 years. After randomization, the immediate intervention group started tongue cleaning with a tongue scraper every morning for 4 weeks, and then waited for 4 weeks. The delayed intervention group initially waited for 4 weeks, and then started tongue cleaning in the same way.

MAIN OUTCOME MEASURES

We assessed the outcomes using the questionnaire on digestive power from Ayurvedic viewpoint, and the General Oral Health Assessment Index for OHRQoL. We estimated the effects of tongue cleaning using generalized estimating equations (GEE). We also conducted a sensitivity analysis, by comparing the changes in outcomes during the first 4 weeks of both groups.

RESULTS

Of 58 participants, 57 completed the study. In GEE analysis, tongue cleaning showed improvement in some components of Ayurvedic digestive power represented by fecal and body conditions. For example, the odds ratio for improvement of constipation was 2.80 (95% CI: 1.04-7.58). The General Oral Health Assessment Index score was significantly increased by 4.33 points (95% CI: 2.18-6.48) after tongue cleaning. In sensitivity analyses, the trends of the results were similar to the main GEE analyses.

CONCLUSIONS

Tongue cleaning may be an effective method to improve digestive power and OHRQoL.