The gastrointestinal aspects of halitosis

BACKGROUND:

Halitosis is a common human condition for which the exact pathophysiological mechanism is unclear. It has been attributed mainly to oral pathologies. Halitosis resulting from gastrointestinal disorders is considered to be extremely rare. However, halitosis has often been reported among the symptoms related to Helicobacter pylori infection and gastroesophageal reflux disease.

OBJECTIVE:

To retrospectively review the experience with children and young adults presenting with halitosis to a pediatric gastroenterology clinic.

METHODS:

A retrospective chart review of patients diagnosed with halitosis as a primary or secondary symptom was conducted. All endoscopies were performed by the same endoscopist.

RESULTS:

A total of 94 patients had halitosis, and of the 56 patients (59.6%) who were recently examined by a dental surgeon, pathology (eg, cavities) was found in only one (1.8%). Pathology was found in only six of 27 patients (28.7%) who were assessed by an otolaryngology surgeon. Gastrointestinal pathology was found to be very common, with halitosis present in 54 of the 94 (57.4%) patients. The pathology was noted regardless of dental or otolaryngological findings. Most pathologies, both macroscopically and microscopically, were noted in the stomach (60% non-H pylori related), followed by the duodenum and the esophagus. Fifty-two of 90 patients (57.8%) were offered a treatment based on their endoscopic findings. Of the 74 patients for whom halitosis improvement data were available, some improvement was noted in 24 patients (32.4%) and complete improvement was noted in 41 patients (55.4%).

CONCLUSIONS:

Gastrointestinal pathology was very common in patients with halitosis regardless of dental or otolaryngological findings, and most patients improved with treatment.     

硫化氢分析仪检测抗口臭牙膏功效的研究

目的用硫化氢分析仪验证抗口臭牙膏的功效;观察牙膏抗口臭的短期作用。方法选择40名自愿受试者,随机分为用含抗口臭有效成分牙膏的实验组和用无有效成分牙膏的对照组,观察2组刷牙前、后即刻和2h、4h口气值变化。结果2组刷牙后即刻口气值一过性增高,与刷牙前比较有显著性差异（P〈0．05）;刷牙后2h、4h口气值与刷牙前比较,2组均明显下降,与刷牙前比较有显著性差异（P〈0．05）;2组口气值刷牙后即刻有显著差异（P〈0．05）,其余各时段均无显著差异（P〉0．05）。结论含与不含抗口臭有效成分牙膏短时间内都有消减口臭作用,但不易区分,应延长观察时间。     

牙周炎治疗前后口腔挥发性硫化物质量浓度变化的便携式气相色谱仪检测

背景：口气中挥发性硫化物是近年来牙周病学的研究热点。目前，有关牙周治疗对挥发性硫化物3种主要成分质量浓度影响的报道较少。 目的：采用便携式气相色谱仪(OralChroma™)检测牙周炎患者口腔挥发性硫化物的质量浓度变化。 方法：采用鼻闻法评定口臭值筛选出全身健康牙周炎患者40例，应用便携式气相色谱仪(OralChroma™)测定牙周基础治疗前及治疗后1周牙周炎患者口气挥发性硫化物中3种主要成分气体(硫化氢、甲基硫醇和二甲基硫)的质量浓度。牙周治疗包括龈上洁治、龈下刮治和根面平整及牙周冲洗。 结果与结论：牙周基础治疗后患者牙周状况得到改善，口气中挥发性硫化物质量浓度显著降低(P < 0.01)，其中硫化氢、甲基硫醇的质量浓度降幅> 80%，二甲基硫质量浓度降幅>50%，硫化氢在3种气体中的质量浓度最高(P < 0.01)。牙周治疗后口臭值显著低于治疗前(P < 0.01)。提示便携式气相色谱仪能有效检测口腔挥发性硫化物的主要成分和质量浓度变化，准确反映口臭程度的改变。牙周治疗是减轻牙周炎患者口臭程度和降低口气中挥发性硫化物质量浓度的有效方法。 关键词：口臭；牙周炎；挥发性硫化物；牙周治疗；气相色谱法 doi:10.3969/j.issn.1673-8225.2010.25.023     

口臭患者舌背菌群分析

目的分析口臭患者舌背菌群多样性变化的规律。方法采集7名口臭患者和4名健康者舌苔标本，使用通用引物扩增标本中所有细菌的16SrDNA片段，测序分析并构建舌背微生物的种系进化树。结果共检测212个克隆，口臭组136个，鉴定出42种微生物（包括9种尚不能确定的微生物）；对照组76个克隆，鉴定出23种微生物（包括7种尚不能确定的微生物）。2组标本中检出率最高、检出数目最多的菌种均为链球菌；其中17种已知细菌只在口臭患者舌苔上检出，检出率最高的是叶瘤杆菌（85．7％），殊异韦荣氏菌（71．4％）和Solobacterium moorei（57．1％）。结论口臭组舌背菌群的生物多样性高于对照组。叶瘤杆菌、殊异韦荣氏菌、Solobacterium moorei可能与口臭的产生相关，需进一步研究证实。     

慢性牙周炎主要牙周致病菌和口臭的相关性分析

目的：分析慢性牙周炎主要牙周致病菌与口臭程度的相关性。方法：选取慢性牙周炎伴口臭患者43例作为研究对象,检测其主要牙周致病菌VSCs含量和OS值,并对OS值和VSCs水平与临床指标以及VSCs水平与Pg、Pi、Tf、Td进行相关分析。结果：治疗前研究组的PD、BI、CAL、OS值和VSCs水平高于对照组,治疗后研究组PD、BI、CAL、OS值和VSCs水平与治疗前相比明显降低,差异均有统计学意义（P＜0．05）。治疗后研究组OS值和VSCs水平与PD、BI、CAL呈正相关,且VSCs水平与舌背、龈下菌斑中Pg、Pi、Tf、Td也呈正相关。结论：慢性牙周炎主要牙周致病菌与口臭程度存在着高度相关性,有效降低牙周致病菌水平,可以改善口臭值。     

O.4%硫酸锌溶液对口气中挥发性硫化物浓度的影响

目的 观察0.4％硫酸锌溶液漱口前后口气中挥发性硫化物(volatile sulfur compounds,VSCs)浓度的变化,研究硫酸锌用于口臭的疗效。方法 根据相关标准筛选出口臭患者125例,随机分为3组,分别采用0.4％硫酸锌溶液、成品漱口水和蒸馏水漱口,使用口气测量仪检测各组患者漱口前和漱口后0、1、2、3 h的VSCs值。结果 漱口后0 h,3组VSCs值均有所下降,硫酸锌组与蒸馏水组差异显著(P<0.001);漱口后1、2、3 h,硫酸锌组VSCs值明显低于其他2组(P<0.001);漱口后3 h时,硫酸锌组的VSCs值仍明显低于漱口前的VSCs值(P<0.001)。结论0.4％硫酸锌溶液漱口可以在短期内有效消除口臭,可以用作口臭的辅助治疗。     

Effects of Streptococcus thermophilus on volatile sulfur compounds produced by Porphyromonas gingivalis

Halitosis as oral malodour is an unpleasant odour caused by volatile sulfur compounds (VSCs). VSCs are produced primarily by anaerobic bacteria that abundantly produce proteinase as trypsin-like enzyme. General therapies, such as mouthwash and plaque control, do not provide a continuous effect on oral halitosis. Streptococcus thermophilus is a probiotic bacterium that is beneficial for human health. The aim of this study was to evaluate the effect of S. thermophilus on Porphyromonas gingivalis-producing VSCs and to analyze the inhibitory mechanism of halitosis. P. gingivalis was cultured with or without S. thermophilus, and the emission of VSCs from the spent culture medium was measured by gas chromatography. In order to analyze the inhibitory effect, the antibacterial activity of S. thermophilus against P. gingivalis was assessed. After the spent culture medium or whole bacterial of S. thermophilus was mixed with the spent culture medium of P. gingivalis, VSCs were again measured by gas chromatograph. When S. thermophilus and P. gingivalis were co-cultivated, VSCs were present at a lower level than those of single-cultured P. gingivalis. S. thermophilus inhibited growth of P. gingivalis, and the whole bacteria and the spent culture medium of S. thermophilus reduced emission of VSCs gas. S. thermophilus may reduce oral malodour by inhibition of P. gingivalis growth and neutralizing VSCs with their metabolites or themselves.     

Oral hygiene associated with antimicrobial photodynamic therapy or lingual scraper in the reduction of halitosis after 90 days follow up: A randomized,controlled, single-blinded trial

BackgroundAlthough antimicrobial photodynamic therapy (aPDT) can reduce halitosis immediately after application, it returns after a week. This probably occurs because bacteria residing in the oral cavity may recolonize the dorsum of the tongue.ObjectiveVerify if modification of oral hygiene behavior associated with aPDT or lingual scraper can reduce halitosis after a 90-day follow-up.MethodsForty adults with positive halitosis were randomized in G1 (n = 20) -aPDT + oral hygiene behavior (OHB) or G2 (n = 20)- lingual scraper + OHB. G1 group were submitted to 0.005 % methylene blue in the middle and posterior third of the tongue, with pre-irradiation of 1 min. Irradiations were performed with red laser diode (λ =660 nm), 100 mW, 318 J/cm², 3537 mW/cm², 9 J per point at 6 points. In the G2 group, the tongue was scraped 10 times on the right side and on the left side with a tongue scraper. All patients were instructed on OHB at baseline, 7 and 90 days (guidance on the use of dental floss and the Bass technique for brushing). Halitosis was evaluated by gas chromatography (OralChroma®). Values ​​> 112 ppb for Hydrogen sulfide (H₂S) gas was considered positive halitosis. Methylmercaptanes and dimethylsulfide were also measured. The gas measures were assessed at baseline, immediately, and at 7 and 90 days. Paired t-test was used for the statistical analysis. For comparison between groups, the t-test was used. Values of p < 0.05 were considered statistically significant.ResultsThere was no difference between groups immediately after treatment (p = .1532) after 7 days (p = 0.9312) and 90 days (p = 0.6642). For the aPDT group, there was a decrease in hydrogen sulfide ​​immediately after treatment (p = 0.0001), after 7 days, values remained 3-fold smaller (p = 0.0088) and 2-fold smaller after 90 days (p = 0.0270). For the scraper group, there was a decrease immediately after treatment (p = 0.0001), the values remains 2-fold smaller ​​(p = 0.0003) after 7 days and 3 months (p = 0.0001).ConclusionThe oral hygiene behavior associated with aPDT or tongue scraper was not able to reduce halitosis after 90-day follow-up. Despite halitosis remaining ​​ higher than 112 ppb in all follow-up periods, the mean values remain 2 or 3 fold smaller than baseline values. Future studies should include other oral hygiene behavior to achieve better results in the treatment of halitosis.     

牙周炎患者牙周袋内硫化物水平与牙周临床指标的相关分析

目的评价牙周炎患者牙周袋内硫化物（pS）与口气挥发性硫化物（VSC）及牙周临床指标的相关性。方法全口洁治后1周，对20例慢性牙周炎伴口臭的患者龈下刮治和根面平整（SRP）前后用Halimeter检测口气中VSC，用金刚探针检测pS，并对牙周袋内pS及菌斑指数、出血指数、探诊深度、临床附着水平纵向观察6个月。结果口内pS〉0的位点数（r=0．592，P〈0．001）和ps值（r=0．506，P〈0．001）与口气VSC均呈显著正相关；治疗后6周、3个月、6个月，pS与出血指数呈低度相关，r值分别为0．183、0．411、0．350（P〈0．05）；SRP后6周，pS及各临床指标较基线水平显著改善（P〈0．001），并在第3、6个月时进一步改善或保持稳定。结论pS值可以特异性地反映牙周袋内硫化物的水平，可作为牙周疗效判断的客观指标，反映和监测维护期的牙周组织炎症状况。     

牙周治疗改善口臭的作用

目的 :探讨牙周基础治疗 (龈上洁治、龈下刮治和根面平整 )对于改善口臭及降低口气中挥发性硫化物 (VSCs)水平的作用 ;牙周治疗配合清除舌苔、单纯牙周治疗和单纯清除舌苔降低VSCs的比较。方法 :全身健康牙周炎患者 117例 ,鼻闻法评价口臭程度 (OR)后分成两组 ,口臭组 85例 ,无口臭组 32例。口臭测量仪 (halimeter)测量清除舌苔前后口气中VSCs水平。检查菌斑指数 (PLI)、牙周袋探诊深度 (PD)和出血指数(BI)。口臭组 46例完成牙周基础治疗后重复以上检查。结果 :清除舌苔可明显降低口气中VSCs(口臭组37% ,无口臭组 2 9% ) (P <0 .0 1) ;牙周治疗前OR为 3.1,VSCs为 462 .3μg/L ,治疗后则分别为 1.0和184.3μg/L ,两者均明显降低 (P <0 .0 1) ,其中VSCs下降了约 5 5 % ;牙周治疗后再清除舌苔VSCs为 116.4μg/L ,降低了约 72 %。方差分析显示三种方法降低口气中VSCs水平有明显差异 (P <0 .0 1) ,其中牙周治疗配合清除舌苔最显著 ,单纯牙周治疗次之 ,单纯清除舌苔最小。结论 :牙周炎和舌苔是口臭和口气中VSCs的重要来源 ,尤其是牙周炎。牙周治疗和清除舌苔是改善口臭的有效方法 ,两者结合效果更好