Relationship between genuine and pseudohalitosis and social anxiety disorder

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.

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.

Role of Probiotics in Halitosis of Oral Origin: A Systematic Review and Meta-Analysis of Randomized Clinical Studies

Halitosis or oral malodor is a condition caused by the putrefaction of sulfur-containing amino acids. It affects 30–50% of the population and causes social rejection, reducing quality of life, and self-esteem. Probiotics, especially Lactobacillus species, have been proposed for the treatment of genuine halitosis, due to their ability to reduce bacterial colonization. Our objective was to evaluate their use for the treatment of oral halitosis. Applying the PRISMA statement guidelines, we searched PubMed, EMBASE, and Web of Science databases for scientific articles from the last 15 years, up to July 2021. The keywords used were “Probiotics”; “Halitosis”; “Mouth diseases”; “Oral health”; “Humans”; “Randomized Clinical Trials” according to the question, “Are probiotics effective for the reduction or elimination of oral halitosis?” Fourteen studies were identified, although only four met the inclusion criteria. We evaluated 283 participants treated with two different probiotics, with a follow-up of at least 2 weeks. Risk of bias was assessed using the Cochrane Collaboration tool. A fixed-effects meta-analysis was performed. No statistical significance was found (p = 0.53). Despite the limitations of this meta-analysis, we believe that some probiotics have a beneficial effect on halitosis, although more clinical trials are needed to establish real evidence on this aspect.

Systematic Review Registration:https://doi.org/10.37766/inplasy2021.9.0009, identifier: INPLASY20211900.

Frog Skin-Derived Peptides Against Corynebacterium jeikeium: Correlation between Antibacterial and Cytotoxic Activities

Corynebacterium jeikeium is a commensal bacterium that colonizes human skin, and it is part of the normal bacterial flora. In non-risk subjects, it can be the cause of bad body smell due to the generation of volatile odorous metabolites, especially in the wet parts of the body that this bacterium often colonizes (i.e., groin and axillary regions). Importantly, in the last few decades, there have been increasing cases of serious infections provoked by this bacterium, especially in immunocompromised or hospitalized patients who have undergone installation of prostheses or catheters. The ease in developing resistance to commonly-used antibiotics (i.e., glycopeptides) has made the search for new antimicrobial compounds of clinical importance. Here, for the first time, we characterize the antimicrobial activity of some selected frog skin-derived antimicrobial peptides (AMPs) against C. jeikeium by determining their minimum inhibitory and bactericidal concentrations (MIC and MBC) by a microdilution method. The results highlight esculentin-1b(1-18) [Esc(1-18)] and esculentin-1a(1-21) [Esc(1-21)] as the most active AMPs with MIC and MBC of 4-8 and 0.125-0.25 µM, respectively, along with a non-toxic profile after a short- and long-term (40 min and 24 h) treatment of mammalian cells. Overall, these findings indicate the high potentiality of Esc(1-18) and Esc(1-21) as (i) alternative antimicrobials against C. jeikeium infections and/or as (ii) additives in cosmetic products (creams, deodorants) to reduce the production of bad body odor.

Psychological characteristics of Chinese patients with genuine halitosis

OBJECTIVE

The present case-control study aimed to compare the psychological status of patients with and without halitosis, and investigate the association between psychological disorders and halitosis.

METHODS

Patients who complained about bad breath and diagnosed with genuine halitosis were assigned to the halitosis group, while patients without genuine halitosis were assigned to the control group (n = 106, each group). Information on the demographics and Symptom Checklist-90 (SCL-90) of participants was collected. The organoleptic score and Halimeter measurement were used to measure halitosis.

RESULTS

The mean SCL-90 score of participants in the halitosis group (0.63) was significantly greater than that in the control group (0.48) (p = .002). The scores of the domains of interpersonal sensitivity, anxiety, depression, and paranoid ideation were found to be significantly different between the two groups (p < .05). However, there were no significant differences in SCL-90 scores between the mild and moderate-severe halitosis groups (p = .479).

CONCLUSION

The psychological status of genuine halitosis patients was significantly worse than normal patients without halitosis complaint and also without halitosis. The main problems were in the aspects of interpersonal sensitivity, anxiety, depression, and paranoia. However, the negative impact was not related to the severity of halitosis.

Microbiota and Malodor-Etiology and Management

Accumulating evidence indicates that microbiota plays a critical role in physiological processes in humans. However, it might also contribute to body malodor by producing numerous odorous molecules such as ammonia, volatile sulfur compounds or trimethylamine. Although malodor is commonly overlooked by physicians, it constitutes a major problem for many otherwise healthy people. Thus, this review aims to investigate most common causes of malodor and describe potential therapeutic options. We searched PUBMED and Google Scholar databases to identify the clinical and pre-clinical studies on bad body smell, malodor, halitosis and microbiota. Unpleasant smell might originate from the mouth, skin, urine or reproductive fluids and is usually caused by odorants that are produced by resident bacterial flora. The accumulation of odorous compounds might result from diet, specific composition of microbiota, as well as compromised function of the liver, intestines and kidneys. Evidence-based guidelines for management of body malodor are lacking and no universal treatment exists. However, the alleviation of the symptoms may be achieved by controlling the diet and physical elimination of bacteria and/or accumulated odorants.

Persistent dysgeusia post-halitosis treatment: How does it impact the patients' quality of life?

BACKGROUND

The objective of this study was to evaluate the quality of life and the presence of anxiety and depression in patients with dysgeusia post halitosis treatment.

MATERIAL AND METHODS

Sixty patients were divided into three groups: Dysgeusia group (DG); Halitosis group (HG) and Control group (CG). The following instruments were used: Medical results study Short form health research of 36 items (SF-36), State-state anxiety inventory (STAI) and Self-report questionnaire-20 (SRQ-20).

RESULTS

Of the 60 subjects studied, 85% were female and 15% were male. The evaluation of SF-36 indicated a statistically significant correlation between some domains for DG and showed low scores for Mental Health. In relation to HG, low scores were obtained for Bodily Pain, Vitality and Emotional Role. The CG showed low scores for Bodily Pain, General Health and Vitality. STAI was significant when DG was compared to HG and CG. The mean SRQ-20 score was higher in DG compared with the other groups.

CONCLUSIONS

Persistent dysgeusia post-halitosis treatment impacts on QoL generically in the Mental health domain, and specifically in trait and state anxiety. Symptoms of depression were also seen in this group of patients.

Prevalence and relevant factors of halitosis in Chinese subjects: a clinical research

BACKGROUND

The aim of this study was to investigate the prevalence of halitosis among Chinese subjects and to analyze the associated factors that influence halitosis.

METHODS

This study included subjects complaining of halitosis who came to the clinic between 2014 and 2016. Questionnaires were used to obtain general information from patients. An organoleptic test was conducted, and volatile sulfur compounds measurement was obtained to assess halitosis. In conjunction with these tests, the oral health status of each patient was recorded.

RESULTS

In total, there were 205 samples entered into data analysis, and the patients' age ranged from 18 to 71 years (mean ± SD: 32.44 ± 10.31). Of these patients, 65.9% had an organoleptic score ≥ 2, and 41% of patients had a volatile sulfur compound level ≥ 110 ppb. The findings indicated that the prevalence of halitosis was higher in males than in females (55.6% vs. 44.4%, respectively, P = 0.018). Several factors including the duration of bad breath, rhinitis, tongue coating and periodontal conditions were found to be associated with the organoleptic score. Tongue coating was also associated with the volatile sulfur compound level.

CONCLUSIONS

Among these subjects, 65.9% had halitosis. Oral health status was strongly associated with halitosis, and tongue coating was the most important factor.

The Halitosis Consequences Inventory: psychometric properties and relationship with social anxiety disorder

Objectives

Individuals who complain of halitosis experience psychological consequences that can lead to social, professional, and affective limitations. Research has identified social anxiety disorder (SAD) as the most common psychopathology associated to halitosis complaints. Combining these two lines of research, we sought to determine the validity of the Halitosis Consequences Inventory (ICH), a scale designed to assess the psychological consequences of halitosis complaints. We also investigated the relationship between these consequences and SAD.

Materials and methods

Participants were 436 individuals, including those with and without halitosis complaints (n=411 and n=25, respectively). Measures administered were the ICH, Social Phobia Inventory and its shortened version, the Liebowitz Social Anxiety Scale, Social Avoidance and Distress Scale, and Fear of Negative Evaluation scale.

Results

The ICH had adequate internal consistency (α=0.93) and could accurately discriminate between participants with and without halitosis complaints. Furthermore, individuals with high scores on the ICH were more likely to have SAD.

Conclusions

The ICH is an important tool for determining the aversive halitosis consequences, allowing to identify, with some degree of accuracy, individuals who might require screening for SAD. Besides, there´s a linear relationship between the presence of halitosis consequences and SAD.