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Genuine halitosis, pseudo-halitosis, and halitophobia: classification, diagnosis, and treatment
Abstract
Although tongue brushing and appropriate mouthrinses are both important and basic treatment measures for halitosis, other dental treatments are sometimes required. The treatment of genuine halitosis caused by oral conditions is not complex. In addition to genuine halitosis patients, psychosomatic halitosis patients also visit dental practitioners. Although psychosomatic halitosis is out of the treatment realm of dental practitioners, patients with this condition will still seek help from a dental practitioner. They often only receive treatment for genuine halitosis without referral to a psychological specialist. If these psychosomatic halitosis patients are incorrectly managed, the psychological condition might become worse than before the visit. To avoid the mismanagement of halitosis patients, classifications of halitosis patients have been established. Genuine halitosis was subclassified as physiologic halitosis and pathologic halitosis. Pathologic halitosis was further categorized to oral pathologic halitosis and extraoral pathologic halitosis. Both pseudo-halitosis and halitophobia patients complain of the existence of halitosis, which is not offensive. Pseudo-halitosis cannot be treated by dental practitioners, and halitophobia patients must be referred to psychological specialists. Clinicians need to examine the psychological condition of halitosis patients at the initial patient visit. A questionnaire prepared for the clinic at the University of British Columbia was found to be advantageous for this purpose.
... Aunado a esto, la sensación de hambre, el ciclo menstrual y otros estadios fisiológicos o patológicos pudieran influir sobre las mediciones organolépticas, más aún el hecho de tomar esta medida en un corto tiempo, no permite que sea repetida de forma exacta en otras oportunidades 7 . Además de la anterior existen otras escalas que oscilan del cero (0) al diez (10) que pueden ser utilizadas para estimar la intensidad del olor exhalado de lugares como la lengua o la nariz y escalas del 0 al 4 las cuales se corresponden con variantes en la intensidad del olor 8 . ...
... de diámetro por 10 o 12,5 cm. de largo, con una pantalla que separa al individuo del evaluador, dándole cierta intimidad al estudio 10 Durante este procedimiento el paciente no observa al examinador y de esta manera tiene la sensación de estar siendo evaluado a través de un examen más objetivo y científico y no solo a través de un juicio subjetivo del olor que emana de la cavidad bucal. Para valorar el aire en la boca, el paciente mantiene la boca cerrada por un minuto aproximadamente tomando aire por la nariz y luego exhala el aliento directamente al exterior o a través del tubo y para evaluar el olor de la nariz el paciente deberá ejecutar el mismo procedimiento ahora expirando el aire a través de la nariz por tres o cuatro segundos y se compara el aliento de la boca con el exhalado por los pulmones 10 . ...
... de largo, con una pantalla que separa al individuo del evaluador, dándole cierta intimidad al estudio 10 Durante este procedimiento el paciente no observa al examinador y de esta manera tiene la sensación de estar siendo evaluado a través de un examen más objetivo y científico y no solo a través de un juicio subjetivo del olor que emana de la cavidad bucal. Para valorar el aire en la boca, el paciente mantiene la boca cerrada por un minuto aproximadamente tomando aire por la nariz y luego exhala el aliento directamente al exterior o a través del tubo y para evaluar el olor de la nariz el paciente deberá ejecutar el mismo procedimiento ahora expirando el aire a través de la nariz por tres o cuatro segundos y se compara el aliento de la boca con el exhalado por los pulmones 10 . ...
La halitosis, también conocida como mal olor de la boca, es una condición común que afecta millones de personas. Este término describe una gama de olores desagradables emitidos en el aliento, con una variedad de causas que usualmente resultan de la putrefacción bacteriana dentro de la cavidad bucal. Miyazaki y cols. 1 publicaron una clasificación de los diferentes tipos de halitosis en tres categorías: pseudohalitosis, halitofobia y halitosis genuina. Frecuentemente las personas que sufren de mal aliento lo desconocen, mientras que otros están convencidos que sufren de mal olor de la boca aunque no exista tal evidencia, es decir, muchas personas emiten mal aliento por años sin percatarse y otras sobreestiman su propio mal olor, teniendo actitudes obsesivas y evitando las interacciones sociales. Existen varios métodos para evaluar la halitosis y muchos investigadores usan métodos combinados para identificar sujetos con halitosis. Este artículo está basado en la revisión bibliográfica de las técnicas y estrategias utilizadas en el análisis clínico del mal olor de la boca, en razón que los pacientes con halitosis, frecuentemente no tienen una base objetiva y esperan un diagnóstico por parte del odontólogo.
... Si può soffrire di alitosi a tutte le età. Yaegaki 170 suddivide l'alitosi in: alitosi genuina, pseudo alitosi e alitofobia. L'alitosi genuina a sua volta si suddivide in alitosi fisiologica e patologica. ...
... L'alitosi genuina a sua volta si suddivide in alitosi fisiologica e patologica. Le cause dell' alitosi patologica sono per il 90% circa 171 legate a patologie del cavo orale è da ricondursi a cause extraorali: otorinolaringoiatriche, gastrointestinali (diverticoli esofagei e reflusso esofageo), infezioni del tratto respiratorio, alterazioni del metabolismo, malattie sistemiche come il diabete mellito, la cirrosi epatica e l'insufficienza renale 170,172 . ...
... Se le cause di alitosi sono extra orali il paziente va riferito ad altri specialisti. In caso di alitofobia si rende necessaria la consulenza psichiatrica 170 . ...
... Usually, halitosis can be defined as genuine halitosis (physiologic or pathologic), or as pseudo-halitosis, which cannot be verified objectively [6], i.e., individuals believe that they have malodor, but there is no evidence of it [3]. The three main methods for diagnosis of halitosis are self-reported halitosis, organoleptic assessment, and volatile sulfur compound (VSC) level measurement [6]. ...
... Usually, halitosis can be defined as genuine halitosis (physiologic or pathologic), or as pseudo-halitosis, which cannot be verified objectively [6], i.e., individuals believe that they have malodor, but there is no evidence of it [3]. The three main methods for diagnosis of halitosis are self-reported halitosis, organoleptic assessment, and volatile sulfur compound (VSC) level measurement [6]. Even though the organoleptic and VSC measurement are objective methods for assessing oral Electronic supplementary material The online version of this article (doi:10.1007/s00784-017-2164-5) contains supplementary material, which is available to authorized users. ...
... Even though the organoleptic and VSC measurement are objective methods for assessing oral Electronic supplementary material The online version of this article (doi:10.1007/s00784-017-2164-5) contains supplementary material, which is available to authorized users. malodor, they demand a trained examiner and specific equipment [6]. On the other hand, self-reported assessment reduces costs and time-consuming clinical examination [7]. ...
Objective:
This study aims to conduct a systematic review to determine the prevalence of halitosis in adolescents and adults.
Methods:
Electronic searches were performed using four different databases without restrictions: PubMed, Scopus, Web of Science, and SciELO. Population-based observational studies that provided data about the prevalence of halitosis in adolescents and adults were included. Additionally, meta-analyses, meta-regression, and sensitivity analyses were conducted to synthesize the evidence.
Results:
A total of 584 articles were initially found and considered for title and abstract evaluation. Thirteen articles met inclusion criteria. The combined prevalence of halitosis was found to be 31.8% (95% CI 24.6-39.0%). Methodological aspects such as the year of publication and the socioeconomic status of the country where the study was conducted seemed to influence the prevalence of halitosis.
Conclusions:
Our results demonstrated that the estimated prevalence of halitosis was 31.8%, with high heterogeneity between studies. The results suggest a worldwide trend towards a rise in halitosis prevalence.
Clinical relevance:
Given the high prevalence of halitosis and its complex etiology, dental professionals should be aware of their roles in halitosis prevention and treatment.
... Halitosis, which is defined as "bad breath or oral malodor problems", often leads to social and psychological impediments (Curd & Thomas, 2012;Madhushankari, Yamunadevi, Selvamani, Kumar, & Basandi, 2015;Yaegaki & Coil, 2000). Clinically, halitosis can be classified as genuine halitosis, pseudo-halitosis, or halitophobia. ...
... Clinically, halitosis can be classified as genuine halitosis, pseudo-halitosis, or halitophobia. Genuine halitosis has both oral and extra-oral etiologies; oral causes include periodontitis and tongue coating, while extra-oral causes include gastrointestinal problems and mental stress (Curd & Thomas, 2012;Madhushankari et al., 2015;Yaegaki & Coil, 2000). Mental stress causes fear and anxiety as well as imbalances in autonomic nervous activity such as overactivity of the sympathetic nervous system (Cannon, 1939;Ishida, 2014;Selye, 1976). ...
... Therefore, mental stress leads to a reduction in saliva secretion, and in turn, genuine halitosis. On the other hand, even though oral malodor is objectively absent, individuals with pseudo-halitosis complain of halitosis symptoms (Curd & Thomas, 2012;Madhushankari et al., 2015;Yaegaki & Coil, 2000), while those with halitophobia, the fear of halitosis, present with halitosis symptoms (Curd & Thomas, 2012;Madhushankari et al., 2015;Yaegaki & Coil, 2000). However, regardless of their differences, genuine halitosis caused by stress, pseudo-halitosis, and halitophobia may all be due to anxiety resulting from an excessive need of approval from others. ...
... 11 Una vez registrado el olor bucal, el examinador se aleja para volver a evaluar en esta oportunidad, el aire expirado a través de la nariz, durante 3 ó 4 segundos, el cual vendrá de los pulmones. 20 El tubo transparente utilizado dentro de la pantalla para la evaluación organoléptica, ha sido sustituido por un instrumento llamado OSMOSCOPIO, que consiste en un tubo largo con varios orificios, los mismos pueden abrirse ó cerrarse para variar la concentración del aire exhalado por el paciente. 12 Siendo que la halitosis de origen bucal puede confundir el olor del aire pulmonar, se recomienda tratar al paciente previamente utilizando peróxido de hidrógeno al 0,75% ó clorhexidina al 0,12%, para la limpieza de la lengua y volver a evaluar el aire pulmonar 2 ó 3 días después. ...
... Cuando el mal olor persiste a pesar del tratamiento, se puede pensar en una halitosis extra-bucal, así mismo si el olor pulmonar y bucal coinciden en la evaluación organoléptica ó si existe mal olor nasal. 20 La evaluación organoléptica incluye también el dorso posterior de la lengua, para ello se ejerce presión digital sobre la misma con una gasa y se desplaza anteriormente. Igualmente para evaluar el olor de los espacios inter.-proximales ...
... Con el se reconocen sulfuro de hidrógeno, mercaptano de metilo y dimetil sufuro. [9][10][11][12][13][14][15][16][17][18][19][20] El equipo consiste en un detector electrónico que permite separar cualitativamente los tipos de compuestos y a su vez realizar mediciones a bajas concentraciones, lo cual constituye una gran ventaja tanto para establecer diagnóstico, como para efectividad de tratamientos. Tiene como desventajas que no se detectan los CVA cuando se han utilizado sustancias que los enmascaran, debe completarse con un método organoléptico, es un equipo muy costoso y no es portátil. ...
RESUMEN: Las investigaciones han demostrado que las principales causas del mal aliento, también conocido como mal olor y halitosis, son las bacterias presentes en la boca que producen compuestos volátiles de sulfuro. Las razones que incrementan la actividad de los compuestos volátiles de sulfuro incluyen el estrés, las enfermedades de las encías y los restos de alimentos. Otros factores asociados al mal aliento son la diabetes, el cigarrillo, pobre higiene bucal, condiciones nasales, alergias y ciertas comidas. En el pasado, el mal aliento era considerado como una afección incurable. Sin embargo, en los últimos años se ha evidenciado que puede ser tratado, siempre y cuando se realice un diagnostico adecuado. PALABRAS CLAVES: halitosis, mal olor, diagnostico, compuestos volátiles ABSTRAT Research has show that the major source of the bad breath, also know as malodor and halitosis, is bacteria found in the mouth and the resulting volatile sulfur compoundds. Causes of increased volatile sulfur compound activity include stress, gum disease, food debris and dry mouth. Other factors associated to bad breath are diabetes, smoking, mouth breathing, nasal conditions, allergies and certain foods. In the past, bad breath was often considered to be an incurable affliction. However, in recent years is has become increasingly evident that bad breath is usually treatable once a proper diagnosis is made.
... Halitosis is caused by oral, systemic, or psychological conditions and may be classified accordingly as genuine halitosis, pseudo-halitosis or halitophobia [1][2][3]. Genuine halitosis is subclassified as either physiological or pathological, and the latter can be either intraoral or extraoral in origin. ...
... oral malodor strength is an important step in the process of diagnosing halitosis. In the clinic, organoleptic measurement is the most popular diagnostic procedure [1,2,4,5]. Given that there are nearly 700 different compounds found in mouth air [6], it is difficult to determine objectively their concentrations in a clinical setting by any method. ...
... For oral malodor measurement, there are objective and subjective procedures. Organoleptic measurement is a subjective method [1,2,4,5] making quantification of odor intensity notoriously difficult. In clinics a major problem of the organoleptic method is that it is impossible to ensure consistency in large numbers of judgments by several examiners. ...
The objective of this study is to standardize protocols for clinical research into oral malodor caused by volatile sulfur compounds (VSCs). To detect VSCs, a gas chromatograph (GC) using a flame photometric detector equipped with a bandpass filter (at 393 nm) is the gold standard (sensitivity: 5 × 10⁻¹¹ gS s⁻¹). The baselines of VSC concentrations in mouth air varied considerably over a week. When the subjects refrained from eating, drinking and oral hygiene including mouth rinsing, the VSC concentrations remained constant until eating. Over a 6 h period after a meal, VSC concentrations decreased dramatically (p < 0.01). These results point to optimal times and conditions for sampling subjects. Several portable devices were compared with the measurements by the GCs. Portable GCs demonstrated capabilities similar to those of the GCs. We also applied the recommended protocols described below to clinical research testing the efficacy of ZnCl2 products, and confirmed that using the recommended protocols in a randomized crossover design would provide very clear results. Proposed protocols include: (a) a short-term study rather than a long-term study is strongly recommended, since the VSC concentrations are constant in the short term; (b) a crossover study would be the best design to avoid the effects of individual specificities on each clinical intervention; (c) measurements of VSCs should preferably be carried out using either a GC or portable GCs.
... Most cases of halitosis are caused by oral factors [10][11][12] , so dentistry is a major resource for its treatment 2,[13][14][15] . Dental-office workers, who treat halitosis, need to pay particular attention to their own oral malodour. ...
... Tooth brushing was carried out using Pearl EX C3 TM toothbrush (Sokenkikaku Co., Chiba, Japan) and toothpaste (Denter-Amino Lion TM , Lion Co. Ltd., Tokyo, Japan) for three minutes with the subjects own techniques. The subjects were instructed to clean their tongues using a tongue brush (Zetu-Fresh TM , GC Co., Tokyo, Japan) according to the method of Yaegaki et al. 2,20 . For the chewing-gum study, the subjects chewed one piece of gum containing sugar (Wrigley Spearmint TM ; Wm. ...
... As the tongue is the main site of VSC production, tongue-cleaning is important 2,[11][12][13][14]21 . Recently, poor effects on oral malodour prevention of tongue-cleaning has been reported, however, incomplete rinsing after cleaning the tongue was carried out in the study 27 . ...
Dentistry is a major resource for the treatment of halitosis, therefore dental professionals must also pay attention to their own oral malodour for professional courtesy. However, oral malodour among dental professionals has not yet been investigated. In this study, the diurnal changes in oral malodour in dental-office workers were determined, and preventative measures were assessed.
Diurnal changes in the levels of volatile sulphur compounds (VSCs), which are the main cause of oral malodour, in mouth air were determined with a gas chromatograph specially designed for such analysis and the effects of several preventive measures were evaluated.
High concentrations of VSCs in mouth air persisted during the morning and decreased after lunch. Tongue-cleaning followed by tooth brushing decreased VSCs dramatically. Further measures such as eating breakfast, drinking tea or using zinc mouthwash significantly decreased VSCs, but the effects were limited in dental hygienists who suffered from persistent oral malodour, especially in the afternoon.
Eating breakfast, cleaning the tongue followed by brushing the teeth and zinc chloride mouthwash were very effective in preventing oral malodour in dental-office workers; however, the effectiveness of these preventive measures was limited in dental hygienists.
... Esta condição possui uma ampla terminologia (mau hálito, halitose ou halitose genuína), que pode indicar a presença de uma condição fisiológica transitória (halitose matinal ou causada por fatores dietéticos) ou patológica (possui prevalência a longo prazo), e esta última possui uma forte relação com sua origem (halitose intra ou extraoral) (DUDZIK; CHOMYSZYN-GAJEWSKA, 2014;MADHUSHANKARI et al., 2015;ORTIZ;FILIPPI, 2021;SEEMANN et al., 2014;TONZETICH, 1977;COIL, 2000a). ...
... A pseudo-halitose ocorre quando o indivíduo não se dá por convencido quanto à ausência de mau hálito, mas com as orientações profissionais e instruções de higiene oral esta situação é facilmente resolvida. Ao contrário desta, na halitofobia o paciente persiste em acreditar que possui halitose, mesmo não tendo evidências relacionadas à sua presença; por isso, esta condição pode estar relacionada a transtornos psiquiátricos e pode culminar em hábitos obsessivos (DUDZIK; CHOMYSZYN-GAJEWSKA, 2014;MADHUSHANKARI et al., 2015;ROSENBERG et al., 1991;ROSENBERG et al., 1995;SEEMANN et al., 2014;COIL, 2000a). ...
A halitose apresenta um impacto social negativo e provoca desconforto aos indivíduos, de tal maneira a afetar a qualidade de vida e a autoconfiança, sendo, por isso, um dos principais motivos de procura a atendimento odontológico. Na maior parte dos casos, sua etiologia tem origem intrabucal, principalmente em decorrência do metabolismo microbiano no dorso lingual e das doenças periodontais. Este trabalho teve como objetivo a realização de uma revisão de literatura sobre halitose, abrangendo informações relacionadas à sua etiopatogenia, ao seu diagnóstico e ao seu tratamento. A coleta de dados foi feita nas bases de dados virtuais PubMed, Scielo e Google Acadêmico, com a busca das palavras-chave: “halitose”, “etiologia”, “saburra lingual”, “língua” e “doenças periodontais”, utilizando publicações em língua portuguesa, inglesa e espanhola, sem limite definido de ano de publicação. Foram utilizados 84 artigos, publicados entre os anos 1939 e 2021, levantando informações relevantes para a construção do texto. A halitose é resultado da degradação de substratos proteicos pelos microrganismos da cavidade bucal. Como produto dessa degradação são formados os compostos sulfurados voláteis, grupo de componentes químicos responsável pela halitose. As doenças periodontais possuem forte relação com a ocorrência da halitose, e é sabido que a intensidade do odor é diretamente proporcional à severidade da doença e que os portadores de doenças periodontais possuem maior quantidade de saburra lingual se comparados aos indivíduos periodontalmente saudáveis. O terço posterior do dorso da língua pode ser considerado a principal fonte da halitose, devido à sua anatomia, que apresenta superfície irregular, fissuras e papilas capazes de reter substratos. Anteriormente à busca de um profissional para diagnosticar e tratar a halitose, é possível que o paciente tenha procurado um profissional baseado na percepção de pessoas do seu convívio ou, até mesmo pela autoavaliação do hálito. O tratamento da halitose varia de acordo com a necessidade e com o diagnóstico relacionado à origem do mau hálito; no entanto, para todos os pacientes devem ser feitos esclarecimentos específicos e orientação de higiene bucal individualizada para cada caso.
... Halitosis can be measured through the objective (i.e. organoleptic test, volatile sulfur compounds -VSC) and subjective (self-report) parameters 6 . Objective tests require trained and calibrated examiner even as specific equipment making these measurements more expensive and difficult to conduct in population-based studies 6 . ...
... organoleptic test, volatile sulfur compounds -VSC) and subjective (self-report) parameters 6 . Objective tests require trained and calibrated examiner even as specific equipment making these measurements more expensive and difficult to conduct in population-based studies 6 . In this way, self-reported assessment can reduce the cost as well as the time to the examination being widely used in epidemiological studies 4,7 . ...
Mood disorders such as stress and depression can promote
alterations of several hormones Aim: The present study aimed
to evaluate if symptoms of depression and stress are associated
with halitosis. The hypothesis is that halitosis is associated
with stress and depression symptoms. Methods: All university
students’ entrants in the Federal University of Pelotas (UFPel)
were invited to participate. Self-reported halitosis was measured
using a visual analog scale. Students were also asked about the
presence of halitosis perceived by close individuals. The stress
level was measured using a modifed version of the Perceived
Stress Scale and symptoms of depression were screened by
Patient Health Questionnaire-2. Poisson Regression Models
were performed. Results: Of a total of 2,058 students who
participated in the study, only 16% of them have reported not
having any degree of halitosis and 17.6% were informed of
closed individuals having halitosis. After adjustments, stress and
depression symptoms remained associated with halitosis selfreported. Individuals from the higher stressed quartile presented
higher scores of halitosis (RR 1.37 CI95% [1.24–1.53]). Students
who presented depressive symptoms showed higher scores of
self-perceived halitosis (RR 1.20 CI95% [1.10–1.32]). When the
association of stress and halitosis reported by close individuals
was tested, symptoms of depression lost the association in
the adjusted model, while individuals from the highest quartile
from stress remained associated (PR 1.36 CI95% [1.02–1.81]).
Conclusion: Halitosis was associated with stress even after
control for oral health and socioeconomic variables.
... 23 Pseudo-halitosis is characterized by the absence of clinical determination of halitosis, but there is a clear complaint about it by the individual. 2,28 This should be contextualized in the present study. One limitation of self-reported halitosis is the possible overestimation of the prevalence rates by pseudo-halitosis cases in the sample studied. ...
... One limitation of self-reported halitosis is the possible overestimation of the prevalence rates by pseudo-halitosis cases in the sample studied. 28 It is uncertain whether this effect may be excluded in this study; however, taking into consideration the relatively low occurrence of halitosis in this study, it is probable that this effect was low. Another important aspect is that women seem to show a higher occurrence of pseudo-halitosis; 8 therefore, the occurrence observed may be overestimated in this gender. ...
Halitosis is still poorly studied in young adults. The aim of this study was to evaluate the occurrence of self-reported halitosis and associate it with demographic and behavioral factors in young adult dental students. This cross-sectional study was designed as a census of students enrolled in three initial and three final semesters of a dental course in a Brazilian public university. Of 284 eligible students, 257 (90.5%) completed a self-administered questionnaire. Self-reported halitosis was the primary study outcome, and was assessed with the question “do you feel you have bad breath?”. Data on age, gender, frequency of tooth brushing and interproximal cleaning, tongue cleaning, mouth rinse use and dry mouth were collected using the questionnaire, and were considered independent variables. Of the students surveyed, 26.5% reported as never, 51.7% as rarely, 21.4% as sometimes, and 0.4% as always feeling they had halitosis. Morning halitosis was reported by 90.6% of those who reported halitosis. In the final multiple model, last semester students had a 55% lower chance of reporting halitosis, compared with students from the first semesters [odds ratio (OR) 0.46; 95%CI 0.24–0.89]. Women had a 2.57fold higher chance of reporting halitosis (OR = 2.57; 95%CI 1.12–5.93). Dry mouth increased the chance of self-reported halitosis 3.95-fold, compared with absence of dry mouth (OR = 3.95; 95%CI 2.03–7.68). It can be concluded that self-reports of halitosis were low among dental students, but may represent an important complaint. Gender, dry mouth and level of college education of the dentist were factors significantly associated with self-reported halitosis.
... Pseudo-Halitosis is described as a condition in which patient believes significant malodour is present but on examination there is no evident pungent odour. 2 Halitophobia is a psychic problem characterized by patients assumption that he or she is having halitosis in spite of reassurance, treatment and necessary counseling. 2,6,9 Halitophobia patients should be referred to psychiatrists. 6 ...
... 2,6,9 Halitophobia patients should be referred to psychiatrists. 6 ...
... [10] If halitosis did not exist, but the patient believed that he or she had oral malodor, the diagnosis was pseudo-halitosis. [25] The organoleptic score measurement was carried out before all other measurements, i.e. TC and Halimeter ® (Interscan Corp., Chatsworth, CA, USA) readings, to avoid any bias. ...
... In order to make a diagnosis of the breath odor, we used the classification of halitosis proposed by Yaegaki and Coil. [25] Data were entered into a statistical computer program, SPSS, version 18 (SPSS Inc., Chicago, IL, USA) for data processing and analysis. Data analysis included descriptive statistics, comparisons of means, and test of association. ...
This study was conducted to estimate the prevalence and awareness of halitosis among the subjects of a population, and also to compare the results of Halimeter(®) readings to self-estimation of halitosis and to assess the relationship between halitosis and oral health.
A sample of 205 employees from the Jordan University for Science and Technology (JUST) were selected as study subjects. A standardized questionnaire focusing on dental hygiene, self-reported halitosis, and smoking was filled by all participants. In the clinical examination, the objective values for assessment of oral health and the presence of halitosis were gathered through an organoleptic test (OLT) and the measurement of volatile sulfur compound (VSC) level by Halimeter for each participant.
The prevalence of halitosis was 78%, with low rate of awareness (20.5%). The amount of TC played the most important role in increasing the concentration of VSCs in mouth air (P < 0.001).
A statistically significant correlation was found between OLT and Halimeter values (P < 0.001). Subjective patients' opinion did not correlate with the objective evaluation of halitosis. TC scores and smoking were the factors significantly associated to halitosis. The Halimeter showed promising characteristics regarding diagnosis of halitosis for clinical setting and field surveys.
... The long duration of bad breath complaint observed in most of the patients before presentation for treatment suggests that these patients may have been unaware of where to seek help, or perhaps the patients may have been poorly managed and they resorted to 'doctor shopping', thereby prolonging the period of suffering from this condition. [2,9] This, together with other predisposing psychosomatic factors, may have contributed to the severe psychological problem found in these patients, as shown by the high mean psychological score 6 (±1.9). ...
... Yaegaki and Coil [2,9] and Murata et al., [10] classified halitosis into genuine halitosis (subdivided into physiological and pathological types), pseudohalitosis, and halitophobia (psychosomatic halitosis), whereas in a recent Nigerian study, Uguru et al., [11] classified halitosis into genuine halitosis and delusional halitosis (subdivided into pseudohalitosis and halitophobia). Other reports [12][13][14] from Nigeria agree with Yaegaki's classification of halitosis, and delusional halitosis was also substituted for psychosomatic halitosis or halitophobia. ...
Objective: Patients with psychological halitosis frequently receive treatment for genuine
halitosis, including use of metronidazole and/or chlorhexidine mouthwash, without
microbiological evidence of bacteria infection. This study aims to evaluate the role of oral
microbiological assessment in the management of patients with psychological halitosis.
Materials and Methods: A 3‑year prospective study in which patients diagnosed of
psychological halitosis were routinely subjected to microbiological assessment of their
tongue swabs. Psychological halitosis was subclassified as pseudohalitosis or delusional
halitosis based on the patients’ psychological score, oral microbiological findings, and initial
response to counseling.
Results: Thirty‑seven (12.9%) patients were diagnosed with psychological halitosis
among the 287 patients seen during the study period. There were 28 (75.7%) males
and 9 (24.3%) females, giving a ratio of 3.1:1. The peak age group was the 3rd decade
of life (n = 17, 45.9%) and the mean age was 36 ± 1.4 years. Most cultures yielded no
growth (n = 15, 40.5%) and normal oral flora (n = 7, 18.9%) [p = 0.000]. The commonest
associated bacteria were Klebsiella species (n = 4, 10.8%), mostly sensitive to gentamicin
(n = 3, 8.1%) and Staphylococcus aureus (n = 4, 10.8%), mostly sensitive to augmentin,
ofloxacin, and cefuroxime sodium (n = 3, 8.1%). The pseudohalitosis patients (n = 20, 54.1%)
were mostly associated with a psychological score of 4 (n = 14, 37.8%) (P = 0.000). The
delusional halitosis patients (n = 17, 45.9%) were mostly associated with a psychological
score of 8 (n = 7, 18.9%).
Conclusion: A low prevalence of psychological halitosis was observed. Oral microbiological
assessment was useful for diagnosis and counseling of the patients.
... Sin embargo, la putrefacción de la saliva, en presencia de enfermedad periodontal, contribuye a incrementar mucho más el metilmercaptano a nivel de los sacos que en la cubierta lingual 37 . Se ha demostrado que muy altos niveles de componentes volátiles de sulfuros, se producen en la superficie dorsal de la lengua en sujetos con enfermedad periodontal y que esto difiere de la cantidad y composición de los tioles en individuos sanos en donde el producto predominante es el sulfuro de hidrógeno 62 . Además de los componentes volátiles de sulfuros, diferentes lugares de la cavidad bucal y una amplia variedad de gases, elaboran malos olores con diferentes características y contribuyen con el mal olor de la boca. ...
La Halitosis es definida como un olor desagradable u ofensivo que emite la cavidad bucal, usualmente tiene una causa bucal, particularmente derivada del metabolismo bacteriano sobre los sustratos y aminoácidos que contienen azufre. Durante mucho tiempo, fue concebida como una consecuencia de la enfermedad periodontal, hoy en día se sabe que, ocasionalmente el consumo de ciertos medicamentos, disfunciones metabólicas, respiratorias, hormonales y otras alteraciones sistémicas pudieran ser el factor etiológico del mal olor de la boca, por lo que el propósito de esta investigación es analizar las condiciones bucales y sistémicas asociadas a la halitosis genuina en los pacientes que acuden a los postgrado de Periodoncia, Prótesis y Endodoncia de la Facultad de Odontología de la Universidad Central de Venezuela (FdeOUCV) partir del sistema de registro organoléptico. PACIENTES Y METÓDOLOGÍA: 38 pacientes diagnosticados con halitosis, durante el período Marzo-Octubre 2010, fueron evaluados a partir de un consentimiento informado admitiendo su participación en el estudio, por medio de un cuestionario con una escala de medición de actitudes y respuestas, una historia de halitosis, un examen clínico para establecer la presencia o no de enfermedad periodontal, la valoración organoléptica en diversos lugares de la cavidad bucal (Rosenberg y Mc Culloch, 1992) y el índice de cubierta lingual (Winkel, 2003). El criterio de exclusión estaba determinado por la ingesta de antibióticos durante tres semanas previas al examen, no obstante ningún paciente fue excluido por esta situación. Se realizó el análisis cualitativo y cuantitativo respectivo. RESULTADOS: Se encontró una diferencia estadísticamente significativa p<0,1 en el grupo con salud periodontal con respecto al grupo con enfermedad periodontal, en los aspectos relacionados con la sensación de hambre, sequedad y mal gusto en la boca y en relación con actitudes específicas asociadas a eructos, alejarse de otras personas, respiración bucal e ingesta de líquidos y dulces, así como también en el índice de cubierta lingual grado ocho (8) CONCLUSIONES: La halitosis es una entidad multifactorial que puede interferir con el estilo de vida de quien la padece, por lo que el conocimiento de las condiciones asociadas a su etiología, podría ayudar en el diagnóstico y en el tratamiento adecuado.
AGRADECIMIENTO: Este estudio fue financiado por el Consejo de Desarrollo Científico y Humanístico de la Universidad Central de Venezuela.
... Este trastorno se caracteriza por la presencia de olores desagradables emanados de la cavidad oral, siendo un motivo frecuente de consulta en la práctica odontológica moderna (2). La literatura científica distingue entre halitosis genuina, pseudohalitosis y halitofobia, siendo fundamental esta clasificación para establecer protocolos de tratamiento adecuados (3,4). ...
Objetivo: describir la prevalencia de halitosis en estudiantes universitarios. Método: Revisión sistemática en 15 articulos. Resultados y Conclusión: La halitosis es una condición multifactorial que afecta tanto la salud oral como el bienestar psicosocial de quienes la padecen, especialmente en poblaciones como los estudiantes universitarios, donde factores como el estrés, los hábitos alimenticios y la higiene oral desempeñan un papel crucial. Comprender su prevalencia y las causas subyacentes, así como establecer protocolos de tratamiento adecuados basados en la clasificación de la halitosis, es necesario para mejorar la calidad de vida de los afectados.
... The main exposure variable of this study was oral malodor. Genuine oral malodor [33][34][35] was assessed through the organoleptic method by a dentist and classified as no, mild, or severe malodor. The following criteria were used to determine the condition during the oral examination with the mask removed. ...
Background
As infrequent social interaction is a potential risk of dementia, oral malodor may increase the risk of dementia, including Alzheimer’s disease.
Objective
This study investigated the association between malodor and dementia.
Methods
We used the Japan Public Health Center-based Prospective Study data obtained at Yokote City. A total of 1,493 individuals aged 56 to 75 years underwent a dental examination and self-reported survey from May 2005 to January 2006. Follow-up for the onset of dementia was conducted using long-term care insurance data from 2006 to 2016. Hazard ratios of oral malodor on dementia were estimated by the Cox proportional hazards model. The inverse probability-weighted Cox model was used as a sensitivity analysis.
Results
The study comprised 1493 participants (53.6% women) with a mean age of 65.6 (SD = 5.8) years old; at the end of the follow-up, 6.4% (n = 96) developed dementia, and the percentage was 20.7 in severe malodor group. Throughout 15274.133 person-years of follow-up, the average incidence rate for the onset of dementia per 1000 person-years was 6.29. The highest incidence rate was seen in participants with severe malodor (22.4 per 1000 person-years). After adjusting for confounders, compared to those with no malodor, there was a 3.8 (95% confidence interval: 1.5 to 9.4) times greater hazard of developing dementia in participants with severe malodor. The inverse probability weighted Cox model confirmed the same trend with an adjusted marginal hazard ratio of 4.4 (1.2 to 16.4).
CONCLUSIONS
A significant association between oral malodor and the onset of dementia exists.
... Dental practitioners estimate that only 25% of the population has halitosis, and the remaining 75% only has a medical condition or halitophobia (5). Several treatment modalities have been suggested for the treatment of halitosis; however, there is no consensus yet on a standard protocol for this problem. ...
Abstract
Objective: Halitosis or bad breath is one problem that can have a profound effect on the quality of life associated with health. The purpose of this systematic review and meta-analysis was to investigate the treatments used to treat halitosis.
Materials and Methods: This study involved a systematic review and meta-analysis. It was used in conjunction with treatment, management, therapy, and therapeutics for the first-call combination of bad breath, bad breath, halitosis, pseudohalitosis,
and halitophobia. Finally, these articles were removed according to the text and 37 articles remained.
Results: The effect of chemical methods on the treatment of bad breath was significant; halitosis was reduced by 1.19 [95% confidence interval (CI), 1.57 to 0.78]. Additionally, there was heterogeneity between studies (Q=11.32). Mechanically,
despite the presence of heterogeneity between studies (Q=5.41), the p-value was not statistically significant (p=0.15), with the effect of the combined methods, bad breath was reduced to 1.18 (with a 95% CI, 1.68 to -0.51). Additionally, there is heterogeneity (Q=12.14).
Conclusion: The results of this study show that chemical and compound methods are effective in reducing bad breath
... 5 Moreover, Systemic, oral, and psychological disorders might attribute to the development of halitosis, and accordingly, the condition can be classified into genuine halitosis, pseudohalitosis, or halitophobia. [6][7][8] Moreover, genuine halitosis has been furtherly classified into pathological and psychological, while pathological might include oral and extraoral conditions. Furthermore, halitosis might be associated with reduced quality of life for the affected patients as a result of the personal and social embarrassments it might cause. ...
Halitosis might be associated with reduced quality of life for the affected patients as a result of the personal and social embarrassments it might cause. The adequate identification and diagnosis of the underlying condition causing halitosis are important to achieve adequate treatment and prevention of many systemic diseases or even neoplasms. In this literature review study, we have discussed the potential role of halitosis in the diagnosis and identification of systemic diseases. We have discussed many diseases as diseases related to the gastrointestinal tract and liver, others related to metabolic and endocrinal disorders. Furthermore, psychological factors might attribute to pseudo-halitosis, while true halitosis comes secondary to oral and extraoral factors and physiological conditions. Poor oral hygiene might be the only reason for oral malodor, while many oral conditions might also contribute to the development of halitosis. Additionally, some conditions might have a characteristic bad smell, which might significantly enhance the diagnostic value and help clinicians. However, further examination and evaluation should also be conducted to prevent a potential overlap between the different conditions. On the other hand, some extra-oral disorders do not have a characteristic oral smell, which indicates that halitosis alone cannot adequately establish a proper diagnosis. Therefore, raising awareness about seeking medical attention when suffering from halitosis is recommended to achieve better outcomes and help clinicians draw efficacious prevention programs.
... Moreover, one limitation of self-reported halitosis is the possible overestimation of the prevalence rates by pseudo-halitosis cases. Pseudo-halitosis is characterized by the absence of clinical determination of halitosis, but there is a clear complaint about it by the individual (Milanesi et al., 2016;Yaegaki & Coil, 2000). Nevertheless, it should be emphasized that the meta-regression analysis from Silva et al. (2018) demonstrated that the method used for halitosis assessment seemed not to influence the heterogeneity between prevalence studies. ...
Aims:
To evaluate the prevalence of self-reported halitosis and its predictors, and to determine the accuracy estimates of self-reported measures with clinical evaluation of halitosis.
Materials and methods:
This cross-sectional study comprised 5,420 individuals (teaching staff, administrative personnel and ongoing students from Federal University of Minas Gerais), who answered a structured questionnaire containing sociodemographic, medical and dental data, and self-reported halitosis measures. A subsample (n=159) underwent halitosis assessment through the organoleptic method. Predictors for self-reported halitosis were determined through univariate and multivariate analyses. Accuracy estimates of self-reported measures were evaluated in this subsample.
Results:
Prevalence of self-reported halitosis varied from approximately 4 to 35%, depending on the self-reported measure. Self-reported halitosis was mainly associated with socioeconomic variables (age, gender, educational level), parameters of oral health (gingival bleeding, gingival infections, tongue coating, general oral health evaluation) and impacts on daily activities (family/social environment and intimate relations). Specificity values for self-reported halitosis measures were determined to be high for clinical (organoleptic score≥2) and strong (organoleptic score≥4) halitosis. Combinations of self-reported measures retrieved useful accuracy estimates for strong halitosis.
Conclusion:
Prevalence rates of self-reported halitosis may be considered moderate. Accuracy diagnostic estimates were determined to be useful, with good prediction for non-diseased individuals.
... The results suggest that people are, for the most part, unable to classify their own oral odor objectively. [31][32][33] Patients who complain of halitosis In absolute values, the control group exhibited an increase in the VAS test, as shown by the negative difference between T1 and T2. This finding shows that the patients in the control group did not experience self-perceived improvements in halitosis. ...
The tongue is one of the primary sources of halitosis. The manual or mechanical removal of biofilm is known to decrease oral malodor.
Objective
To evaluate a new tongue hygiene technique hereby referred to as “the X technique” and its effects on both halitosis and the number of microorganisms based on microbiological parameters and diagnostic features of the breath.
Material and Methods
The study included thirty patients divided into a control group (patients without systematized guidelines of lingual hygiene, but who performed the mechanical cleaning of tongue dorsum, each in its own way), the 3R group (instructed to perform the movements of the X technique for 3 repetitions at each brushing), and the 6R group (instructed to perform 6 repetitions of the technique at each brushing). After two weeks, a new data collection was performed.
Results
Patients in the 6R group presented the lowest score on the organoleptic assessment scale at the second consultation, followed by the 3R group and the controls. Regarding the self-perception of breath by the method of Visual Analog Scale (VAS), the control group did not perceive improvements in oral malodor; the results of the 3R group and the 6R group were similar.
Conclusion
These results indicate that the X technique improves both measurements and perceptions of halitosis. Microbiological analyses revealed greatest reduction in the 6R group. The findings show that the X technique reduces both organoleptic scores and the number of bacterial colonies, and improves users’ perceptions of their breath.
... The halitosis diagnosis usually takes some time to be determined in patients seeking treatment due to several factors that may be associated and are causing repulsion of people. Products resulting from tissue necrosis or systemic factors were excluded from this study so that this does not interfere with the behavior of the studied gases, since such problems require other approaches [62,63]. Even healthy patients and apparently without oral problems may be suffering from halitosis by protein degradation from the tongue coating or present in the crevicular fluid. ...
Aim: To assess the effectiveness of chlorhexidine (CHX) or essential oils (EO) based mouthrinses, with or without alcohol, for reduction of H2S and CH3SH levels. Materials and methods: This single centre, randomized, crossover control trial compared: Periogard® with alcohol (positive control) (CHXw/a) and without alcohol (CHXn/a); ListerineTotal® (EOw/a) and ListerineZeroTM (EOn/a) arranged into four sequences of use. 21 volunteers with intra-oral halitosis used each product at once, followed by a one-week washout period. The breath was measured by portable gas chromatograph OralChroma™ before rinsing and after 1, 2 and 3 hours. Results: Compared to the baseline, at the first hour, only EOw/a was able to significantly reduce the breath (H2S p<0.0001 and CH3SH p=0.001) for both gases and its effect lasted for up to three hours (H2S p<0.0001 and CH3SH p=0.001). CHXw/a(control) reduced H2S at the first hour (p=0.001) and lasted for three hours (H2S p<0.0001) without effect on CH3SH. CHXn/a just reduced H2S levels but less effectively at the whole period (p=0.001 for the 3 times). EOn/a had no effect on breath, which increased with time for both gases. Conclusion: The EOw/a presented the best performance against intra-oral halitosis followed by the control CHXw/a and CHXn/a.
Keywords: Halitosis, mouthrinses, gas chromatography, controlled clinical trial.
Acknowledgment: #Grant CNPq (143061/2011-9)
... Intraoral halitosis is more common than extraoral type; however, extraoral treatment is more complicated, and patients should be referred to medical specialists (physicians). [16,17] Probable contribution of several bacterial species (mainly Gram-negative anaerobes) to intraoral halitosis instead of a single specific species has been reported. [18] Volatile sulfur compounds (VSCs), diamines, and short-chain fatty acids (agents mainly causing oral malodor) are products of methionine, cystine, and cysteine metabolism as precursors of bacterial metabolism. ...
Tea is the second most consumed beverage. Polyphenolic catechins of green tea have a number of beneficial effects in oral cavity. This study aims to evaluate the clinical effects of green tea on halitosis through a systematic review of available literature. All available randomized, clinical trials – with a relevant subject that met the inclusion criteria – were included by searching PubMed, Cochrane, ProQuest, and Google Scholar, and Scopus databases. To score the selected articles, 27 items of CONSORT 2010 checklist were considered. Each article was reviewed by all the authors. Searching the PubMed database yielded 42 articles, 2 of which met the inclusion criteria. None of the 12 articles were obtained through Cochrane library, and 85 articles retrieved from ProQuest database met the inclusion criteria. Three hundred and five articles were obtained from Google Scholar, three of which fulfilled the inclusion criteria. Two articles were omitted because they were duplicated, and the rest were excluded. Searching the Scopus database yielded 270 articles, 2 of which met the inclusion criteria, but they were also duplicated. Finally, two studies were selected according to the inclusion criteria of the study. In both of the included articles, the early effect of green tea use was statistically significant in comparison with baseline. One of the studies showed the long-term effect of green tea mouthwash. Green tea can reduce halitosis through rinsing and antimicrobial effect.
... Approximately 60% of the volatile sulfur compounds (VSCs) that are responsible for halitosis are caused by coating on the tongue. 27 Many gram-negative bacteria, which produce VSCs are responsible for respiratory system inflammation. In our study, we focused on the quantitative variation in tongue coating, but further studies should be performed on the qualitative changes in the tongue coating. ...
Purpose: Our research aimed at shedding light on the effective frequency of professional oral care for those who require nursing care from oral health specialists.
Methods: Thirty-eight residents (average age, 80.0±9.4 years) of Niigata Prefecture who required nursing care agreed to participate in our study. They were divided into 3 groups; a control group (13 persons), provided with no professional oral health care: Group A (15 persons), provided with professional oral care once or twice per month: and Group B (10 persons), provided with professional oral care 4 times per month (once a week). Three dentists investigated the general health status and oral conditions such as dental formula, gingivitis index (GI), gingival bleeding index (GBI), degree of coating of on the tongue, and the type of pneumonia-causing pathogens on the pharyngeal mucosa. Professional oral care was provided by 14 dental hygienists for 3 months.
Results: Multiple comparison tests revealed that subjects in Group B showed a statistically significant improvement in GI and GBI compared to the controls. Although there was a trend showing some improvement associated with care frequency between pre- and post-intervention, no statistically significant difference was found eventually. Further, no significant difference was found before intervention with regard to the types of pneumonia-causing pathogens on the pharyngeal mucosa. Only Group B manifested a tendency of decreasing number pathogens when compared to the pre-intervention numbers, although it was not statistically significant.
Conclusion: Considering the limited time, cost, and manpower, a frequency of 4 times per month may be the most effective, but a higher frequency is recommended to prevent inflammations of the respiratory system.
... Three methods have been more commonly used for halitosis detection: self-reported, organoleptic and VSC level measurement (Yaegaki & Coil, 2000). ...
Aim:
To systematically review the literature in order to investigate a potential association between periodontitis and halitosis.
Methods:
Electronic searches were performed in four different databases: PubMed, Scopus, Web of Science and Scielo. Population based observational studies that tested the association between periodontitis and halitosis were included. Additionally, meta-analysis, meta-regression and subgroup analyses were performed to synthesize the evidence.
Results:
A total of 1,107 articles were identified in electronic searches; out of which, 5 were included within the meta-analysis. Pooled estimates revealed that individuals with periodontitis presented 3.16 times higher odds (OR 3.16; 95%CI 1.12-8.95) of having halitosis. Meta-regression and subgroups analyses showed that criteria used for halitosis and periodontitis assessment explained nearly 45% and 24% of heterogeneity between studies, respectively.
Conclusions:
Positive association between periodontitis and halitosis was found in pooled results of population based observational studies. However, this evidence is derived from cross-sectional studies. This article is protected by copyright. All rights reserved.
... Selain itu, metilamin, dimetilamin, asam propionik, asam butirat, indol, skatol, merkaptol dan kadaverin telah dilaporkan dapat menyebabkan halitosis. 4 Klasifikasi halitosis menurut Miyazaki dkk., 5 dan Yaegaki dkk., 6 dikategorikan sebagai halitosis murni (genuine), pseudohalitosis dan halitophobia. Halitosis murni (genuine) merupakan halitosis yang dapat disubklasifikasi menjadi halitosis fisiologis atau patologis. ...
Volatile sulfur compounds (VSCs) oral dihasilkan dari produk putrifikasi mikroba gas hidrogen sulfida (H2S), metil merkaptan (CH3SH) dan dimetil sulfida [(CH3)2S] yang merupakan gas utama penyebab halitosis. Ritma circadian mempunyai pengaruh terhadap fungsi beberapa organ tubuh termasuk sekresi saliva, produksi hormon, fungsi sistem tubuh, dan aktivitas mikroorganisma. Penelitian bertujuan menguji pengaruh ritma circadian terhadap produksi VSC oral yang diukur menggunakan OralChroma portable. Penelitian dilakukan dengan mengukur gas VSC individu yang sama pada pagi, siang dan malam hari di laboratorium riset terpadu FKG UGM. Hasil pengukuran H2S, CH3SH dan (CH3)2S diuji menggunakan analisis statistik Anava dua jalur dilanjutkan uji LSD dan uji korelasi Pearson dengan derajat kemaknaan 95%. Hasil penelitian menunjukkan terdapat perbedaan yang sangat bermakna antara produksi gas H2S, CH3SH dan (CH3)2S dengan waktu pengukuran (efek circadian) (p=0,000). Perbedaan sangat bermakna diketahui pula pada pengukuran gas H2S dan (CH3)2S antara pagi, siang dan malam (p=0,01 dan p= 0,00), serta pengukuran gas CH3SH siang dan malam (p=0,006), tetapi tidak pada CH3SH pagi hari (p=0,061). Produksi gas H2S tertinggi diketahui pada pagi hari (mean 1,198 ng/10 ml, CH3SH pada malam hari (mean 0,099 ng/10 ml), dan (CH3)2S pada siang hari (mean 1,216 ng/10 ml). Kekuatan hubungan pengukuran antara ke tiga gas dengan efek circadian diketahui sebesar r=0,738. Disimpulkan bahwa ritma circadian berpengaruh terhadap produksi VSCs oral. Produksi gas H2S dan (CH3)2S berbeda antara pagi, siang dan malam hari, sedangkan produksi gas CH3SH berbeda hanya pengukuran siang dan malam hari. Produksi gas H2S tertinggi diketahui pada pagi hari, gas CH3SH pada malam hari, dan gas (CH3)2S pada siang hari. Maj Ked Gi. Juni 2013; 20(1): 14 - 20.The Effect Of Circadian Rhythm To Oral Volatile Sulfur Compounds Production. Oral volatile sulfur compound (VSC) is produced from microbial purification of hydrogen sulfide (H2S), methyl mercaptan (CH3SH) and dimethyl sulfide [(CH32S] gases. They are the main gases that cause halitosis. Circadian rhythm influenced the function of several organs of the human body including salivary secretion, hormone production, the body’s systems function, and activity of microorganisms. The purpose of this research is to examine the influence of circadian rhythm to oral VSC production measured by using a portable Oral Chroma. The research was carried-out by measuring the individual VSC gases in the morning, afternoon and evening at the integrated research laboratory, Faculty of Dentistry, UGM. Gases of H2S, CH3SH and (CH3)2S were tested by two-way ANOVA followed by Post-hoc LSD and Pearson correlation test with 95% significance level. The results showed the positive significant differences among the production of H2S, CH3SH and (CH3)2S with circadian time (p=0.000). Highly significant difference was also detected in amount of H2S and (CH3)2S gases in the morning, afternoon and evening (p=0.01 and p=0.00), as well as the amount of CH3SH gas in the afternoon and night (p=0.006), but not in amount of CH3SH gas in the morning (p=0.061). The highest production of H2S gas was known in the morning (mean 1.198 ng/10 ml), CH3SH gas was detected in the night (mean 0.099 ng/10 ml), and (CH3)2S gas was observed in the afternoon (mean 1.216 ng/10 ml). The strength of relationship among amount of three gases with circadian effects was r = 0.738. It is concluded that circadian rhythm markedly influences the production of oral VSCs. H2S and (CH3)2S gases production were significantly different among in the morning, afternoon and evening. However, amount of CH3SH gas production was significantly different only in the afternoon and the night. The highest gas production of H2S, CH3SH, and (CH3)2S was observed in the morning, in the night, and in the afternoon, respectively.
... This instrument is used for the measurement of VSCs present in the air expired through the mouth, such as hydrogen sulfate (H 2 S), methyl mercaptane (CH 3 SH), and also, to a lesser degree, dimethyl sulfide (CH 3 ) 2 S. The examination involves all the components, and the result in ppb (parts per billion) reflects the total VSC content. However, it should be remembered that the final results may be affected by, among others, alcohol, smoking, aromatic oils, and oral hygiene fluids [3,[8][9][10]. Despite certain limitations, such as the fact that the halitometer only measures the levels of VSCs, with no regard for other smells such as cavaderin [5,11,12], the use of this instrument enables obtaining objective and reproducible results and seems to be the most reliable method for evalu− ating halitosis intensity. ...
Background: Halitosis, or bad breath, is believed to be caused by the metabolism of microorganisms, mainly anaerobic bacteria, inhabiting the oral cavity which release volatile sulfur compounds (VSCs). The high incidence of this condition and the lack of effective treatment methods make it a significant problem of contemporary dentistry. Objectives: The aim was to objectivize halitosis symptoms using a halitometer and to determine the microbiological spectrum from smears collected from the tongue root and periodontal pockets of patients with clinical symptoms of halitosis. Material and Methods: The study involved 67 patients of both sexes, divided into two groups: those with symptoms of halitosis (36 subjects, mean age: 38.0 years) and those without (31 subjects: mean age: 33.8 years). Subjects classified as generally healthy were qualified for the examinations. Halitosis symptoms were objectivized using a halitometer (RH-17 Halimeter, Interscan Corp., USA and Canada) in units of parts per billion (ppb). Mean halitometric readings (from three examinations) above 125 ppb were considered halitosis positive. Clinical examination evaluated oral hygiene (PII index according to Loe and Silness, PI2 according to O'Leary, and API according to Lange et al.) and the condition of the periodontium (PBI index according to Saxer and Muhlemann and periodontal pocket depth using a Periprobe electronic probe on four dental surfaces). Bacteriological evaluation involved smears from the back of the tongue and, in case of inflammation, also from the periodontal pockets. Statistical analysis was performed using the chi-squared test and the non-parametric Mann-Whitneys U test assuming a level of significance of p < 0.05. Results: The bacterial species Prevotella oralis, Prevotella dentalis, and Leptotrichia buccalis significantly affected the VSC levels. The highest halitometer values were observed in patients whose bacterial levels were high. The clinical parameters did not differ significantly between the groups. Conclusions: The use of a halitometer enables an objective, reproducible measurement of volatile sulfur compounds in expired air. Halitometer readings increase with increased levels of some oral bacteria. Tests using a halitometer confirm less objective organoleptic examinations; however, it should be remembered that the instrument does not evaluate other smells.
... We used self-reported halitosis, which is often unreliable. Discriminating halitosis from halitophobia, which is a delusional disorder that is considered a type of olfactory reference syndrome (ORS), and from pseudo-halitosis, which refers conditions that are characterized with a subjective sensation of malodor with an inability to provide objective evidence, was difficult [28,29]. However, objective measurements using a portable VSC detector, halimeter, or gas chromatography to assess halitosis quantitatively are generally insensitive and often unavailable under clinical circumstances [30][31][32]. ...
This study was conducted to estimate the prevalence and associated factors of subjective halitosis in adolescents. In total, 359,263 participants were selected from the Korea Youth Risk Behavior Web-based Survey (KYRBWS) from 2009 through 2013. Demographic data including age, sex, obesity and residency; psychosocial factors such as subjective health, stress, and economic levels; and dietary factors such as alcohol consumption; smoking; and fruit, soda, fast food, instant noodle, confection, and vegetable consumption were analyzed for correlations with halitosis using simple and multiple logistic regression analyses with complex sampling. In total, 23.6% of the participants reported the presence of halitosis. The following subjectively assessed factors were related to halitosis: poor health status (adjusted odds ratio [AOR] = 2.56), overweight or obese (AOR = 1.37), stress (AOR = 2.56), and lower economic levels (AOR = 1.85). The high intake of fast food (AOR = 1.15), instant noodles (AOR = 1.17), and confections (AOR = 1.17) and the low intake of fruits (AOR = 1.22) and vegetables (AOR = 1.19) were also related to halitosis. The prevalence of subjective halitosis in the studied adolescents was 23.6%. Specific psychosocial factors and dietary intake were related to halitosis.
... Halitosis could be categorized into three classes of genuine halitosis, pseudo-halitosis and halitophobia(1, 6,9,15,[34][35][36][37][38]. ...
Halitosis generally refers to the unpleasant odor of breath irrespective of its origin. Oral malodour could result in diverse problems in daily life such as social embarrassment and can adversely affect individuals' social interactions. Though many oral and non-oral sources could give rise to halitosis, it was mainly associated with oral cavity conditions and volatile sulfur compounds -produced by microbial activity- were the main elements of oral malodor. Objective measurement was the first step in assessment to determine presence of malodour. Then, taken a complete history including diet and habit history and performing a comprehensive physical examination contribute to the primary two steps for evaluating a patient complaining. The oral malodor management was mainly achieved by determining and eliminating the etiology of the condition. A major step in this regard was improving the oral health by means of establishing appropriate oral hygiene measures and controlling tongue flora by brushing or scraping and also, use of antiseptics as adjuvant therapy. Current article was systematic reviews the literature on prevalence, classification, diagnosis and treatment of halitosis. © 2015, Iranian Association of Gastroenterology and Hepatology. All rights reserved.
... In addition, it is the only method of assessing the degree of social offensiveness of breath odor [7]. Sometimes, patients sense halitosis but the malodor is neither offensive nor noticeable [8]. Self-perception of halitosis may be related to a psychogenic or psychosomatic disorder [9]. ...
Self-perceived halitosis could be a symptom of a psychosomatic or psychogenic disorder. The aim of this cross-sectional study was to clarify the relationship of self-perceived halitosis with psychological and oral health statuses.
One hundred participants with a history of halitosis were enrolled from a teaching hospital. They were divided into the self-perceived and suggested groups if they sensed and did not sense the malodor, respectively. Demographic and socioeconomic information, smoking status, and oral hygiene practices were noted. Complete nasal, oral, and periodontal examinations with organoleptic tests (OLTs) and N-benzoyl-DL-arginine-2-naphthylamide (BANA) tests were conducted. The participants also completed the validated Arabic version of the 90-item revised symptom checklist (SCL-90R). Data were compared by analysis of variance, chi-square test, Student’s t-test, and multivariate logistic regression.
The self-perceived group had higher OLT scores (p = 0.005) and were significantly younger (p = 0.001) than the suggested group. A significantly higher number of its participants were smokers (p = 0.004). No significant differences were observed in socioeconomic information, oral hygiene practices, oral conditions, and BANA test results. Further, no significant association was noted between self-perceived halitosis and the nine psychological dimensions of SCL-90R.
Halitosis is a multifactorial symptom that requires multidisciplinary management. Self-reporting of the condition is unique entity and trust worthy symptom. It tends to be related to nonoral pathologies and extrinsic causes such as smoking.
... Yaegaki & Coil (63,64) que hacen una magnifica revisión del problema. O los de Bosy(65) que ya en 1999 le otorga un valor del 4% y el de Filippi & Müller (66) que un trabajo de 144 pacientes encuentra un 84% de causa oral, un 3,5% de causa extra oral y un 12,5% de causa sicológica. ...
La halitosis o mal aliento es un problema importante dado que puede comprometer la vida de relación de las personas. Es frecuente que se atribuya el origen al estómago o a problemas nasales o pulmonares. No obstante, sabemos que hasta en el 90% de los casos, el origen se encuentra en la cavidad oral, y de forma preponderante debido al acúmulo de placa en el dorso lingual "cubierta lingual". La enfermedad periodontal también está directamente relacionada con el mal aliento, de manera que el acumulo de placa, bolsas y/o sangrado son aspectos directamente relacionados con el problema. Desde el punto de vista patogénico, las proteínas de la dieta, las de las bacterias y las de los propios tejidos de la boca, son degradadas por la acción de las proteasas bacterianas hasta aminoácidos. Los aminoácidos ricos en azufre son los máximos responsables del mal aliento. De hecho los tres productos más directamente relacionados son el sulfuro de hidrógeno, el metil mercaptano y el dimetil sulfuro. En la presente revisión repasamos todos estos aspectos y las causas más directamente relacionadas con el problema, revisando igualmente el concepto de halitofobia y pseudohalitosis.
... This was adapted to North American society with regards halitophobia, and appeared in publications a decade ago. [7][8][9] This classification is inflexible since multiple diagnoses for one patient are not enabled. The broad category "extra-oral, pathologic halitosis" does not aid referral choice, or help the receiving clinician, and is also poor for researchers who need to precisely classify extra-oral halitosis according to etiology. ...
Background:
There is no universally accepted, precise definition, nor standardisation in terminology and classification of halitosis.
Objective:
To propose a new definition, free from subjective descriptions (faecal, fish odour, etc), one-time sulphide detector readings and organoleptic estimation of odour levels, and excludes temporary exogenous odours (for example, from dietary sources). Some terms previously used in the literature are revised.
Results:
A new aetiologic classification is proposed, dividing pathologic halitosis into Type 1 (oral), Type 2 (airway), Type 3 (gastroesophageal), Type 4 (blood-borne) and Type 5 (subjective). In reality, any halitosis complaint is potentially the sum of these types in any combination, superimposed on the Type 0 (physiologic odour) present in health.
Conclusion:
This system allows for multiple diagnoses in the same patient, reflecting the multifactorial nature of the complaint. It represents the most accurate model to understand halitosis and forms an efficient and logical basis for clinical management of the complaint.
... Delusional halitosis may present clinically as a spectrum ranging from an overvalued belief to a frank delusional disorder in which the individual can hardly be dissuaded from his or her belief of mouth odor; in other words the person will be presenting with false offensive mouth odor. Both Pseudo-halitosis and halitophobia patients must be referred to psychological specialists [45]. ...
Psychosomatic disorders are defined as disorders characterized by physiological changes that originate partially from emotional factors. This article aims to discuss the psychosomatic disorders of the oral cavity with a revised working type classification. The author has added one more subset to the existing classification, i.e., disorders caused by altered perception of dentofacial form and function, which include body dysmorphic disorder. The author has also inserted delusional halitosis under the miscellaneous disorders classification of psychosomatic disorders and revised the already existing classification proposed for the psychosomatic disorders pertaining to dental practice. After the inclusion of the subset (disorders caused by altered perception of dentofacial form and function), the terminology "psychosomatic disorders of the oral cavity" is modified to "psychosomatic disorders pertaining to dental practice".
... The halitophobic patients show a disproportionate concern and are obsessed with their breath. It is also verified that pseudo-halitosis patients accept the clinician's diagnosis after receiving explanations, even without the establishment of any treatment, while halitophobics never believe the nonexistence of oral malodor [9]. ...
It is known that almost one-third of patients who seeks treatment for bad breath do not have genuine halitosis. Halitosis can occur even in cases when the malodor is not perceived by those around the patient and can neither be confirmed by organoleptic tests, nor by sulfur portable monitor readings. In such cases, these patients have been considered as halitophobic or have pseudo-halitosis. The complaint might signal the existence of a chemosensory dysfunction. Factors associated with taste and smell perception can be potentially connected to the occurrence of oral malodor. The threshold values of volatile sulfur compounds that have been used to establish the diagnosis of genuine halitosis do not take into account that the patient may perceive low levels of these and of other volatile compounds through retronasal olfaction. The current concept of halitosis requires the presence of a signal that has been based on equipment results, from the olfactory perception of the examiners and of those who interact with the patient. Nevertheless, the concept does not encompass the symptoms of halitosis. This paper addresses some of the possible causes of chemosensory dysfunction and proposes a new definition for halitosis.
... Gas chromatography can be specific for VSCs, which are the primary cause of oral malodor. Moreover, GC can quantitatively analyse the concentrations of the three primary malodorcausing substances: (H 2 S), (CH 3 SH) and ((CH 3 ) 2 S) (9,(49)(50)(51)(52). Sulphide monitors analyse for the total sulphur content of a subject's mouth air and are not specific for VSCs (8,25,51,53). ...
Objective:
The objective of this study is to systematically review the literature regarding the impact of mouthrinses on oral malodor and present evidence for the treatment effects of mouthrinses on oral malodor.
Material and methods:
PubMed-MEDLINE, the Cochrane-CENTRAL and EMBASE were searched through February 10, 2012 to identify appropriate studies. Volatile sulphur compound measurements, organoleptic measurements and tongue coating were selected as outcome variables. SEARCH RESULTS: The independent screenings of 333 unique titles and paper abstracts revealed 12 publications (12 experiments) that met the eligibility criteria. Means and standard deviations were extracted. The results were separated into short-term (<3 weeks) and longer-term (≥3 weeks) studies.
Conclusion:
In this review, nearly all mouthwashes with active ingredients had beneficial effects in reducing oral malodor in both short- and longer-term studies. The most compelling evidence was provided for chlorhexidine mouthwashes, and those that contained a combination of cetyl pyridinum chloride and zinc provided the best evidence profile on oral malodor. Little data with respect to tongue coating were available, and none of the studies showed a beneficial effect for this parameter.
... According to the classification of halitosis by Yaegaki et al., genuine halitosis is defined as "obvious malodor with intensity beyond a socially acceptable level is perceived", and pseudohalitosis is defined as "obvious malodor is not perceived by others, although the patient stubbornly complains of its existence. [7,8]" Some research indicates that pseudohalitosis patients have a stronger tendency for depression compared with genuine halitosis patients [9,10]. It has also been suggested that pseudohalitosis is related to both their somatic and emotional status, and that psychological disorders are strongly associated with the halitosis classification. ...
There is a possibility that genuine halitosis patients' anxiety do not recover after oral malodor treatment due to their social anxiety disorder. The objective of this study was to investigate the influence of social anxiety disorder on the level of anxiety in genuine halitosis patients before and after treatment for oral malodor.
The subjects were 262 genuine halitosis patients who visited the Fresh Breath Clinic from March, 2008 to October, 2009. The subjects who had score 2 or higher by the organoleptic test were diagnosed as genuine halitosis patients. Gas chromatography (GC) was conducted before and after oral malodor treatment for the oral malodor measurement. Based on their risk of social anxiety disorder, subjects were divided into low- and high-risk groups using the Liebowitz Social Anxiety Scale (LSAS). The questions related to oral malodor and the clinical oral examination were both conducted before oral malodor treatment. The level of anxiety before and after oral malodor treatment was evaluated using the Visual Analogue Scale of Anxiety (VAAS).
More than 20% of subjects had a score of 60 or more on the LSAS (high LSAS group). The mean age and the percentage of females were significantly higher in the high LSAS group compared to the low LSAS group. The high LSAS group was more likely to have problems associated with oral malodor and to adopt measures against oral malodor compared to the low LSAS group. The mean concentrations of H2S and CH3SH by GC significantly decreased after the oral malodor treatment in both LSAS groups. VAAS scores also significantly decreased after treatment in both LSAS groups. The logistic regression analysis indicated that the high LSAS group had a 2.28 times higher risk of having a post-VAAS score of 50 or more compared to the low LSAS group.
This study revealed that genuine halitosis patients with a strong trait of social anxiety disorder have difficulty overcoming their anxiety about oral malodor. Oral malodor treatment of genuine halitosis patients requires not only regular oral malodor treatment but also attention to social anxiety disorder.
Objective: The present study aimed to evaluate the level of perceived stress is associated with self-reported halitosis among undergraduate dental students in Pakistan Method: The crossectional study based on survey design was directed to evaluate the association of level of perceived stress and halitosis among undergraduate dental students. Sample size of the study was 278 undergraduate dental students from private dental colleges of Lahore. Independent sample t test was used. Results: The results of independent sample t test revealed a significant difference of level of perceived stress between the undergraduate dental students with halitosis and without halitosis (t=-21.784, P=.000). Undergraduate dental students who don’t have reported halitosis have lower level of perceived stress (Mean±SD, 11.76±3.01) as compared to those students who reported halitosis (Mean±SD, 22.13±4.32) Conclusion: Higher prevalence of halitosis was found among dental students with moderate perceived stress Keywords: Halitosis, Dental students, Perceived stress
Is there a role for alternative therapies in controlling intra-oral halitosis? Treatments other than tongue cleaning and anti-halitosis products containing zinc, chlorhexidine and cetylpyridinium chloride were considered as alternative therapies. Four databases were searched (PubMed, EMBASE, Web of Science and The Cochrane Library). Inclusion criteria were: examination of alternative halitosis therapies, study population with oral malodour, a (negative or positive) control group and evaluation of breath odour via organoleptic and/or instrumental assessment. Data were extracted for descriptive analysis. The screening of 7656 titles led to the inclusion of 26 articles. Analysis showed heterogeneity concerning the population of interest (from cysteine-induced to genuine halitosis), the examined treatment and the reported outcomes. This made a meta-analysis impossible. Essential oils, fluoride-containing products and herbal substances were the most studied. Results varied enormously and none of the active ingredients had an unambiguously positive effect on the malodour. The risk of bias was assessed as high in all articles. Given the fact that little evidence was found for each of the investigated treatments, it could be concluded that there is currently insufficient evidence that alternative therapies are of added value in the treatment of halitosis.
Clinical relevance
Scientific rationale: Halitosis is a common problem causing social isolation. Out of embarrassment, patients search the internet, leading to many questions about alternative solutions (e.g. oil pulling, herbs). This is the first systematic review on these alternative therapies.
Principal findings: Results varied among studies. Some promising results were found for fluoride-containing toothpastes and probiotics. For other products (such as herbal and antibacterial products and essential oils) results were inconsistent. Long-term follow-up studies on these products are scarce. Moreover, the quality of the studies was poor.
Practical implications: No clear evidence was found to support a certain alternative anti-halitosis therapy.
Background- Halitosis is perceptibly unpleasant or offensive odors emanating from the mouth while exhaling during breathing and per se does not imply any particular cause or source The aim of this study was to estimate the self-reported prevalence and extent of awareness of halitosis among dental students to assess its prevalence, relationship between halitosis and self-reported symptoms of oral health and oral hygiene practices. Materials and methods- The Structured questionnaire consisted of 3 parts in which first part was related to gender, age, and educational level, second was participant’s perception of any malodor and its history and social effects and third was concerned with oral hygiene practice and health habits and involved dental students from the 5 dental colleges. Out of the 500 questionnaires distributed, 180 were filled and returned with overall response rate of 36%. From these responses, the incomplete questionnaires were discarded and, 152 were selected for analysis. The age range of the participants was between 17-47 yrs. Females and males accounted for 80.9% and 19.1% respectively. The prevalence of self-perceived halitosis was 17% among the males and 45.5% among the female participants. Conclusion-Our results indicate that the prevalence of self-perceived malodor among dental students is in the similar range reported by other studies. However, these findings need to be corroborated by objective examination to ascertain the prevalence.
This study assessed the effects of Weissella cibaria (W. cibaria) CMU on oral health in male and female beagles (n = 18) by measuring oral malodor and periodontal disease-related parameters (calculus, plaque, and gingivitis indices). Oral malodor and indicators of periodontal disease were assessed in five treatment groups: negative control (scaling and 0.24 mg of maltodextrin, n = 3), positive control (0.24 mg of maltodextrin, n = 3), and W. cibaria CMU groups (each n = 4) at low (CMU-L, 2 ? 107 colony forming unit [CFU]), medium (CMU-M, 2 ? 108 CFU), and high (CMU-H, 2 ? 109 CFU) concentrations. After feeding with W. cibaria CMU for 6 weeks, total volatile sulfur compound concentrations in the CMU-L (2.0 ? 1.04 ng/10 mL), CMU-M (2.4 ? 1.05 ng/10 mL), and CMU-H (2.6 ? 1.33 ng/10 mL) groups were significantly lower than in the positive control group (3.2 ? 1.65 ng/10 mL). Also, CMU-L (1.4 ? 0.83 ng/10 mL) and CMU-H (1.9 ? 1.14 ng/10 mL) groups had methyl mercaptan levels lower than that in the positive control group (2.4 ? 1.21 ng/10 mL) at week 2. The plaque index was significantly lower in the CMU-H group (4.5 ? 0.28) than in the positive control group (5.9 ? 1.08) at week 6. W. cibaria CMU could be useful as a novel oral hygiene probiotics for reducing volatile sulfur compounds production and inhibiting plaque growth in companion animals. © 2018 Korean Society of Veterinary Science. All rights reserved.
Psychogenic denture intolerance is a complex and rising problem of dentistry and presents many intricate problems, which are being tackled by various disciplines of both basic and clinical research. This book reviews research on the subject of psychogenic denture intolerance including peculiarities of denture-related psychological and psycho-physiological phenomena, background and pathomechanisms of denture induced psychosomatic manifestations, preventive- diagnostic and treatment strategies of premised conditions, basic principles of communication and patient-nurse-dentist interrelationships as well as an introduction in several treatment methods like psychotherapeutic approaches and others.
Berichte über Mundgeruch (Halitosis, Foetor ex ore) gibt es bereits in der antiken Literatur. Das Wissen über die richtige Diagnose und suffiziente Therapie der Halitosis ist demgegenüber nur spärlich verbreitet. Die Hauptursache der echten Halitosis liegt intraoral. Der Zahnarzt ist hier der richtige Ansprechpartner. Die Kenntnis der außerhalb des zahnmedizinischen Fachgebiets liegenden Halitosisauslöser mit entsprechender Fachüberweisung ist wichtige Grundlage der erfolgreichen Therapie.
Halitosis is a general term defined as an unpleasant or offensive odor emanating from the breath, arising from either oral or nonoral sources. Extraoral factors, such as ear-nosethroat conditions or gastrointestinal, respiratory, and systemic diseases, may also contribute to oral malodor. Although, halitosis has a multifactorial etiology, local factors play an important role in the majority of cases. Halitosis may lead to significant personal discomfort and social embarrassment. Assessment of halitosis can be performed using organoleptic measurements, sulfide monitoring, gas chromatography, microbial testing and chemical test strips. Management approaches are based on masking oral malodor, reducing the levels of volatile organic compounds (VOCs) and volatile sulfur compounds (VSCs), and mechanical and/or chemical treatment. This review aims to identify the etiology of oral halitosis, describe the methods available for assessment and differential diagnosis and introduce a variety of management strategies. The importance of a multidisciplinary approach for the improvement of overall health and for the management and prevention of halitosis is highlighted.
How to cite this article
Mokeem SA. Halitosis: A Review of the Etiologic Factors and Association with Systemic Conditions and its Management. J Contemp Dent Pract 2014;15(6):806-811.
Objective: Social interactions among frail elders in care facilities are limited, but to what extent body image and perceived oral health influence their social relations are poorly understood. A positive body image and the perception of adequate oral health are linked to increased social contacts, as well as improved health, well-being and quality of life irrespective of age. However, as frailty increases it is unclear if appearance and oral health priorities remain stable. A preliminary study of these relationships suggested that oral health may have an important influence on the body image and social interactions of institutionalized elders. The current study has expanded this investigation to explore these relationships within a more diverse group of dependant frail elders. The research question underlying this study is how are the social interactions and body image of institutionalized frail elders influenced by perceived oral health and disease?
Methods: Open-ended interviews were conducted with a purposefully selected group of cognitively intact, institutionalized elder men and women who exhibited varying degrees of frailty, social engagement and oral health conditions. The narratives were analyzed using a constant comparative technique, and second interviews with the participants were conducted to check trustworthiness of the analysis.
Results: Three major themes emerged from the analysis: 1) institutional culture; 2) frailty and priorities; 3) comfort, function & hygiene.
Conclusions: Perceived oral health and body image among institutionalized frail elders are influenced by comfort, hygiene, and function. These findings are similar to that of elders who reside in the community; however the degree to which social interactions are negatively impacted appears to be dependent on institutional culture, degree of frailty, and how an elder prioritizes their care.
Aim:
The study objective was to collect diagnostic data, to explore correlations between diagnostic variables, to provide an accurate initial diagnosis, and to provide appropriate management in consecutive subjects consulting with a multidisciplinary halitosis team because of a halitosis complaint.
Method:
Nine hundred and fifty-four subjects with halitosis complaints applied for consultation. Subjects' history data were collected and organoleptic measurements and a physical examination were performed. Finally, genuine halitosis or pseudo-halitosis/halitophobia was diagnosed initially and management was provided.
Result:
Genuine oral halitosis was diagnosed initially in 93% of cases. Using oral cleaning materials, performing mechanical tongue cleaning, and periodical dentist consultation were over-represented in women, whereas men were more likely to have observable biofilm and carious lesions than women. Female gender was associated with tongue coating. Positive associations were found between age and performing mechanical tongue cleaning, organoleptic measurement scores as well as poor oral health. Educational level was positively associated with oral self care behaviours. Performing mechanical tongue cleaning was not associated with periodical dentist consultation.
Conclusion:
In nearly all subjects complaining of halitosis, an oral cause could be detected.
At the moment there are no clear protocols for the assessment of bad breath. An organoleptic evaluation is still the reference. To date there are several tools available to detect and quantify specific compounds related to halitosis. This paper reviews the available information on three sulphur monitors (OralChroma™ (CHM-1), Halimeter® and Breathtron®), in order to suggest guidance for the general dental practitioner. All three devices showed an acceptable correlation with organoleptic scores. The Halimeter® and Breathtron® seem the most appropriate devices for a general dental practitioner, because they are easy to handle. Because of its capacity of distinguishing between different sulphur compounds and due to its time-consuming and complicated use, the OralChroma™ (CHM-1) seems more suitable in a research environment.
Recently, we reported that myrsinoic acid B purified from Myrsine seguinii inhibited methyl mercaptan (CH(3)SH) production by Fusobacterium nucleatum JCM8532. Since hydrogen sulfide (H(2)S) is the main component of physiological halitosis, while CH(3)SH is involved in pathological oral halitosis, the objective of this study is to determine whether myrsinoic acid B inhibits H(2)S production by oral microorganisms. F. nucleatum, Porphyromonas gingivalis and Treponema denticola were incubated with myrsinoic acid B and a substrate such as l-cysteine or l-methionine. H(2)S or CH(3)SH concentration in the headspace air, was determined using a gas chromatograph. The concentration of myrsinoic acid B inhibiting 50% (IC(50)) of H(2)S production by F. nucleatum was 0.142 µg ml(-1), and the IC(50) of P. gingivalis and T. denticola were 2.71 µg ml(-1) and 28.9 µg ml(-1), respectively. The presence of pyruvate, a by-product of H(2)S production, was determined. The IC(50) values of myrsinoic acid B for pyruvate production were 22.9 µg ml(-1) for F. nucleatum, 87.7 µg ml(-1) for P. gingivalis and 165 µg ml(-1) for T. denticola. We concluded that myrsinoic acid B inhibited the production of both H(2)S and pyruvate by periodontal pathogens.
To compare the use of the Halimeter and the Oral Chroma™ to assess the ability of common oral anaerobic bacteria isolated from the Kuwaiti population to produce volatile sulfur compounds (VSCs).
Broth cultures of common anaerobes isolated from supragingival plaque were centrifuged and pellets resuspended in phosphate buffer (pH 7.7) with an optical density OD(550) of 0.3. 100 μl of this suspension and 870 μl of buffer were added in 2 sterile 15-ml head space vials. Reaction was initiated by addition of 30 μl of 33 mML-methionine and L-cysteine, respectively, in each vial and incubation at 37°C for 90 min. 500 μl of 3 M phosphoric acid was added to tubes and was kept aside for 10 min. Production of VSCs was measured using the Halimeter and the Oral Chroma.
The major VSC producers identified by both Halimeter and Oral Chroma with L-cystenine as substrate were Campylobacter ureolyticus, Porphyromonas gingivalis, Tannerella forsythia, Prevotella intermedia, Aggregatibacter actinomycetemcomitans and Gemella morbillorum. The concentrations of hydrogen sulfide recorded by both Halimeter and Oral Chroma were essentially identical. With L-methionine as substrate, both Halimeter and Oral Chroma identified different complements of anaerobes with C. ureolyticus,P. gingivalis,Fusobacterium nucleatum and P. intermedia as major VSC producers. The concentrations of methyl mercaptan recorded by the Halimeter were lower compared to those assessed by the Oral Chroma.
The results suggest that the Oral Chroma may produce a more comprehensive assessment of VSC production by oral microflora than the Halimeter.
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