Production of volatile sulphur compounds in diseased periodontal pockets is significantly increased in smokers

OBJECTIVE: This study was undertaken in order to test the hypothesis that the consequences of tobacco smoking may include increased synthesis of toxic volatile sulphur compounds in diseased periodontal pockets. DESIGN: A cross-sectional, parallel study comparing groups of smokers and non-smokers with periodontitis and the level of volatile sulphur compounds in the gingival sulci of these subjects. PATIENTS AND METHODS: Levels of volatile sulphur compounds were measured in diseased periodontal sites of 12 smokers and 11 non-smokers using a portable sulphide monitor. Anaerobic and aerobic counts of the total cultivable subgingival microflora of both groups were also determined. RESULTS: The percentage of sites per subject with high levels of sulphides (> or = 10 units) detected in moderate (4-6 mm) and deep (> or = 7 mm) periodontal pockets was found to be significantly higher in smokers, compared to non-smokers (P = 0.040 and P = 0.005, respectively). No significant difference in the microbiological parameters tested were observed between the two groups. CONCLUSIONS: Increased production of volatile sulphur compounds may represent a further mechanism of increased susceptibility to periodontitis in smokers and also help to explain the reported association between smoking and halitosis.     

Comparative effects of different chlorhexidine mouth-rinse formulations on volatile sulphur compounds and salivary bacterial counts

AIM: To compare five different commercial mouth rinses with chlorhexidine (CHX) with respect to their anti-halitosis effect and anti-microbial activity on salivary bacterial counts, following a standardised research protocol. And secondly, to validate the study model proposed in the evaluation of patients suffering from halitosis. PATIENTS AND METHODS: Ten volunteers, with a healthy oral status, were enrolled in a double-blind, cross-over design, using sterile saline as negative control and five CHX-containing mouth rinses: 0.12% CHX alone (CHX+NO), plus alcohol (CHX+ALC), plus 0.05% cetylpiridinium chloride (CHX+CPC), plus sodium fluoride (CHX+NaF), and 0.05% CHX plus 0.05% CPC, plus 0.14% zinc lactate (CHX+Zn). The levels of whole-mouth volatile sulphur compounds (VSCs) were measured by means of a sulphide monitor at baseline, 1 and 5 h after rinsing with the assigned product. Baseline measurements also included an organoleptic assessment and the recording of the tongue-coating index. Aerobic and anaerobic salivary bacterial counts were also obtained by collecting unstimulated saliva samples at the same evaluation times, and processed by culturing techniques. Analysis of variance was used to evaluate whether significant differences existed among groups, at each evaluation point, or in changes between evaluations. RESULTS: No significant differences were detected at baseline, with VSC levels ranging between 190 and 227 parts per billion (p.p.b.) After rinsing, VSC levels were reduced with all products (except saline), after 1 h. Significant differences at 1 h were detected (p=0.04), corresponding to a lower amount of p.p.b. (109) in (CHX+Zn) as compared with the other groups (except CHX+NO). At 5 h, VSC levels were lower for CHX+CPC and CHX+Zn (155 and 169, respectively), while the other groups showed levels higher than 220 p.p.b. With respect to aerobic salivary bacterial counts, CHX+CPC demonstrated the lowest percentage of survival (6% after 1 h and 18% after 5 h). For anaerobic bacterial counts, again CHX+CPC demonstrated the lowest percentage of survival (10% at 1 h and 23% at 5 h), together with CHX+ALC (18% of survival at 5 h). However, salivary counts and VSCs were only significantly correlated at baseline, but not after treatment. CONCLUSION: Important differences can be expected from different CHX formulations, in relation to both their anti-halitosis effect and anti-microbial activity in saliva. Formulations that combine CHX and CPC achieved the best results, and a formulation combining CHX with NaF resulted in the poorest.     

The levels of volatile sulfur compounds in mouth air from patients with chronic periodontitis

Background and Objective: Volatile sulfur compounds may be the main source of oral malodor. The aim of this study was to clarify the relationship between periodontal parameters and volatile sulfur compounds and to evaluate the improvement of several halitosis‐related outcomes by tongue scraping, nonsurgical periodontal treatment (including oral hygiene instruction) and oral hygiene instruction/chlorhexidine + cetyl pyridinium gargling. Material and Methods: Seventy‐two chronic periodontitis patients with heavy tongue coating were assessed for oral malodor and periodontal status. Oral malodor was evaluated by measuring the levels of volatile sulfur compounds using OralChroma? and the organoleptic test score. Thirty participants were selected for the subsequent experiments: tongue scraping; nonsurgical periodontal treatment; and oral hygiene instruction/chlorhexidine + cetyl pyridinium gargling. Twenty‐five participants completed all experimental stages. Results: Significant correlations were observed between the organoleptic test score and hydrogen sulfide (H₂S), methyl mercapton (CH₃SH), tongue coating score and volatile sulfur compounds, which was also significantly correlated with bleeding on probing percentage and tongue coating score. Tongue scraping significantly reduced the levels of volatile sulfur compounds. Further reduction of volatile sulfur compounds after nonsurgical periodontal treatment and oral hygiene instruction/chlorhexidine + cetyl pyridinium gargling were noted compared with baseline. Conclusion: Volatile sulfur compounds, with H₂S and CH₃SH as the main components, in mouth air are the prominent elements of malodor. Volatile sulfur compounds were decreased by more than 50% after tongue scraping. Nonsurgical periodontal treatment and oral hygiene instruction/chlorhexidine + cetyl pyridinium gargling maintained a significantly lower level of malodor compared with baseline.     

牙周袋内挥发性硫化物与牙周炎症程度的关系

目的初步探讨牙周袋内挥发性硫化物与侵袭性牙周炎(aggressive periodontitis,AgP)和慢性牙周炎(chronic periodontitis,CP)炎症程度的关系。方法用金刚牙周探针诊断仪检查探诊深度、附着丧失、探诊出血等临床指标的同时,检测牙周袋内硫化物水平。共检查15例AgP和16例CP患者870个患牙的5 220个位点。结果无论是AgP还是CP患者,硫化物阳性位点的各项临床指标均明显高于阴性位点(P<0.001);硫化物水平与各项临床指标间都有明显的正相关关系(P<0.001);中、深袋组的硫化物水平和阳性位点率均明显高于浅袋位点(P<0.001);有附着丧失位点的硫化物水平和阳性位点率均高于无附着丧失位点,在浅袋组其差异有显著性。结论牙周袋内挥发性硫化物的检测可以反映侵袭性牙周炎和慢性牙周炎患者的牙周炎症程度。     

Is transmission of bacteria that cause halitosis from pets to humans possible?

Objective:  Bacteria that cause halitosis naturally colonize the animal's mouth. The possibility of transmission of these bacteria from pets to human is an intriguing question. Therefore, the possible correlation between halitosis and regular contact of dental patients with pet animals was the aim of the presented study.
Materials and methods:  The study covered 84 patients suffering from halitosis and 40 healthy controls aged 20–62 years. Each person completed a questionnaire and was then examined for organoleptic score, volatile sulphur compounds (VSC) and evaluation of low molecular mass amines in saliva by a ninhydrin colorimetric reaction. Halitosis was diagnosed if the average level of VSC was 125 ppb and the organoleptic measurement using a 0–5 point scale was 2. Statistical analysis was performed using Wilcoxon's and chi-square tests.
Results:  The results showed that among the halitosis group over 80% of patients had reported having pets in childhood and over 70% owned a pet at present. In the control group results are 47 and 40%, respectively. Analysis showed a significant correlation between frequency of halitosis and regular contact with pets at present ( P  < 0.001) or in childhood ( P  < 0.001).
Conclusion:  Pets (dogs, cats) owned in childhood or at present may transmit bacteria that cause halitosis.     

Insoluble zinc, cupric and tin pyrophosphates inhibit the formation of volatile sulphur compounds

Oral malodour is mainly a result of the production of volatile sulphur compounds (VSC). The present study was concerned with investigating the anti-VSC effect of insoluble pyrophosphates (PP) of zinc, copper(II) and tin(II). The hypothesis to be tested was that the sulphide anions produced when VSC are solubilized in water have a higher affinity for the respective metal ions than the PP anion. The anti-VSC effects of insoluble PP were compared with the corresponding soluble metal salts using three in vitro methods: saliva putrefaction; dialysis of a suspension of PP and saliva against water; and analysis of water containing hydrogen sulphide and methyl mercaptan gases, and gases in the headspace. The levels of VSC were analysed by gas chromatography in the first and third methods, and released metal ions were analysed by atomic absorption spectroscopy in the second. The results showed that: the insoluble metal PP inhibited VSC formation in saliva by 99-100%; under dialysis, only minute amounts of metal ions are released from the combination of PP and saliva; and the PP lost their metal cations in water containing dissolved gases and inhibited VSC formation. Hence, the results support the experimental hypothesis. Sulphide ions are obviously very strong ligands for these metal ions.     

Inhibitory effect of Weissella cibaria isolates on the production of volatile sulphur compounds

AIMS: The objective of this study was to characterize the inhibitory effects of Weissella cibaria isolates on volatile sulphur compounds (VSC) production both in vitro and in vivo. MATERIAL AND METHODS: We isolated and identified three hydrogen peroxide-generating lactobacilli from children's saliva, and assessed their inhibitory effects on VSC production and Fusobacterium nucleatum proliferation. Clinical studies were conducted with 46 subjects in order to measure the VSC of their mouth air. RESULTS: These lactobacilli were identified as W. cibaria. These isolates inhibited the production of VSC by F. nucleatum (p<0.05). The concentration of F. nucleatum was decreased by 5-log cycles as a result of exposure to the W. cibaria strains (p<0.05), whereas the catalase-treated W. cibaria cultures exerted no evident inhibitory effects on F. nucleatum replication. In the clinical studies, gargling with one isolate resulted in a significant reduction in the levels of H2S and CH3SH by approximately 48.2% (p<0.01) and 59.4% (p<0.05), respectively. CONCLUSIONS: These results indicate that W. cibaria isolates possess the ability to inhibit VSC production under both in vitro and in vivo conditions, demonstrating that they bear the potential for development into novel probiotics for use in the oral cavity.     

Short‐term effect of strontium‐ and zinc‐containing toothpastes and mouthrinses on volatile sulphur compounds in morning breath: a randomized,double‐blind,cross‐over clinical study

Zinc (Zn) reduces the formation of volatile sulphur compounds (VSCs) associated with oral malodour. Although strontium (Sr) is included in some products for reducing dental hypersensitivity, it may also have anti‐halitosis properties. This randomized, double‐blind, cross‐over clinical study compared the anti‐VSC effect of brushing with commercial toothpastes and rinses containing Zn and Sr. The volunteers (n = 30) either brushed/rinsed with/without tongue brushing using Zn‐containing toothpaste/rinse, Sr‐containing toothpaste/rinse, or placebo (control). Volatile sulphur compounds [hydrogen sulphide (H₂S) and methyl mercaptan (CH₃SH)] were measured, in morning breath, using gas chromatography. The anti‐VSC effects of the test toothpastes and test rinses were significantly better than the anti‐VSC effects of the respective controls. Toothbrushing with test toothpastes gave median reductions, compared with the control, of 70% for H₂S and 55–57% for CH₃SH. Rinsing with the Sr‐ and Zn‐containing solutions had the same anti‐VSC effect as toothbrushing and tooth‐ and tongue brushing with the Sr‐ and Zn‐containing toothpastes. Zinc‐containing rinse resulted in a significantly higher median salivary level of Zn compared with brushing with Zn‐containing toothpaste, although this effect did not correlate with the anti‐VSC effect. It can be concluded that the Sr‐ and Zn‐containing toothpastes and the Zn‐ and Sr‐containing rinses, when used in the evening, are equally effective in reducing morning‐breath VSCs the following day.     

Genuine halitosis in patients with dental and laryngological etiologies of mouth odor: severity and role of oral hygiene behaviors

The aims of the study were to determine the severity of halitosis and the association between oral hygiene practices and the severity of malodor in patients with dental and laryngological etiologies of genuine halitosis. Thirty‐five laryngological and 40 dental patients with halitosis completed a structured interview and underwent laryngological and dental examinations. Halitosis was assessed using organoleptic and halimeter tests. Greater halitosis severity in laryngological patients was associated with worse clinical status of the palatine tonsils, less frequent toothbrushing, less frequent use of tongue cleaners, fewer daily meals, and increased use of mouthrinses. Among dental patients, more severe halitosis was associated with worse clinical status of the periodontium, more tongue coating, less saliva secretion, and less frequent use of dental floss, interdental toothbrushes, and tongue cleaners. Oral hygiene was found to be a key moderator of the relationship between status of the periodontium or tonsils and severity of halitosis. The severity of halitosis in laryngological patients and dental patients is essentially similar; however, oral hygiene routines are associated with different effects in each group. Consequently, individual recommendations for patients with halitosis should be adjusted for the underlying disease and emphasize the role of effective specific hygiene behaviors.