Comparison between self-estimated and clinical oral malodor

Abstract

Objectives. The aims were to evaluate the validity of patients' self-estimation and clinical diagnosis of oral malodor and to examine the relationship of oral malodor with oral health status. Methods. The subjects were 252 patients (mean age 43.7 ± 10.7 years) who complained of oral malodor. Oral malodor was assessed by patients' self-estimation, organoleptic test and Oral Chroma. Oral health status, including dental and periodontal conditions, oral hygiene status and flow rate of saliva, was examined. The N-benzoyl-DL-arginine-2-napthilamide (BANA) positive bacteria in tongue coating were evaluated by BANA test. A Spearman's correlation coefficient was used to test correlation between self-perceived and clinical oral malodor. The stepwise multiple regression analysis was used to assess predictors of patients' self-estimated and clinical oral malodor. Results. The percentage of patients who were diagnosed with pseudo-halitosis was 38.5%. Patients' self-estimated oral malodor was significantly correlated with organoleptic test (r = 0.61), H₂S (r = 0.50) and CH₃SH (r = 0.46). There were 47.1% of patients who estimated correctly their oral malodor's scores with those by examiner. The highest correspondence was found in patients without oral malodor (52.6%), followed by in those with moderate or strong oral malodor (46.7%) and in those with slight oral malodor (33.3%). The significant predictors of patients' self-estimated and clinical oral malodor were bleeding on probing, tongue coating, BANA test and flow rate of saliva. Conclusion. Patients' self-estimated oral malodor was found to correspond significantly with clinical oral malodor and be associated with oral health status. Current findings suggest that self-estimation can be used to judge one's own oral malodor.     

口源性口臭与牙周病的相关性

口源性口臭与牙周病之间存在密切关系,本文将从口源性口臭的病因、检测、主要成分挥发性硫化物对牙周组织的影响以及治疗等几方面进行综述。     

Assessment of newly developed tongue sulfide probe for detecting oral malodor

AIM: The present study examined the relationship between sulfide levels on tongue dorsum surfaces (pS levels) and oral malodor. METHOD: The pS levels of 20 systemically healthy volunteers were evaluated using an industrial device equipped with a newly-developed tongue sulfide probe. The pS levels on 3 parts of the tongue--anterior, middle and posterior along the median groove of the tongue dorsum--were determined for each subject. RESULTS: The device reported the pS level in a digital score ranging from 0.0 (< 10(-7) M of sulfide) to 5.0 (> or = 10(-2) M of sulfide) in increments of 0.5. Oral malodor was assessed by measuring the level of volatile sulfur compounds in mouth air, as well as by the organoleptic method. The pS levels were 0.03 +/- 0.11, 0.20 +/- 0.41 and 0.88 +/- 0.76 for the anterior, middle and posterior parts, respectively. This difference was significant (p<0.001). Both oral malodor measurements showed significant correlation (p<0.05) with the pS levels of middle and posterior parts of tongue. CONCLUSION: It was concluded that the tongue sulfide probe might be useful in management of subjects with oral malodor.     

Association between oral malodor and adult periodontitis: a review

BACKGROUND: Bad breath has a significant impact on our daily social life to those who suffer from it. The majority of bad breath originates within the oral cavity. However, it is also possible that it can come from other sources such as gastric-intestine imbalance. The term "oral malodor" is used to describe a foul or offensive odor emanating from the oral cavity, in which proteolysis, metabolic products of the desquamating cell, and bacterial putrefaction are involved. Recent evidence has demonstrated a link between oral malodor and adult periodontitis. The process of developing bad breath is similar to that noted in the progression of gingivitis/periodontitis. Oral malodor is mainly attributed to volatile sulfur compounds (VSC) such as hydrogen sulfide, methyl mercaptan and dimethyl sulfide. The primary causative microbes are gram-negative, anaerobic bacteria that are similar to the bacteria causing periodontitis. These bacteria produce the VSC by metabolizing different cells/tissues (i.e., epithelial cells, leukocytes, etc.) located in saliva, dental plaque, and gingival crevicular fluid. Tongue surface is composed of blood components, nutrients, large amounts of desquamated epithelial cells and bacteria, suggesting that it has the proteolytic and putrefactive capacity to produce VSC. One of the challenges in dealing with oral malodor is to identify a reliable test for detecting bad breath. AIMS: The purposes of this review article were: (1) to correlate the relationship between oral malodor and adult periodontitis; (2) to analyze current malodor tests and discuss available treatment regimens.     

Relationship between tongue coating and secretory-immunoglobulin A level in saliva obtained from patients complaining of oral malodor

AIM: The aim of this study was to confirm the relationships between oral malodor and periodontal condition, oral malodor and tongue coating, and to investigate the secretory-immunoglobulin A (S-IgA) level in saliva in relation to the accumulation of tongue coating. METHODS: Fifty-four patients complaining of oral malodor were included in the study. Their periodontal conditions, tongue coating status and salivary characteristics (flow rate, protein and S-IgA concentrations) were assessed in addition to the level of volatile sulfur compounds (VSC) in oral cavity. The patients were divided into three groups according to their tongue coating level. RESULTS: There are significant relationships between oral malodor and specific periodontal parameters used. The degree of tongue coating was also significantly correlated with the amount of H2S, CH3SH and the total amount of VSC determined. The concentration of S-IgA in the group identified as slight tongue coating was significantly higher than in the moderate or the severe group. By Western immunoblotting analysis, a high level of S-IgA specific to Streptococcus species was recognized in all groups, whereas the reactivity of Porphyromonas gingivalis and Fusobacterium nucleatum with S-IgA was very weak in both the slight and the moderate groups. CONCLUSION: Data herein indicate that tongue coating is closely related to oral malodor. Furthermore, S-IgA in saliva may influence the accumulation of tongue coating, and S-IgA antibodies directed to Streptococcus species may play a role in protective immunity against the initial colonization of tongue plaque.     

In vitro models for oral malodor

A model is a representation of some real phenomena and contains aspects or elements of the real system to be modeled. The model reflects (or duplicates) the type of behavior (or mechanisms) seen in the real system. The main characteristic of any model is the mapping of elements or parameters found in the system being studied (e.g. tongue dorsum biofilm in situ ) on to the model being devised (e.g. laboratory perfusion biofilm). Such parameters include correct physico-chemical (abiotic) conditions as well as biotic conditions that occur in both model and reality. The main purpose of a model is to provide information that better explains the processes observed or thought to occur in the real system. Such models can be abstract (mental, conceptual, theoretical, mathematical or computational) or 'physical', e.g. in the form of a real disaggregated in vitro system or laboratory model. A wide range of different model systems have been used in oral biofilm research. These will be briefly reviewed with special emphasis on those models that have contributed most to knowledge in breath odor research. The different model systems used in breath odor research are compared. Finally, the requirements for developing an overall 'bad breath model' from considering the processes as a whole (real oral cavity, substrates in saliva, biotransformation by tongue microflora, odor gases in the breath) and extending this to the detection of malodor by the human nose will be outlined and discussed.     

Clinical oral malodor measurement with a portable sulfide monitor

Objective:  The aim of this study was to evaluate the clinical ability of Breathtron^® by comparing it with other malodor measurement procedures: the organoleptic test (OT) and gas chromatography (GC).
Subjects and methods:  Patients were 475 patients who visited a fresh breath clinic. Oral malodor was measured with the OT, GC, and Breathtron^®. Correlation analysis and two linear regression analyses were conducted to examine the relationship of the Breathtron^® values with OT scores and volatile sulfide compound (VSC) concentrations by GC: i.e. the regression of Breathtron^® on OT and the regression of Breathtron^® on total VSCs by GC. Receiver operating characteristics (ROC) analysis was conducted to investigate the sensitivity and specificity of Breathtron^®.
Results:  The Breathtron^® values were significantly correlated with OT and VSCs by GC. In the regression analysis, predicted Breathtron^® values were 199.3 and 520.1 ppb for OT scores 1 and 2, and reasonably close to total VSCs by GC between 550 and 750 ppb. The ROC analysis demonstrated that Breathtron^® is a useful and valuable adjunct measurement tool.
Conclusions:  Breathtron^® is a simple, rapid and reliable appliance for screening oral malodor if an appropriate malodor threshold level is chosen.     

The ADA guidelines on oral malodor products

For over 130 years the ADA has been an important information source on the safety and effectiveness of dental products. The Council has recently completed the development of Acceptance Program Guidelines for products used in the management of oral malodor. The ADA Seal Program will ensure that professional and consumer dental products meet rigorous ADA criteria for safety and effectiveness     

口腔卫生指导对老年牙周患者治疗效果的影响

目的：通过对97名老年患者的跟踪调查,探讨在牙周治疗中口腔卫生指导对治疗效果的影响。方法：将97名患者随机分为两组进行对照研究,分别记录治疗后0天、3个月、6个月的菌斑指数和出血指数,并进行统计学分析。结果：重复测量设计的方差分析表明,分组、时间、分组与时间的交互作用因素对菌斑指数和出血指数的主效应均有统计学意义（P〈0.01）。两两比较的结果表明,治疗后3个月、6个月的指导组菌斑指数和出血指数均低于未指导组（P〈0.01）。结论：随着治疗后时间的增加,口腔卫生指导能够更好的维持牙周治疗的效果。     

口腔黏膜病患者牙周健康状况调查分析

目的通过流行病学调查方法了解口腔黏膜病患者牙周健康状况,为口腔黏膜病患者牙周病的预防与治疗提供依据。方法对中国医科大学附属盛京医院口腔科门诊的黏膜病患者766人进行牙周专科检查,填写调查问卷,检查结果采用SPSS 13.0软件进行统计学分析。结果口腔黏膜病患者牙周健康者只有10.70%。不同性别、年龄、学历、口腔护理情况显著影响口腔卫生及口腔健康情况;口腔黏膜病中,患者就诊率最高的是口腔溃疡(34.20%),其次为扁平苔癣(32.64%);口腔溃疡及扁平苔藓的牙周炎患病率均较高,分别是95.42%和92.80%。结论口腔黏膜病的发病与发展与牙周健康水平有着密切的相关性,应从多角度分析口腔黏膜病患者牙周健康不良原因,及牙周健康不良是否会影响口腔黏膜病变,并采取积极预防及治疗措施。     

Clinical assessment of oral malodor intensity expressed as absolute value using an electronic nose

Objectives:  In our previous study, scores determined via a multiple linear regression method (EN-MLR) involving an electronic nose provided objective halitosis-related measurements; however, this model afforded only relative expression exclusively. The objective of this investigation was to assess clinically oral malodor intensity expressed as an absolute value using an electronic nose.
Subjects and methods:  Sixty-six subjects were evaluated based on results of an actual organoleptic test (OLT), measurements of volatile sulfur compound (VSC) concentrations, a score representing malodor intensity (EN-MI) as the absolute value and EN-MLR measured with an electronic nose system. Oral health parameters were also examined.
Results:  The OLT score served as a benchmark. The area under the receiver-operating characteristic (ROC) plots of EN-MI score (0.975) was significantly larger than that of log VSC (0.896) ( P  = 0.036); however, the area did not differ significantly from that of EN-MLR score (0.932). Percentage of teeth with pocket depth ≥4 mm, tongue coating score and plaque control record displayed meaningful association with EN-MI score in multiple logistic regression analyses.
Conclusion:  Oral malodor intensity expressed as an absolute value employing an electronic nose may be a suitable method for clinical evaluation of oral malodor.     

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.     

Effects of an oral health education program targeting oral malodor prevention in Japanese senior high school students

Abstract

Objective. Previous research has suggested that oral malodor could be a useful motivational tool for increasing the awareness of oral health in adolescents and improving their oral health behaviors. Hence, the aims of this research were: (1) to develop an oral health education program that included oral malodor prevention and (2) to test the effects of the program in Japanese senior high school students by comparing the changes of oral health outcomes between the intervention and control groups. Materials and methods. Subjects were 163 Grade 1 and 135 Grade 2 senior high school students in Tokyo, Japan. A novel oral health education program, which incorporated prevention of oral malodor, was developed and conducted on all Grade 1 students (intervention group). Grade 2 students (control group) did not receive the program. Changes in oral health status from baseline to 1-year follow-up were compared between the intervention and control groups. Results. The intervention group, compared with the control group, had a significantly higher proportion of students who improved or maintained good oral health status (i.e. dental plaque, gingivitis, tongue coating and oral malodor). Among students in the intervention group, the change was more evident in subjects with detectable oral malodor at the commencement of the program. Conclusions. An oral health education program focusing on the prevention of oral malodor is effective for promoting oral health among Japanese senior high school students. Therefore, embedding such a program in the school oral health curriculum would be beneficial for adolescents.     

Association between oral malodour and periodontal disease-related parameters in a population of 71 Israelis

The aim of the present study was to determine whether oral malodour and periodontal disease parameters are associated with one another in 71 Israeli subjects (mean age 36.2 ± 18.4; ages ranging from 15 to 65). Parameters measured included whole mouth odour judge scoring, Halimeter, OK to Kiss test, gingival index, plaque index and probing depth. Odour judge scores were significantly associated with Halimeter^® ( r  = 0.55; P  < 0.001), as well as the OK to Kiss test ( r  = 0.52; P  < 0.001). However, neither gingival index, plaque index nor probing depth was significantly associated with odour judge scores or Halimeter^® scores. Logistic regression analysis showed that both Halimeter^® and OK to Kiss scores factored significantly ( P  = 0.005 and 0.018, respectively, odds ratios 14.9 and 2.7, respectively) in predicting the severity of oral malodour. Results suggest that in the population studied, periodontal health and oral malodour are not associated with one another.     

Immediate post-operative effects of different periodontal treatment modalities on oral health-related quality of life: a randomized clinical trial

AIM: Oral health-related quality of life (OHQoL) characterizes a person's perception of how oral health influences an individual's life quality. The aim of this study is to investigate how the treatment modalities may affect the immediate post-operative quality of life of patients with periodontitis. MATERIALS AND METHODS: Sixty psychologically and socio-demographically matched periodontitis patients were randomly divided into three groups [20 non-surgical (NS), 20 surgical (SG), 20 surgical plus enamel matrix protein derivative (S+EMD)]. The OHQoL was assessed with two patient-centred outcome measures [Oral Health Impact Profile-14 (OHIP-14) and General Oral Health Assessment Index (GOHAI)] in the post-operative period of 1 week. RESULTS: Whereas there were no differences of OHQoL at the baseline, the patients treated by surgery had reported that they had experienced a worse OHQoL compared with the NS and S+EMD groups both in the OHIP-14 and GOHA indexes (p=0.001). CONCLUSIONS: The results of this study clearly indicated that patient perceptions on the immediate post-operative period were significantly better in the NS and S+EMD groups when compared with the SG group. These findings need to be confirmed in further studies with larger populations.     

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目的评价口腔卫生宣教和指导在老年人牙周治疗中的作用。方法选择2008年6月至2009年6月肇庆市第一人民医院口腔科轻、中度牙周病患者100例,随机分为试验组和对照组,各50例。在牙周治疗过程中对试验组患者进行口腔卫生宣教和指导。在初诊及之后1周、3个月、6个月、1年时分别检测两组患者的菌斑指数-QT改良法(PLI-QT)和牙龈指数(GI)。结果试验组与对照组初诊时的PLI和GI指数差异无统计学意义(P>0.05);治疗后两组PLI和GI指数差异均有统计学意义(P<0.05)。试验组治疗后1周至1年的PLI和GI指数均明显低于治疗前,差异有统计学意义(P<0.05);而对照组治疗后1周和3个月的PLI和GI指数虽与治疗前比较,差异有统计学意义(P<0.05),但治疗后6个月至1年指数逐渐增长至治疗前水平。结论在口腔医疗服务中增加口腔卫生宣教和指导的内容,把口腔健康教育贯穿于老年牙周患者治疗的全过程,有助于牙周治疗效果的维护。