The proportion of pseudo-halitosis patients in a multidisciplinary breath malodour consultation

AIM: To report the data from a multidisciplinary bad breath consultation in Germany. MATERIALS AND METHODS: In this cross sectional study, 407 patients attending a bad breath consultation were examined by a specially trained dentist, with an ENT-specialist, an internist, and a psychologist on call. RESULTS: All patients reported suffering from bad breath but only 72.1% showed detectable signs of breath malodour. Within this group, 92.7% revealed an oral cause, 7.3% revealed an extra-oral cause. Within the group without malodour, 76.3% had received prior diagnostics and treatments from other doctors, whereby 36% had received one or more gastroscopies and 14% had undergone an ENT operation. In only ten cases had an organoleptic evaluation of the putative malodour been performed. CONCLUSION: Our data reveal that breath malodour is mainly of oral origin and that patients with pseudo-halitosis are frequently not diagnosed correctly by doctors, resulting in a considerable amount of over-treatment.     

Oral malodour and its association with age and sex in a general population in Brazil

AIM: To assess the prevalence of persistent oral malodour in a general population in Rio de Janeiro and to find out whether sex and age are risk factors for this condition. METHODS: This was a cross-sectional survey in which university students (informants) were interviewed regarding the prevalence of persistent oral malodour in their households. To estimate the effects of sex and age logistic regression models with and without random effects for the informant were applied. RESULTS: The prevalence of persistent oral malodour was 15% (95% confidence interval: 11-19). The risk of persistent malodour was nearly three times higher in men than in women, regardless of age. The risk was slightly more than three times higher in people over 20 years of age compared with those aged 20 years or under, controlling for sex. CONCLUSIONS: Oral malodour is common in Rio de Janeiro, more prevalent in men and in those over 20 years of age, in both sexes. CLINICAL RELEVANCE OF THE FINDINGS: Freedom from disabling oral malodour is an outcome indicator of social well-being. Health professionals in general, and dentists in particular, should be trained to appropriately manage and treat people who suffer from persistent oral malodour.     

The rationale and potential for the reduction of oral malodour using Streptococcus salivarius probiotics

The primary treatment for oral malodour is the reduction of bacterial populations, especially those present on the tongue, by use of a variety of antimicrobial agents or mechanical devices. However, shortly after treatment the problematic bacteria quickly repopulate the tongue and the malodour returns. In our studies, we have used a broadly-active antimicrobial (chlorhexidine) to effect temporary depletion of the oral microbiota and then have attempted to repopulate the tongue surface with Streptococcus salivarius K12, a benign commensal probiotic. The objective of this is to prevent re-establishment of non-desirable bacterial populations and thus help limit the re-occurrence of oral malodour over a prolonged period. In this paper, we discuss why contemporary probiotics are inadequate for treatment of oral malodour and examine the rationale for selection of particular bacterial species for future use in the treatment of this condition. In our preliminary trials of the use of a chlorhexidine rinse followed by strain K12 lozenges, the majority (8/13) of subjects with confirmed halitosis maintained reduced breath levels of volatile sulphur compounds for at least 2 weeks. We conclude that probiotic bacterial strains originally sourced from the indigenous oral microbiotas of healthy humans may have potential application as adjuncts for the prevention and treatment of halitosis.     

Longitudinal study on oral health of dental students at Paris VII University

Abstract This survey was conducted on young dental students, with the aim of evaluating the influence of scientific information dispensed during their studies on their own oral state and on their behavior towards it. Therefore, various parameters were considered at the very beginning of their university studies and at the end other studies. A questionnaire was used to collect information on the socioeconomic origin and oral hygiene habits of the students. In order to assess actual improvement in oral health standardized clinical examinations were utilized. The comparison of parameters measured at the beginning and at the end of the clinical studies of the students revealed that the OHI-S and the GI scores had decreased highly significantly (P < 0.01), and that the DM FT score had increased significantly (P < 0.01). The increase in the DM FT score was mainly due to a high number of fillings. The answers to the questionnaire were indicative of a favorable modification in hygiene habits. At the end of their clinical studies the students were on an average more aware of their oral health, the quality and the duration of their toothbrushing had improved, and they more often sought early treatment and preventive care than at the beginning of their studies.     

Patients' self-assessment of oral malodour and its relationship with organoleptic scores and oral conditions

Abstract: Objectives: The aim of this study was to compare patients’ self‐rating of oral malodour with organoleptic evaluation and to relate them to oral conditions. Methods: One hundred and eighty systemically healthy patients with a primary complaint of oral malodour participated in this cross‐sectional study. They were asked to complete a questionnaire regarding family and social discomfort and type of halitosis complaint, and to score the degree of their own oral malodour. The quality of the mouth air was assessed organoleptically by a calibrated odour judge. Odour‐judge scores and self‐assessments of bad breath were compared with one another as well as with clinical parameters (plaque index, bleeding index, probing depth and tongue coating score). Results: The organoleptic test revealed that 93.9% of the subjects were found actually to have halitosis. The self‐rating of oral malodour varied widely among patients. In 37.8% of patients, there was a correspondence between subjective and organoleptic measurements. The better correspondence was evident at 2–3 scores. The organoleptic ratings were significantly related to clinical parameters, whereas patients’ self‐measurements did not. The bleeding index had the highest correlation coefficient among the periodontal parameters examined (r = 0.665, P < 0.001). Conclusions: Self‐estimation of bad breath correlated well with the presence of oral malodour as determined by organoleptic examination. Patients with slight or moderate oral halitosis presented the highest correlation rate between self‐ and odour‐judge assessment.     

The analysis of oral air using selected ion flow tube mass spectrometry in persons with and without a history of oral malodour

Abstract: Objectives: Oral malodour is a common disorder predominantly caused by bacterial metabolism of food stuffs in the mouth. It is routinely diagnosed and monitored by either the subjective rating or the measurement of oral volatile sulphur compound (VSC) levels. Non‐sulphur compounds are also believed to contribute significantly to the condition although there is currently no direct means to assess their levels. In this study, we utilized selective flow tube mass spectrometry (SIFT‐MS) to measure, in real time, a range of sulphur and non‐sulphur containing compounds in oral air to determine whether the technique can be used to objectively monitor oral malodour. Methods: Oral malodour was assessed using organoleptic scores in subjects with and without a history of oral malodour (n = 18) by a trained rater, while the chemical composition of oral air was analysed by both VSC sensor and SIFT‐MS. Results: Total VSC levels were significantly correlated with levels of hydrogen sulphide and methylmercaptan measured by SIFT‐MS, but not with organoleptic scores. In subjects with elevated organoleptic score, only levels of methylmercaptan were significantly elevated. In three subjects with elevated tongue organoleptic scores but normal total VSC levels, SIFT‐MS suggested that one subject possessed high levels of oral acetone while another had high oral levels of acetic acid. Conclusions: Our data suggest that SIFT‐MS can be used to assess a wide range of compounds in oral air in addition to VSC to provide a clearer picture of the chemical nature of malodour. This may assist in the diagnosis and monitoring of the condition.     

Association between soft drink consumption,oral health and some lifestyle factors in Swedish adolescents

Objective. The aim was to investigate the relationship between soft drink consumption, oral health and some lifestyle factors in Swedish adolescents. Materials and methods. A clinical dental examination and a questionnaire concerning lifestyle factors, including drinking habits, oral hygiene, dietary consumption, physical activity and screen-viewing habits were completed. Three hundred and ninety-two individuals completed the study (13–14 years, n = 195; 18–19 years, n = 197). The material was divided into high and low carbonated soft drink consumption groups, corresponding to approximately the highest and the lowest one-third of subjects in each age group. Differences between the groups were tested by the Mann-Whitney U-test and logistic regression. Results. Intake of certain dietary items, tooth brushing, sports activities, meal patterns, screen-viewing behaviors, BMI and parents born outside Sweden differed significantly between high and low consumers in one or both of the two age groups. Dental erosion (both age groups) and DMFT/DMFS (18–19 years group) were significantly higher in the high consumption groups. Logistic regression showed predictive variables for high consumption of carbonated soft drinks to be mainly gender (male), unhealthy dietary habits, lesser physical activity, higher BMI and longer time spent in front of TV/computer. Conclusion. High soft drink consumption was related to poorer oral health and an unhealthier lifestyle.     

Diurnal changes in oral malodour among dental-office workers

PURPOSE: Dentistry is a major resource for the treatment of halitosis, therefore dental professionals must also pay attention to their own oral malodour for professional courtesy. However, oral malodour among dental professionals has not yet been investigated. In this study, the diurnal changes in oral malodour in dental-office workers were determined, and preventative measures were assessed. METHODS: Diurnal changes in the levels of volatile sulphur compounds (VSCs), which are the main cause of oral malodour, in mouth air were determined with a gas chromatograph specially designed for such analysis and the effects of several preventive measures were evaluated. RESULTS: High concentrations of VSCs in mouth air persisted during the morning and decreased after lunch. Tongue-cleaning followed by tooth brushing decreased VSCs dramatically. Further measures such as eating breakfast, drinking tea or using zinc mouthwash significantly decreased VSCs, but the effects were limited in dental hygienists who suffered from persistent oral malodour, especially in the afternoon. CONCLUSION: Eating breakfast, cleaning the tongue followed by brushing the teeth and zinc chloride mouthwash were very effective in preventing oral malodour in dental-office workers; however, the effectiveness of these preventive measures was limited in dental hygienists.     

A longitudinal study of oral health in immigrant children in Sweden

Children immigrating into Sweden from Finland and Southern Europe (Greece, Yugoslavia and Turkey) were subjected to a longitudinal study on caries activity and gingival condition. For each immigrant child a Swedish "twin" of the same sex and age was used as a control. Out of 124 pairs originally examined, 75 were reexamined after a 2 1/2-year stay in Sweden. The study showed that on arrival in Sweden the Finnish children had more caries and a higher Gingival Index (GI) than the controls and that they acquired more carious lesions during their stay in this country. Their GI, however, did not develop less favorably than that of the Swedish controls. The South-European children did not seem to have more carious lesions than the Swedish controls on arriving, nor did they seem to acquire more carious lesions during the period of observation. Their GI was higher at the first examination but the change in this index ran parallel with that of the controls. It was concluded that the children immigrating from Finland should be considered a risk group with regard to oral health.     

Oral health status and oral health behaviour of urban and rural schoolchildren in Southern Thailand

AIM: To describe the level of oral disease in urban and rural schoolchildren in Southern Thailand; to analyse self-care practices and dental visiting habits of 12-year-olds, and to assess the effect of socio-behavioural factors on dental caries experience. DESIGN: A cross sectional study of 6- and 12-year-old children, urban and rural schools chosen at random from 19 districts of one province. SETTING: Suratthani Province, Southern Thailand. PARTICIPANTS: A total of 1,156 children of grade 1 (6 yrs) and 1,116 children of grade 6 (12yrs). METHODS: Clinical recordings of dental caries and periodontal CPI scores 0, 1 or 2 according to WHO; structured interviews of 12-year-olds (n=1,084) concerning oral health behaviour and attitudes. RESULTS: At age 6, 96.3% of children had caries and mean dmft was 8.1. In 12-year-olds, 70% had caries in permanent teeth and the level of DMFT was 2.4. Experience of pain during the previous 12 months was reported by 53% of 12-year-olds, 66% saw a dentist within the previous year and 24% reported that visits were due to troubles in teeth. Toothbrushing at least once a day was claimed by 88%. Significant numbers of the children reported having hidden sugar every day: soft drinks (24%), milk with sugar (34%), and tea with sugar (26%). Important predictors of high caries experience were dental visits, consumption of sweets, ethnic group (Muslim) and sex (girls) whereas lower risk was observed in children with positive oral health attitudes. CONCLUSIONS: Systematic health education may further improve the oral health of Thai children and the primary school provides a unique setting for such programmes.     

Trimethylaminuria (fish-odour syndrome) and oral malodour

A small but important percentage of oral malodour cases have an extra-oral aetiology and certain of these fall into the category of 'blood-borne halitosis'. Odoriferous substances generated within the body and transported to the lungs via the circulatory system may, if sufficiently volatile, leave with the exhaled air and impart a foetid odour to the breath. The aliphatic tertiary amine, trimethylamine, is such a volatile compound that is generated to excess in patients with a metabolic disorder known as trimethylaminuria (fish-odour syndrome). This article highlights this condition and draws attention to its potential role in the causation of recalcitrant oral malodour.     

Effect of regular small group instruction per se on oral health status of Danish schoolchildren

A 1-year study of the isolated effect of an intensive motivation program aimed at improving the oral health status of 11-13-year-old schoolchildren was conducted in a Danish provincial town where all children have access to a free and comprehensive school oral health program. The effect was negligible as measured by epidemiologic indices.     

Effect of proper oral hygiene on gingivitis and dental caries in Swedish schoolchildren

ABSTRACT The present paper reports the effect of a 3-year study of regularly repeated professional toothcleaning on oral hygiene status, gingivitis, and dental caries. At the initiation of the study in 1971, the children were 7–8 years old (Group 1), 10–11 (Group 2) or 13–14 (Group 3). The children were divided into test and control groups. Before the study all the children were examined regarding oral hygiene, state of the gingiva and dental caries. Throughout the 3-year period the controls brushed their teeth with a 0.2 % sodium fluoride solution once a month under supervision. During the first 2 years of the trial all the children of the test groups were given professional oral prophylaxis once every second week during the school terms. During the third year the interval between consecutive prophylactic sessions was prolonged to 4 weeks in Groups 1 and 2 and to 8 weeks in Group 3. The results demonstrated that regularly repeated professional cleaning of the teeth combined with fluoride applications and toothbrushing instructions, over a 3-year period in schoolchildren resulted in the establishment and maintenance of excellent oral hygiene standards. Inflammation of the marginal gingiva almost entirely disappeared, and practically no new carious lesions developed.