Stimulated and unstimulated saliva progesterone in menopausal women with oral dryness feeling

The aim of this study was to investigate the stimulated and unstimulated salivary progesterone in menopausal women with oral dryness (OD) feeling. A case–control study was carried out on 70 selected menopausal women aged 42–78 years with or without OD feeling (35 as cases with xerostomia and 35 as control without xerostomia), conducted at the Clinic of Oral Medicine, Tehran University of Medical Sciences (TUMS). Unstimulated and paraffin-stimulated saliva samples were obtained by expectoration. The salivary concentration of progesterone was determined with an enzyme immunoassay kit. Statistical analysis of the Student's t test was used. The mean stimulated and unstimulated whole saliva progesterone concentrations and unstimulated saliva flow, but not stimulated saliva flow rate, was significantly lower in the case than in the control. The results showed that subjects with dry mouth had decreased unstimulated saliva flow and salivary progesterone compared with those without dry mouth. Thus, salivary progesterone level appears associated with OD feeling in menopause.     

Relationship of unstimulated saliva cortisol level with severity of oral dryness feeling in menopausal women

Background: Menopause may be associated with some adverse changes, such as oral dryness (OD) feeling. The exact mechanisms that mediate sensation of OD in menopausal women have not been firmly established. The purpose of this study was to assess the relationship of unstimulated whole saliva cortisol level with severity of OD feeling in menopausal women. Methods: A case control study was carried out on 70 selected menopausal women with/without OD feeling, conducted at the Clinic of Oral Medicine, Tehran University of Medical Sciences, Iran. The xerostomia inventory (XI) score was used as an index of OD feeling severity. Unstimulated whole saliva cortisol concentration was measured by ELISA. Statistical analysis of student’s t‐test and Spearman correlation was used. Results: The mean cortisol concentration of saliva was significantly higher in women with OD feeling than the control. There was significant positive correlation between the XI score and the concentration of unstimulated whole saliva cortisol (r = 0.559, p = 0.025). Conclusions: Unstimulated whole saliva cortisol is higher in menopausal women with OD feeling than in controls and this correlates with the severity of OD.     

Influence of oral health and lifestyle on oral malodour

Objective: To assess the influence of oral health and lifestyle on the prevalence of oral malodour among university students. Materials and methods: Self‐administered questionnaires. Chi‐square test was used to detect any significant association between malodour and various variables. Results: 9% of males and 6% of females complained of malodour, while 36% of males and 31% of females did not complain of malodour. Nevertheless, 12% of the males and 6% of females were unable to decide. The highest percentage of respondents not complaining of malodour were non‐smokers (55%). A significant number of respondents were free from caries (48%), gingival disease (55%) and also were not complaining of malodour. Statistically, a significant association was found between malodour and gingival disease (p < 0.05) and between malodour and the use of a toothbrush on a daily basis (p < 0.001). Conclusions: The results highlight the influence of oral self‐care and lifestyle on malodour. Public awareness, diagnosis and treatment of malodour are primarily the responsibility of dentists. Malodour can have a distressing effect and the affected person may avoid socialising.     

Clinical reliability of non-organoleptic oral malodour measurements

Aim: Measurement of volatile sulphur compounds (VSC) by portable sulphur monitors (Halimeter^®, OralChroma^™) is a common practice for diagnosis of oral malodour. In this study, the clinical value of these devices was examined.
Materials and Methods: Two hundred and eighty patients with bad breath complaints attending a halitosis consultation were enrolled. Organoleptic scores were given by a trained and calibrated judge, before measurement of the VSC levels (Halimeter^®, OralChroma^™), to avoid any bias.
Results: Significant correlations were found between the organoleptic assessment, the Halimeter^®, and the OralChroma^™ ( R =0.74 for organoleptic versus Halimeter^®; 0.66 for organoleptic versus OralChroma^™; 0.63 for Halimeter^® versus OralChroma^™). The sensitivity and specificity (with regard to the organoleptic score) to detect patients with/without oral malodour for the Halimeter^® were 63% and 98%, respectively, and for the OralChroma^™ 69% and 100% when using the cutoffs suggested by the manufacturer. By lowering these values, sensitivity could be improved without a significant decrease in specificity (both devices).
Conclusions: We concluded that the measurement of the VSC levels can be used as an adjunct to the organoleptic assessment. Thresholds should be revisited in order to improve their clinical utility. These devices can prove the absence of malodour in case of pseudo-halitosis.     

Modelling oral malodour in a longitudinal study

The aim of this study was to develop an in vitro model of the tongue microflora in order to assess anti-malodour compounds before clinical evaluation. Biofilms, derived from the tongue microflora, were grown in a constant depth film fermentor (CDFF) with nutrients supplied in the form of mucin- and serum-containing artificial saliva. Differential agars and a halimeter were used to determine the bacterial microflora and production of volatile sulphur compounds (VSCs), respectively. The resulting biofilms had a bacterial population which contained, on average, 29% streptococci, 48% Gram-negative anaerobes and 2.5% with an H2S-producing phenotype. When the biofilms were pulsed with either chlorhexidine or zinc acetate there was a reduction in the number of H2S-producing bacteria, however these counts subsequently recovered as pulsing continued. The generation of VSCs was correlated to the viable counts of the H2S-producing bacteria. By pulsing with anti-malodour compounds over time we observed a reduction in the quantity of VSCs produced and a change in the composition of the plaque to one which contained fewer H2S-producing bacteria.     

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.     

The relationship between alcohol consumption and oral malodour

Objective : To analyse the relationship between alcohol consumption and oral malodour. Subjects : 235 individuals, aged 46.5 ± 15.3 years (mean ± SD), who complained of oral malodour. Methods : An organoleptic test (OLT) was used to estimate the degree of oral malodour, gas chromatography was used to measure volatile sulphur compounds (VSCs), and a questionnaire was used to gather data about the subjects' habits related to alcohol consumption. Results : Of the 55 individuals who consumed alcohol daily, 17 (30.9%) had strong malodour (OLT score, 4), and there were significant differences among the ‘daily,’ ‘sometimes,’ and ‘no alcohol’ groups (Kruskal‐Wallis test, p < 0.01). The daily group also had a higher VSC concentration than the ‘sometimes’ and ‘no alcohol’ groups (t‐test, p < 0.05), and there was no difference in the VSC concentration among the subjects with strong malodour. Analyses of the relationships between drinking habits and the clinical factors causing oral malodour revealed that daily drinking was positively associated with a probing pocket depth ≥ 5mm (χ² test, p < 0.01). Conclusion : This study found an association between daily alcohol consumption and strong malodour, especially related to periodontal disease.     

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.     

Detection and measurement of oral malodour in periodontitis patients.

BACKGROUND & OBJECTIVES: Malodour has been correlated with the concentration of volatile sulphur compounds produced in the oral cavity by metabolic activity of bacteria colonizing the periodontal sites and the dorsum of the tongue. The aim of this study was to detect malodour in mouth air organoleptically and using a portable sulphide monitor and to correlate it with the clinical parameters, halitosis linked toxins and BANA, using tongue and subgingival plaque samples. The halitosis grading is also correlated with the microbial colonies of the subgingival plaque sample. METHODS: 20 patients with chronic periodontitis with 5-7 mm pocket depth, radiographic evidence of bone loss and presence of oral malodour participated in this study. Assessment of mouth air was done organoleptically and by using a portable sulphide monitor. The clinical parameter, plaque index (PI), gingival index (GI), gingival bleeding index (BI), were obtained from all the areas. Samples for BANA and to detect halitosis linked toxins were taken from the dorsal surface of the tongue and periodontal pockets ranging 5-7 mm. Halitosis related microbial colonies were identified using anaerobic culturing from the subgingival plaque. RESULTS: The scores of PI, GI, BI and sample that tested positive for halitosis linked toxins and with the halitosis grading were not significant. The presence of tongue coating and the halitosis grading and toxin levels were significant. BANA has shown to be non contributory due to technical problems. Anaerobic culture has shown to identify Streptococcus, Bacteroides, Fusobacterium, Porphyromonas and Prevotella colonies. INTERPRETATION & CONCLUSION: The results confirmed that there was no correlation between the clinical parameters, halitosis linked toxins and halitosis grading. The microbial colonies have shown to correlate with the presence of oral malodour.     

Clinical oral dryness score: evaluation of a new screening method for oral dryness

The purpose of this study was to explore the association of the clinical oral dryness score (CODS) with salivary flow rates, xerostomia inventory (XI), and bother index (BI). 147 patients were screened using CODS, which determined 10 features of oral dryness. Each feature contributed 1 point, and the total score varied from 0 to 10. Unstimulated (UWS), chewing-stimulated (CH-SWS) and acid-stimulated (A-SWS) whole salivary flows and the XI and BI were measured. Associations were explored with a bootstrapped Spearman rank correlation test (1000 × bootstrapping). Based on unstimulated salivary flow, 55 patients were classified as hyposalivators, 31 as low salivators, 48 as normosalivators and 13 as high salivators. Median CODS in the hyposalivation group was 5 (IQR 3–6) compared with 3 (IQR 2–5) in the low salivation group, 2 (IQR 1–4) in the normal salivation group and 2 (IQR 1–2.5) in the high salivation group. Significant associations between CODS and the other parameters were only found in the hyposalivation group between CODS and UWS (ρ(53) = ? 0.513; p < 0.01), between CODS and CH-SWS (ρ(53) = ? 0.453; p < 0.01), between CODS and A-SWS (ρ(53) = ? 0.500; p < 0.01), CODS and XI (ρ(53) = 0.343; p < 0.001) and between CODS and BI (ρ(53) = 0.375; p = 0.01). In patients with hyposalivation, CODS is associated with unstimulated and stimulated salivary flow and XI and BI. CODS alone or a combination of CODS with a subjective measure, such as the XI or BI, could be recommended during routine clinical assessment to detect hyposalivation.     

Review of the treatment strategies for oral malodour

Breath malodour, a significant social and/or psychological handicap, may be caused by several intra- and extraoral factors. Malodour of intraoral origin is the result of microbial putrefaction, during which volatile sulphur compounds (VSC) and other volatile compounds are produced. The treatment of oral malodour can therefore be focused on the reduction of the intraoral bacterial load and/or the conversion of VSC to nonvolatile substrates. This article outlines the efficacy and mechanisms of different antimalodour approaches. Most approaches were found to be inefficient and/or short lasting. The most successful treatment involves mechanical debridement (including toothbrushing, flossing, and tongue cleaning), possibly combined with the use of an antimicrobial mouthrinse.     

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.     

Association between oral malodour and periodontal disease-related parameters in the general population

Abstract

Aim. To determine the association between halitosis detection and periodontal status in systemically healthy non-smokers and to assess whether halitosis was related to quantities of Fusobacterium nucleatum and Porphyromonas gingivalis on the tongue dorsum. Methods. Periodontal examinations, tongue coating determination, Halimeter® readings and organoleptic assessments of mouth odour were performed in 28 chronic periodontitis patients, 23 chronic gingivitis patients and 27 healthy individuals. The quantities of P. gingivalis and F. nucleatum were determined in tongue specimens by real-time PCR. Results. Halitosis was more likely to be detected in patients with periodontitis (OR = 9.2) and gingivitis (OR = 4.6) than in healthy subjects. The posterior tongue odour was similar for all groups; had the highest score of all organoleptic assessments and was significantly correlated with Halimeter® scores and the odour of the whole mouth air. Periodontitis patients harboured significantly greater amounts of P. gingivalis on their tongue, yet similar quantities of F. nucleatum compared to gingivitis patients and healthy subjects. The amount of P. gingivalis residing on the tongue dorsum of periodontitis patients was significantly associated with halitosis recordings, while the amount of F. nucleatum was related to tongue coating in healthy controls, which corroborates its role in biofilm formation. Conclusions. Patients with periodontal disease were at higher risk for halitosis detection than healthy individuals. The posterior portion of the tongue dorsum seems to be an important source of odourous compounds, regardless of periodontal condition. P. gingivalis residing on the tongue of periodontitis patients may play a key role in oral malodour production.     

Use of synthetic saliva in dryness of the mouth in prosthetic stomatology]

A model experiment has been performed to investigate the possibilities of improving the adhesion of dentures. The best results were obtained with a synthetic saliva which, due to its medicamentous side-effect, might be indicated in case of hyposalivation.     

Role of saliva,salivary glands and epidermal growth factor (EGF) on oral wound healing

Saliva perform a number of biologic functions that are instrumental in maintaining oral health. Those are: lubrication, remineralization, buffering, antimicrobial protection, cleansing and maintenance of mucosal integrity. Saliva provides a natural reservoir of growth factors. By far the most highly characterized growth factor is EGF. Animal and human studies suggest that EGF plays a fundamental role in systemic and oral wound healing. This brief review is designed not to discuss all effects of EGF in detail but to highlight the basic principles of growth factors' action and their role in oral health.     

The association of periodontal disease with oral malodour in a Japanese population

Oral Diseases (2010) 16 , 702–706 Aim: The purpose of this study was to evaluate the association between oral malodour and periodontal disease, and to determine the effect of periodontal therapy on oral malodour. Materials and Methods: Oral malodour parameters, including volatile sulphur compound (VCS) measurement, methyl mercaptan/hydrogen sulphide ratio by gas chromatography, organoleptic testing, tongue coating score, and periodontal parameters were evaluated in 823 patients complaining of oral malodour. Amongst these patients, 89 with oral pathogenic halitosis received tongue cleaning and periodontal therapy. Oral malodour and periodontal parameters were measured at baseline and after treatment. Results: Amongst 823 patients, 102 were diagnosed with gingivitis and 721 with periodontitis. VCS levels and periodontal parameters increased according to the severity of oral malodour. Organoleptic testing significantly correlated with periodontal probing depth and a percentage of periodontal pocket depth ≥4 mm (r = 0.40 and 0.39 respectively). There were significant correlations between methyl mercaptan/hydrogen sulphide ratio and periodontal parameters. Significant decrease in oral malodour and periodontal parameters in 89 patients with oral pathogenic halitosis was also observed after periodontal treatment. Conclusions: Oral malodour is associated with periodontal disease, and periodontal therapy combined with tongue cleaning is beneficial for oral pathogenic halitosis.