Prevalence estimation of halitosis and its association with oral health-related parameters in an adult population of a city in North Italy

Evaluation of self-perceived halitosis and effective conditions in periodontology clinic applicants: A cross-sectional study

Halitosis is defined as an unpleasant odor emanating from the oral cavity and has social and economic effects. Halitosis is a common complaint in individuals with periodontal disease, but limited data are available. The aim of this study is to evaluate self-reported halitosis and related conditions. It is a cross-sectional study using a questionnaire consisting of 10 questions on the self-perception of halitosis in patients who applied to the periodontology clinic. Five hundred nine individuals were included in the study. The relationship between individual-reported oral malodor and sociodemographic, medical history and oral hygiene variables was examined. Periodontal clinical parameters (plaque index, gingival index, and bleeding on probing) recorded in the patient forms of the individuals included in the study were evaluated. The prevalence of halitosis reported by the patients participating in the study is 34.2%. Factors that are significantly associated with self-perceived halitosis, low frequency of tooth brushing, increased degree of periodontal disease, regular drug use of patients, and low education level. Halitosis remains one of the main issues facing people in today's world. As a result, dentists should play a bigger part in educating and alerting patients about oral malodor. There should be more public education regarding the causes of foul breath and potential treatments.

Halitosis in oral lichen planus patients

To investigate the halitosis level in oral lichen planus (OLP) patients and OLP-free participants. This cross-sectional study recruited 70 participants at the New Zealand's National Centre for Dentistry. Halitosis was determined using the objective measurements (parts per billion (ppb) volatile sulphur compounds (VSCs) in the exhaled air) and subjective measurement (self-reported halitosis questionnaire). The VSCs values of OLP participants (mean ± SD: 144.64 ± 23.85 ppb) were significantly greater than that in the OLP-free participants (105.52 ± 22.31ppb) (mean difference: 39.12 ppb;p< 0.05; 95% CI: 27.95, 50.29). The VSCs value of hyperplastic (mean difference: 34.11; 95% CI: 20.07, 48.15;p< 0.05) and erosive/ulcerative (mean difference: 57.47; 95% CI: 34.19, 80.76;p< 0.05) OLP participants were statistically greater than that of OLP-free participants. No statistical significance was found between hyperplastic and erosive/ulcerative OLP (p> 0.05). 'Type (OLP-free/OLP)' has a significant effect on the dependent variable VSCs. 78.6% of OLP and 90.5% of OLP-free brushed their teeth at least twice daily, with a statistically significant observation (Mean square: 1.61; F: 13.13;p< 0.05). The levels of VSCs were greater in participants with hyperplastic and erosive/ulcerative OLP than that in the OLP-free participants.

Assessment of the Quality and Readability of Web-Based Arabic Health Information on Halitosis: Infodemiological Study

BACKGROUND

Halitosis, characterized by an undesirable mouth odor, represents a common concern.

OBJECTIVE

This study aims to assess the quality and readability of web-based Arabic health information on halitosis as the internet is becoming a prominent global source of medical information.

METHODS

A total of 300 Arabic websites were retrieved from Google using 3 commonly used phrases for halitosis in Arabic. The quality of the websites was assessed using benchmark criteria established by the Journal of the American Medical Association, the DISCERN tool, and the presence of the Health on the Net Foundation Code of Conduct (HONcode). The assessment of readability (Flesch Reading Ease [FRE], Simple Measure of Gobbledygook, and Flesch-Kincaid Grade Level [FKGL]) was conducted using web-based readability indexes.

RESULTS

A total of 127 websites were examined. Regarding quality assessment, 87.4% (n=111) of websites failed to fulfill any Journal of the American Medical Association requirements, highlighting a lack of authorship (authors' contributions), attribution (references), disclosure (sponsorship), and currency (publication date). The DISCERN tool had a mean score of 34.55 (SD 7.46), with the majority (n=72, 56.6%) rated as moderate quality, 43.3% (n=55) as having a low score, and none receiving a high DISCERN score, indicating a general inadequacy in providing quality health information to make decisions and treatment choices. No website had HONcode certification, emphasizing the concern over the credibility and trustworthiness of these resources. Regarding readability assessment, Arabic halitosis websites had high readability scores, with 90.5% (n=115) receiving an FRE score ≥80, 98.4% (n=125) receiving a Simple Measure of Gobbledygook score <7, and 67.7% (n=86) receiving an FKGL score <7. There were significant correlations between the DISCERN scores and the quantity of words (P<.001) and sentences (P<.001) on the websites. Additionally, there was a significant relationship (P<.001) between the number of sentences and FKGL and FRE scores.

CONCLUSIONS

While readability was found to be very good, indicating that the information is accessible to the public, the quality of Arabic halitosis websites was poor, reflecting a significant gap in providing reliable and comprehensive health information. This highlights the need for improving the availability of high-quality materials to ensure Arabic-speaking populations have access to reliable information about halitosis and its treatment options, tying quality and availability together as critical for effective health communication.

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.

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.

Revisiting Standard and Novel Therapeutic Approaches in Halitosis: A Review

Halitosis, or bad breath, is an oral health problem characterized by an unpleasant malodor emanating from the oral cavity. This condition can have different origins and causes a negative burden in social interactions, communication and quality of life, and can in uncommon cases be indicative of underlying non-oral non-communicable diseases. Most cases of halitosis are due to inadequate oral hygiene, periodontitis and tongue coating, yet the remaining proportion of cases are due to ear-nose-throat-associated (10%) or gastrointestinal/endocrine (5%) disorders. For this reason, the diagnosis, treatment and clinical management of halitosis often require a multidisciplinary team approach. This comprehensive review revisits the etiology of halitosis as well as standard and novel treatment that may contribute to higher clinical success.

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.

Efficacy of a Zinc Lactate Mouthwash and Tongue Scraping in the Reduction of Intra-Oral Halitosis: A Single-blind, Controlled, Crossover Clinical Trial-A Pilot Study

Intra-oral halitosis is defined as an unpleasant odor that comes out of the mouth. The aim of this study was to investigate the effect of zinc lactate mouthwash and tongue scraping on intra-oral halitosis. The study was conducted on 60 volunteers that were divided into two groups and fol-lowed two types of 14-day oral hygiene protocols on a cross-over basis after a 7-day wash-out period. One protocol was based on tooth brushing only, while the other was based on additional mouth rinsing with a zinc lactate product and tongue scraping. Morning mouth breath was as-sessed organoleptic and by volatile sulfur compound concentrations. The highest mean organo-leptic and volatile sulfur compound measurement values were found in the tooth brushing without mouth washing and tongue scraping oral hygiene protocol (p < 0.05). The zinc lactate mouthwash combined with tongue scraping appears to be an important hygienic procedure to reduce breath odor.

Effect of fixed orthodontic appliances on self-assessment and diagnosis of halitosis in undergraduate dental students

Background:

The effects of fixed orthodontic therapy on the occurrence of halitosis are not yet fully understood. This study aimed to evaluate the effect of fixed orthodontic appliances on self-assessment and diagnosis of halitosis in undergraduate dental students.

Materials and Methods:

Sixty-two undergraduate dental students were included in this cross-sectional study. Two groups (n = 31 per group) were composed of participants with (study group) or without (control group) fixed orthodontic appliance. Halitosis self-assessment and clinical diagnosis were assessed using a visual analogic scale (VAS) and sulfur volatile compounds (SVCs) assessment, respectively. The subjective (VAS) and objective (SVC) malodor assessments were classified in absence, light, moderate, or severe malodor. Chi-square Pearson test and Spearman's correlation were applied for data analysis, with a significance level of 5%.

Results:

The use of fixed orthodontic appliances had no effect on self-assessment (P = 0.490) or clinical diagnosis (P = 0.610) of halitosis. Self-assessment was not significantly associated with the diagnosis of halitosis regardless the use of fixed orthodontic appliance (P ≥ 0.737). Male participants showed higher diagnosis of halitosis (P = 0.007). SVC measurements showed the absence of halitosis in 51.6% and 58.1% of participants with or without orthodontic appliances, respectively.

Conclusion:

The use of fixed orthodontic appliances affected the self-assessment of halitosis but no SVC measurements. It was not verified a correlation between subjective and objective methods to diagnose halitosis in dental students.

Dynamic Alterations of Oral Microbiota Related to Halitosis in Preschool Children

Objective

This longitudinal study was aimed to evaluate the dynamic shift in oral microbiota during the process of halitosis progression among preschool children.

Methods

The oral examinations, questionnaires and tongue coating specimens were collected at the baseline and 12-month follow-up. All children were oral healthy at the enrollment. At the 12-month follow-up, children who developed halitosis were included to the halitosis group (n = 10). While children who matched the age, gender, kindergarten and without halitosis were included to the control group (n = 10). 16S rRNA gene sequencing was used to reveal the shift of the tongue coating microbiome in these children during the 12- month period with the Human Oral Microbiome Database.

Results

A remarkable shift in relative abundance of specific bacteria was observed prior to halitosis development. The principal coordinates and alpha diversity analyses revealed different shifting patterns of halitosis and the healthy participants’ microbiome structures and bacterial diversity over the 12-month follow-up. Both groups showed variable microbiota community structures before the onset of halitosis. Halitosis-enriched species Prevotella melaninogenica, Actinomyces sp._HMT_180 and Saccharibacteria TM7_G-1_bacterium_HMT_352 were finally selected as biomarkers in the halitosis-onset prediction model after screening, with a prediction accuracy of 91.7%.

Conclusions

The microbiome composition and relative abundance of the tongue coatings in the halitosis and control groups remarkably differed, even prior to the onset of the clinical manifestations of halitosis. The halitosis prediction model constructed on the basis of tongue coating microbiome biomarkers indicated the microbial shifts before the halitosis onset. Therefore, this can be considered for the timely detection and intervention of halitosis in children.

Knowledge and Management of Halitosis in France and Lebanon: A Questionnaire-Based Study

Halitosis is a growing issue and its management is highly challenging. The aim of this study was to evaluate the knowledge and treatment strategies used by French (FD) and Lebanese (LD) dentists. A self-administered structured questionnaire was sent to FD and LD comprising questions about professional characteristics, management, and treatment of halitosis, patients’ referral, and halitosis-related knowledge. A multivariate analysis was conducted to determine differences between FD and LD and to identify parameters that could influence dentists’ management of halitosis. The questionnaire was filled out by 156 FD and 257 LD. Among them, 78.8% of FD and 68.9% of LD were confronted with halitosis management, while only a few routinely asked their patients about halitosis (16% FD, 13.2% LD). Regarding anamnesis, oral hygiene habits were more investigated by FD than LD (p < 0.05). The overall treatment satisfaction was low with 39.7% of FD and 28.4% of LD considering their treatment effective. Regarding halitosis-related knowledge, extra-oral causes were overestimated in both populations. FD (83.4%) and LD (65.8%) considered their education regarding halitosis as insufficient. This study highlights the need of professional education in both countries, targeting proper diagnosis and treatment strategies of halitosis.

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.

Halitosis, reduced salivary flow and the quality of life in pre-kidney transplantation patients

Background

Halitosis is a condition that affects 50% of adults and one third of patients with chronic kidney disease. The aim of this study was to evaluate oral manifestations and volatile sulfur compounds (VSCs) associated with halitosis and quality of life in pre-kidney transplantation candidates.

Material and Methods

The organoleptic test (OT) and halimetry (HA) (before and after cysteine mouthwash) were performed in patients with the Oralchroma® device, stimulated (SE) and non-stimulated sialometry (SN), Tongue Coating Index (TCI). The OHIP-14 questionnaire was administered to assess the impact of oral health on quality of life.

Results

Fourteen individuals with a mean age of 49.64 ± 13.35 years were evaluated. In the organoleptic test, 57.14% of the individuals presented halitosis. Oralchroma results showed that dimethyl sulfide was above the threshold in 85.71% of the individuals, while hydrogen sulfide and methyl mercaptan were above threshold in 28.57%; after the use of cysteine, hydrogen sulfide was present in 100% of the cases, dimethyl sulfide in 57.14% and methyl mercaptan in 50%. In the non-stimulated sialometry, 57.14% of the individuals presented hyposalivation and 21.42% in the stimulated. Regarding the tongue coating index, 100% of the individuals presented tongue coating, with a mean of 7.64. The assessment of impact of oral health on quality of life showed a negative impact in all dimensions.

Conclusions

Tongue coating, in association with hydrogen sulfide, was the main cause of halitosis in the study subjects, and hyposalivation may contribute to higher tongue-coating indices. These oral changes negatively affect the quality of life for pre-kidney transplantation patients.

Key words:Halitosis, chronic kidney disease, quality of life, kidney transplantation.

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.

Etiology and characteristics of halitosis in patients of a halitosis center in Northern Italy

BACKGROUND

As there are few studies in Europe describing characteristics of breath malodor for large groups of patients, this retrospective study was designed to analyse the etiology of halitosis among patients attending a breath malodor center in Northern Italy.

METHODS

Clinical records of 547 consecutive patients were reviewed and data on self-perceived halitosis, organoleptic scores, volatile sulphur compound (VSC) levels, and oral health condition were extracted and analysed.

RESULTS

The prevalence of intra-oral halitosis was 90.7%. In 21 patients no objective signs of breath malodor could be found. Periodontitis and gingivitis were the main cause of bad breath in 33.9% of subjects and in combination with tongue coating in 55.2%. Only eight subjects have tongue coating as the only cause of halitosis. Ear, nose and throat (ENT)/extra-oral causes were found in 5.2% of the patients. VSC concentrations were lower in the psychogenic halitosis group, whereas no statistically significant differences were detected when comparing intra-oral and extra-oral halitosis except for (CH3)2S.

CONCLUSIONS

Psychogenic halitosis is a rare condition among subjects complaining of suffering from bad breath. The most prevalent cause of halitosis is intra-oral, in particular a combination of tongue coating and periodontal disease. Tongue coating is rarely the primary cause of oral malodor.

Self-Perception of Periodontal Health and Associated Factors: A Cross-Sectional Population-Based Study

The aim of this cross-sectional study was to explore sociodemographic, behavioral, and clinical factors associated with self-awareness of periodontal health. Data were collected from a representative sample of 736 adults (25–75 years old) in a city of Northern Italy who self-assessed gingival bleeding, oral malodor, and tooth mobility in a questionnaire and who underwent clinical periodontal examination and organoleptic evaluation. Approximately 50% of the subjects were aware of their actual gingival health status and oral odor. The logistic regression analysis revealed that females presented higher odds of correctly perceiving their gingival conditions and mouth odor, while those who were older and smokers had a greater probability of being less objective in reporting them. Tooth type and position in the dental arches were positively associated with self-perception of tooth mobility. These findings reflected a low level of self-awareness that may influence oral care-seeking behavior. Subjects may be unconcerned about their periodontal health condition or lack enough knowledge to be aware of it. This points to the need for planning strategies to improve education and knowledge about periodontal health, which, by enhancing self-perception of periodontal symptoms, could help everyone to seek treatment in the initial stage of the disease.

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.

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.

A randomized cross-over short-term study on the short-term effects of a zinc-lactate containing mouthwash against oral malodour

AIM

This randomized controlled cross-over-design-study investigated short-term effects on oral malodour of a zinc-lactate-containing mouthwash.

MATERIALS AND METHODS

Sixteen subjects (18-65 years) with an organoleptic score (OLS) ≥2 were included. Following rinses were used: (A) a zinc-lactate-containing mouthwash (10 ml/30 s); (B) a zinc-lactate-containing mouthwash (15 ml/60 s); (C) a rinse without zinc-lactate (3 droplets/10 ml tap water/30 s) and (D) tap water (10 ml/30 s). Each formulation was evaluated by two blinded examiners comparing OLS and three volatile-sulphur-compounds (VSC; H₂S (hydrogen sulphide), CH₃SH (methyl mercaptan) and (CH₃)₂S (dimethyl sulphide)) before, 1 and 3 h after rinsing. Subject's perception was investigated with a visual-analogue-scale. Linear mixed models were used to compare all parameters simultaneously with respect to the four treatment groups with a significance level α < 0.05.

RESULTS

OLS was significantly reduced by A and B compared to C and D after 3 h (p < 0.006). The sum of the 3 VSCs as well as H₂S alone were significantly reduced by rinses A and B after 1 and 3 h compared to rinses C and D (p < 0.05). Significant differences were found between the four rinses for 'Taste' (p = 0.003), for 'Change of mouth feeling' (p = 0.001), for 'Feeling of freshness' (p = 0.002) and for 'Effectiveness' (p = 0.002) in favour of A & B.

CONCLUSION

A zinc-lactate-containing mouthwash reduced OLS and VSC over a period of 3 h with favourable patient reported outcomes.

Intra-Oral Factors Influencing Halitosis in Young Women

Objectives

The aim of this research was to determine intra-oral factors that affect halitosis in young women.

Methods

This study was performed between March 2014 to May 2014, and included 35 women in their 20s with good oral health. Correlation and logistic regression analyses were performed to investigate the change in halitosis immediately, and 1 hour after scaling.

Results

In both oral gas (OG) and extraoral gas (EG) groups, halitosis was reduced after scaling compared to before scaling. The logistic regression analysis of oral state factors in OG showed that as oral fluid [odds ratio (OR) = 0.792, p = 0.045] and dental plaque (OR = 0.940, p = 0.016) decreased by 1 unit, the OR in the OG group decreased (> 50). In addition, as glucose levels in the oral cavity (OR = 1.245, p = 0.075) and tongue coating index (OR = 2.912, p = 0.064) increased by 1 unit, the OR in the OG group increased (> 50). Furthermore, in the EG group, as oral fluid (OR = 0.66, p = 0.01) and dental plaque (OR = 0.95, p = 0.04) decreased, the OR in the EG group decreased (> 50) significantly.

Conclusion

To control halitosis, it is necessary to increase oral fluid and decrease the amount of tongue plaque. Furthermore, maintaining a healthy oral environment, aided by regular scaling and removal of dental plaque, may significantly control halitosis.

Reliability, Accuracy, and Use Frequency of Evaluation Methods for Amount of Tongue Coating

OBJECTIVE

To classify the evaluation methods for amount of tongue coating (TC) and investigate their reliability, accuracy, and frequency of use.

METHODS

Articles published from 1985 to 2015 were searched for evaluation methods for the amount of TC in PubMed and the Cochrane Library. Only clinical researches were included except protocol articles. The methods were classified according to their characteristics.

RESULTS

Finally, 113 articles were selected. The evaluation method for the amount of TC from the articles was classified into 4 types: intuitive, specificative, computerized, and weighing TC. The reliability in the intuitive and specificative methods (κ =0.33-0.92) showed varying levels among the studies. In general, the amount of TC calculated by the specificative method (Spearman's r=0.68-0.80) was more strongly related to the directly measured value than to the value estimated by the computerized method (Pearson's r=0.442). The number of articles published on this topic has increased consistently, and the specificative method was the most frequently used. Despite the higher reliability of the computerized method, it has not been widely used.

CONCLUSIONS

The high prevalence of the specificative method would continue in clinical practice because of its convenience and accuracy. However, to establish higher reliability, the limitation of the subjectivity of the assessors should be overcome through calibration training. In the computerized method, novel algorithms are needed to obtain a higher accuracy so that it can help the practitioners confidently estimate the amount of TC.

Effect of photodynamic therapy in the reduction of halitosis in patients with multiple sclerosis: clinical trial

Smell and odours play a vital role in social interaction. Halitosis is a social problem that affects one third of the population, causing a negative impact on the quality of life. There is little knowledge on the prevalence and management of halitosis in multiple sclerosis (MS) patients. The present study aims to evaluate the presence of halitosis in patients with MS when compared to a control group, and also evaluate treatment of the problem with antimicrobial photodynamic therapy (aPDT). This is a case-control clinical study in which 60 patients were evaluated: 30 MS patients in treatment at the Specialties Clinic School of Medicine, and 30 healthy patients, matched in age and gender for the control group. Data was collected on the duration of the disease as well as the degree of disability and medication use in the MS group. For all patients, halitosis was assessed with Oral Chroma™. Individuals with halitosis underwent treatment with tongue scraping and aPDT. The photosensitizer was methylene blue (0.005%) and a THERAPY XT-EC^® laser (660 nm, 9 J, 100 mW for 90 s per point, 320 J cm^-2, 3537 mW cm^-2) was used. Six points 1 cm apart from each other were irradiated in the tongue dorsum. There was a positive correlation between the disability and disease duration. No parameter was correlated with halitosis. Patients with MS have higher levels of SH₂ compounds when compared to the control group (p = 0.003, Mann-Whitney), but after aPDT both groups significantly reduced the levels to under the halitosis threshold. The aPDT scraping treatment was effective in the immediate reduction of halitosis in both groups.

Halitosis Assessment and Changes in Volatile Sulfur Compounds After Chewing Gum: A Study Performed on Dentistry Students

OBJECTIVE

The objective of this study is to estimate the prevalence of halitosis (with subjective and objective methods), evaluate the immediate effect of chewing gum on volatile sulfur compounds (VSCs), assess the perception of halitosis by dentistry students, and estimate the distribution of positive and negative frequencies, when comparing objective and subjective methods for the diagnosis of halitosis.

METHODS

The study was performed on a sample of dentistry students attending the Faculty of Medicine and Health Sciences at the University of Barcelona. A questionnaire about halitosis perception was provided and a clinical examination, organoleptic test (OT), and gas chromatography were performed to determine the presence of halitosis. The subjects were also given chewing gum to modify their breath, and gas chromatography was carried out to evaluate possible changes in VSCs.

RESULTS

The sample comprised 80 individuals. Twenty-seven (33.75%) self-perceived halitosis during the period of evaluation; the OT was positive in 38 subjects (47.5%); and individuals positive for halitosis on gas chromatography were distributed as follows: H₂S in 25 (31.25%), CH₃SH in 28 (35%), and (CH₃)₂S in 70 individuals (87.5%). A statistical difference before and after chewing gum (P < .05) was found for each VSC; a difference in frequencies was observed between the variable OT and H₂S (P < .05) and between the OT and (CH₃)₂S (P < .001). There was no significant difference (P > .05) between the positive and negative frequencies retrieved between the variable OT and CH₃SH and between the OT and the student's halitosis perception.

CONCLUSION

Prevalence of halitosis in the studied sample is high, considering that it comprised healthy individuals. The relationship between the OT and gas chromatography is not completely established. Chewing gum could be considered a therapeutic alternative to decrease or neutralize the amount of VSCs present in oral breath.

Self-perception, knowledge, and awareness of halitosis among female university students

Background

Halitosis or oral malodor is defined as an unpleasant breath odor. It can become a serious problem affecting individuals’ social communication and self-confidence. Furthermore, it is a discomforting issue for the people around the person affected, because they consider it embarrassing to inform the person of the problem.

Aim

This study was designed to measure self-perception, knowledge, and awareness of halitosis among female university students in Saudi Arabia.

Materials and methods

A cross-sectional survey was implemented with 392 volunteer participants who responded to a questionnaire on their self-perception, knowledge, and awareness of halitosis.

Results

The response rate was 89.1% (392/440). Self-perception of halitosis was low (21.4%), whereas a larger percentage (78.1%) indicated noticing people with bad breath. Most participants (80.4%) thought that the gastrointestinal tract is the primary source of halitosis. Seventy-seven percent preferred using personal methods such as mouthwash and chewing gum to treat oral malodor. According to 82.1% of respondents, a dentist is the most appropriate professional to treat halitosis.

Conclusion

The investigation revealed low self-perception and limited knowledge regarding halitosis. Therefore, the role of dentists in informing and educating their patients concerning oral malodor should be enhanced. Public education about the causes of and possible ways of managing bad breath should be increased.