P3 The analysis of characteristics of the elderly people with high VSC level

The purpose of the present study was to evaluate the extent of self-reported bad breath in an Israeli population of young army recruits and to assess its relationship with other self-reported parameters, as well as general dental status. Self-reported parameters included smoking status, bad taste, gingival bleeding and the presence of tonsilloliths. The study comprised 426 young adults recruits (ages 18–19), almost all males (95%), all of whom agreed to answer a questionnaire. All participants underwent a dental screening and were divided into three groups regarding to their dental status (do not need treatment, need moderate treatment, need extensive treatment). Statistical analysis included Pearson's chi square test of association using BMDP statistical software. Among the recruits, 142 (33 %) were active smokers. Thirty-five participants (8.2%) reported bad breath as well as bad taste. Twenty-seven (6.3%) reported being told that they had bad breath. Tonsilloliths were reported by 31 participants (7.3%) and gingival bleeding by 80 (18.8%). Self-reported bad breath was positively associated with bad taste, gingival bleeding, the presence of tonsilloliths and general dental status ( P  < 0.05). The study indicates that self reports of bad breath are associated by objective factors (e.g. dental status, tonsilloliths) as well as subjective parameters (bad taste). To our knowledge this is the first report indicating that one young adult in thirteen may suffer from tonsilloliths.     

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。     

Breath odor evaluation by detection of volatile sulfur compounds – correlation with organoleptic odor ratings

Background:  Detection of oral volatile sulfur compounds (VSC) by gas chromatography (GC) is a widely used method for evaluating breath odor. Air aspirated from the mouth is injected into the GC column for analysis. To eliminate discrepancies caused by variations in operator sampling or injection techniques, a new GC system designed to aspirate breath samples directly into the GC was developed.
Objective:  A clinical study was performed to compare this new automated breath-sampling GC system to organoleptic evaluation by two trained odor judges.
Methods:  A randomized, two-cell, double-blind, parallel design was used in which subjects were tested before and 3 h after using either a mouthrinse containing zinc or a matching placebo rinse. Thirteen subjects used the zinc mouthrinse, and 12 used the placebo. Subjects with a wide range of VSC levels were studied. The average organoleptic ratings for each subject at each time-point were compared with the average VSC measurements made with the GC, and Pearson product–moment correlation coefficients between the corresponding GC and organoleptic measurements were determined.
Results:  The correlation between the GC and organoleptic assessment methods were highly significant ( P  ≤ 0.001) for: total VSC, 0.65; H₂S, 0.63; CH₃SH, 0.61; and (CH₃)₂S, 0.46. The correlation between the two judges was also highly significant (0.823, P  < 0.001).
Conclusion:  These results demonstrate the utility of the automated GC method for evaluating breath odor.     

A longitudinal study of quality of life of elderly with mandibular implant-supported fixed prostheses

Objectives: To verify the consequences of implant-supported fixed oral rehabilitation on the quality of life (QL) of elderly individuals.
Material and methods: Fifteen patients were studied, being 10 females and five males; all were aged >60 years, were completely edentulous, wore removable dentures on both arches, and were treated with implant-supported fixed dentures. Three QL questionnaires were applied, two related to the oral conditions (Oral Impact on Daily Performance – OIDP – and Oral Health Impact Profile, short version – OHIP-14) and one dealing with global aspects (World Health Organization Quality of Life – WHOQOL-BREF), before 3, 6, and 18 months after surgical placement of implants.
Results: Scores in the OIDP and OHIP-14 questionnaires were better after dental treatment. The WHOQOL-BREF was less sensitive, confirming the higher reliability of specific questionnaires (focal) compared with general questions in such situations.
Conclusion: Treatment with implant-supported fixed prostheses improved QL in the elderly; these effects are better detected by specific instruments focused on the subject.     

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.     

The impact of oral disease among the institutionalized and non-institutionalized elderly in Hong Kong

The study aimed to describe and compare the psychosocial and functional impact of oral disease on the quality of life of the institutionalized and non-institutionalized elderly in Hong Kong. A total of 268 institutionalized and 318 non-institutionalized elderly aged 60-80 years took part. The 49-statement Oral Health Impact Profile (OHIP) was administered in a structured interview format and sociodemographic information collected prior to a clinical, oral examination. A greater number of the institutionalized were edentulous (19%); they also had more untreated dental disease. The number of elderly reporting negative impacts was generally low. The percentage of institutionalized elderly reporting a negative impact was significantly lower in one of the OHIP subscales (handicap, P < 0.001) and similar in the other six. The main factors affecting the OHIP score were living location, socio-economic status, dental disease and treatment seeking behaviour. In conclusion, the psychosocial and functional impact of oral conditions was low and similar in the institutionalized and non-institutionalized elderly although the pattern of oral disease was different. Life events and socially and culturally derived values appeared to affect the elderly perception of the impact of oral disease.     

老年口腔健康评价指数(GOHAI)中文版的信度考评

目的:考评老年口腔健康评价指数GOHAI中文版的信度。方法:按照国际生存质量评价(IQOLA)项目的标准程序,对GOHAI进行翻译、回译和文化调适,建立GOHAI中文版;使用GOHAI中文版和一般项目表对随机抽取的60岁及以上老年人进行口腔健康生存质量调查,调查结果经统计分析,考评量表的内部一致性信度和重测信度。结果:共有343位老年人接受调查。有效问卷312份,数据缺失问卷28份。GO-HAI中文版内部一致性Cronbach′sα系数为0.81,分半信度系数0.80,条目-量表相关系数在0.25~0.71之间;重测相关系数为0.866(P<0.01)。结论:GOHAI中文版具有良好的信度。     

成都市社区中老年人口腔健康相关生活质量评价及其影响因素分析

目的　了解成都市社区中老年人的口腔健康相关生活质量状况并分析影响因素。方法　随机抽取成都市600名社区中老年人调查,收集人口社会学特征、全身健康状况、口腔健康行为等信息,使用口腔健康影响程度量表（OHIP-14）评估口腔健康相关生活质量。结果　中老年人的口腔健康相关生活质量得分为（3.91±6.67）分,回归分析显示,收入水平（OR=0.387,P<0.05）、患慢性病（OR=0.665,P<0.05）、患口腔疾病（OR=0.260,P<0.05）、自评心理健康状况（OR=0.338,P<0.05）、每天刷牙2次（OR=1.846,P<0.05）、吸烟（OR=0.566,P<0.05）、主动获取口腔健康知识（OR=2.431,P<0.05）、就医方便程度（OR=0.499,P<0.05）是影响因素。结论　口腔健康相关生活质量受多重因素影响,积极开展社区口腔综合干预措施,提高居民口腔健康行为,改善社区中老年人口腔健康相关生活质量。     

Dental status, xerostomia and the oral health-related quality of life of an elderly institutionalized population

The author examined the relative effects of tooth loss and xerostomia on the oral health-related quality of life of an elderly, medically compromised population, living in a long-term care setting. Data were collected from 225 subjects (mean age: 83 years) via a questionnaire and review of dental charts. Oral health-related quality of life was assessed using self-ratings, satisfaction ratings, an index of chewing capacity, the GOHAI, and OH1P-14. Almost all participants had one or more chronic medical conditions and were taking prescribed medications. Two-thirds of the study group was dentulous with a mean number of 16 remaining teeth. One-third of the participants had scores on a xerostomia index indicating marked oral dryness. In bivariate and multivariate analyses, xerostomia index scores were significantly associated with all oral health-related quality of life outcomes. Dental status was associated with chewing capacity only. The results suggest that xerostomia has an important influence on the well-being and quality of life of this population.     

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目的    分析辽宁省老年人群口腔健康状况,为制定适合于辽宁省老年人群的口腔预防保健规划提供基础资料。方法    2005年9月至2006年9月采用多阶段分层等容量随机抽样的方法,从沈阳市、锦州市、瓦房店市和辽中县、义县、灯塔地区分别随机抽取132名65～74岁长住居民作为调查对象,男女各半,共792人。所有调查对象均进行根面龋的口腔临床检查。再随机抽取50%的老年人进行口腔相关行为的问卷调查,采取面对面询问并记录的方式,回收有效问卷396份,并对问卷调查数据进行统计分析。结果    辽宁省65～74岁年龄组受调查者中,患根面龋148人,患龋率为18.69%,龋均为0.36,根面龋充填率仅为2.7%。辽宁省65～74岁年龄组城市老年人群根面龋的患病率为19.95%,龋均为0.40;农村地区的根面龋患病率为17.42%,龋均为0.32。二者间患龋率和龋均差异均无统计学意义（P > 0.05）。城市老年人根面龋的充填率为1.27%,农村地区为4.35%,差异亦无统计学意义（P > 0.05）。受调查者中男性根面龋的患病率为16.67%,龋均为0.34;女性根面龋患病率为20.71%,龋均为0.39。男、女间患龋率和龋均差异无统计学意义（P > 0.05）。男性根面龋的充填率为1.52%,女性为3.66%,差异亦无统计学意义（P > 0.05）。回归分析显示,吸烟情况（β =-1.58）、含糖食品摄入量（β =0.46）、刷牙频率（β =0.53）、牙膏种类选择（β =0.37）、看牙费用支付途径（β =0.67）这5种因素对于辽宁省老年人群根面龋的发生都有显著影响（P < 0.05）。结论    目前辽宁省口腔卫生保健工作仍存在许多缺陷和不足之处,根面龋还没有引起人们的足够重视。     

口腔癌患者术后生存质量评价及影响因素分析

目的：评价口腔癌患者术后的生存质量（quality of life,QOL）,并探讨影响无瘤生存者术后QOL的可能因素。方法：采用SF-36及UW-QOL测量55例口腔癌患者术前和术后12个月的QOL,采用SPSS12.0软件包对数据进行统计学分析。结果：①复发患者术后的QOL显著低于无瘤生存者。②与术前相比,术后12个月时,无瘤生存者仍存在较严重的治疗相关的特异性问题和较差的社会功能状况。③文化程度、婚姻状况、共病、缺损范围及放疗影响无瘤生存者术后QOL,初、高级文化程度、配偶健在、不伴有共病、缺损最大径〈6cm及术后未放疗的患者,术后QOL较高。④不同的颈清扫术式对无瘤生存者手术前后QOL总分的差值没有影响,但副神经保留组术后的肩功能明显优于副神经切除组。结论：保留副神经可改善颈清扫患者的肩功能;降低复发率、加强慢性病的预防及控制、改进放疗手段、增加社会支持及必要的康复指导和治疗可提高口腔癌患者术后的QOL。     

Induction and inhibition of oral malodor

Volatile sulfur compounds (VSCs) such as hydrogen sulfide (H₂S) and methyl mercaptan (CH₃SH) are the main components of oral malodor, and are produced as the end products of the proteolytic processes of oral microorganisms. The main pathway of proteolysis is the metabolism of sulfur‐containing amino acids by gram‐negative anaerobic bacteria. Gram‐positive bacteria may promote VSC production by gram‐negative anaerobes by cleaving sugar chains from glycoproteins and thus providing proteins. A large variety of bacteria within the oral microbiota are thought to be involved in the complex phenomenon of halitosis. Oral microbiota associated with a lack of oral malodor, oral microbiota associated with severe and H₂S‐dominant oral malodor, and oral microbiota associated with severe and CH₃SH‐dominant oral malodor have been distinguished through molecular approaches using the 16S rRNA gene. Pathological halitosis may primarily be addressed through treatment of causative diseases. In all cases, plaque control is the basis of oral malodor control, and dentifrices, mouthwashes, and functional foods play a supplementary role in addition to brushing. Recently, the use of natural ingredients in products tends to be favored due to the increase in antibiotic‐resistant strains and the side effects of some chemical ingredients. In addition, probiotics and vaccines are expected to offer new strategies for improving the oral conditions through mechanisms other than antibacterial agents.     

A German version of the GOHAI

Abstract – Objectives: Translation, reliability analysis and validation of a German version of the Geriatric/General Oral Health Assessment Index (GOHAI) was the aim of this study. Methods: Translation was performed by a forward–backward process. Validity was assessed as convergent validity in comparison with another self‐perceived assessment of oral health (OHIP‐14) and as group validity (n = 218; mean age 73 years). Reliability was proved in terms of internal consistency, inter‐item and item‐scale correlations, and stability (test–retest procedure; n = 36; mean age 77 years). The responsiveness to change in oral health status was assessed by pre‐ and post‐treatment comparison (n = 21; mean age 63 years). Results: A German version of the GOHAI is presented. Convergent validity was sufficient (r = ?0.76 compared with OHIP‐14); group validity could be demonstrated for self‐perceived need for treatment, chewing problems, number of own teeth, caries lesions present and dental status. The internal consistency was high (Cronbach's alpha = 0.92) as were inter‐item and item‐scale correlations, for which good homogeneity of the index was apparent. The test–retest correlation for the summary score was r = 0.84, single item correlations ranged from r = 0.36 to r = 0.89. The GOHAI sum score increased significantly after patients received new dentures, indicating responsiveness of the GOHAI to clinical change in the expected direction. Conclusions: The German version of the GOHAI had sufficient reliability, validity and responsiveness to be used as measure of oral health‐related quality of life in cross‐sectional and longitudinal studies of the elderly.     

Comparison of the GOHAI and OHIP-14 as measures of the oral health-related quality of life of the elderly

OBJECTIVES: This paper compares the performance of the GOHAI and the OHIP-14 as measures of the oral health-related quality of life of the compromised elderly. METHODS: Data were obtained from a cross-sectional survey of 225 participants, most of whom lived in a large geriatric care centre. RESULTS: The mean age of subjects was 83 years and the majority had one or more chronic medical conditions and physical disabilities. Their main oral problems were high rates of tooth loss and xerostomia. Additive and simple count methods were used to derive GOHAI and OHIP-14 scores. Using the additive method, 8.4% had a GOHAI score of zero and 30.3% an OHIP-14 score of zero. Using the simple count method the percentage with a score of zero was 15.1% and 45.8%. Both measures discriminated between dentate subjects with and without one or more dentures, with and without a chewing problem and with and without dry mouth. Both also showed significant associations with self-rated oral health and satisfaction with oral health status. Associations tended to be stronger between GOHAI scores and these variables. The measures were equally good at predicting overall psychological well-being and life satisfaction. Although the GOHAI identified more oral functional and psychosocial impacts than the OHIP-14, neither was markedly superior to the other when used as discriminatory measures. However, the high prevalence of subjects with zero scores may compromise the ability of the OHIP-14 to detect within-subject change.     

The clinical comparison of a triclosan/copolymer/fluoride dentifrice vs a breath-freshening dentifrice in reducing breath odor overnight: a crossover study

Objective: The objective of this randomized, crossover study was to compare the effectiveness of the triclosan/copolymer/sodium fluoride (TCF‐AF) dentifrice and a commercially available breath‐freshening dentifrice containing fluoride for their ability to reduce volatile sulfur compounds (VSC) associated with oral malodor overnight. Methods: Following a 1‐week washout period of brushing with a regular fluoride dentifrice, subjects reported to the clinical site without performing oral hygiene, eating or drinking in preparation for baseline breath sampling. Subjects were randomly assigned a test dentifrice and instructed to brush their teeth for 1 min, twice a day for 1 week. On the morning of day 8, subjects returned to the test site, having refrained from oral hygiene, eating and drinking, for overnight sampling. Following a second 1‐week washout period, subjects repeated the same regimen, but now using the other test product. At each measurement, the level of breath VSC was evaluated using a gas chromatograph equipped with a flame photometric detector. Measurements were taken in duplicate, and then averaged. The levels of VSC were expressed as parts per billion (ppb) in mouth air. Results: At baseline, the mean breath VSC levels for the TCF‐AF and breath‐freshening dentifrice were 618 and 581 ppb respectively. There was no statistically significant difference between the baseline levels. Overnight, the TCF‐AF and the breath‐freshening dentifrice reduced breath mean VSC levels to 267 and 521 ppb respectively. This gave a 56.7 and 10.2% reduction in VSC levels for these two products, respectively, compared with baseline. The reduction for the TCF‐AF dentifrice was significantly different (P < 0.05%) from that of the breath‐freshening dentifrice. Conclusion: The results of this randomized, double‐blind, crossover study indicate that the TCF‐AF dentifrice was significantly more effective than a commercially available breath‐freshening dentifrice containing fluoride in reducing breath VSC associated with bad breath overnight.     

97例口腔癌患者术前生存质量的初步评价

目的:描述口腔癌患者术前的生存质量(quality of life,QOL)状况;分析社会人口学特点、临床特点对术前QOL的影响.方法:采用36条目简明健康状况调查问卷(SF-36)中文版和华盛顿大学生存质量问卷(UW-QOL)第4版,对97例口腔鳞癌患者术前的QOL进行测量.将97例患者分别按社会人口学特点和临床特点分组.组间差异采用SPSS12.0软件包进行Mann-Whitney U检验.将癌症患者SF-36的得分与普通人群参考值进行独立样本t检验.结果:①与普通人群配伍组比较,高龄患者有着相似的QOL值,而低龄患者则在躯体角色、身体疼痛和情感角色等领域表现出较低的QOL值;②T分期是影响术前QOL的最重要因素;③社会人口学特点如性别、年龄和共病等对QOL的影响主要体现在活力、躯体功能、躯体角色、情绪等反映身体状况和心理状况的指标上,而与口腔相关的特异性问题(口干除外)基本无关.而临床特点如肿瘤分期和部位对QOL的影响则不仅表现在与口腔相关的多项特异性问题上,如咀嚼、吞咽、发音、味觉等,还与身体疼痛、躯体角色、情感角色等反映身体状况和心理状况的指标密切相关.结论:与普通人群参考值进行比较.能更精确地反映口腔癌患者的QOL信息;临床特点对术前QOL的影响大于社会人口学特点;将普适性测量与头颈特异性量表结合,能更全面地评价口腔癌患者的QOL.联合使用UW-QOL和SF-36能较好地达到这一目的.     

Pilot study of a breath test for volatile organic compounds associated with oral malodor: evidence for the role of oxidative stress

Background:  We performed a pilot study of a new method to identify the volatile organic compounds (VOCs) in breath associated with oral malodor, using gas chromatography and mass spectroscopy (GC/MS).
Methods:  Oral cavity breath was collected from seven patients with oral malodor. Breath samples (150 ml) were concentrated onto sorbent traps and analyzed by GC/MS.
Results:  Organoleptic scores ranged from 3.0 to 4.0 (mean = 3.3) on a scale of 0–5. Twenty-four of 30 (80.0%) of the most abundant oral malodor volatile organic compounds (OMVOCs) were alkanes and methylated alkanes. These VOCs are products of oxidative stress, generated by lipid peroxidation of polyunsaturated fatty acids in cell membranes.
Conclusions:  Increased oxidative stress in the oral cavity of patients with oral malodor may account for the increased risk of atherosclerosis, coronary heart disease and stroke associated with periodontal disease. The breath test for OMVOCs could potentially provide an objective new test for the assessment of oral malodor.