Article

Halitosis and gastroesophageal reflux disease: A possible association

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Abstract

Previous reports have suggested that gastrointestinal (GI) diseases may cause halitosis. The aim of this study was to evaluate the relationship between upper GI conditions, especially gastroesophageal reflux disease (GERD), and halitosis. One hundred and thirty two consecutive patients complaining of upper GI symptoms were included in the study. All the patients completed a validated questionnaire that was designed to characterize and measure the severity of their symptoms. The questionnaire also contained questions about awareness and severity of oral bad breath. Following the filling of the questionnaire, the patients were physically examined and subjected to an upper GI endoscopy. The final diagnosis among the 132 patients (M/F = 70/62, mean age 45.2 years, range 20-87 years) was GERD in 72 patients (55%), Functional dyspepsia in 52 (39%), Peptic ulcer in seven patients (5%) and gastric cancer in one patient (1%). Halitosis was significantly associated with the occurrence and severity of heartburn (P = 0.027), regurgitation (P = 0.002) sour taste (P < 0.001), belching (P = 0.001) and burburigmus (P = 0.006). Halitosis was not associated with upper abdominal pain, bloating, early satiety and chest pain. In relation to the final diagnosis, halitosis was significantly associated only with GERD (P = 0.002) but not with functional dyspepsia (P = 0.855) and peptic ulcer disease (0.765). No correlation was found between Helicobacter pylori infection status and halitosis occurrence and severity (analysis of variance F = 0.001, P = 0.977). Halitosis is a frequent symptom of GERD and may be considered as an extra-esophageal manifestation of GERD. On the other hand, we did not find an association between functional dyspepsia, peptic ulcer disease and H. pylori infection with halitosis occurrence or severity.

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... Some studies have shown that halitosis is one of the common symptoms of gastroesophageal reflux as far as it can be described as an extra-oral manifestation of the disease (4,6). In a study of the relationship between gastroesophageal reflux and halitosis, Moshkowitz et al (9) showed that halitosis is one of the common symptoms of gastroesophageal reflux and may be considered as an extra-esophageal manifestation of gastroesophageal reflux. In the review study conducted by Struch et al (10), it was shown that the risk of halitosis increased with the severity of the gastroesophageal reflux symptoms. ...
... As reported by Kinberg et al (11), some patients with halitosis reported a significant improvement in halitosis after drug treatment for GERD. Since research has shown that 80-90% of cases of halitosis have oral origin (15)(16)(17) and several studies have also found a relationship between halitosis and GERD Anbari F, et al (9,12,18), it can therefore be concluded that there is a relationship between bad breath and GERD. In general, gastroesophageal reflux can occur at all ages, but is more common in the fourth and fifth decades of life (9,19). ...
... Since research has shown that 80-90% of cases of halitosis have oral origin (15)(16)(17) and several studies have also found a relationship between halitosis and GERD Anbari F, et al (9,12,18), it can therefore be concluded that there is a relationship between bad breath and GERD. In general, gastroesophageal reflux can occur at all ages, but is more common in the fourth and fifth decades of life (9,19). However, in their study, Bolepalli et al (20) have shown that the incidence of GERD at a younger age is also common, which is consistent with the present study, where the mean age of patients was 19.4. ...
Article
Background: Prevalence of Halitosis includes a variety of 22 up to 50% in different societies. There have been reports of remarkable improvements in Halitosis after Gastroesophageal Reflux Disease (GERD) treatment. The aim of this study was to investigate the relationship between oral factors and halitosis in patients suffering from GERD. Methods: This cross-sectional analytical study was conducted on 98 patients (45 females and 53 females) with mean age of 19.4 years whose gastroesophageal reflux was diagnosed by gastroenterologist. Halitosis was detected by organoleptic method. Decayed, Missing, and Filled Teeth (DMFT) was utilized to record the dental status. Oral hygiene was evaluated using the Oral Hygiene Index (OHI-S), Debries Index (DI), Calculus Index (CI), and coated tongue. Data were analyzed by Spearman and Pearson correlation tests. Results: There was not a significant relationship between halitosis and DMFT, OHI-S, and debris index and calculus index, and coated tongue (p>0.01). Also, there was a direct and significant relationship between DI and CI (p<0.01). Conclusion: Based on the results of the present study, there is no relationship between oral factors (debris index, calculus index, oral hygiene index, and DMFT) and halitosis in patients with GERD. Therefore, the presence of halitosis might be attributed to the presence of GERD in these patients.
... The erosion of the teeth can be detected with various factors and characteristics. For a correct diagnosis we need to dry the tooth surface, using a good lighting and mirror then look for the following possible indicatives: A neat teeth appearance 11 with very rounded incisal borders, shiny and burnished looking enamel can be seen, worn out shape that the morphology has been almost lost, (figure 1). Teeth have a darker and more yellowish color; the enamel is so thin that the dentin's color is prominent (figure 2). ...
... This emphasizes the necessity of the communication between dentists and gastroenterologists and guiding the dentist for a more precise and quicker diagnosis of this disorder. (11) In this disorder we shouldn't forget the important role of saliva, within the cleaning of the esophagus of the acid with 2 different procedures: 1 st by ingesting the saliva it provokes the peristalsis, 2 nd they neutralize the acidic by its buffering effect. The continuous swallowing of the saliva will also cause oral dryness and more incidence of dental erosion. ...
... In the future studies to correctly assess the severity of halitosis in GERD patients a halimeter (an instrument that calculates the level of bad breathe using volatile sulfur) would be helpful. (11) The study of Warsi I, et al was the first research conducted that overcame various flaws in modern misleading evidence on the effects of GERD on the oral mucosa. In this research the presence of oral lesions and conditions has been evaluated according to the severity of gastric reflux and different predisposing and risk factors. ...
Article
Gastroesophageal reflux (GERD) is the movement of gastric contents to the esophagus, they irritate and damage the tissues that are not adapted to the presence of these acids. According to the previous studies it has been proven that many structures may be affected by the direct contact with gastric contents and may cause complications not only pulmonary and chest pain but also many serious oral and dental effects. Dentists are normally the first ones that diagnose this by their impacts on the oral cavity...
... Cependant des étiologies non buccales de l'halitose, nettement moins fréquentes, sont également évoquées; ce sont essentiellement des affections oto-rhino-laryngologiques et gastroentérologiques [17]. Plusieurs études antérieures ont suggéré que les maladies du tractus gastro-intestinal (TGI) peuvent causer l´halitose [10,17,20]. Et des études récentes suggèrent que l´infection à H. pylori chez les patients atteints de maladies du TGI serait l´une des principales étiologies de l´halitose [10,20]. ...
... Plusieurs études antérieures ont suggéré que les maladies du tractus gastro-intestinal (TGI) peuvent causer l´halitose [10,17,20]. Et des études récentes suggèrent que l´infection à H. pylori chez les patients atteints de maladies du TGI serait l´une des principales étiologies de l´halitose [10,20]. En effet, lorsque l'estomac se remplit, les glandes gastriques entrent en action pour faciliter la digestion des aliments par la production de chyme [2]. ...
... Bien que la recherche de H. pylori n'a pas été faite chez tous nos patients (absence de moyens financiers), nos résultats ont montré une forte fréquence de l'infection au cours de l'halitose (sur 10 patients atteints d'halitose dépistés pour l'infection à H. pylori, 90% étaient porteurs de la bactérie), confortant ainsi le lien supposé entre H. pylori et l'halitose retrouvé dans la littérature [10,[21][22][23]. Mais les études existantes montrent des résultats contradictoires; pour d´autres études l´halitose serait liée aux maladies du TGI autres que l´infection à H. pylori [20,24]. ...
Article
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Introduction L’halitose, état morbide caractérisé par une mauvaise haleine, présente à la fois un aspect pathologique et social. Dans notre contexte, l’halitose pose de nombreux problèmes de prise en charge aux plans diagnostique et thérapeutique en pratique clinique. Le but de notre travail était d’étudier les aspects diagnostiques et thérapeutiques de l’halitose. Méthodes Il s’agit d’une étude transversale sur une année. Ont été inclus, les patients âgés de plus de 15 ans qui ont consulté pour halitose au centre hospitalier universitaire Yalgado Ouédraogo. Ont été exclus les patients avec mauvaise haleine mais consultant pour un autre motif. L’haleine a été évaluée par un praticien selon le test organoleptique de Rosenberg. Résultats Au total 35 patients ont été inclus pour un sex-ratio de 1,2. L’âge moyen était de 31,9 ans. Dans 57,1% des cas, la plainte venait du patient lui-même. La durée moyenne de l’halitose était de 4,3 ans. Dix-neuf patients avaient un score de Mel Rosenberg ≥ 2. La carie dentaire (07 cas), la sinusite (07 cas), l’infection à Helicobacter pylori (09 cas) et l’ulcère gastro-intestinal (10 cas) étaient associés à l’halitose. Le traitement a été étiologique dans 82.9% des cas avec une amélioration satisfaisante à deux semaines de l’ordre de 71,8%. Conclusion L’halitose reste une pathologie peu étudiée et pose un problème de diagnostic positif, mais aussi étiologique dans notre contexte. Le rôle de l’odontologiste est crucial dans la recherche de la cause de l’halitose. Cependant, une prise en soins pluridisciplinaire de l’halitose permettra d’y apporter une réponse plus efficace.
... 5 Recently, gastroesophageal reflux disease (GERD) has been reported to be one of the causes of halitosis. [15][16][17][18][19] Moreover a study has reported that GERD-related symptoms were associated with halitosis, regardless of the oral conditions. 17 In contrast, some studies have reported that halitosis is not associated with erosive GERD. ...
... So far, the diagnosis of halitosis has been mainly dependent on subjective self-reported questionnaires developed by various researchers. [17][18][19] A Halimeter (RH-17K; Interscan Co., Chatsworth, CA, USA) has been introduced for diagnosis of halitosis by detecting VSCs, and is considered as an objective test for halitosis. The aim of this study was to investigate an association between GERD and halitosis diagnosed by self-reported questionnaires and VSCs measurements by the Halimeter. ...
... 5,14 However, other studies have proposed a significant relationship between halitosis and GERD (Table 4). [16][17][18][19]29 Di Fede et al 18 have reported that patients with endoscopically detectable erosion exhibited higher levels of self-reported halitosis in comparison to controls. Moreover, Moshkowitz et al 19 have reported that subjective halitosis may be considered as an extra-esophageal manifestation of GERD. ...
Article
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Background/Aims The relationship between halitosis and gastroesophageal reflux disease (GERD) remains controversial. The aim of this study was to investigate an association between subjective and objective halitosis and GERD. Methods The subjects were enrolled from participants who visited a health promotion center at Seoul National University Bundang Hospital. For diagnosis of halitosis, a questionnaire was requested, and volatile sulfur compounds (VSCs) were measured by Halimeter. Self-conscious halitosis was defined as halitosis perceived by himself or herself. Informed halitosis was defined as halitosis perceived by others. Objective halitosis was defined when mean VSCs values were > 100 parts per billion. GERD was defined based on a questionnaire and endoscopy, including erosive esophagitis and non-erosive reflux disease (NERD). Results A total of 54 subjects (male:female = 33:21) with mean age of 46.0 ± 11.4 years were analyzed. The mean VSCs values were not significantly different between presence and absence of self-conscious halitosis (P = 0.322), but significantly different between presence and absence of informed halitosis (P = 0.021). Informed halitosis was associated with objective halitosis (P = 0.039). GERD, erosive esophagitis and NERD did not correlate with objective halitosis (P = 0.556, 0.206 and 0.902, respectively). In multivariable analysis, the relationship between objective halitosis and GERD symptoms including chest pain, heart burn, acid regurgitation, epigastric pain, hoarseness, globus sensation and coughing was not significant. Besides, GERD was not associated with self-conscious halitosis, informed halitosis and objective halitosis, respectively. Conclusions GERD might not be associated with self-conscious, informed halitosis and objective halitosis indicated by Halimeter results. Informed halitosis could be correlated with objective halitosis determined by the Halimeter.
... The association between halitosis and gastroesophageal reflux disease remains controversial. Moshkowitz et al. (2007) suggested that halitosis may be a result of gastroesophageal reflux disease. Struch et al. (2008) reported that gastroesophageal reflux disease increases the risk for halitosis in both edentulous and dentate subjects. ...
... By contrast, some studies have shown no association between halitosis and erosive gastroesophageal reflux disease (Tas et al., 2011;Kislig et al., 2013). In contrast to previous reports (Moshkowitz et al., 2007;Struch et al., 2008), the effects of gastrointestinal conditions on halitosis were not significant in this study. We examined the effects of various factors on halitosis and interactions among these factors and have developed a decision tree model to identify the risk factors associated with halitosis that may be useful to develop programs for halitosis diagnosis and management. ...
... Loesche et al [110] reported that 74% of the bacteria cultured from the lingual dorsum were Veillonella parvula, Actinomyces odontolyticus, Streptococcus intermedius and Clostridium innocuum. Table 5 shows the different research groups that attempted to relate halitosis to H. pylori [111][112][113][114][115][116][117][118][119][120][121][122][123] . The first were Tiomny et al [111] , who in 1992 in Israel studied 6 patients with halitosis, 5 of whom were H. pylori-positive. ...
... Gall-Troselj et al [114] N-PCR (ureA) AG: 87 (32) Tg: 43/268 (16) 17/87 (20), BMG: 37 (14) 1/37 (3), BMS: 144 (54) 12/54 (22), (54 Tg, 13/90 (14) Serin et al [115] EGB Adler et al [113] EGB, SHal, OHal, Giemsa, PCR (SSA) y (16SrRNA) [118] EGB, RUT GDSS [GERD: 72 (55)] H. pylori vs Hal: P > 0.05 Hal vs GERD: P < 0.05 Suzuki et al [119] OLT, GC, PCR (16S rRNA) [117] . Suzuki et al [119] studied the relationship between halitosis and H. pylori-presence in saliva. ...
Article
Full-text available
Helicobacter pylori (H. pylori) has been found in the oral cavity and stomach, and its infection is one of the most frequent worldwide. We reviewed the literature and conducted a Topic Highlight, which identified studies reporting an association between H. pylori-infection in the oral cavity and H. pylori-positive stomach bacterium. This work was designed to determine whether H. pylori is the etiologic agent in periodontal disease, recurrent aphthous stomatitis (RAS), squamous cell carcinoma, burning and halitosis. Record selection focused on the highest quality studies and meta-analyses. We selected 48 articles reporting on the association between saliva and plaque and H. pylori-infection. In order to assess periodontal disease data, we included 12 clinical trials and 1 meta-analysis. We evaluated 13 published articles that addressed the potential association with RAS, and 6 with squamous cell carcinoma. Fourteen publications focused on our questions on burning and halitosis. There is a close relation between H. pylori infection in the oral cavity and the stomach. The mouth is the first extra-gastric reservoir. Regarding the role of H. pylori in the etiology of squamous cell carcinoma, no evidence is still available.
... There was no correlation with epigastric pain, flatulence, early satiety, and chest pain. No significant relationship was found between halitosis and functional dyspepsia [14]. ...
Article
Full-text available
Bad breath is a clinical symptom encountered by doctors of various specialties in their daily practice. The symptom causes lower self-esteem and a negative perception of the patient by society, and consequently personal and social isolation. Bad breath can be an early manifestation of many systemic diseases. Because its causes are numerous, it is important to properly diagnose the condition and apply the appropriate treatment. The aim of the study was to present the gastroenterological aspect of halitosis on the basis of available literature reports.
... The study concluded that no changes were seen in breath sulfide levels after using an antiseptic mouth rinse in patients who were H pylori positive and the infection was not eradicated [24]. Furthermore, Moshkowits found that halitosis is a common symptom of gastric helicobacter pylori infection and may be an extra-esophageal manifestation of it [25]. In this case control, comparative study, all these studies were taken into account when evaluating the relationship between halitosis and H pylori infection. ...
Article
Background: Halitosis is a common human condition; however, the pathophysiological mechanism of halitosis is still unclear. Halitosis is mostly attributed with oral pathological conditions, in addition, halitosis resulting from gastrointestinal disorders is not rare either. Halitosis is often reported with symptoms related to Helicobacter pylori infection, epigastric pain and gastroesophageal reflux disease. Objective: Halitosis can stem from a number of gastric conditions and one of the most common causes of halitosis include the presence of a gastric infection with Helicobacter pylori. This study was conducted to evaluate the incidence ofhalitosis in patients presenting with Helicobacter pylori infection and epigastric pain. Additionally, to review whether there is a correlation between H pylori infection and halitosis; moreover, to determine whether halitosis is a valid indication for H pylori infection. Methods and Materials: This case control, comparative study was done at Medicine department of Isra University hospital and Civil hospital, Karachi during the period of January 2019 to December 2019. Participants were enrolled only after taking verbal and signed consent. Prior permission from the hospital management was taken as well. Result: Halitosis and H pylori are statistically significant with p value of 0.026. There was a clear correlation between halitosis and H pylori infection, and it may be a common contributor to halitosis.
... Furthermore, the symptom is often present in patients with verified infection with Helicobacter pylori, a bacterium that is among the major pathogenic factors of inflammatory and ulcerative changes on the gastric mucosa [33][34][35][36]. In addition, a high correlation has been demonstrated between halitosis and gastroesophageal reflux disease and peptic ulcer disease [37], and some authors have linked halitosis to volatile sulfur compounds [30,38,39] and to the chemical compounds cadaverine, some types of indoles [30]. Cadaverine (1,5-pentanediamine) is a toxic diamine formed by tissue putrefaction. ...
Chapter
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Esophageal diseases are diagnosed by gastroenterological processing indicated due to typical gastrointestinal symptoms, but typical gastrointestinal symptoms are not the only possible manifestation of esophageal disease. There are also external symptoms such as chronic cough, laryngitis, pharyngitis, oropharyngeal dysphagia, odynophagia, laryngopharyngeal reflux, dysphonia, sinusitis, ear pain, and changes in laryngopharyngeal mucosa (erythema, edema, ventricular obliteration, cricoid hyperplasia and pseudosulcus). Extraesophageal symptoms are common in esophagitis and GERD, and studies show increasing prevalence of LPR in patients with GERD, as well as an association of reflux disease with cough and dysphonia symptoms. The aim of the chapter is to describe these extraesophageal symptoms of esophageal disease and how to recognize and treat them, in order to facilitate gastroenterologists’ diagnostic processing of patients with these symptoms, improve their treatment and assessment of the therapy effectiveness, prevent the development of stronger symptoms, and encourage multidisciplinary cooperation and exchange of knowledge, scientific and clinical work.
... 19,21 A key diagnostic task is to exclude differential diagnoses like angina pectoris, peptic ulcer disease, other causes of esophagitis, asthma and chronic obstructive airway disease. 20,22,23 Patients may also present with complications such as ulceration, stricture, dental erosion, Barrett's esophagus and adenocarcinoma of the esophagus - Table 3. [24][25][26][27] These conditions, though uncommon, confer appreciable morbidity and decrease in quality of life. 10,19 However, GERD carries minimal risk for mortality (estimated at 1 death per 100,000 patients per year) and most deaths arise from GERD-induced esophageal adenocarcinoma. ...
Article
Full-text available
Dyspepsia is a common reason for the clinical encounters in primary care. Two common causes of dyspepsia are gastroesophageal reflux disease (GERD) and peptic ulcer disease (PUD). These diseases clinically overlap and may present diagnostic and management challenges in primary care, especially in low resource settings. Proton pump inhibitors, eradication of H. pylori infection and endoscopy form the backbone of management of both diseases. This article reviews current considerations in the diagnosis and management of GERD and PUD in primary care.
... Twelve of them showed the direct relationship between the 2 events, and 7 showed statistically significant differences [Bartlett et al., 1996;Gregory-Head et al., 2000;Muñoz et al., 2003;Oginni et al., 2005;Wang et al., 2010]. Moreover, it was observed that the exams used to diagnose GERD were usually endoscopy or esophageal pH monitoring [Jensdottir et al., 2004;Moazzez et al., 2005;Moshkowitz et al., 2007;Wang et al., 2010]. The indices used to record ETW were Eccles and Jenkins and Smith/Knight. ...
Article
The aim of this study was to establish and compare the prevalence and severity of erosive tooth wear (ETW) in children with and without erosive esophagitis. Children aged 5-12 years, scheduled for upper digestive endoscopy at the Pediatric Gastroenterology Service of the Children's Hospital Santo Antonio, Porto Alegre, Brazil, were eligible to participate in this study. Patients who presented erosive esophagitis at endoscopy were defined as gastroesophageal reflux disease (GERD) carriers, and the severity was described according to the Los Angeles classification. The oral cavity examination was performed by a trained and calibrated dentist and ETW was classified using the Basic Erosive Wear Examination (BEWE) index. Parents/guardians answered a questionnaire about the patients' diets and frequency of consumption of acidic foods and beverages. A total of 110 children were included in the study. Erosive esophagitis was observed in 24 patients (21.8%) and all of them (100%) presented ETW, showing a statistically significant association between these 2 conditions (p < 0.05). Among children who did not present with erosive esophagitis (n = 86), 54 (64.3%) had an ETW risk level of none according to their BEWE scores (0-2). The results of this study showed a statistically significant association between erosive esophagitis and ETW, thus it can be concluded that it is important to recognize groups at risk of ETW and act together with medical professionals to ensure adequate oral health for these patients.
... It can have several origins ranging from oral to systemic conditions. Moskowitz et al. noted that GERD is strongly related to the occurrence and severity of halitosis based on data obtained with self-administered questionnaires [68]. In contrast, a study published by Lee et al. using information obtained from both questionnaires and a Halimeter, an instrument that measures volatile sulfur compounds (VSCs), did not find a significant relationship between GERD and halitosis [69]. ...
Article
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Introduction: Gastroesophageal reflux disease (GERD) is one of the most prevalent conditions in Western Countries, normally presenting with heartburn and regurgitation. Extra-esophageal (EE) GERD manifestations, such as asthma, laryngitis, chronic cough and dental erosion, represent the most challenging aspects from diagnostic and therapeutic points of view because of their multifactorial pathogenesis and low response to proton pump inhibitors (PPIs). In fact, in the case of EE, other causes must by preventively excluded, but instrumental methods, such as upper gastrointestinal endoscopy and laryngoscopy, have low specificity and sensitivity as diagnostic tools. In the absence of alarm signs and symptoms, empirical therapy with a double-dose of PPIs is recommended as a first diagnostic approach. Subsequently, impedance-pH monitoring could help to define whether the symptoms are GERD-related. Areas covered: This article reviews the current literature regarding established and proposed EE-GERD, reporting on all available options for its correct diagnosis and therapeutic management. Expert opinion: MII-pH could help to identify a hidden GERD that causes EE. Unfortunately, standard MII-pH analysis results are often unable to define this association. New parameters such as the mean nocturnal baseline impedance and post-reflux swallow-induced peristaltic wave index may have an improved diagnostic yield, but prospective studies using impedance-pH are needed.
... There is a considerable evidence to show ,however ,that bad oral odor is linked more to peptic ulcer patients as compared to healthy control, our result is highly similar to that reported by Moshkowitz et al. (9) , illustrated that seven (5%) of peptic ulcer patients have halitosis and also they found that ,halitosis was significantly associated with the occurrence and severity of heartburn ,regurgitation ,sour taste, this is highly agreement with the present study and may be explained by the fact that anaerobic bacteria in peptic ulcer patients produces foul smelling compounds which could cause halitosis under suitable conditions. ...
Article
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studying the Oral manifestation ,microbial study and enzyme analysis in patients with peptic ulcer journal college of dentistry volume 23 no 2 p.56-60.2011
... pylori) can be found in the periodontal pockets in the oral cavity and cause halitosis [4]. Moskowitz et al. [37] investigated gastrointestinal system diseases and halitosis association in 132 patients. They demonstrated a high correlation between the presence and severity of gastroesophageal reflux disease and halitosis. ...
Article
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Background Halitosis, in other words, oral malodor is an important multifactorial health problem affecting the psychological and social life of individuals and is the most common reason for referral to dentists after dental caries and periodontal diseases. Objective The objective of this review was to present and discuss conventional and recently introduced information about the types, causes, detection and treatment methods of halitosis. Methods An expanded literature review was conducted which targeted all articles published in peer-reviewed journals relating to the topic of halitosis. Only articles written in Turkish and English languages were considered. The review itself began with a search of relevant subject headings such as ‘halitosis, oral malodor, volatile sulfur compounds in PubMed/Medline, Scopus, Google Scholar and Tubitak Ulakbim databases. A hand search of references was also performed. Results When search results are combined, the total number of relevant literature was found to be 4646 abstracts and 978 full-text articles. Abstracts, editorial letters were not included and about half of full-text articles were not related to dental practice. Among the remaining 124 full-text articles, duplicated articles and articles written other than Turkish and English languages were removed and 54 full-text articles were used for this review. Discussion According to the reviewed articles, both conventional and new methods were introduced in the management of halitosis. However, conventional methods seem to be more effective and widely used in the diagnosis and treatment of halitosis. Conclusion As being first line professionals, dentists must analyze and treat oral problems which may be responsible for the patient's malodor, and should inform the patient about halitosis causes and oral hygiene procedures (tooth flossing, tongue cleaning, appropriate mouthwash and toothpaste selection and use) and if the problem persists, they should consult to a medical specialist.
... Poelmans et al [8] showed that patients with suspected GERD-related ENT symptoms had a high prevalence of esophagitis and this was associated with better response to antisecretory therapy. Moshkowitz et al [9] found that halitosis was a frequent symptom of GERD and might be considered an extra-esophageal manifestation of GERD. Struch et al [10] showed clear evidence for an association between GERD and halitosis and suggested treatment options for halitosis, such as proton pump inhibitors. ...
Article
Background: Halitosis is used to describe any disagreeable odor of expired air regardless of its origin. Numerous trials published have investigated the relation between Helicobacter pylori (H pylori) infection and halitosis, and even some regimes of H pylori eradication have been prescribed to those patients with halitosis in the clinic. We conducted a meta-analysis to define the correlation between H pylori infection and halitosis. Objectives: To evaluate whether there is a real correlation between H pylori infection and halitosis, and whether H pylori eradication therapy will help relieve halitosis. Methods: We searched several electronic databases (The Cochrane Library, MEDLINE, EMBASE, PubMed, Web of Science, and Wanfangdata) up to December 2015. Studies published in English and Chinese were considered in this review. After a final set of studies was identified, the list of references reported in the included reports was reviewed to identify additional studies. Screening of titles and abstracts, data extraction and quality assessment was undertaken independently and in duplicate. All analyses were done using Review Manager 5.2 software. Results: A total of 115 articles were identified, 21 of which met the inclusion criteria and presented data that could be used in the analysis. The results showed that the OR of H pylori infection in the stomach between halitosis-positive patients and halitosis-negative patients was 4.03 (95% CI: 1.41-11.50; P = 0.009). The OR of halitosis between H pylori-positive patients and H pylori-negative patients was 2.85 (95% CI: 1.40-5.83; P = 0.004); The RR of halitosis after successful H pylori eradication in those H pylori-infected halitosis-positive patients was 0.17 (95% CI: 0.08-0.39; P <0.0001), compared with those patients without successful H pylori eradication. And the RR of halitosis before successful H pylori eradication therapy was 4.78 (95% CI: 1.45-15.80; P = 0.01), compared with after successful H pylori eradication therapy. Conclusions: There is clear evidence that H pylori infection correlates with halitosis. H pylori infection might be important in the pathophysiological mechanism of halitosis, and H pylori eradication therapy may be helpful in those patients with refractory halitosis.
... In turn, colonization of the gastric mucosa by H. pylori can cause peptic ulcers. There is no 100% clear correlation found between these ulcers and halitosis [14,15]. In vitro studies show significant VSC production by H. pylori [16]. ...
Article
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Objective: Halitosis is a widespread problem, normally attributable to specific volatile sulphur compounds (VSC) in the breath. The aim of this study was to first relate halitosis with possible gastric infection by Helicobacter pylori and secondly to quantify specific bacterial groups in the oral cavity flora, thus correlating them with VSC concentrations and Proton Pump Inhibitors (PPIs) intake. Four selected lactobacilli were then assessed in the possible reduction of halitosis in subjects with a total salivary bacterial concentration higher than 105 CFU/ml. Methods: Specific bacterial groups, namely total bacteria, total coliforms, sulphite-reducing bacteria (SRB) and lactobacilli, were quantified in samples of saliva from 29 subjects taking PPIs compared with 36 control subjects. The amount of the three VSC hydrogen sulfide (H2S), methyl mercaptan (CH3SH) and dimethyl sulfide (CH3)2S in the breath and the presence of H. pylori were determined. Results: No significant correlation was found between H. pylori and halitosis as well as with PPIs intake. The baseline bacterial groups quantification (log10 CFU/ml of saliva, PPI group vs. control) showed: total bacteria 8.44 vs. 4.47 (p=0.001); total coliforms 4.95 vs. 2.82 (p=0.001); sulfite-reducing bacteria 5.47 vs. 2.58 (p=0.052); total lactobacilli 4.00 vs. 2.36 (p=0.016). After 15 days of lactobacilli supplementation, the same parameters (d15 vs baseline) gave: total bacteria 7.92 vs. 8.44 (p=0.019); total coliforms 3.13 vs. 4.95 (p=0.001); sulfite-reducing bacteria 4.69 vs. 5.47 (p=0.047); total lactobacilli 7.86 vs. 4.00 (p=0.048). No statistically significant differences were noted in VSC concentrations at any time. Conclusions: The intake of PPIs directly correlated with the overgrowth of specific bacterial groups in the oral cavity, but there was no correlation with H. pylori or with VSC concentration. The significant reduction in all the bacterial groups analysed after two weeks suggested the improvement of the overall oral flora in subjects chronically treated with PPIs.
... Many studies have tried to identify the relationship between halitosis and gastroesophageal reflux, but the relationship between halitosis and LPR has not been studied. 20 Metabolic products of diabetes mellitus, uremia, hepatic diseases, and reflux cause extraoral halitosis. As mentioned above, the risk for extraoral halitosis in patients with LPR is high, which causes multisystem symptoms. ...
Article
OBJECTIVE: We evaluated the halimetric, olfactory, and taste functions of patients with laryngopharyngeal reflux (LPR). STUDY DESIGN: Prospective clinical study. SETTING: Multicenter tertiary care hospital. METHODS: Patients who were diagnosed with LPR for the first time on the basis of a Reflux Finding Score (RFS) >11 and a Reflux Symptom Index (RSI) >13 were enrolled in this study. A control group was selected from patients without a complaint of LPR. OralChroma was used for the halimetric measurement; Sniffin' Sticks were used for the smelling test; Taste Strips were used for the taste test; and monosodium L-glutamate was used for the umami test. RESULTS: A total of 110 subjects were included, with a mean age of 36.8 ± 10 years (range, 19-57 years). The differences in odor threshold scores were significant between the groups (P < .001), but no change was detected for the odor identification or discrimination scores between the groups. Bitter taste scores were significantly diminished in the reflux group compared with those in the control group (P = .001), whereas no impairments were found in the other taste scores (sweet, salty, and sour). The reflux group had significantly higher umami taste scores than those of the control group for the posterior tongue and soft palate anatomic sites (P < .001 and P < .001, respectively). Dimethyl sulfite levels were significantly higher in the reflux group than in the control (P = .001). CONCLUSION: Questioning patients who present with halitosis, taste, or smelling disorders is important to diagnose LPR.
... Extraoral or systemic conditions leading to halitosis include gastrointestinal (GIT) problems [11,12] and even stress. [13] Enumeration of possible etiological sources [9,[14][15][16][17][18][19][20][21] is given in Table 1. ...
Article
Full-text available
Halitosis is a condition where the breath is altered in an unpleasant manner for the affected individuals and impairs them socially as well as psychologically. Halitosis can be clinically classified as real halitosis, pseudohalitosis, and halitophobia. Real halitosis has oral and extra-oral etiologies and the pathophysiology involves interaction of anaerobic microbes (mainly) with the proteins present in the oral cavity fluids and contents, resulting in production of volatile sulfur compounds (VSCs). These VSCs, beyond responsible for halitosis, can also initiate and accelerate periodontal disease progression. Thus, this review is about the pathophysiology and various etiologies of halitosis, the knowledge of which can help in the betterment of treatment options.
... Extraoral or systemic conditions leading to halitosis include gastrointestinal (GIT) problems [11,12] and even stress. [13] Enumeration of possible etiological sources [9,[14][15][16][17][18][19][20][21] is given in Table 1. ...
... this erythema and mucosal atrophy may be present as a result of chronic exposure of tissues to acid (5). Oral complaints GERD patients often mention other oral complaints such as sensitation of burning or heat in the mouth, halitosis, xerostomia, dysgeusia -foul taste, and dental sensitivity related to hot or cold drinks or foods due to the erosions (5,9,18,20). ...
Article
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Several gastrointestinal disorders affect the oral cavity, and also the tissues around the mouth in the maxillo-facial region. In some cases, oral signs may be present in the absence of obvious gastrointestinal complaints or signs and also may suggest the disease. In this review we summarize some oral abnormalities in patients affected by the gastro-oesophageal reflux disease.
... 19,21 A key diagnostic task is to exclude differential diagnoses like angina pectoris, peptic ulcer disease, other causes of esophagitis, asthma and chronic obstructive airway disease. 20,22,23 Patients may also present with complications such as ulceration, stricture, dental erosion, Barrett's esophagus and adenocarcinoma of the esophagus - Table 3. [24][25][26][27] These conditions, though uncommon, confer appreciable morbidity and decrease in quality of life. 10,19 However, GERD carries minimal risk for mortality (estimated at 1 death per 100,000 patients per year) and most deaths arise from GERD-induced esophageal adenocarcinoma. ...
Article
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Background. Incongruence of standardised patient (SP) portrayals is worsened when SPs are given basic scenarios and too little background information on short notice. Consequently, SPs are confronted with questions they find difficult to answer owing to a lack of insight, internalisation and association with the role. Objective. To determine whether training in characterisation enhances the congruence of SP portrayals. Methods. SP encounters were recorded, after which the participating SPs and students reflected on the congruence of the SPs’ performances. The researchers analysed the videorecordings and reflections for incongruent behaviours. The findings were triangulated and themes of incongruency were established. The intervention comprised training of SPs in the creation of subtext (the story behind the story), characterisation, and linking to and making use of emotion memory, with the aim of rectifying the observed incongruent behaviours. Pre-training activities were repeated with Cohort 2 students. Results. Two themes depicting congruence, i.e. internalisation of character and congruence of verbal and non-verbal communication, were identified. Post-training outcomes revealed an improvement in all subthemes. Applicable and real emotions, complementing verbal and non-verbal cues, gestures and appropriate use of voice and facial expression, led to believable/congruent role play and improved communication on various levels. Conclusion. The post-training outcomes showed clear improvement regarding the congruence of SP portrayals. The changes can be contributed to SP training focused on 3D character development by creating subtext, providing basic clinical information, emotion memory, acting skills, managing energy levels, and not focusing on the scenario alone.
... H. pylori is only considered to be a possible cause of halitosis and more research is needed to determine existence of such an association (Scully and Greenman, 2008). This association, suggested in a dental research review article, was made based on two studies on gastro-esophageal reflux and halitosis (Struch et al., 2008;Moshkowitz et al., 2007): ...
Article
Halitosis or mouth malodor is a known problem for many years. The knowledge regarding the possible association of Helicobacter pylori infection is quite limited in literature. A comparative quasi experimental clinical trial study was conducted on 17 H. pylori positive patients and 16 H. pylori negative patients who were complaining of halitosis. All patients, regardless of H. pylori infection, received two-week's treatment of clarithromycin (500 mg BID) and amoxicillin (1 g BID) along with three month's long omeprazole; a pretested questionnaire was used for self-reported measurement of halitosis. Halitosis was assessed after three and six months of continued treatment. Patients were also checked for eradication of H. pylori infection. Mean estimated time for improvement was 74.4 days for H. pylori negative group compared to 46.8 days for H. pylori positive group. 12 out of 17 patients in this group improved during the treatment time, while only 4 of the 16 patients in H. pylori negative group improved (P<0.01). The relative risks of halitosis resolution in H. pylori positive group over H. pylori negative group were 2.8 and 3.3, respectively after 3 and 6 months. H. pylori eradication can resolve halitosis in majority of patients without an oral pathology causing halitosis. H. pylori may be a probable rather than a possible cause of halitosis.
... Very rarely, this can have serious medical implications because there are numerous medical conditions that predispose to oral malodor. [7][8][9] There lies a necessity to enhance the knowledge of self-perception of oral and general health among dental students. [10] Therefore, it is essential both from a social and a medical point of view that halitosis is reported and a definitive remedy is given to treat the underlying cause. ...
Article
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Background: Halitosis or oral malodor is characterized by unpleasant odor arising from the oral cavity. The prevalence of halitosis however is not studied extensively. The aim of this study was to evaluate the self perception of oral malodor and oral hygiene habits amongst dental students. Materials and Methods: A structured questionnaire consisting of ten questions was administered to 285 undergraduate students of Madha Dental College and Hospital. The questionnaire was designed to evaluate the self perception of halitosis, oral hygiene aids used, presence of dental caries, gingival bleeding, and dryness of mouth. Results: Of the 285 students, 259 students completed the questionnaire. The response rate was 90%, with male response rate being 85.7% and female 95.8%. Self-perceived halitosis was reported by 44.1% males and 45.32% females. The difference in reporting self-perception of halitosis between females and males was found to be statistically significant (P < 0.05). Significant difference was found for use of mouth wash, presence of carious teeth, bleeding gums, and use of tongue cleaners between females and males (P < 0.05). Conclusion: The results of this study indicate higher prevalence of halitosis among this population consisting of dental students. The awareness of halitosis was also higher among this population. The awareness of halitosis as an individual entity should be promoted to the general population and the therapeutic measures should be made available to all.
... Some studies report self reported/subjective halitosis complaints are associated with GERD. [68][69][70][71] One study reported gastroesophageal pathology in >50% of patients complaining of halitosis, [72] whilst others report that GI disorders may account for up to 5% of objective halitosis complaints. [31] A systematic review investigated the relationship between GERD and halitosis (among other things). ...
Article
Full-text available
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.
... However, the association between H. pylori infection and VSCs was not significant in the present study (AOR = 1.79 for (CH 3 ) 2 S defined halitosis, p = 0.386, data not shown). H. pylori infection was considered a possible cause of halitosis [44][45][46][47]. Further study to assess the other non-oral factors of halitosis will be needed. ...
Article
Full-text available
Objective: Oral malodor can be increased in breath of liver patients. However, no study has been performed for the association between volatile sulfur compounds (VSCs) and viral hepatitis. The aim of the present study was to determine the relationship between viral hepatitis and VSCs. Methods: This study analyzed 182 subjects and measured hydrogen sulfide (H2S), methyl mercaptan (CH3SH) and dimethyl sulfide [(CH3)2S] using the OralChroma(®). Hepatitis type B was evaluated. Periodontal health was assessed using the Community Periodontal Index (CPI) and bleeding on probing (BOP). Tongue coating score (TCS) was evaluated. Multiple logistic regression analyses were conducted to evaluate the relationship. Results: Viral hepatitis had an elevated odds of dimethyl sulfide defined halitosis (OR = 9.22, 95% CI = 2.08-40.95) after controlling for age, gender, alcohol consumption, current smoking, periodontitis, BOP, TCS and tongue brushing habit. The magnitude of the association between viral hepatitis and VSCs defined halitosis attenuated with adjustment of mediators (alcohol consumption, periodontitis, BOP, TCS and tongue brushing habit for hydrogen sulfide defined halitosis; periodontitis, TCS and tongue brushing habit for methyl mercaptan defined halitosis; tongue brushing habit for dimethyl sulfide defined halitosis). Conclusions: Findings of this study suggest that viral hepatitis may be associated with methyl mercaptan defined halitosis.
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INSAC WORLD HEALTH SCIENCES
Article
Background and aim: Although patients report either improved or worsened halitosis after Helicobacter pylori (H. pylori) eradication therapy, such complaints are subjective. Only a few studies have objectively evaluated reports of changes in halitosis after H. pylori eradication; thus, this study aimed to investigate these changes after a successful H. pylori eradication. Methods: Between February 2015 and October 2018, 56,347 patients visited the clinic. Informed consent for participation in this study was obtained from 164 patients scheduled to undergo upper gastrointestinal endoscopy due to halitosis. Of the 91 patients with H. pylori infection, the halitosis values were evaluated as Refres breath (RB) values using a Total Gas Detector™ System and compared before and after successful H. pylori eradication, as confirmed with urea breath testing. Results: Among the 91 patients treated, 77 patients were successfully eradicated of H.pylori and had their Refres values measured (21 males and 56 females; mean age, 64.2±11.5 years, including 10 smokers); among these 77 patients, 27 showed RB values of >60. Their RB values significantly improved from 73.5 Â (95% confidence interval (CI), 64.1-82.9) to 59.4 Â (95% CI, 50.0-68.8) (p=0.038). Of the 30 patients who could be followed up for >2 years after successful H. pylori eradication, 8 with an RB value ≥60 showed significant RB value improvements from 77.9 Â (95% CI, 59.4-96.4) to 30.1 Â (95% CI, 11.6-48.6) (p=0.0016). Conclusions: H. pylori eradication therapy could improve halitosis, and such improvement could be maintained even 2 years after successful eradication.
Article
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Halitosis is a health condition associated with an unpleasant odor from the oral cavity. The origin of bad breath may be related to systemic and oral conditions, but the large percentage of cases (about 85%) are related to oral factors. Because of its personal nature it can cause social embarrassment and psychological distress. Different society culture diverges acutely starts from those who believe that bad breath is genetically determined to those who turn to use crude scented items or over-the-counter products to camouflage the bad breath to others who consider the bad breath condition taboo subject finds it difficult to discuss or considered a private matter. The measurement of odors will not be as long as Corona is before Corona. Advanced dental clinics and also younger adults are newly equipped with many types of digital halite-testing devices and mobile phone applications making the diagnosis easy, safe and time-consuming. A Halitus patient initially visits the general dental practitioner for the betterment of the condition and here the responsibility lies on the dentists to diagnose and manage the condition. Treatment program must therefore address educative, preventive, curative and symptomatic line. In this review article we tried to highlight the bad breath condition and illustrate definitions, terminology, prevalence, etiology, classification, new measurement methods and management protocols.
Article
Full-text available
Halitosis is a health condition associated with an unpleasant odor from the oral cavity. The origin of bad breath may be related to systemic and oral conditions, but the large percentage of cases (about 85%) are related to oral factors. Because of its personal nature it can cause social embarrassment and psychological distress. Different society culture diverges acutely starts from those who believe that bad breath is genetically determined to those who turn to use crude scented items or over-the-counter products to camouflage the bad breath to others who consider the bad breath condition taboo subject finds it difficult to discuss or considered a private matter. The measurement of odors will not be as long as Corona is before Corona. Advanced dental clinics and also younger adults are newly equipped with many types of digital halite-testing devices and mobile phone applications making the diagnosis easy, safe and time-consuming. A Halitus patient initially visits the general dental practitioner for the betterment of the condition and here the responsibility lies on the dentists to diagnose and manage the condition. Treatment program must therefore address educative, preventive, curative and symptomatic line. In this review article we tried to highlight the bad breath condition and illustrate definitions, terminology, prevalence, etiology, classification, new measurement methods and management protocols.
Article
Introduction We aimed to evaluate the oesophagus of patients with reflux oesophagitis using ultrasonography and sought associations between the measurements of the mucosa, submucosa and muscularis propria, and endoscopic and clinical findings. Methods Thirty‐nine patients with endoscopically proven reflux oesophagitis and 19 patients with negative endoscopy for oesophagitis were included in the study. Two radiologists assessed the cervical oesophagus at the level of the thyroid gland. The data belonging to the ultrasonographic assessment of the patient group were compared to those of the controls. Results The muscular, submucosal and mucosal thicknesses of the cervical oesophagus measured by two observers significantly differed between the patient and control groups. The P‐values for mucosa, submucosa and muscularis propria were .02, <.001 and <.001, respectively for observer 1, .004, .001 and <.001, respectively for observer 2. The regression analysis showed that among the symptoms of heartburn, regurgitation and dysphagia, heartburn was independently associated with decreased mucosal and submucosal thicknesses of the oesophagus. Discussion Our findings confirmed that the layers of oesophagus in the gastroesophageal reflux disease were thicker compared to those of healthy people. We also found that heartburn was associated with decreased thicknesses of mucosal and submucosal layers in patients.
Chapter
In the absence of well-informed science, people intuitively associate breath odors with the digestive system. Perhaps, the stomach odors that arise transiently during eructation (burping) lead many to assume that breath odor may originate in the stomach. Old medical texts on this topic (Howe 1898; Shifman et al. 2002) cite indigestion, constipation, and dyspepsia as potential causes of breath odors further illustrates this point. Even nowadays, patients complaining of breath odors to their physicians or dentists are sometimes referred to the gastroenterologist (Delanghe et al. 1996).
Article
Full-text available
The accurate examination of oral cavity may acknowledge findings that demonstrate the presence of underlying systemic, which helps in earlier diagnosis as well as treatment. The oral tissues are accountable to damage as a disease consequence that primarily affects other body systems. Various systemic diseases show oral manifestation. Some of these oral conditions include oral ulcers, caries, dry mouth, gingival bleeding, and gingival hypertrophy. This review article is prepared to make general physicians as well as dentist aware about systemic disorders or conditions that show dental or oral manifestation.
Article
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Abstract: Background/Objectives: The patients who are overweight and obese, are under stress of excess body weight, embarrassed, one may imagine the impact of halitosis on this group of patients, this is an attempt to evaluate this extra impact, and which aspect of quality of life will be affect in the overweight and obese. Subjects/Methods: A prospective case series study including 885 overweight or obese patients, they were consulting for advice, diet and or drugs and various bariatric operations. A group of normal weight patients with halitosis, matched in age group and gender were enrolled as a control group for comparison. Patients who have either oral causes of the condition or pseudo halitosis or halite-phobia or were using drugs like phenytoin, cyclosporine or calcium channel blockers, isosorbide di-nitrate, Chloral hydrate, Nitrites and Nitrates, Dimethyl sulphoxide, Disulphiram, cytotoxic agents, Phenothiazine were excluded. Interventions/methods: The work conducted over a period of 6 years from February 1st, 2012 to March 1st, 2018. Prospective evaluation of the type and etiology of halitosis was done by using organoleptic measurement, which is not a slandered but evaluated by a group of academic colleagues. The patients were advised to avoid eating odiferous foods for 48 hours before the assessment and both the patient and the examiner should refrain from drinking coffee, tea or juice, smoking and using scented cosmetics before the assessment. Results: Halitosis in the overweight and obese patients magnifies the negative aspects of quality of life: avoidance, narrow social circle (P Value=0.3415, 95% confidence interval=11.43924 -29.67085), avoidance of sex by partner (P Value=0.0143, 95% confidence interval=04.11537 -17.08480), low self-esteem (P Value=0.0100, 95% confidence interval=10.66794 -28.44776), teasing by others and negative thoughts (P Value=0.4013, 95% confidence interval=11.43924 -29.67085). While obesity was not a cause of avoidance of to be kissed by partner in obese patients, but was a direct cause for this avoidance in obese patients with halitosis (P Value=0.0143, 95% confidence interval=04.11537 -17.08480). Halitosis in normal weight patients affects the quality of life remarkably but not to the extent of halitosis in overweight and obese patients, especially social life and self-esteem which will suffer most. .Conclusions: The quality of life of overweight and obese, especially emotional and social aspects was significantly disturbed by halitosis more than normal weight subjects with halitosis. Key words: Overweight, Obesity, Halitosis, emotional aspects, social aspects.
Article
Full-text available
Background/Objectives The patients who are overweight and obese, are under stress of excess body weight, embarrassed, one may imagine the impact of halitosis on this group of patients, this is an attempt to evaluate this extra impact, and which aspect of quality of life will be affect in the overweight and obese. Subjects/Methods A prospective case series study including 885 overweight or obese patients, they were consulting for advice, diet and or drugs and various bariatric operations. A group of normal weight patients with halitosis, matched in age group and gender were enrolled as a control group for comparison. Patients who have either oral causes of the condition or pseudo halitosis or halite-phobia or were using drugs like phenytoin, cyclosporine or calcium channel blockers, isosorbide di-nitrate, Chloral hydrate, Nitrites and Nitrates, Dimethyl sulphoxide, Disulphiram, cytotoxic agents, Phenothiazine were excluded. Interventions/methods The work conducted over a period of 6 years from February 1st, 2012 to March 1st, 2018. Prospective evaluation of the type and etiology of halitosis was done by using organoleptic measurement, which is not a slandered but evaluated by a group of academic colleagues. The patients were advised to avoid eating odiferous foods for 48 hours before the assessment and both the patient and the examiner should refrain from drinking coffee, tea or juice, smoking and using scented cosmetics before the assessment. Results Halitosis in the overweight and obese patients magnifies the negative aspects of quality of life: avoidance, narrow social circle (P Value=0.3415, 95% confidence interval=11.43924 -29.67085), avoidance of sex by partner (P Value=0.0143, 95% confidence interval=04.11537 -17.08480), low self-esteem (P Value=0.0100, 95% confidence interval=10.66794 -28.44776), teasing by others and negative thoughts (P Value=0.4013, 95% confidence interval=11.43924 -29.67085). While obesity was not a cause of avoidance of to be kissed by partner in obese patients, but was a direct cause for this avoidance in obese patients with halitosis (P Value=0.0143, 95% confidence interval=04.11537 -17.08480). Halitosis in normal weight patients affects the quality of life remarkably but not to the extent of halitosis in overweight and obese patients, especially social life and self-esteem which will suffer most. Conclusions The quality of life of overweight and obese, especially emotional and social aspects was significantly disturbed by halitosis more than normal weight subjects with halitosis. Keywords OverweightObesityHalitosisemotional aspectssocial aspects
Thesis
Helicobacter pylori est une bactérie dont la responsabilité est connue dans les pathologies gastriques telles que les gastrites, l’ulcère ou encore le cancer de l’estomac. Son rôle est connu et son traitement a été perfectionné au fur et à mesure des années de recherches. Cependant, les investigations poussées ont pu démontrés qu’il existait des réservoirs potentiels d’ Helicobacter pylori dans la plaque dentaire. En se basant sur cette découverte, la question de la corrélation entre le taux de charge bactérienne buccal et les éventuelles pathologies parodontales dont la parodontite a été soulevée. Dans un premier point, nous étudierons Helicobacter pylori comme facteur étiologique des problèmes gastriques. Dans une seconde partie, nous nous intéresserons plus spécifiquement à l’influence de la cavité buccale comme réservoird’ Helicobacter pylori et son impact sur les pathologies gastriques. Nous verrons dans un troisième temps, les interrelations possibles entre la bactérie et la santé parodontale. Enfin en dernier lieu, nous nous pencherons sur le rôle du chirurgiendentiste dans la prise en charge du patient infecté par Helicobacter pylori ainsi que sur l’influence du traitement buccal sur la charge bactérienne gastrique.
Chapter
In the absence of well-informed science, people intuitively associate breath odors with the digestive system. Perhaps, the stomach odors that arise transiently during eructation (burping) lead many to assume that breath odor may originate in the stomach. Looking into old medical texts on this topic (Howe 1898; Shifman et al. 2002), in which indigestion, constipation, and dyspepsia are considered prime causes of breath odors, further illustrates this point. Even nowadays, patients complaining of breath odors to their physicians or dentists are often referred to the gastroenterologist (Delanghe et al. 1996).
Article
The gastrointestinal tract is closely related to the oral cavity, therefore its disorders may manifest among other oral symptoms. Gastrointestinal dysfunctions are often accompanied by episodes of reflux or vomiting during which the acidic stomach content comes into contact with the oral cavity. Frequent or chronic reflux episodes or vomiting can lead to pathological changes in the oral cavity. These include mainly erosive defects of hard dental tissues, burning or sour taste in the mouth and malodour, which may occur before the typical symptoms of the disease. In our paper we describe the most common oral manifestations of gastroesophageal reflux disease and eating disorders (anorexia mentalis and bulimia nervosa).
Article
Full-text available
Objectives: Gastric infection with Helicobacter pylori may be one of the main causes of halitosis. This study was performed to evaluate the relationship of Helicobacter pylori infection with halitosis. Materials and Methods: This case control study was performed on 44 dyspeptic patients with a mean age of 34.29±13.71 years (range 17 to 76 years). The case group included 22 patients with halitosis and no signs of diabetes mellitus, renal or liver failure, upper respiratory tract infection, malignancies, deep carious teeth, severe periodontitis, coated tongue, dry mouth or poor oral hygiene. Control group included 22 patients without halitosis and the same age, sex, systemic and oral conditions as the case group. Halitosis was evaluated using organoleptic test (OLT) and Helicobacter pylori infection was evaluated by Rapid Urease Test (RUT) during endoscopy. The data were statistically analyzed using chi square, Mann Whitney and t-tests. Results: Helicobacter pylori infection was detected in 20 (91%) out of 22 halitosis patients, and 7 control subjects (32%) (P<0.001). Conclusion: Helicobacter pylori gastric infection can be a cause of bad breath. Dentists should pay more attention to this infection and refer these patients to internists to prevent further gastrointestinal (GI) complications and probable malignancies.
Chapter
The majority of cases of halitosis originate from the oral cavity. Less commonly halitosis is due to a systemic disease (eg liver failure), esophageal or gastric disease. Initial evaluation may lead to an oral source such as poor dentition, periodontal disease, or an abscess. Mouthwash can reduce oral bacteria and neutralize odor. On very rare occasions gas chromatography is useful to distinguish the offending gas. Since the tongue may be a source, tongue cleaning is warranted.
Article
Many systemic diseases exert their influence on oral health. Among these, gastroesophageal reflux disease (GERD) is the most common. In this study, 100 patients who were previously diagnosed with GERD were examined following a 12-hour fast and evaluated in terms of the severity (grade) of the disease as well as any oral, dental, and/or salivary pH changes. Results found 11 patients with tooth erosion. These patients were older, and their average mean duration of GERD was longer in comparison to those without erosion. There was an inverse relationship between salivary pH and the GERD duration and grade of severity. As the GERD grade increased, the severity of tooth erosion increased. Patients with erosion also exhibited oral mucosal changes. Thus severe, long-term GERD was found to be potentially detrimental to oral soft tissues, dental structures, and salivary pH, whereas milder forms of the disease did not necessarily cause dental side effects.
Article
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.
Article
AimThe aims of this study were to compare the volatile sulphur compounds (VSC)-reducing effect of two commercial mouthrinses using a morning bad breath model and to assess the role of mechanical plaque control (MPC) when performed previously to mouthrinse use.Patients and methodsEleven volunteers with good oral health were enrolled in a double-blind, randomized, six-step crossover design study with a 7-day washout period. Two commercial mouthrinses were tested using a saline solution (NaCl 0.9%) as a negative control: one mouthrinse contained 0.05% chlorhexidine, 0.05% cetylpyridinium chloride and 0.14% zinc lactate (CHX-CPC-Zn), while the other contained 0.05% chlorhexidine, 0.15% triclosan and 0.18% zinc pidolate (CHX-triclosan-Zn). A portable sulphide monitor (Halimeter®) was used for VSC quantification. Measurements were made at baseline, and 1, 3 and 5 h after rinsing. Significant differences were detected by analysis of variance.ResultsNo significant differences between groups were detected at baseline. We were unable to demonstrate a significant influence of mechanical plaque control on the reduction of VSC levels when performed before mouthrinse use (P = 0.631). Both mouthrinses effectively lowered VSC levels in all test intervals (P < 0.05). No statistically significant differences were found between mouthrinses in any of the test intervals (P = 0.629, 0.069 and 0.598 at 1, 3 and 5 h).Conclusion This study demonstrated that CHX-CPC-Zn and CHX-triclosan-Zn have significant and similar effects in reducing VSC levels, which persist for at least 5 h. Such effects were independent of previous MPC, which failed to improve on the results of mouthrinse use alone.
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Diagnostic Principles and Applications Robert B. Taylor, MD This book is intended to make you a better clinician, as you learn some unfamiliar, perhaps even forgotten, pathways to important diagnostic destinations. If this book were a road map, it would be about the “blue highways”--the less-traveled roads, the ones that may become vital when the "red line" major highways don't get you where you need to go. Think about the observation by American laryngologist Chevalier Jackson cited above: When presented with a wheezing patient, an experienced clinician would consider asthma to top the list of diagnostic considerations. But, in certain clinical contexts, the astute clinician might also think of foreign body aspiration, Wegener granulomatosis, parasitic infection, or airway constriction by an aortic aneurysm. Considering these other possibilities is the first step in making the correct diagnosis. Thus, this is not a typical, “comprehensive” differential diagnosis book, with long lists of diseases, most familiar to practicing clinicians, that might explain a symptom, sign, or abnormal laboratory finding. Instead I offer selected topics, the uncommon—and sometimes exasperatingly esoteric—disease causes we sometimes fail to consider. As an analogy, I offer the Lifeguard Paradox: If aspiring lifeguards were to spend the bulk of training time practicing what they will do most of the day at work, they would focus on learning to apply sunscreen to their own bodies. But in lifeguarding, unanticipated events happen, and the lifeguard must know how to handle them. In medicine, uncommon diseases and unlikely manifestations of common diseases occur with sometimes-surprising frequency, and we need to review them from time to time. Of course, clinicians also encounter the some diseases—whether everyday or rare--that we especially do not want to overlook, such as toxic megacolon and testicular torsion; when one of these appears in the coming pages it is tagged as a must-not-miss diagnosis. In this book, the emphasis is on the enlightened uses of traditional diagnostic tools—clinical history, physical examination, and basic laboratory tests and imaging. The more esoteric investigative methods—PET scans and genetic testing--seem to evolve constantly, and are best studied in journal and web-based sources that are more timely than books. Because the content of this book is selective, rather than attempting to be all-inclusive, I have tilted my choices toward identification of high-impact diseases. And also because this is a diagnosis book, I have included information about therapy only when I believed it would enrich the discussion or when I wanted to emphasize the urgency of reaching a timely, precise diagnostic end-point. What will you find in this book? I have included the following categories of diagnostic facts: Classical diagnostic pearls: For example, the patient with acute pericarditis often leans forward to relieve the anterior chest pain. Red flag symptoms and signs of serious illness: A salty taste when kissing an infant may represent the first clue to a diagnosis of cystic fibrosis. Counterintuitive clinical manifestations: The patient with gout may have a normal or low serum uric acid level during the acute attack; and nocturnal back pain has, in fact, not been found to be a useful indicator for serious spinal pathology. Bellwether signs and symptoms allowing an occasional early diagnosis: Abdominal distension is a common early manifestation of ovarian cancer; and patients with gastric cancer sometimes lose their appetite for meat early in the course of the disease. Curious clinical manifestations that may point to specific diagnoses: Here I think of the aquagenic pruritus of polycythemia vera, with itching that is aggravated by a hot shower. And the cutaneous “wake sign,” skin lesions resembling the wake left by a moving ship, has been described as seen only with scabies. Who needs this book? As medicine has become increasingly specialized, medical books have become correspondingly limited in their scope. This book, on the other hand, casts a very wide net, presenting diagnostic facts related to all ages and body systems. Thus, intended readers include medical students, residents, and practicing physicians, nurse practitioners, physician assistants, nurses and, in fact, anyone involved in making diagnostic observations and decisions. Do YOU need this book? Let’s see. If you see real, live patients in any specialty setting and cannot answer the following are five questions, I suggest that you put Diagnostic Principles and Applications high on your reading list: 1. What are the three characteristics of the scenario in which a diagnosis of breast cancer is often missed? 2. Of all the sites of possible lymphadenopathy, which is the most worrisome? 3. Low back pain that improves with forward flexion of the spine suggests what diagnosis? 4. Hyponatremia may be the clue to what psychiatric disorder? 5. Can you describe the Au-Henkind test for acute iritis, the Wartenberg sign in ulnar nerve palsy, and the Tullio phenomenon as a clue to the cause of vertigo? What are key features of this book? Medical education and clinical experience are remarkably capricious. A newly minted medical graduate may never have seen a patient with Guillain-Barré syndrome or osteomyelitis of the spine. Even the experienced practitioner may never have encountered anyone complaining of pathologically excessive yawning or a patient with suspected cerebrospinal fluid rhinorrhea. Owing to the variability in individual training and experience, each reader will be well acquainted with some of the entities described in this book, considering what I present to be well known and wondering why I included them at all. Others will find this same information to be new knowledge. For the most part, I have attempted to select facts not generally covered in basic physical examination courses or textbooks. Traditional diagnosis books are organized by symptoms and signs—hemoptysis, chest pain or bullous eruption of the skin—in contrast to disease-oriented reference books, which are organized by names of various clinical entities: lung cancer, myocardial infarction, or pemphigus. In this book, I present information under both types of headings, manifestations and diseases. When questions arose, I listed items under the body organ or system in which manifestations are most likely to occur. For example, consider the clue that the patient with herpes zoster who develops a vesicle near the tip of the nose is at risk of developing herpes zoster ophthalmicus; this pearl is presented in Chapter 5 (The Ear, Nose, and Throat) rather than Chapter 4 (The Eye). To save space, and with apologies to all the often-anonymous “et al” co-authors of the world, I have used a shorthand reference style, citing the first author only, plus article title, journal, year, volume and initial page number. Using an abbreviated reference style allows more pages for facts, and still provides enough information to find the article on PubMed, BioMedLib, or Google Scholar. Also, readers will find reference citations listed immediately following the stated fact and commentary, rather than at the end of the chapter; in my own reading I find this placement of references to be especially helpful. In the appendix, I have included a list of a glossary of statistical terms used in the book. This book is literature-based, by which I mean that all facts in this book are found somewhere in the medical literature. Not all assertions, however, are classically evidence-based. We just don’t know with precision (or, at least, I could not locate) the sensitivity or specificity of uncommonly occurring clinical manifestations, such as upbeating nystagmus sometimes observed in Wernicke encephalopathy, or the positive predictive value of some uncommon observations, such ¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬the “red ear syndrome” that has occurred in some patients with migraine. Some phenomena presented, such as yellow vision with digitalis intoxication, represent examples of often-repeated clinical lore, validated by repeated observations of experienced clinicians, and are included because they seem to be have weathered the test of time, supported by a few case reports. But most of what is presented here, such as the positive correlation of a high pulse pressure and white coat hypertension, has been subjected to statistical analysis and peer review. I recognize that some of what I describe is controversial and that future clinical studies may lead us to reconsider what we think is true and wise today. I urge the reader to use this book as a series of prompts, and then consult the current literature before making clinical decisions if in unfamiliar territory. In my research for this book, I found that a number of my reference citations for physical findings and diagnostic maneuvers--such as the Lisker tibial tap sign for deep vein thrombophlebitis of the lower extremity, discussed in Chapter 6--are found in literature that some may call "dated." Today, teaching indicator symptoms and physical biomarkers of disease seems to be out of style in medical school, and as Verghese writes, “Because the echocardiogram, magnetic resonance imaging, and computed tomographic can precisely characterize anatomy, the physical exam is too often viewed as redundant.” [2] I hold that so-called "old-fashioned" historical clues and physical signs are not only part of our medical heritage; their recognition can often spell the difference between prompt identification of disease versus an expensive, time-consuming journey through the clinical laboratory and diagnostic imaging suite. In fact, with the inconsistent quality of medical school teaching regarding the physical examination and the rising costs of high-tech health care, I think this book is needed more than ever. How should you use this book? This is not a classical course text to be studied in a classroom setting. Nor is it a clinical reference book, intended to be “searched,” but not really “read.” This is a “topical” book, presenting a somewhat eclectic collection of facts that someday may prove useful in specific puzzling situations. Hence, the book should be read, cover-to-cover. Put it at your bedside; take it to the beach; enjoy it on a plane trip. The goal is both to learn diagnostic principles and applications today, and to imprint them deep in your memory for future reference. I continue to like my metaphor of “Post-It” notes used to describe my book: Essential Medical Facts Every Clinician Should Know. [3] What you read today may not be clinically pertinent for months or years, but when the time comes, the information is there, “posted” in memory. Then, just to confirm your recollection, you can find it here again using the index provided or perhaps check out the original report on-line. In addition to my “read, post it, recollect, and confirm” approach, the book’s index will be a good place to look when faced with a head-scratching, seemingly unsolvable diagnostic puzzle. Use the index to locate the answers to the five questions posed above. It is axiomatic that the most common diseases occur most commonly. What clinician has not heard the axiom that when you hear hoof-beats, expect to hear horses, not zebras? But it is also true that we all encounter the uncommon entity occasionally, perhaps when we least expect to do so. Knowing the contents of this book can help you recognize the unlikely disease manifestation of a “horse” disorder or spot the “zebra” diagnosis when it presents itself in the middle of a busy office session or on an exam question. Finally, this book is intended to be easy to read, with just enough statistical details to support assertions, without becoming excessively burdened with methodologic minutiae. I have attempted to enrich your knowledge of our heritage by including a few historical anecdotes. And most of all, I have done my best to make this book clinically useful, as the title says: To prevent medical errors Pass board examinations, and Provide informed patient care 1. Jackson C. A new diagnostic sign of foreign body in trachea of bronchi, the “asthmatoid wheeze.” Am J Med Sci. 1918;156:626. 2. Verghese A. Culture shock: patient as icon, icon as patient. N Engl J Med. 2008;359:2748. 3. Taylor R. Essential clinical facts every clinician should know. New York: Springer; 2011. Robert B. Taylor, MD Oregon Health & Science University Portland, Oregon USA taylorr@ohsu.edu
Article
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Gastroesophageal reflux (GER) is a common cause of chronic cough. Moreover, chronic cough can be the sole presenting manifestation of GER disease (GERD). It has been suggested recently that GER most often causes chronic cough by stimulating the distal esophagus. To gain further diagnostic and pathophysiologic knowledge, we prospectively evaluated a group of patients with chronic cough likely to be due to GER with extensive gastrointestinal and respiratory studies and then observed their response to antireflux therapy. We prospectively characterized 12 subjects whose chronic cough was likely to be due to GER by chest radiographs, barium esophagography, 24-h esophageal pH monitoring (EPM) with probes in the distal and proximal esophagus, esophagoscopy, and bronchoscopy. Then, prior to instituting antireflux therapy, we objectively counted coughs during the distal esophageal infusion of 0.1 N HCl or 0.9 percent saline solution administered in a randomized, double-blind, standardized fashion (ie, Bernstein acid-perfusion test). Gastroesophageal reflux was determined to cause cough in all subjects based on disappearance of cough with antireflux therapy. It was clinically "silent" in 75 percent. The EPM was the test most frequently abnormal (sensitivity, 92 percent). Distal esophageal data revealed that 10 of 12 subjects had GER-induced coughs (12 +/- 12) while only 7 of 12 had an abnormal esophageal pH conventional parameter (eg, percent time pH < 4). Compared with the distal esophagus, GER to the proximal esophagus occurred (p = 0.017) and induced cough (p = 0.004) less often. Compared with baseline (9.3 +/- 17.6), there were no differences in coughs induced by the infusion of saline solution (9.2 +/- 15.9) or acid (15.1 +/- 26.7); the number of coughs induced by acid was negatively correlated with distal esophageal acid-GER events during EPM (r = -0.64, p = 0.01). Neither bronchoscopy nor chest radiographs were consistent with aspiration. There is a clinical profile that prospectively predicts which patients have chronic cough due to GER. The cough was most likely due to stimulation of the distal esophagus, not aspiration. Intraesophageal acid is unlikely to be the sole mediator in gastric juice causing the cough. While EPM is the single most helpful diagnostic test, conventionally utilized diagnostic indices of GERD can be misleadingly normal; observing GER-induced coughs is more frequently helpful.
Article
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With the aim of investigating a possible relationship between "objective" halitosis (established by sulfide levels in the breath) and Helicobacter pylori, we performed a study in 58 dyspeptic patients reported to suffer from "bad breath." Furthermore, we evaluated the effects on halitosis of eradication therapy (only for H. pylori-positive patients) and chlorhexidine antiseptic mouth rinses (in all patients). Sulfide compound assay indicated objective halitosis in 52/58 patients, 30 of whom were positive and 22 negative for H. pylori. In 19/30 eradication by double therapy provoked a decrease to below the cutoff value of sulfide levels in 15. In the other 11 of the 30 subjects, in whom H. pylori positivity persisted, halitosis parameters did not change. Chlorexidine reduced sulfides to below the cutoff value in 16/22 H. pylori-negative patients, but did not provoke any change in the 11 unsuccessfully treated H. pylori-positive subjects. In these, objective halitosis disappeared only after a successful eradication by triple therapy (9/11). Our results show a possible association between halitosis and H. pylori since bacterial eradication may resolve the symptom. Antiseptic mouthwashes may be effective only in absence of H. pylori, when halitosis may be due to oral putrefactive microbial activity. In a small number of subjects the cause and treatment of halitosis need to be clarified.
Article
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Endoscopic oesophageal changes are diagnostically helpful and identify patients exposed to the risk of disease chronicity. However, there is a serious lack of agreement about how to describe and classify the appearance of reflux oesophagitis To examine the reliability of criteria that describe the circumferential extent of mucosal breaks and to evaluate the functional and clinical correlates of patients with reflux disease whose oesophagitis was graded according to the Los Angeles system. Forty six endoscopists from different countries used a detailed worksheet to evaluate endoscopic video recordings from 22 patients with the full range of severity of reflux oesophagitis. In separate studies, Los Angeles system gradings were correlated with 24 hour oesophageal pH monitoring (178 patients), and with clinical trials of omeprazole treatment (277 patients). Evaluation of circumferential extent of oesophagitis by the criterion of whether mucosal breaks extended between the tops of mucosal folds, gave acceptable agreement (mean kappa value 0.4) among observers. This approach is used in the Los Angeles system. An alternative approach of grouping the circumferential extent of mucosal breaks as occupying 0-25%, 26-50%, 51-75%, 76-99%, or 100% of the oesophageal circumference, gave unacceptably high interobserver variation (mean kappa values 0-0.15) for all but the lowest category of extent (mean kappa value 0.4). Severity of oesophageal acid exposure was significantly (p<0.001) related to the severity grade of oesophagitis. Preteatment oesophagitis grades A-C were related to heartburn severity (p<0.01), outcomes of omeprazole (10 mg daily) treatment (p<0.01), and the risk for symptom relapse off therapy over six months (p<0.05). Results add further support to previous studies for the clinical utility of the Los Angeles system for endoscopic grading of oesophagitis.
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Helicobacter pylori is a curved microaerophilic Gram-negative bacterium considered as a risk factor for gastric cancer. The aim of this study was to find an association between burning sensations, acid taste, halitosis, and lingual hyperplasia with the effect of H. pylori on the mouth. A total of 124 subjects with different gastric diseases were studied: 46 patients with burning, halitosis and lingual dorsum hyperplasia and 78 patients with other diseases. The detection of H. pylori in the oral cavity by histopathologic diagnosis and molecular biology was confirmed in 40/46 (87%) patients with burning, halitosis, and lingual hyperplasia, and in 2/78 (2.6%) subjects with other diseases. Chi2: 91.26 (p < .001) Mantel-Haenszel. This trial showed an association between H. pylori and burning, halitosis, and lingual hyperplasia, and further considered this bacterium a risk factor for gastric infection.
Conference Paper
Acid reflux - most often associated with heartburn - may also cause a wide range of laryngopharyngeal symptoms, including laryngitis and chronic cough. Symptoms of laryngopharyngeal reflux (LPR), like those of gastro-oesophageal reflux disease, result from abnormal exposure of tissues to acid refluxate. Deranged sensorimotor function of the upper oesophageal sphincter appears to play a key role in the aetiology of LPR, but the disease is not completely understood. Among the significant long-term complications of LPR are bronchopulmonary disorders, recurrent pneumonia, chronic cough, chronic or recurrent laryngitis, and oral cavity disorders. It also appears to be a risk factor for the development of laryngeal carcinoma. Diagnosis of LPR is based on physical examination, medical history, and results of specific tests. At present, the test of choice for LPR diagnosis is intraluminal oesophageal pH monitoring. Barium contrast oesophagography, intraoesophageal acid perfusion challenge, and flexible endoscopic evaluation of swallowing with sensory testing may also be used in LPR diagnosis. Treatment for LPR includes changes to the diet and lifestyle, and acid-suppressing therapy. The Therapeutic Working Party at the First Multi-Disciplinary International Symposium on Supraesophageal Complications of Gastroesophageal Reflux Disease has recommended twice-daily dosing with a proton pump inhibitor as an initial therapy for LPR, with treatment continued between 4 weeks and 6 months. Such treatment has been found highly effective in resolving symptoms of LPR, and it may also prevent the serious long-term complications of this condition. (C) 2002 Lippincott Williams Wilkins.
Article
Objective: To determine the relation between gastroesophageal reflux disease and dental erosion using ambulatory 24-hour esophageal pH testing. Design: Cross-sectional observational study. Setting: Tertiary referral center. Patients: The dental group consisted of 12 patients with idiopathic dental erosion who were identified by dentists and screened for gastroesophageal reflux disease using 24-hour pH testing. The gastroenterology group consisted of 30 patients who had 24-hour pH testing in the esophageal laboratory and who were referred for dental evaluation (10 did not have reflux, 10 had distal reflux, and 10 had proximal reflux). Measurements: 24-hour esophageal pH monitoring using a pH probe in the distal and proximal esophagus. Complete dental examination with particular attention to the presence and severity of dental erosion; plaque; gingival damage; and decayed, missing, and filled teeth. Analysis of saliva for pH, flow rates, buffering capacity, and calcium and phosphorus levels. Standardized questionnaire to ascertain possible causes of dental erosion and presence of reflux symptoms. Results: Ten of the 12 patients in the dental group (83% [95% CI, 52% to 98%]) had gastroesophageal reflux on esophageal pH monitoring. Nine had distal and 7 had proximal reflux. Seven had reflux in the upright position only, 1 had reflux in the supine position only, and 2 had both upright and supine reflux. No saliva abnormalities were found. Ten patients had typical symptoms of gastroesophageal reflux, but dietary or mechanical problems that may have been causing dental erosion were not identified. In the gastroenterology group, upright reflux was seen in 5 of the 10 patients with distal reflux and in all 10 patients with proximal reflux. In addition, 40% of patients in the gastroenterology group (12 of 30) had dental erosion (4 of the 10 with distal reflux [40%], 7 of the 10 with proximal reflux [70%], and only 1 of the 10 without reflux [10%]; P=0.02 for those with reflux compared with those without reflux). The cumulative dental erosion score correlated with proximal upright reflux when all 24 study patients with erosion were analyzed (r=0.55 [P<0.01]); this correlation was even stronger in the subgroup of 12 patients with abnormal amounts of proximal upright reflux (r=0.84 [P=0.001]). Conclusion: Dental erosion is a common finding in patients with gastroesophageal reflux disease and should be considered an atypical manifestation of this disease
Article
Organoleptic studies indicate that the oral cavity is usually the principal source of physiologic malodor associated with the early morning halitosis. In all individuals, regardless of the age or health status of the oral tissues, the most intense oral malodor is exhibited after prolonged periods of reduced saliva flow and abstinence from food and liquid. This results from normal metabolic activity in the oral cavity and is accentuated in cases with poriodontal involvement. Physiologic oral malodor is transient in duration as it can be controlled to varying degrees in most individuals by oral hygiene measures, such as tooth brushing, dental prophylaxis, tongue scraping and rinsing with antiseptic mouth washes. Experimental evidence strongly suggests that putrefaction of sulphur containing proteinaceous substrates by predominantly gram negative oral microorganisms is the primary cause of oral malodor. Brushing studies indicate that both plaque and tongue are important sources of malodor with most of the odor emanating from the dorso posterior surface of the tongue. None of the gas chromatographic or mass spectrometric analyses have detected the presence of amines, indole, or skatole in the head space, mouth air, or breath vapor samples.
Article
Saliva plays a central role in the formation of oral malodor. Such formation has as its basis bacterial putrefaction, the degradation of proteins, and the resulting amino acids by microorganisms. Saliva provides substrates that are readily oxidized and in the process facilitates oxygen depletion. This favors the reduced conditions conducive to production of odoriferous volatiles. At the same time, saliva is a major source of oxygen for the oral bacteria which generally is inhibitory of their formation. The pH is also critical to malodor development; acidity inhibits, whereas neutrality and alkalinity favor malodor production. Since the pH on oral mucosal surfaces where odor formation occurs is largely determined by the fermentative and putrefactive activities of the adhering bacteria, these acid-base processes are necessarily of major regulatory importance. Because oral malodor and periodontitis both involve excessive oral putrefaction, a better understanding of putrefaction could lead to more substantive methods of oral malodor treatment than exists today, as well as identifying new approaches to amelioration of the bacterial attack on the soft tissues leading to the destruction associated with periodontal disease.
Article
The exact pathophysiological mechanism of halitosis is not clear, and in many patients the etiology is an enigma. We followed three couples in which one member or both had halitosis. All the subjects had evidence of Helicobacter pylori infection. All received a treatment course of colloidal bismuth subcitrate four times a day and 250 mg metronidazole three times a day. There was impressive improvement in their symptoms, the halitosis disappearing along with eradication of the organism. We call the attention of physicians to the possible connection between halitosis, H. pylori infection, and familial occurrence. Further studies to confirm this surprising association are in order.
Article
Occult (silent) gastroesophageal reflux disease (GER, GERD) is believed to be an important etiologic factor in the development of many inflammatory and neoplastic disorders of the upper aerodigestive tract. In order to test this hypothesis, a human study and an animal study were performed. The human study consisted primarily of applying a new diagnostic technique (double-probe pH monitoring) to a population of otolaryngology patients with GERD to determine the incidence of overt and occult GERD. The animal study consisted of experiments to evaluate the potential damaging effects of intermittent GER on the larynx.
Article
Research suggests that the tongue plays an important role in the production of oral malodor. To investigate the role of tongue surface characteristics and oral bacteria in halitosis development, the authors tested associations between odor measurements, volatile sulfur compound levels, periodontal parameters, tongue surface characteristics, presence of trypsinlike activity of organisms on the tongue and teeth and bacteriological parameters in 16 participants with complaints of oral malodor. The data indicate that the proteolytic, anaerobic flora residing on the tongue plays an essential role in the development of halitosis.
Article
To determine the relation between gastroesophageal reflux disease and dental erosion using ambulatory 24-hour esophageal pH testing. Cross-sectional observational study. Tertiary referral center. The dental group consisted of 12 patients with idiopathic dental erosion who were identified by dentists and screened for gastroesophageal reflux disease using 24-hour pH testing. The gastroenterology group consisted of 30 patients who had 24-hour pH testing in the esophageal laboratory and who were referred for dental evaluation (10 did not have reflux, 10 had distal reflux, and 10 had proximal reflux). 24-hour esophageal pH monitoring using a pH probe in the distal and proximal esophagus. Complete dental examination with particular attention to the presence and severity of dental erosion; plaque; gingival damage; and decayed, missing, and filled teeth. Analysis of saliva for pH, flow rates, buffering capacity, and calcium and phosphorus levels. Standardized questionnaire to ascertain possible causes of dental erosion and presence of reflux symptoms. Ten of the 12 patients in the dental group (83% [95% CI, 52% to 98%]) had gastroesophageal reflux on esophageal pH monitoring. Nine had distal and 7 had proximal reflux. Seven had reflux in the upright position only, 1 had reflux in the supine position only, and 2 had both upright and supine reflux. No saliva abnormalities were found. Ten patients had typical symptoms of gastroesophageal reflux, but dietary or mechanical problems that may have been causing dental erosion were not identified. In the gastroenterology group, upright reflux was seen in 5 of the 10 patients with distal reflux and in all 10 patients with proximal reflux. In addition, 40% of patients in the gastroenterology group (12 of 30) had dental erosion (4 of the 10 with distal reflux [40%], 7 of the 10 with proximal reflux [70%], and only 1 of the 10 without reflux [10%]; P = 0.02 for those with reflux compared with those without reflux). The cumulative dental erosion score correlated with proximal upright reflux when all 24 study patients with erosion were analyzed (r = 0.55 [P < 0.01]); this correlation was even stronger in the subgroup of 12 patients with abnormal amounts of proximal upright reflux (r = 0.84 [P = 0.001]). Dental erosion is a common finding in patients with gastroesophageal reflux disease and should be considered an atypical manifestation of this disease.
Article
Breath odor research has recently received increasing attention from periodontologists. Because a large portion of the adult population suffers from gingivitis and eventually periodontitis, the etiologic factor in all cases at risk must be considered. The first patient visit should, therefore, systematically include examination of the paranasal cavities and throat to avoid unnecessary time loss and frustration. Metabolic diseases and imaginary malodor should also be considered. Not only the mere presence of a chairside volatile sulfide monitor but also of that of an ear, nose, and throat specialist and eventually a psychiatrist or psychologist who determines whether a breath odor clinic merits its denomination. Volatile sulfur components are an important cause of breath malodor but they are not the sole cause. This explains why organoleptic and gas chromatographic diagnosis scores better than a portable sulfide monitor. Other than etiologic therapy, masking can be achieved for a number of hours by toothpastes containing a combination of triclosan and zinc chloride.
Article
Prevalence of gastroesophageal reflux disease (GERD) is common in the adult US population, but likely is underestimated as many patients present with symptoms other than heartburn or regurgitation. Ears, nose, throat, pulmonary, and cardiac symptoms also frequently are related to GERD. The diagnosis of GERD as a cause of these symptoms can be difficult and treatment strategies are much less clear than in patients presenting with heartburn or regurgitation. This article discusses the epidemiology, pathogenesis, diagnosis, and treatment of some of the manifestations of extraesophageal reflux disease.
Article
The cause of dental erosion may be difficult to establish because of its many presentations. Determination of the cause is an important aspect of diagnosis before extensive prosthodontic rehabilitation. This cross-sectional study evaluated the association between loss of tooth structure as a result of dental erosion and gastroesophageal reflux disease. Twenty consecutive adult dentate subjects referred to the Division of Gastroenterology for investigation of gastroesophageal tract disease were also evaluated for signs of dental erosion. All subjects underwent a dental evaluation that included a patient history to determine potential etiologic factors responsible for dental erosion. Subjects were examined clinically to quantify loss of tooth structure using a Tooth Wear Index (TWI). Endoscopic examination and 24-hour pH manometry were carried out to determine which subjects met the criteria for gastroesophageal reflux disease (GERD). Scores for maxillary versus mandibular dentition and anterior versus posterior dentition were also compared. Data were analyzed with the Kruskal-Wallis test (P =.004). Ten subjects were diagnosed with GERD and 10 subjects had manometry scores below the level indicating GERD. Overall, subjects diagnosed with GERD had significantly higher TWI scores compared with control subjects (mean difference = 0.6554; P =.004). GERD subjects had higher TWI scores in all quadrants, except in the mandibular anterior region where there was no difference. The results indicated that a relationship exists between loss of tooth structure, as measured by the TWI index, and the occurrence of GERD in this group of subjects.
Article
Nested polymerase chain reaction (PCR) was performed to detect the presence of Helicobacter pylori in tongue mucosa in 268 patients divided into four groups according to their diagnosis: 87 with atrophic glossitis, 37 with benign migratory glossitis and 144 with burning mouth syndrome (BMS). The latter group was subdivided according to anatomic site of burning sensation: subgroup A (54 patients) with complaints limited to tongue and subgroup B (90 patients) with burning sensations in other parts of oral mucosa. H. pylori was found in 43 samples (16%). Bacteria were significantly less present in tongue mucosa affected with benign migratory glossitis compared with atrophic glossitis and BMS (P=0.025). This difference was more obvious when compared with atrophic glossitis only (P=0.006). Mucosal changes in these conditions might make the oral environment more acceptable for H. pylori colonization compared with normal mucosa, and this mechanism may play a role in its oro-oral transmission.
Article
The relationship between gastrointestinal conditions and halitosis is discussed. Few reports have suggested that gastrointestinal diseases may cause halitosis. H. pylori infection, which causes gastric ulcers, is considered as a possible cause for halitosis. Intensity of malodour of mouth air was found to be higher in H. pylori-positive patients than in negative patients. The levels of hydrogen sulphide and dimethyl sulphide in mouth air were also significantly higher in the positive patients than in the negative patients (P<0.05). When odour strength in exhaled breath was compared between the two groups, no significant difference was found. Hence, H. pylori infection might not cause a systemic condition producing breath odour. Although there were no significant differences in periodontal parameters or tongue coating between the positive and negative groups, H. pylori may be a frequent contributor to the production of malodour even though its role had not been suspected before. Further study would be necessary to clarify the reason for the increase of volatile sulphur compounds (VSCs) level in H. pylori infection.
Article
BACKGROUND: The aims of this study were to investigate the frequency of halitosis before and after eradication therapy and to determine whether halitosis is a valid indication for eradication therapy in patients with Helicobacter pylori (H. pylori)-positive non-ulcer dyspepsia. METHODS: Dyspepsia, related symptoms, and halitosis were investigated by way of a questionnaire. Only H. pylori-positive patients who showed no organic lesions on endoscopic examination and no atrophy histopathologically were included. A total of 148 patients fulfilled the above criteria and completed the study. Four weeks after the end of eradication treatment, the symptoms were re-evaluated and repeat endoscopy was done to check for H. pylori in the gastric mucosa. Results: H. pylori eradication was successful in 109 patients (73.6%). Prior to treatment, bloating was the most frequent symptom (74.3%), followed by diurnal pain (62.2%) and halitosis (61.5%). The most successfully resolved symptoms in the group as a whole, regardless of eradication status, were halitosis, diurnal pain, and hunger-like pain, respectively. In the patients with confirmed H. pylori eradication, the most successfully resolved symptoms were halitosis and hunger-like pain, respectively. CONCLUSION: Halitosis is a frequent, but treatable, symptom of H. pylori-positive non-ulcer dyspepsia and may be a valid indication for eradication therapy.
Article
Acid reflux--most often associated with heartburn--may also cause a wide range of laryngopharyngeal symptoms, including laryngitis and chronic cough. Symptoms of laryngopharyngeal reflux (LPR), like those of gastrooesophageal reflux disease, result from abnormal exposure of tissues to acid refluxate. Deranged sensorimotor function of the upper oesophageal sphincter appears to play a key role in the aetiology of LPR, but the disease is not completely understood. Among the significant long-term complications of LPR are bronchopulmonary disorders, recurrent pneumonia, chronic cough, chronic or recurrent laryngitis, and oral cavity disorders. It also appears to be a risk factor for the development of laryngeal carcinoma. Diagnosis of LPR is based on physical examination, medical history, and results of specific tests. At present, the test of choice for LPR diagnosis is intraluminal oesophageal pH monitoring. Barium contrast oesophagography, intraoesophageal acid perfusion challenge, and flexible endoscopic evaluation of swallowing with sensory testing may also be used in LPR diagnosis. Treatment for LPR includes changes to the diet and lifestyle, and acid-suppressing therapy. The Therapeutic Working Party at the First Multi-Disciplinary International Symposium on Supraesophageal Complications of Gastroesophageal Reflux Disease has recommended twice-daily dosing with a proton pump inhibitor as an initial therapy for LPR, with treatment continued between 4 weeks and 6 months. Such treatment has been found highly effective in resolving symptoms of LPR, and it may also prevent the serious long-term complications of this condition.
Article
An assessment of oral symptoms and signs in patients with inflammatory bowel disease (IBD). Fifty-four patients with IBD, 34 with Crohn's disease (CD) and 20 with ulcerative colitis (UC) participated in the study. Forty-two patients without gastrointestinal disease or complaints attending the orthopedic clinic served as controls. Each patient completed a written questionnaire and was subjected to an oral examination. The main findings of this study were the higher prevalence of halitosis (50% vs 10% P < 0.0008), nausea (30% vs 7%, P < 0.017) and reflux (regurgitation) (45% vs 17%, P < 0.017) in patients with UC, and nausea (50% vs 7%, P < 0.026), dry mouth and halitosis (29% vs 10%, P < 0.026) and vomiting (41% vs 5%, P = 0.01) in patients with CD, compared with controls. Patients with active CD had a higher prevalence of dry mouth, nausea and vomiting compared with controls (46, 69 and 54% vs 10, 7 and 5%, respectively, P < 0.001) and of reflux compared with non-active CD (46% vs 5%, P < 0.001). Patients with active UC had a higher prevalence of halitosis and regurgitation (50 and 60% vs 10 and 17%, P < 0.001) compared with controls. The present study demonstrates increased frequency of oral signs and symptoms in patients with IBD. Patients with active CD had more oral signs compared with non-active CD patients. Manifestations such as nausea, vomiting, regurgitation and dry mouth may have detrimental effects on teeth and soft tissues of the oral cavity. Communication between gastroenterologists and dentists is imperative for success of the overall treatment of their patients.
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Helicobacter pylori is an important gastrointestinal pathogen associated with gastritis, peptic ulcers, and an increased risk of gastric carcinoma. The oral cavity has been indicated as a possible H. pylori reservoir, and may therefore be involved in the reinfection of the stomach which sometimes follows treatment of H. pylori infection. The objective of the present study was to evaluate the prevalence of H. pylori as detected by polymerase chain reaction (PCR) in the oral cavity of periodontitis patients testing positive for this bacterium in the stomach. Thirty adult patients with alterations of the superior digestive tract, testing urease positive after endoscopy and biopsy, were selected. A full-mouth periodontal examination was performed in every patient and the subjects were allocated to two groups: gingivitis (15 patients) and chronic periodontitis (15 patients). Plaque and saliva samples collected from each patient were stored in 0.5 ml of TE buffer. DNA was extracted from the samples by the boiling method and was evaluated for the presence of H. pylori using the PCR method. JW 22/23 primers were used. The DNA of ATCC H. pylori 43629 (positive control) and water (negative control) were used for controlling the reactions. Of the 30 evaluated patients, 13 (43.3%) harbored H. pylori in the mouth. The bacterium was not found on the dorsum of the tongue of any patient, but was found in saliva in three patients (10%), in the supragingival plaque in six patients (20%), and in the subgingival plaque in eight patients (26.6%). The presence of H. pylori was similar in the gingivitis and chronic periodontitis groups. In conclusion, a high percentage of patients harbored H. pylori in their mouth. The bacterium was detected in saliva, supragingival and subgingival plaque, suggesting that these sites may be considered reservoirs for H. pylori in urease-positive patients.
Article
It is well established that various ENT disorders and symptoms may be a manifestation of gastroesophageal reflux disease (GERD). Erosive esophagitis is considered a rare finding in ENT patients and therefore upper gastrointestinal (GI) endoscopy is not recommended in the diagnostic work-up. However, large prospective studies underscoring this policy are lacking. The aim of the present study was to investigate the prevalence and severity of esophagitis in patients with suspected GERD-related chronic ENT symptoms. Endoscopy was performed in 405 ENT patients with suspected GERD and 545 typical GERD patients. The presence of erosive esophagitis, Barrett's esophagus, hiatal hernia, peptic ulcer, and Helicobacter pylori infection on biopsies was determined and compared with the results of a symptom questionnaire. The prevalence of erosive esophagitis (52.3% vs 38.4%; p < 0.05), mainly grade 1 (31.9% vs 22.7%; p < 0.05), and of peptic ulcer (8.4% vs 4.3%; p < 0.05) was significantly higher in patients with GERD-related ENT symptoms compared to typical GERD. Barrett's mucosa occurred in, respectively, 4.9% and 4.5% of the patients (NS). Esophagitis prevalence was highest in patients with predominant cough and lowest in globus pharyngeus and throat symptoms. The presence of esophagitis was associated with significantly higher rates of symptom relief during the first 8 wk of proton pump inhibitor (PPI) therapy. Patients with suspected GERD-related ENT symptoms have a high prevalence of esophagitis and this is associated with better response to antisecretory therapy.
Article
The lymphoid follicles at the base of the tongue can be detected when examining the pharynx of adults, but the presence of large follicles, denoted "severe" hypertrophy of the base of the tongue (HBT) is rare. The objective of the present study was to identify severe HBT cases and their symptoms and to correlate them with the presence of pharyngolaryngeal signs and esophageal symptoms of gastroesophageal reflux (GER) in patients seen at a laryngology clinic. Severe HBT was considered to be present when the follicles prevented the view of the epiglottis or were massively distributed through the pharynx and larynx. Five cases of severe HBT were detected among 306 patients submitted to videolaryngoscopy over a period of 2 years, corresponding to 1.6% (5/306) of the total sample studied. However, this index markedly increases to 4% (4/101) among patients with pharyngolaryngeal signs of GER and reached 7.5% (4/53) among patients presenting GER symptoms such as heartburn, regurgitation, retrosternal burning feeling, and dysphagia. The complaints due to severe HBT were noisy respiration, hoarseness, throat clearing, dry cough, globus pharyngeus, and nasal voice. We conclude that the frequency of hypertrophied follicles is increased in the presence of signs and symptoms of GER and those HBT symptoms are confused with those of GER, except for nasal voice and noisy respiration.
Article
GERD is one of the most common gastrointestinal conditions in the general US population. ENT become more commonly recognized or suspected by physicians, although the direct association between symptoms and acid reflux has been difficult to establish. Most patients with suspected supraesophageal GERD do not have the typical symptoms of heartburn and acid regurgitation. Possible mechanisms of GERD-mediated damage to extraesophageal structures include direct-contact damage of mucosal surfaces by acid-pepsin exposure and a vagal reflex arc between the esophagus and the upper aerodigestive tract, triggered by acid reflux. Dual-channel ambulatory pH monitoring is the most sensitive and specific diagnostic test for determining transient reflux episodes, although demonstrating the presence of acid reflux alone does not prove that it is the cause of suspected GERD-related signs or symptoms. Therefore, physicians must sometimes resort to an empirical treatment strategy for both diagnosis and treatment. High-dose PPI therapy for 9 to 12 weeks is the recognized first-line therapy; operative therapy is reserved for patients who have severe complications or whose condition incompletely responds to treatment. Complete lack of response should prompt reconsideration of alternative diagnoses. Controlled, well-designed clinical trials to assess treatment and more sophisticated techniques to quantify acid reflux are needed to help determine which patients with suspected extraesophageal complications actually have GERD as the primary cause.
Article
The aim of the study was to evaluate the level of interest in fetor ex ore among respondents, patients of the Department of Conservative Dentistry in Warsaw. A questionnaire was completed by 295 patients, 202 females and 93 males aged 18-74 years (average 38.73 years). Each person was also examined for organoleptic score and volatile sulfur compounds (VSC) by Halimeter. Halitosis was diagnosed if the average level of VSC was > or =125 ppb and the organoleptic measurement using a 0-5 point scale was > or =2. Statistical analysis was performed using chi-square test. Incidence of halitosis was greatest in age ranges 25-34 years (29.68%) and 45-54 years (24.52%). Sixty-eight (43.87%) persons with diagnosed halitosis frequently reported having a problem with bad breath and only 5.81% persons with halitosis did not notice this problem (P < 0.001). Among 54 healthy persons three (5.56%) reported having a problem with halitosis (P < 0.001). A statistically significant correlation was found between clinical organoleptic diagnosis of halitosis and VSC level by halimeter. Subjective patients' opinion correlated well with objective evaluation of halitosis.
Article
The patient with extraesophageal manifestations of gastroesophageal reflux disease presents a clinical challenge. Symptom presentation overlaps with other otolaryngologic and pulmonary disease, and heartburn might be infrequent or absent. Endoscopy and pH monitoring are insensitive and therefore not useful in many patients as diagnostic modalities. Thus, antisecretory therapy is used as both a diagnostic trial and as therapy in the majority. Attention to optimizing therapy and judicious use of endoscopy and reflux monitoring are needed to minimize cost and maximize success.
Article
To assess the volatile sulfur compounds produced by three strains of Helicobacter pylori in broth cultures mixed with sulfur-containing amino acids. Halitosis has been reported in H. pylori-positive patients, and volatile sulfur compounds such as hydrogen sulfide and methyl mercaptan are known to be responsible for inducing oral malodor. Whether H. pylori produces these volatile sulfur compounds has yet to be established. Three strains of H. pylori (ATCC 43504, SS 1, DSM 4867) were cultured with 5 mM cysteine and methionine. After 72 hours of incubation, the headspace air was aspirated and injected directly into a gas chromatograph. The concentrations of hydrogen sulfide and methyl mercaptan were analyzed and compared between experimental and control cultures In broth containing 5 mM cysteine, hydrogen sulfide was increased by ATCC 43504 (P < 0.01) and SS 1 (P < 0.05), while methyl mercaptan was elevated only by SS 1 (P < 0.05). In broth containing 5 mM methionine, methyl mercaptan increases were significant for SS 1 (P < 0.05) and DSM 4867 (P < 0.05). In broth containing 5 mM cysteine and 5 mM methionine, the concentration of hydrogen sulfide was higher than in controls for all three strains (P < 0.01); that of methyl mercaptan was higher only for SS 1 (P < 0.01). Cysteine addition to cultures containing methionine increased hydrogen sulfide and methyl mercaptan for ATCC 43504 (P < 0.05) and SS 1 (P < 0.05). Conversely, addition of methionine to cultures containing cysteine increased methyl mercaptan only for DSM 4867 (P < 0.01). The production of volatile sulfur compounds by H. pylori is not only very complicated but also strain-specific. Nevertheless, H. pylori was shown to produce hydrogen sulfide and methyl mercaptan, which suggests that this microorganism can contribute to the development of halitosis.
Chronic cough due to gastroesophageal reflux
  • French Cl Curley Fj
  • Zawacki
  • Jk
  • Bennett
  • Fm
Irwin RS, French CL, Curley FJ, Zawacki JK, Bennett FM (1993). Chronic cough due to gastroesophageal reflux.