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

Assessment of photodynamic therapy with annatto and led for the treatment of halitosis in mouth-breathing children: Randomized controlled clinical trial

OBJECTIVE

To assess the effectiveness of antimicrobial photodynamic therapy (aPDT) employing an annatto-based (20%) dye combined with blue LED for the treatment of halitosis in mouth-breathing children.

MATERIALS AND METHODS

Fifty-two children six to twelve years of age with diagnoses of mouth breathing and halitosis (score of ≥ 3 on portable breath meter) Breath Alert™ (Tanita Corporation®-Japan), were randomly allocated to two groups (n = 26). Group 1: brushing, dental floss and aPDT applied to middle third of the dorsum of the tongue. Group 2: brushing, dental floss and tongue scraper. Breath meter results before, immediately after treatment as well as seven and 30 days after treatment were compared. The hypothesis of normality in the data was discarded by the Shapiro-Wilk test (p < 0.05) and for statistical analysis the Wilcoxon and Mann-Whitney tests were used.

RESULTS

A significant difference was found between the pre-treatment reading and all other readings (p < 0.05) in both groups, suggesting the effectiveness of the proposed treatments. No significant difference was found between the post-treatment reading and two follow-up readings, suggesting the maintenance of the effect of treatment over time (p > 0.05). However, significant differences were found between groups for all post-treatment assessments (p < 0.0001 for all comparisons), indicating greater effectiveness with aPDT. No association was found between the initial reading and the presence of coated tongue.

CONCLUSION

Antimicrobial photodynamic therapy using annatto and blue LED proved to be a viable therapeutic option for the treatment of halitosis in mouth-breathing children.

ZnO Hexagonal Nano- and Microplates Modified with Nanomaterials as a Gas-Sensitive Material for DMS Detection-Extended Studies

The detection of dimethyl sulphide (DMS) at levels between ppb and ppm is a significant area of research due to the necessity of monitoring the presence of this gas in a variety of environments. These include environmental protection, industrial safety and medical diagnostics. Issues related to certain uncertainties concerning the influence of high humidity on DMS measurements with resistive gas sensors, e.g., in the detection of this marker in exhaled air, of the still unsatisfactory lower detection limit of DMS are the subject of intensive research. This paper presents the results of modifying the composition of the ZnO-based sensor layer to develop a DMS sensor with higher sensitivity and lower detection limit (LOD). Improved performance was achieved by using ZnO in the form of hexagonal nano- and microplates doped with gold nanoparticles (0.75 wt.%) and by using a well-proven sepiolite-based passive filter. The modification of the layer composition with respect to the authors' previous studies contributed to the development of a sensor that is highly sensitive to 1 ppm DMS (S = 11.4) and achieves an LOD of up to 406 ppb, despite the presence of a high water vapour content (90% RH) in the analysed atmosphere.

Laser Therapy: An Alternative Approach for the Management of Halitosis

Halitosis is the result of combining the Greek word "osis" (pathological alteration) with the Latin phrase "halitus" (breath). No matter what the cause, halitosis can be described as the presence of a foul odour. Effective treatment of halitosis may be facilitated by knowledge of the illnesses and factors that contribute to the condition as well as its symptoms. To properly diagnose and treat patients, healthcare professionals, general practitioners, and dentists must comprehend the cause of the ailment and the best course of treatment. A prevalent issue affecting a large proportion of the global population is halitosis. In 90% of cases, the onset of this illness is oral; however, in 10% of cases, it is systemic. The primary source of the unpleasant smell is the volatile sulphur compounds that Gram-negative bacteria create. The majority of halitosis sufferers find their disease humiliating which makes it difficult for them to go about their daily lives and social lives. A thorough examination was carried out. An evaluation of the tongue was done. The halitosis was treated in afflicted areas using the "Epic Biolase Laser". It is the most robust dental laser and has a low power output which uses a solid-state diode to produce invisible infrared radiation. This device operates aseptically and offers more convenience due to its wireless design, which is powered by a Bluetooth foot pedal. This is used to lower the number of bacteria, and then periodic maintenance is performed to keep them under control. Benefits and outcomes were accomplished. Laser therapy destroys the bacteria that produce volatile compounds and efficiently treats foul breath for a longer period of time. But with a combination of conventional techniques, the results we obtain are even better.

Phyllanthus emblica fruit extract alleviates halitosis and reduces the inflammatory response to oral bacteria

OBJECTIVE

To assess the efficacy of Phyllanthus emblica extract in alleviating halitosis and reducing the inflammatory response to halitosis-related bacteria.

METHODOLOGY

This investigation, using Phyllanthus emblica fruit extract (PE), involved four aspects. First, we evaluated the effect on growth and aggregation of halitosis-related bacteria, including Fusobacterium nucleatum, Porphyromonas gingivalis, and Solobacterium moorei, using a microdilution assay and scanning electron microscopy. Second, volatile sulfur compound (VSC) levels were measured on individuals with halitosis in randomized short-term (26 participants) and double-blind randomized long-term trials (18 participants in each group) after rinsing with PE for 3, 6, and 12 h, and 28 days. Third, we analyzed pro-inflammatory cytokine expression in TR146 cells using quantitative real-time PCR and enzyme-linked immunosorbent assays. Lastly, we assessed pro-inflammatory cytokine secretion and Toll-like receptor (TLR) 2 mRNA expression via the same experimental methods in a three-dimensional oral mucosal epithelial model (3D OMEM).

RESULTS

PE extract dose-dependently inhibited the growth of F. nucleatum (50% inhibition concentration [IC50]=0.079%), P. gingivalis (IC50=0.65%), and S. moorei (IC50=0.07%) and effectively prevented bacterial aggregation. Furthermore, VSC contents decreased significantly at 3, 6, and 12 h after rinsing with 5% PE compared with those in the control. Long-term use of mouthwash containing 5% PE for 28 days led to a significant decrease in VSC contents. PE attenuated the F. nucleatum- or P. gingivalis-stimulated mRNA expression and protein release of interleukin (IL)-6 and IL-8 in TR146 cells. It also suppressed IL-8 and prostaglandin E2 secretion and TLR2 mRNA expression in F. nucleatum-induced OMEMs.

CONCLUSION

Our findings support the use of PE in oral care products to alleviate halitosis and it may reduce inflammation.

Narrative review on artificially intelligent olfaction in halitosis

Halitosis, commonly known as oral malodor, is a multifactorial health concern that significantly impacts the psychological and social well-being of individuals. It is the third most frequent reason for individuals to seek dental treatment, after dental caries and periodontal diseases. For an in-depth exploration of the topic of halitosis, an extensive literature review was conducted. The review focused on articles published in peer-reviewed journals and only those written in the English language were considered. The search for relevant literature began by employing subject headings such as 'halitosis, oral malodor, volatile sulfur compounds, artificial intelligence, and olfaction' in databases such as PubMed/Medline, Scopus, Google Scholar, Web of Science, and EMBASE. Additionally, a thorough hand search of references was conducted to ensure the comprehensiveness of the review. After amalgamating the search outcomes, a comprehensive analysis revealed the existence of precisely 134 full-text articles that bore relevance to the study. Abstracts and editorial letters were excluded from this study, and almost 50% of the full-text articles were deemed immaterial to dental practice. Out of the remaining articles, precisely 54 full-text articles were employed in this review. As primary healthcare providers, dentists are responsible for diagnosing and treating oral issues that may contribute to the development of halitosis. To effectively manage this condition, dentists must educate their patients about the underlying causes of halitosis, as well as proper oral hygiene practices such as tongue cleaning, flossing, and selecting appropriate mouthwash and toothpaste. This narrative review summarises all possible AI olfaction in halitosis.

Evaluation of the Change in Halitosis with the Improvement in Oral Health in Cleft Lip and Palate Patients

AIM

This study aimed to assess the effects of hygiene education on periodontal health and mouth/nasal halitosis in patients with cleft.

MATERIALS AND METHODS

39 patients with cleft who were accepted for orthodontic treatment divided into two groups as with (Group1; n = 24) and without braces (Group2; n = 15). Plaque Index (PI), Gingival Index (GI), and Tongue coating Index (TCI) values were recorded. The BANA test microbiological kit, was used to determine the amount of anaerobic bacteria. Values of volatile sulfur components (VSC) for the measurement of oral and nasal halitosis were measured with a Halimeter device. After the initial measurements, oral hygiene instructions were given to eliminate the plaque production on teeth, periodontal structure, tongue and palate. All measurements were repeated 4 weeks after the hygiene instructions. Wilcoxon and Mann-Whitney U test were used for statistical analysis.

RESULTS

In both groups, the PI, GI, values were significantly decreased (P < .05). Tongue coating area, thickness and TCI were significantly reduced (P < .05). Oral halitosis values decreased significantly (P < .05). The PI values decreased significantly more in the Group 1 (P < .05). Non significant difference was detected in nasal halitosis in both groups. In unilateral cleft lip and palate cases cases (n = 23), no significant difference was found in nasal halitosis values between the cleft and the healthy sides (P > 0.05).

CONCLUSION

In patients with clet cases, periodontal health was improved and oral halitosis was reduced by the given hygiene education; brushing the teeth, especially the tongue and palate. However, hygiene education did not have a significant effect on nasal halitosis. Key Words: Cleft lip and palate, Halitosis, BANA test, Periodontal index.

Halitosis: etiology, prevention, and the role of microbiota

OBJECTIVES

This study aims to review halitosis research, discuss its various causes, and propose effective interventions based on the underlying etiologies and mechanisms. The main research question is to identify the primary factors contributing to halitosis and appropriate strategies to address them.

MATERIALS AND METHODS

A comprehensive literature review was conducted on halitosis and its associated causes, including oral pathological factors, oral microbial influences, microbial metabolic pathways, gastrointestinal diseases, and gut microbiota dysbiosis.

RESULTS

Unhealthy eating habits and an imbalance of microorganisms in the oral cavity and gastrointestinal tract were identified as primary causes of halitosis. Dental caries, periodontal disease, xerostomia, and digestive disorders like gastritis and irritable bowel syndrome were also found to be related to the development of halitosis. Due to poor oral hygiene or antibiotic use, disruption of microbial communities can result in dysbiosis, inflammation, and halitosis.

CONCLUSIONS

Halitosis is a multifactorial condition with various underlying causes, including oral and systemic diseases. Effective interventions should be tailored based on the specific etiologies and mechanisms involved.

CLINICAL RELEVANCE

Understanding the factors contributing to halitosis is crucial for developing appropriate treatment strategies. Enhancing oral hygiene habits, using antimicrobial drugs, or administering probiotics may help regulate oral or intestinal flora, thereby improving halitosis and overall oral health.

Polyphenols in Oral Health: Homeostasis Maintenance, Disease Prevention, and Therapeutic Applications

Polyphenols, a class of bioactive compounds with phenolic structures, are abundant in human diets. They have gained attention in biomedical fields due to their beneficial properties, including antioxidant, antibacterial, and anti-inflammatory activities. Therefore, polyphenols can prevent multiple chronic or infectious diseases and may help in the prevention of oral diseases. Oral health is crucial to our well-being, and maintaining a healthy oral microbiome is essential for preventing various dental and systemic diseases. However, the mechanisms by which polyphenols modulate the oral microbiota and contribute to oral health are still not fully understood, and the application of polyphenol products lies in different stages. This review provides a comprehensive overview of the advancements in understanding polyphenols' effects on oral health: dental caries, periodontal diseases, halitosis, and oral cancer. The mechanisms underlying the preventive and therapeutic effects of polyphenols derived from dietary sources are discussed, and new findings from animal models and clinical trials are included, highlighting the latest achievements. Given the great application potential of these natural compounds, novel approaches to dietary interventions and oral disease treatments may emerge. Moreover, investigating polyphenols combined with different materials presents promising opportunities for developing innovative therapeutic strategies in the treatment of oral diseases.

Validation of the Romanian Version of the Halitosis Associated Life-Quality Test (HALT) in a Cross-Sectional Study among Young Adults

Halitosis is a common condition with a significant impact on individuals' quality of life. The Halitosis Associated Life-Quality Test (HALT) is a reliable instrument for measuring this impact. This study aimed to introduce and validate the Romanian translation of the HALT questionnaire (R-HALT). We hypothesized that the R-HALT would demonstrate good reliability and validity in measuring the impact of halitosis on quality of life among Romanian teenagers and young adults. Our objectives were to translate and adapt the HALT, validate it among a cross-sectional group, and evaluate the extent of halitosis in this population. A multicentric cross-sectional design followed, which was approved by the Ethics Research Committee in Romania. The translation process involved independent translations, retro-translations, expert review, and pre-testing. The psychometric properties were evaluated among 150 patients (mean age 23.6 ± 1.8; 51% males) at dental clinics, including reliability, convergent, and discriminant validity, using accepted statistical measures such as Cronbach's alpha and Intraclass Correlation Coefficient (ICC). The R-HALT revealed strong internal consistency with Cronbach's alpha values ranging from 0.93 to 0.96, and an ICC value of 0.87 (95% CI = 0.70-0.99), demonstrating excellent test-retest reliability. Mean scores of individual items ranged from 0.82 ± 0.94 (Q3) to 3.23 ± 1.15 (Q11). The corrected item-total correlation ranged from 0.30 (Q2) to 0.90 (Q19). Organoleptic test scores diagnosed 41% (62 patients) with a score of 2, with increasing severity in 9% (13 patients) with a score of 5. The R-HALT exhibited robust reliability and validity in assessing the impact of halitosis among Romanian teenagers and young adults. The questionnaire is a strong tool for understanding, diagnosing, and managing halitosis in Romania, ultimately aiming to improve the quality of life of affected individuals. Further studies with diverse populations could enhance the applicability of the R-HALT.

Oral microbiome as a co-mediator of halitosis and periodontitis: a narrative review

Objective

Halitosis or oral malodor is an unpleasant odor from the oral cavity. However, although patients with periodontitis often complain of halitosis, their relationship has not been fully elucidated. We reviewed previous literature based on the hypothesis that the relationship between halitosis and periodontitis is mediated by the oral microbiome.

Materials and methods

This narrative review sought to provide insight into the causative role of the oral microbiome in influencing halitosis and periodontitis. In addition, we tried to deepen knowledge related to the relationship between halitosis and periodontitis generated by the oral microbiome accumulated over the past 40 years.

Results

From 1984 to 2023, a total of 106 papers that carefully and scientifically dealt with halitosis and periodontitis were included in this narrative review. Based on previous results, halitosis and periodontitis were closely related. For decades, researchers have taken an intriguing approach to the question of whether there is a relationship between halitosis and periodontitis. Central factors in the relationship between halitosis and periodontitis include volatile sulfur compounds (VSCs), the oral microbiota that produce VSCs, and the inflammatory response.

Conclusions

Taken together, the more severe periodontitis, the higher the level of VSC in halitosis, which may be mediated by oral microbiome. However, the relationship between the occurrence, maintenance, and exacerbation of periodontitis and halitosis is not a necessary and sufficient condition for each other because they are complex interplay even in one individual.

Investigation of volatile sulfur compound level and halitosis in patients with gingivitis and periodontitis

This study aimed to measure the levels of volatile sulfur compounds and investigate the occurrence of halitosis in patients with gingivitis and periodontitis. Additionally, the incidence rates of gingivitis and periodontitis in patients with halitosis were investigated. Through various statistical analyses, we attempted to determine the relationship between periodontal disease and halitosis. One-hundred-and-four participants (52 females and 52 males, mean age: 46.49 ± 16.03 years) were enrolled in this cross-sectional study, comprising 33 healthy controls, 43 patients with gingivitis, and 28 patients with periodontitis. Gas chromatography was used to measure hydrogen sulfide (H2S) and methyl mercaptan (CH3SH), which are representative VSCs. The VSC cut-off values for diagnosing halitosis were 65.79 ppb for women and 79.94 ppb for men. Total VSC level was significantly higher in the gingivitis than the healthy control group (186.72 ± 374.83 ppb vs. 19.80 ± 40.19 ppb, p = 0.035). There was no significant difference between the gingivitis and periodontitis (153.79 ± 278.51 ppb) groups. H2S level was significantly higher in the gingivitis (100.51 ± 183.69 ppb) and periodontitis (91.57 ± 132.06 ppb) groups than in healthy controls (14.97 ± 31.22 ppb), and CH3SH level was significantly higher in gingivitis group (29.31 ± 59.16 ppb) than in the healthy control (5.73 ± 14.10 ppb) (all p < 0.05). Halitosis was found in 3% of healthy controls and 39.5% and 42.9% of patients with gingivitis and periodontitis patients, respectively, making it significantly higher in the gingivitis and periodontitis groups than the healthy controls (p = 0.005). Conversely, among participants with halitosis, 53.1% had gingivitis, 37.5% had periodontitis, and 90.6 incidence had periodontal disease. Multivariate logistic regression analysis to predict the presence of halitosis, found periodontal disease was a significant predictor of halitosis (OR = 3.607, 95% CI 1.023-12.718, p = 0.046). Considering area under curve value for halitosis, the cut-off value of healthy control (H2S:61.5 ppb, CH3SH:3.5 ppb), gingivitis (H2S:50.0 ppb, CH3SH:6 ppb), and periodontitis (H2S:62.0 ppb, CH3SH:3.5 ppb) were (all p < 0.05). Our results emphasize the close and strong relationship between periodontal disease and halitosis through human clinical evidence based on the high co-occurrence rate of mutual diseases. Additionally, the presence of periodontal disease increased the probability of halitosis by 3.607 times. These results suggest that H2S can be used as a biomarker of halitosis in patients with periodontal disease.

Causes and Management of Halitosis: A Narrative Review

Halitosis is defined as the presence of an unpleasant odor in exhaled air, regardless of its cause. In most patients with halitosis, the condition causes embarrassment and interferes with social interactions and daily life. Furthermore, bad breath can be a sign of an underlying disease. Understanding the factors and causes that lead to halitosis and its manifestations could facilitate proper management of this condition. To properly diagnose and treat patients, healthcare professionals, including primary care physicians and dental professionals, must be familiar with the etiology and appropriate management of the disease. Consequently, this review aims to provide practitioners with up-to-date information on the etiological factors of halitosis to facilitate the establishment of preventive measures and provide accurate diagnosis and management.

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.

Knowledge and Practices Regarding Oral Hygiene, Cariogenic Diet Intake, and Dental Check-Ups Among Registered Nurses in Nigeria: A Pilot Study

Objectives To investigate the knowledge and practices of registered nurses in Nigeria concerning oral hygiene, cariogenic diets, and dental check-ups through a pilot study.

Methods This study was an online survey of 129 registered nurses in Nigeria. Data were collected via the WhatsApp social media using an electronic questionnaire (Google form). Data analysis was done using the SPSS version 26 software (IBM Corp, New York, USA).

Results The response and completeness rates of this pilot study were 41.7% (129/311) and 96.9% 9125/129), respectively. The majority (62.2%) of the respondents were females. The majority (89.1%) had average/above average score on basic oral health knowledge; however, there was no significant relationship between their level of basic oral health knowledge and their sociodemographic characteristics (p > 0.05). The majority (66.7%) of the respondents brushed twice daily, 86.8% used a fluoridated toothpaste, and 60.5% changed their toothbrush every 3 months. Furthermore, more than half (55.8%) consumed sugary snack/drink on daily basis, while 55.0% rinsed their mouth with water immediately after taking sugary snack, and only 55.8% did floss their teeth. Among those who flossed their teeth, only 37.5% did it once daily. It is also striking that 26.4% of the respondents had never visited a dentist for a dental check-up.

Conclusion Study findings showed a high level of basic oral health knowledge and a lower level of appropriate oral self-care practices among nurses in Nigeria. However, there is a need for a nationally representative study of nurses in Nigeria to further establish these findings.

Advanced materials and technologies for oral diseases

Oral disease, as a class of diseases with very high morbidity, brings great physical and mental damage to people worldwide. The increasing burden and strain on individuals and society make oral diseases an urgent global health problem. Since the treatment of almost all oral diseases relies on materials, the rapid development of advanced materials and technologies has also promoted innovations in the treatment methods and strategies of oral diseases. In this review, we systematically summarized the application strategies in advanced materials and technologies for oral diseases according to the etiology of the diseases and the comparison of new and old materials. Finally, the challenges and directions of future development for advanced materials and technologies in the treatment of oral diseases were refined. This review will guide the fundamental research and clinical translation of oral diseases for practitioners of oral medicine.

Accuracy of two methods to detect the presence of halitosis: the volatile sulfur compounds concentration in the mouth air and the information from a close person

This study aimed to analyze the accuracy of two methods for detecting halitosis, the organoleptic assessment by a trained professional (OA) with volatile sulfur compounds (VSC) measurement via Halimeter® (Interscan Corporation) and information obtained from a close person (ICP). Participants were patients and companions who visited a university hospital over one year period to perform digestive endoscopy. A total of 138 participants were included in the VSC test, whose 115 were also included in the ICP test. ROC curves were constructed to establish the best VSC cut-off points. The prevalence of halitosis was 12% (95%CI: 7% to 18%) and 9% (95%CI 3% to 14%) for the OA and ICP, respectively. At the cut-off point >80 parts per billion (ppb) VSC, the prevalence of halitosis was 18% (95%CI: 12% to 25%). At the cut-off point >65 ppb VSC, sensitivity and specificity were 94% and 76%, respectively. At the cut-off point >140 ppb, sensitivity was 47% and specificity 96%. For the ICP, sensitivity was 14% and specificity 92%. VSC presents high sensitivity at the cut-off point of >65 ppb and high specificity at the cut-off point of >140 ppb. ICP had high specificity, but low sensitivity. The OA can express either occasional or chronic bad breath, whereas the ICP can be a potential instrument to detect chronic halitosis.

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.

Effect of Photodynamic Therapy on Halitosis: A Systematic Review of Randomized Controlled Trials

BACKGROUND

This systematic review aimed to assess the effectiveness and safety of aPDT for the treatment of halitosis.

METHODS

Search strategies were conducted in October 2021 without language or data restrictions, on the following databases: MEDLINE, EMBASE, CENTRAL, LILACS and BBO, as well as a manual search. Randomized clinical trials (RCTs) with parallel design were considered for inclusion, assessing individuals (adolescents and adults) with a clinical diagnosis of halitosis treated with photodynamic therapy (aPDT). Primary outcomes assessed were halitosis measurements, adverse events and quality of life. The risk of bias for each included study was evaluated with the Cochrane Risk of Bias tool and the certainty of the body of the evidence was assessed with the GRADe approach.

RESULTS

Six RCTs (total of 225 participants) were included and due to clinical diversities it was not possible to group the outcome data in meta-analyses. Based on very low-certainty evidence (GRADE) the results showed that, when compared to tongue scraper, aPDT seems to promote a little to no difference in reducing halitosis and in the microbiological analysis. No adverse events were reported. Considering aPDT combined with tongue scraper, better outcome results were observed when compared to tongue scraper alone.

CONCLUSIONS

Based on very low-certainty evidence, the findings of this review are uncertain about the effects of aPDT for halitosis control. Further RCTs with higher number of participants and long term assessments need to be conducted to support the use of this intervention. The protocol was registered in the PROSPERO database (number: CRD42020215319) on 19 November 2020-retrospectively registered.

A Literature Review and Framework Proposal for Halitosis Assessment in Cigarette Smokers and Alternative Nicotine-Delivery Products Users

Halitosis is a health condition which counts cigarette smoking (CS) among its major risk factors. Cigarette smoke can cause an imbalance in the oral bacterial community, leading to several oral diseases and conditions, including intraoral halitosis. Although the best approach to decrease smoking-related health risks is quitting smoking, this is not feasible for many smokers. Switching to potentially reduced-risk products, like electronic vapor products (EVP) or heated tobacco products (HTP), may help improve the conditions associated with CS. To date, there have been few systematic studies on the effects of CS on halitosis and none have assessed the effects of EVP and HTP use. Self-assessment studies have shown large limitations owing to the lack of reliability in the participants' judgment. This has compelled the scientific community to develop a strategy for meaningful assessment of these new products in comparison with cigarettes. Here, we compiled a review of the existing literature on CS and halitosis and propose a 3-layer approach that combines the use of the most advanced breath analysis techniques and multi-omics analysis to define the interactions between oral bacterial species and their role in halitosis both in vitro and in vivo. Such an approach will allow us to compare the effects of different nicotine-delivery products on oral bacteria and quantify their impact on halitosis. Defining the impact of alternative nicotine-delivery products on intraoral halitosis and its associated bacteria will help the scientific community advance a step further toward understanding the safety of these products and their potentiall risks for consumers.

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.

The Problem of Halitosis in Prosthetic Dentistry, and New Approaches to Its Treatment: A Literature Review

The aim of this work is a review of recent scientific literature about intra-oral halitosis among patients using dentures. Halitosis is a condition in which an unpleasant smell comes out of the oral cavity, which is caused mainly by volatile sulfur and non-sulfured compounds. The etiology of halitosis may be intra- or extra-oral; in most patients, however, it is due to the activity of microorganisms in the oral cavity. The problem of the occurrence of intra-oral halitosis has accompanied patients for many years. In dental prosthetics, the problem of halitosis occurs in patients using removable or fixed dentures. In both cases, new niches for the development of microorganisms may be created, including those related to intra-oral halitosis. It should be noted that dentures—both fixed and removable—are a foreign body placed in the patient’s oral cavity which, in case of insufficient hygiene, may constitute a reservoir of microorganisms, causing this unpleasant condition. Conventional treatment of intraoral halitosis reduces microbial activity via chemical and/or mechanical action. Currently, the search for new strategies in the treatment of halitosis is in progress. One idea is to use photodynamic therapy, while another is to modify poly(methyl methacrylate) (PMMA) with silver and graphene nanoparticles. Additionally, attempts have been made to combine those two methods. Another unconventional method of treating halitosis is the use of probiotics.

Periodontitis, Halitosis and Oral-Health-Related Quality of Life-A Cross-Sectional Study

We aimed to explore the association between volatile sulfurous compounds (VSCs) and periodontal epithelial surface area (PESA) and periodontal inflamed surface area (PISA) on a cohort of periodontitis patients. Consecutive patients were assessed for periodontitis and halitosis. A full-mouth periodontal status assessment tested probing depth (PD), clinical attachment loss (CAL), gingival recession (REC), bleeding on probing (BoP), PISA and PESA. A halitosis assessment was made using a VSC detector device. Periodontal measures were regressed across VSC values using adjusted multivariate linear analysis. From a total of seventy-two patients (37 females/35 males), the PESA of posterior-lower regions was found to be significantly higher in halitosis cases than their non-halitosis counterparts (p = 0.031). Considering all patients, the PESA of the posterior-lower region (B = 1.3, 95% CI: 0.2–2.3, p = 0.026) and age (B = −1.6, 95% CI: −3.1–0.2, p = 0.026) showed significant association with VSCs. In halitosis patients, the PESA of the posterior-lower region (B = 0.1, 95% CI: 0.0–0.1, p = 0.001), PISA Total (B = −0.1, 95% CI: −0.1–0.0, p = 0.008) and the OHIP-14 domain of physical disability (B = −2.1, 95% CI:−4.1–0.1, p = 0.040) were the most significant variables in this model. The PESA from the posterior-lower region may be associated with VSCs when other causes of extra-oral halitosis are excluded. Further intervention studies are needed to confirm this association.

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.

Comparative study between photodynamic therapy with urucum + Led and probiotics in halitosis reduction-protocol for a controlled clinical trial

Background

Halitosis is a term that defines any foul odor emanating from the oral cavity. The origin may be local or systemic. The aim of the proposed protocol is to determine whether treatment with antimicrobial photodynamic therapy (aPDT) and treatment with probiotics are effective at eliminating halitosis.

Materials and methods

Eighty-eight patients, from 18 to 25 years old with a diagnosis of halitosis (H₂S≥112 ppb, determined by gas chromatography) will be randomly allocated to four groups (n = 22) that will receive different treatments: Group 1 –treatment with teeth brushing, dental floss and tongue scraper; Group 2 –brushing, dental floss and aPDT; Group 3 –brushing, dental floss and probiotics; Group 4 –brushing, flossing, aPDT and probiotics. The results of the halimetry will be compared before, immediately after, seven days and thirty days after treatment. The microbiological analysis of the coated tongue will be performed at these same times. The normality of the data will be determined using the Shapiro-Wilk test. Data with normal distribution will be analyzed using analysis of variance (ANOVA). Non-parametric data will be analyzed using the Kruskal-Wallis test. The Wilcoxon test will be used to analyze the results of each treatment at the different evaluation periods.

Clinical trail registration

NCT03996044.

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.

Effect of local hygiene protocols on denture-related stomatitis, biofilm, microbial load, and odor: A randomized controlled trial

STATEMENT OF PROBLEM

Denture stomatitis affects complete denture wearers and is frequently treated with antifungals drugs, as well as treating the denture with sodium hypochlorite. Whether the limitations of these treatments can be overcome with local hygiene protocols that do not damage the denture materials or adversely affect the patient is unclear.

PURPOSE

The purpose of this randomized controlled trial was to evaluate the effect of denture hygiene protocols on complete denture wearers with denture stomatitis.

MATERIAL AND METHODS

For this randomized, double-blind controlled clinical trial, 108 participants were assigned to parallel groups: 0.25% sodium hypochlorite (positive control) 0.15% Triclosan, denture cleaning tablets, or denture cleaning tablets plus gingival cleaning tablets. The participants were instructed to brush the dentures and the palate and immerse the denture in the solutions. The outcomes of denture stomatitis remission, biofilm removal, decrease of microbial load (colony-forming units), and odor level of the mouth and denture were measured at baseline and after 10 days. Descriptive analyses were used for sociodemographic characterization of the participants; the Pearson chi-square test was used to compare participant frequency with different degrees of denture stomatitis. The data were not normally distributed (Shapiro-Wilks test) or homogeneous (Levene test). So, the Kruskal-Wallis and Dunn post hoc tests and Wilcoxon test were used to compare the effects of solutions and time on the variables (α=.05).

RESULTS

The frequency of the highest to lowest denture stomatitis scores was significantly different for the 0.15% Triclosan and denture cleaning tablets groups. No significant difference was found among the groups in terms of denture stomatitis scores, biofilm, or colony-forming unit count of Candida spp. or C. albicans and S. mutans; a significant reduction was found in these parameters. The 0.25% sodium hypochlorite and 0.15% Triclosan treatments caused a significant reduction in Gram-negative microorganisms; these 2 protocols, and the denture cleaning tablets showed a significant reduction in Staphylococcus spp.; all protocols had similar effects. Only the S. mutans count of the palate decreased after 10 days. The odor level of the mouth and the denture was not significantly different (P=.778).

CONCLUSIONS

The evaluated protocols can be recommended for the hygiene of complete dentures, since they were effective for all the variables studied.

Role of the oral microbiome, metabolic pathways, and novel diagnostic tools in intra-oral halitosis: a comprehensive update

Halitosis or oral malodor is one of the most common reasons for the patients' visit to the dental clinic, ranking behind only dental caries and periodontitis. In the present times, where social and professional communications are becoming unavoidable, halitosis has become a concern of growing importance. Oral malodor mostly develops due to the putrefaction of substrates by the indigenous bacterial populations. Although culture-based studies have provided adequate information on halitosis, the high throughput omics technologies have amplified the resolution at which oral microbial community can be examined and has led to the detection of a broader range of taxa associated with intra-oral halitosis (IOH). These microorganisms are regulated by the interactions of their ecological processes. Thus to develop effective treatment strategies, it is important to understand the microbial basis of halitosis. In the current review, we provide an update on IOH in context to the role of the oral microbiome, metabolic pathways involved, and novel diagnostic tools, including breathomics. Understanding oral microbiota associated with halitosis from a broader ecological perspective can provide novel insights into one's oral and systemic health. Such information can pave the way for the emergence of diagnostic tools that can revolutionize the early detection of halitosis and various associated medical conditions.

"Say Ahhh": Experience and Views on Halitosis Management in the General Public in Victoria, Australia

Introduction

Halitosis is common and can have a significant impact on quality of life. It is attributed to both intraoral and extraoral causes. Although halitosis treatment depends on the aetiology, little is known about consumers’ perception of halitosis causes and the types of assistance sought. The Say Ahhh Study aimed to explore the interprofessional care for halitosis and improve understanding by the general public. Phase 1 explored the perceptions of health care providers. This article reports the findings of Phase 2, which explored the general public's knowledge of halitosis, its management, and help-seeking behaviour.

Methods

Patients and clients at 2 medical clinics, 3 dental clinics, and 2 pharmacies in Melbourne and rural Victoria were approached and invited to participate in a short semistructured interview. Qualitative data was thematically analysed.

Results

A total of 122 participants (54 males, 66 females, 2 missing) were interviewed. Participants’ past experience with halitosis influences their understanding of the cause. Halitosis was attributed mostly to poor oral hygiene and diet and less commonly to systemic disease. Their perception of the condition's severity influenced whether they seek professional help. Their perceived roles of health professionals and ease of access influenced their choice of health professionals to seek help from.

Conclusion

The Victorian general public is aware of the causes of halitosis and the available treatment options. Choice of treatment and help-seeking behaviour are influenced by experience, perceived severity of the condition, and perceived role of health professionals and their accessibility.

Treatment of halitosis with photodynamic therapy in older adults with complete dentures: A randomized, controlled, clinical trial

BACKGROUND

Halitosis of oral origin is mainly caused by the release of H₂S (hydrogen sulfide) by bacteria lodged on the tongue. Antimicrobial photodynamic therapy (aPDT) has been evaluated for the treatment of halitosis, but there are no previous reports of the use of this treatment modality in older people with dentures. The aim of the present study was to compare the effect of aPDT and tongue scraping (standard treatment) in older people with complete dentures diagnosed with halitosis (H2S gas concentration>112 ppb).

METHODS

The participants were divided into two groups: G1- treatment with a tongue scraper (n = 20); G2- treatment with aPDT (n = 20). Halimeter testing was performed before and after treatments using gas chromatography and was repeated after seven days.

RESULTS

After treatment, the group treated with aPDT had a lower mean concentration of H2S gas (18.5 ppb) than the tongue scraping group (185.3 ppb). After one week, the mean concentration of H2S increased to 218.2 ppb in the tongue scraping group and 39 ppb in the PDT group.

CONCLUSIONS

Both treatments were able to reduce the concentration of H2S but only treatment with aPDT was able to decrease halitosis to socially unnoticeable levels. Moreover, this normal breath condition remained for seven days only in the aPDT group.

Antimicrobial capacity of photodynamic therapy on oral health-related quality of life and halitosis among elderly patients wearing removal dentures

PURPOSE

The aim of the present clinical trial was to evaluate the efficacy of antimicrobial photodynamic therapy (PDT) for the treatment of halitosis in elderly patients wearing dentures.

METHODS

Elderly patients (>60 years age) wearing complete dentures and diagnosed with halitosis (H₂S levels >112 ppb) were divided into two groups: patients undergoing treatment with tongue scraper and full mouth disinfection (Group I) and patients undergoing treatment with tongue scraper, full mouth disinfection and single application of PDT (Group II). Oral health related quality of life (OHRQoL) was assessed using a 14-point Likert scale used in oral health impact profile (OHIP). The assessment of halitosis was done with the help of a device called Oral Chroma™. Microbial sampling for detection of Porphyromonas gingivalis (P. gingivalis) was performed from the dorsum of the tongue using a sterile swab at baseline and after treatment on day 5, 15 and 30 and quantified using polymerase chain reaction.

RESULTS

Forty elderly patients with halitosis completed the trial. The mean age in Group I and Group II was estimated to be 66.42 years and 67.91 years, respectively. Group II participants also maintained good OHRQoL in the post-operative period that reported statistically significant difference when compared with the control group (p < 0.01). Group II showed significant improvement in H₂S concentration values at final analysis compared to Group-I (p = 0.001). P. gingivalis showed statistically significant reduction on day 5 only with PDT in Group II (p < 0.05).

CONCLUSION

Antimicrobial PDT helped in reducing H₂S gas concentration and improving quality of life in elderly patients wearing dentures. A significant reduction of P. gingivalis occurred only in the short-term follow-up.

Small, but smelly: the importance of Solobacterium moorei in halitosis and other human infections

Solobacterium moorei (S. moorei) has been described as Gram-positive, non spore forming, obligate anaerobic bacillus from human feces. The traditional culture and identification of these strains is very difficult (as the strains are often not cultivable or they grow only relatively slowly, in addition to producing only a very few positive biochemical reactions in commercially available identification kits); thus, reliable identification may only be carried out using methods, such as matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and DNA sequencing. Regarding its pathogenic role, the relevance of S. moorei in halitosis (oral malodor) has a good standing, as it has been suggested by multiple studies, while the isolation of these bacteria from invasive infections is very rare; there are only a few reports available in the literature, regarding infections outside the oral cavity. Based on these reports, affected patients are predominantly characterized compromised immunity and are frequently associated with a dental focus of infection. The aim of our present review is to summarize the currently available knowledge on the pathogenic role of S. moorei in halitosis and other infections and to emphasize the relevance of this neglected anaerobic pathogen.

The Effect of Phase I Therapy on the Clinical Parameters, VSC Levels, and RBS Levels in Chronic Periodontitis Patients With Diagnosed Diabetes

Introduction:

The relationship between chronic periodontitis and type 2 diabetes mellitus (DM) is bidirectional. Halitosis or oral malodor has an effect on psychological and social life of persons, and is seen in individuals with diabetes.

Aims and Objectives:

The aim of this study was to find out the effect of phase I therapy on the clinical parameters, volatile sulfur compound (VSC) levels, and random blood sugar (RBS) levels in chronic periodontitis patients with diagnosed DM.

Materials and Methods:

Our study included 80 patients with diabetes and chronic periodontitis. We collected subgingival plaque samples at 1 week and 1 month after scaling and root planing. The parameters measured were probing pocket depth and clinical attachment level for all the teeth at four sites per each tooth. RBS levels were recorded for all the patients. Malodor was measured with Tanita Breath Checker (Tanita India Private Limited, Mumbai, Maharashtra, India).

Results:

We found a statistically significant reduction in clinical parameter levels, VSC levels, and N-benzoyl-DL-arginine-2-naphthylamide (BANA) levels in both the groups from baseline to 4 weeks with highest levels in diabetic chronic generalized periodontitis (CGP) and lowest in nondiabetic CGP at baseline. The mean intergroup comparison of BANA levels was statistically significant at all intervals of time between the two the groups.

Conclusion:

There is a significant correlation observed between oral malodor levels, RBS, and clinical parameters in the diabetic group.

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.

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.

A Transparent, Wearable Fluorescent Mouthguard for High-Sensitive Visualization and Accurate Localization of Hidden Dental Lesion Sites

Accurate detection and early diagnosis of oral diseases such as dental caries and periodontitis, can be potentially achieved by detecting the secretion of volatile sulfur compounds (VSCs) in oral cavities. Current diagnostic approaches for VSCs can detect the existence and concentrations, yet are not capable of locating the dental lesion sites. Herein, the development of a unique approach for accurately locating dental lesion sites using a fluorescent mouthguard consisting of the zinc oxide-poly(dimethylsiloxane) (ZnO-PDMS) nanocomposite to detect the local release of VSCs is reported. The ZnO-PDMS mouthguard displays a highly sensitive and selective response to VSCs, and exhibits high fluorescent stability, good biocompatibility, and low biological toxicity in normal physiological environments. Then, the wearable ZnO-PDMS mouthguard is demonstrated to be able to identify the precise locations of lesion sites in human subjects. Combined with image analysis, the mouthguards successfully uncover the precise locations of dental caries, allowing convenient screening of hidden dental lesion sites that are oftentimes omitted by dentists. Due to low cost, long-term stability, and good patient compliance, the proposed wearable mouthguard is suitable for large-scale production and enables widely applicable, preliminary yet accurate screening of dental lesions prior to dental clinics and routine physical examinations.

Antimicrobial photodynamic therapy with Bixa orellana extract and blue LED in the reduction of halitosis-A randomized, controlled clinical trial

BACKGROUND

This study aimed to evaluate the reduction of halitosis when using antimicrobial photodynamic therapy (aPDT) with Bixa orellana extract and blue light-emitting diode (LED).

METHODS

Forty-four UNINOVE students or employees with a diagnosis of sulfide (H2S) ≥ 112 ppb in gas chromatography were selected. The patients were randomly divided in groups: Group 1 (n = 15): aPDT with annatto and LED; Group 2 (n = 14): tongue scraping; Group 3 (n = 15): tongue scraping and aPDT. For aPDT, a wasBixa orellana extract used in a concentration of 20 % w/v (Fórmula e Ação®, São Paulo, Brazil) on the tongue for 2 min, associated with a blue-violet LED (Valo Cordless Ultradent® Products, Inc., South Jordan, UT, USA) (395-480 nm). Six points were irradiated on the back of the tongue, at wavelength 395-480 nm for 20 s, energy of 9.6 J and radiant energy of 6.37 J/cm² per point. The results were compared before, immediately after treatment and 7 days after. The Friedman test was used for the intragroup analysis and the Kruskal Wallis test for the intergroup analysis.

RESULTS

In all groups, there was a difference between baseline and the value immediately after the treatment. In Groups 1 and 3, there was no difference between the baseline and the 7 days control.

CONCLUSION

There was an immediate reduction of halitosis, but the reduction was not maintained after 7days.

Effects of stabilized stannous fluoride dentifrice on dental calculus, dental plaque, gingivitis, halitosis and stain: A systematic review

Objectives

The aim of the present systematic review was to examine the scientific evidence for the efficacy of stabilized stannous fluoride (SnF₂) dentifrice in relation to dental calculus, dental plaque, gingivitis, halitosis and staining.

Data and sources

Medline OVID, Embase.com, and the Cochrane Library were searched from database inception until June 2017. Six researchers independently selected studies, extracted data, and assessed methodological quality. A meta-analysis of the 6-month gingivitis studies was done. Risk of bias was estimated using a checklist from the Swedish Agency for Health Technology Assessment (SBU, 2018).

Study selection

Two studies on dental calculus, 21 on dental plaque and gingivitis, 4 on halitosis, and 5 on stain met the inclusion criteria. Risk of bias was high for the studies on dental calculus, halitosis, and stain, and varied for the dental plaque and gingivitis studies. Significant reductions in dental calculus and in halitosis were reported for the SnF₂ dentifrice; no differences in stain reduction were noted. A meta-analysis on gingivitis found better results for the SnF₂ dentifrice compared to other dentifrices, though the results of the individual trials in the meta-analyses showed a substantial heterogeneity.

Conclusions

The present review found that stabilized SnF₂ toothpaste had a positive effect on the reduction of dental calculus build-up, dental plaque, gingivitis, stain and halitosis. A tendency towards a more pronounced effect than using toothpastes not containing SnF2 was found. However, a new generation of well conducted randomized trials are needed to further support these findings.

Clinical relevance

Adding a SnF₂ toothpaste to the daily oral care routine is an easy strategy that may have multiple oral health benefits.

Potential antibacterial and anti-halitosis activity of medicinal plants against oral bacteria

This study aimed to evaluate the in vitro activity of the crude extracts obtained from Caesalpinia ferrea Mart. (Jucá), Cinnamomum cassia B. (Cinnamon), Mallow sylvestris L. (Mallow), Punica granatum L. (Pomegranate), Rosmarinus officinalis L. (Rosemary), Aeolanthus suaveolens (Als.) Spreng. (Macassá), Sysygium aromaticum L. (Clove), and Tamarindus indica L. (Tamarind) against oral microorganisms (e.g., Fusobacterium nucleatum, Porphyromonas gingivalis, Prevotella intermedia, and Parvimonas micra) that produce volatile sulfur compounds (VSC). The pure extracts were placed in culture medium for the diffusion test in agar. The Minimum Inhibitory Concentration (MIC) was determined by the microdilution method, and microbial growth was assayed with resazurin. Total polyphenols in the extracts were measured by using the Prussian Blue Method. For the salivary sediment test, the sediments were exposed to the Jucá and Pomegranate extracts, which was followed by incubation and organoleptic measurements with a monitor (Halimeter®) at 1-, 2-, 4-, and 24 -h intervals. The diffusion test revealed mixed results for the extracts. When the zone of inhibition was present, it ranged from 1.6-10.3 mm. The Pomegranate extract was the only extract that inhibited all the evaluated microorganisms; the MIC values ranged from 50 to 400 μg/mL. The Pomegranate and Jucá extracts presented higher levels of polyphenols, 7.3 % and 3.9 %, respectively, and less VSC formation as compared to the negative control. In conclusion, the extracts display antimicrobial activity against the tested microorganisms. The investigated plants have the potential to reduce the main substances related to halitosis of oral origin.

Evaluation of halitosis in adult patients after treatment with photodynamic therapy associated with periodontal treatment: Protocol for a randomized, controlled, single-blinded trial with 3-month follow up

RATIONALE

Halitosis is an unpleasant odor that emanates from the mouth. Studies show halitosis returns in a week, after treatment with PDT. Probably, bacteria living in the periodontal sulcus could recolonize the dorsum of the tongue. Until nowadays, there are no study in adult population that associates halitosis and periodontal treatment with follow-up evaluation. The aim of this randomized, controlled, single-blinded clinical trial is to treat oral halitosis in healthy adults with photodynamic therapy (PDT), associated with periodontal treatment and follow them up for 3 months. PATIENT CONCERNS:: the concerns assessments will be done over the study using anamnesis interviews and specific questionnaire. DIAGNOSES:: halitosis will be evaluated by OralChroma.

INTERVENTIONS

The participants (n = 40) with halitosis will be randomized into 2 groups: G1-treatment with PDT (n = 20) or G2-cleaning of the tongue with a tongue scraper (n = 20).

OUTCOMES

Halitosis will be evaluated by measuring volatile sulfur compounds using gas chromatography. After the treatments, a second evaluation will be performed, along with a microbiological analysis (RT-PCR) for the identification of the bacteria T. denticola. The assessment of halitosis and the microbiological analysis will be repeated. After that, patients will receive periodontal treatment. The participants will return after 1 week and 3 months for an additional evaluation. Quality of life will be measured by Oral Health Impact Profile questionnaire (OHIP-14).

LESSONS

This protocol will determine the effectiveness of phototherapy regarding the reduction of halitosis in adults. clinicaltrials.gov NCT03996915.

ETHICS AND DISSEMINATION

This protocol received approval from the Human Research Ethics Committee of Universidade Nove de Julho (certificate number: 3.257.104). The data will be published in a peer-reviewed periodical.

Evaluation of the treatment of halitosis with photodynamic therapy in older patients with complete denture: Protocol for a randomized, controlled trial

BACKGROUND

Halitosis is the term used to define an unpleasant odor emanating from the mouth. However, no studies have evaluated the causes and treatment of halitosis in the population of older adults with denture.

METHODS

A randomized, controlled trial is proposed. The patients will be divided into 2 groups: G1: older adults who wear complete dentures and will be treated with tongue scraper (n = 20); G2 older adults who wear complete dentures and will be treated with PDT (n = 20). If the halitosis persists, the participants will be submitted to hygiene procedures for the mucosa and dentures. The evaluation of halitosis will be made before and after treatments, with OralChroma. If the halitosis is solved, the participants will return after 1 week for an additional evaluation. Oral Health Impact Profile (OHIP-14) will be administered by a calibrated examiner on the day the patient history is taken (baseline) and 1 week after treatment for halitosis.

DISCUSSION

This protocol will determine the effectiveness of photodynamic therapy regarding the reduction of halitosis in older adults with complete denture.

TRIAL REGISTRATION

This protocol was registered in ClinicalTrial.gov, under number NCT03960983. It was first posted and last updated in May 23, 2019. https://clinicaltrials.gov/ct2/show/NCT03960983.

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.