Halitosis: a conceptual, etiologic and therapeutic approach / Halitose: uma abordagem conceitual, etiológica e terapêutica

Objective: Halitosis is the offensive odor emanated by the oral and nasal cavities and perceived by the individual and/or by other people. Halitosis is a symptom that directly impacts on the social aspects of an individual's life and may be a sign for a systemic disorder in some cases. Material and Methods: A search was conducted on the literature in order to gather the main aspects about halitosis and make a review about the main features necessary to the clinical practice when a professional deals with a patient with halitosis. Results: The information was summarized and discussed with a focus on what clinicians should be aware of when dealing with a patient with halitosis. Conclusion: Halitosis is a prevalent symptom that affects approximately 25% of the individuals. Its classification takes into consideration the origin of the compounds producing the malodor. The diagnosis must take into consideration the various etiological possibilities before defining the treatment. The treatment must be focused on the cause and since there is a wide range of possible causes, halitosis needs a multidisciplinary approach (AU)

Objetivo: Halitose é um cheiro ofensivo expelido pela cavidade bucal e pela cavidade nasal e percebido pelo indivíduo e/ou pelas outras pessoas. A halitose é um sintoma que impacta diretamente aspectos sociais da vida de um indivíduo e pode ser um sinal de alguma desordem sistêmica em alguns casos. Material e Métodos: Uma busca foi feita na literatura para reunir os principais aspectos da halitose e conduzir uma revisão sobre as principais características necessárias à prática clínica quando um profissional lida com um paciente com a queixa de halitose. Resultados: A informação disponível foi sumarizada e discutida com foco naquilo que um clínico deve estar atento quando lida com um paciente com a queixa de halitose presente. Conclusão: A halitose é um sintoma prevalente que afeta aproximadamente 25% dos indivíduos. Sua classificação leva em consideração a origem dos compostos que produzem o mau hálito. O diagnóstico deve levar em conta as várias etiologias possíveis antes de definir um tratamento. O tratamento deve ser focado na causa e, como há uma ampla variedade de possíveis causas, a halitose é um sintoma que precisa de uma abordagem multidisciplina (AU)

Antimicrobial activity of violacein against oral bacteria associated with halitosis: an in vitro study

Introduction: violacein is a natural purple pigment produced by environmental bacteria that presents antimicrobial activity, particularly against Gram-positive bacteria. Intraoral halitosis (IOH) is a condition defined by the unpleasant odor emanating from the mouth, whose main source are volatile sulfur compounds, produced by Gram-negative oral bacteria on the tongue coating. In IOH treatment, antimicrobials have been indicated as chemical adjuncts, including natural products. Objective: thus, this study tested the antimicrobial activity of a violacein extract on key IOH-related bacteria (Porphyromonas gingivalis, Porphyromonas endodontalis, Fusobacterium nucleatum, Prevotella intermedia, Solobacterium moorei). Materials and Methods: bacteria were cultured in fastidious anaerobe blood agar in anaerobiosis, and 109 cells/ml suspensions were plated. Crude extract of violacein obtained from Chromobacterium violaceum was diluted in a 25% ethanol aqueous solution to 8, 4, 2, 1, 0.5 and 0.25 mg/ml. Using the disk agar diffusion method, 10 µl aliquots of each dilution were deposited on the seeded plates. Chlorohexidine (0.1%) and 25% ethanol solution were used as controls. Plates were incubated in anaerobiosis at 37°C for 72h, and the inhibition halos were recorded. Results: although chlorhexidine showed higher inhibition halos than the violacein extract, most species were inhibited at 4 and 8 mg/ml concentrations (p<0.05). P. gingivalis followed by F. nucleatum were the most affected species in relation to the other bacteria, although statistical significance was only reached for P. gingivalis (p<0.05). Conclusion: crude violacein extract from C. violaceum demonstrated antimicrobial activity against IOH-associated oral bacteria, being a potential antimicrobial to be studied as an adjunct in the control of IOH.

Introdução: a violaceína é um pigmento roxo natural produzido por bactérias ambientais que apresenta ação antimicrobiana, particularmente contra bactérias Gram-positivas. A halitose intraoral (HIO) é uma condição definida pelo odor desagradável que emana da boca, cuja principal fonte são os compostos sulfurados voláteis produzidos por bactérias Gram-negativas da saburra lingual. No tratamento da HIO, antimicrobianos têm sido indicados como adjuvantes, incluindo produtos naturais. Objetivo: assim, este estudo avaliou o potencial antimicrobiano de um extrato de violaceína em patógenos-chave da HIO (Porphyromonas gingivalis, Porphyromonas endodontalis, Fusobacterium nucleatum, Prevotella intermedia, Solobacterium moorei). Materiais e Métodos: bactérias foram cultivadas em meio ágar sangue para fastidiosos, em anaerobiose, e suspensões de 109 células/ml foram semeadas. O extrato bruto de violaceína obtido de Chromobacterium violaceum foi diluído em solução aquosa com 25% de etanol nas concentrações de 8, 4, 2, 1, 0,5 e 0,25 mg/ml. Através do método de disco difusão, 10 µl de cada diluição foram depositados nas placas semeadas. A clorexidina (0,1%) e a solução etanólica a 25% foram usadas como controles. As placas foram incubadas em anaerobiose a 37°C por 72h, e os halos de inibição foram registrados. Resultados: embora a clorexidina tenha apresentado os maiores halos de inibição do do que o extrato, a maioria das espécies foi inibida nas concentrações de 4 e 8 mg/ml (p<0,05). P. gingivalis e F. nucleatum foram as espécies mais afetadas em relação às outras bactérias, porém só foi observada significância estatística para P. gingivalis (p<0,05). Conclusão: o extrato bruto de violaceína de C. violaceum demonstrou atividade antimicrobiana contra bactérias orais associadas a HIO, sendo um potencial antimicrobiano a ser estudado como adjuvante no controle da HIO.

Association between Volatile Sulfur Compounds Prevotella intermedia and Matrix Metalloproteinase-8 Expression

Abstract Objective: To determine the correlation between levels of methyl mercaptan (CH3SH) hydrogen sulfide (H2S), the proportion of Prevotella intermedia (Pi), and matrix metalloproteinase-8 (MMP-8) gene expression levels in periodontitis patients accompanied by halitosis. Material and Methods: Samples were obtained from gingival crevicular fluid (GCF) in the deepest pocket and by swabbing in the tongue coating area in patients with periodontitis presenting with halitosis (n = 23) and healthy subjects as controls (n = 7). The values of CH3SH and H2S were obtained using Oral Chroma. The proportion of Pi and MMP-8 expression levels were evaluated using PCR-RT. All the result was statistically analyzed using SPSS software. Results: The levels of CH3SH and H2S in participants with PD ≥ 6 mm showed a robust negative correlation with the proportion of P. intermedia in GCF and tongue coating. No statistically significant association was detected between CH3SH and H2S levels and MMP-8 expression levels (p>0.05). Conclusion: There is no association between CH3SH and H2S levels, the proportion of P. intermedia, and MMP-8 expression in patients with periodontitis accompanied by halitosis (AU).

Are stress and symptoms of depression associated with halitosis? A cross-sectional study

Mood disorders such as stress and depression can promote alterations of several hormones Aim: The present study aimed to evaluate if symptoms of depression and stress are associated with halitosis. The hypothesis is that halitosis is associated with stress and depression symptoms. Methods: All university students' entrants in the Federal University of Pelotas (UFPel) were invited to participate. Self-reported halitosis was measured using a visual analog scale. Students were also asked about the presence of halitosis perceived by close individuals. The stress level was measured using a modified version of the Perceived Stress Scale and symptoms of depression were screened by Patient Health Questionnaire-2. Poisson Regression Models were performed. Results: Of a total of 2,058 students who participated in the study, only 16% of them have reported not having any degree of halitosis and 17.6% were informed of closed individuals having halitosis. After adjustments, stress and depression symptoms remained associated with halitosis selfreported. Individuals from the higher stressed quartile presented higher scores of halitosis (RR 1.37 CI95% [1.24­1.53]). Students who presented depressive symptoms showed higher scores of self-perceived halitosis (RR 1.20 CI95% [1.10­1.32]). When the association of stress and halitosis reported by close individuals was tested, symptoms of depression lost the association in the adjusted model, while individuals from the highest quartile from stress remained associated (PR 1.36 CI95% [1.02­1.81]). Conclusion: Halitosis was associated with stress even after control for oral health and socioeconomic variables

Association between bariatric surgery and oral health: a literature review

Objective: to review the literature on the relationship between oral health and bariatric surgery in obese individuals. Methods: articles published until March 2021 were searched in the Medline/PubMed, LILACS, BBO, and Web of Science databases. The search used a combination of descriptors related to the words: obesity, bariatric surgery, and oral health. Results: one hundred thirty-five studies were identified in the database search. Of these, 47 were included in this review. The oral changes investigated in the literature for individuals who underwent bariatric surgery were dental caries, tooth wear/erosion, hypersensitivity, periodontal disease, hyposalivation, halitosis, and changes in mastication and oral soft tissue. The evaluated articles showed methodological controversy regarding the study design, follow-up period, sample size, and assessed clinical parameters, which complicated the comparison of studies. Final considerations: there is no consensus in the literature regarding the relationship between oral health and bariatric surgery in obese individuals. Further prospective cohort studies should be conducted to investigate this association better.(AU)

Objetivo: revisar a literatura sobre a relação entre saúde bucal e cirurgia bariátrica em indivíduos obesos. Métodos: foi realizada uma busca de estudos publicados até março de 2021 nas bases de dados Medline/PubMed, LILACS, BBO e Web of Science. Foi utilizada uma combinação de descritores relacionada às palavras: obesidade, cirurgia bariátrica e saúde bucal. Resultados: foram identificados 135 estudos nas bases de dados pesquisadas. Desses, 47 estudos foram incluídos nesta revisão. As alterações bucais investigadas em indivíduos que realizaram cirurgia bariátrica apresentadas na literatura foram: cárie dentária, desgaste dentário/erosão dentária, hipersensibilidade, doença periodontal, hipossalivação, halitose, alterações da função mastigatória e alterações no tecido mole bucal. Os estudos avaliados mostraram controvérsia metodológica em relação a: tipo de desenho de estudo, tempo de seguimento, tamanho da amostra e parâmetros clínicos avaliados, fato que dificultou comparar os estudos. Considerações finais: não há consenso na literatura sobre a relação entre saúde bucal e cirurgia bariátrica em indivíduos obesos. Mais estudos de coorte prospectivos devem ser realizados para estudar melhor essa associação.(AU)

Avaliação in vivo da halitose e sensibilidade ao toque em pacientes que recebem prótese sobre implante / In vivo evaluation of halitosis and touch sensitivity in patients receiving implant prostheses

Com a implantodontia, muitos problemas relacionados aos tratamentos reabilitadores puderem ser solucionados. Quando um paciente perde um elemento dentário, remove-se terminações nervosas que diminuem a função táctil naquela região. A halitose é um fator comum em próteses sobre implantes, devido a maior dificuldade de higienização. O objetivo do presente estudo foi avaliar a sensibilidade e halitose de 48 pacientes (n=48), em quatro grupos distintos: Grupo 1 (próteses fixas unitárias); Grupo 2 (próteses fixas múltiplas); Grupo 3 (prótese tipo overdenture); Grupo 4 (próteses fixas do tipo protocolo). A aferição da halitose nos pacientes será por meio de um halímetro (FitScan Breath Checker ­ Tanita, Japan) e a função somatossensorial nos tecidos moles periimplantares através do teste psicofísico de sensação de toque leve (LTS) utilizando monofilamentos de von frey (Aesthesio® - Exacta). Foram realizadas as mensurações em 4 períodos distintos: no momento da colocação dos cicatrizadores (T1), 30 dias após a instalação dos cicatrizadores (T2), no momento da instalação da prótese (T3) e 30 dias após a instalação da prótese (T4). Após os dados coletados, foi realizada análise estatística e comparativa entre os grupos. Foi possível observar que a interação entre os fatores tempo, condição e tipo de prótese interferiram de forma significativa nos valores médios da sensação ao toque utilizando monofilamentos de von frey (P = 0,001). Foi possível verificar que houve associação entre o nível de halitose e o tempo de análise para o uso de prótese protocolo e para prótese overdenture. Porém, o mesmo não ocorreu para prótese unitária ou múltipla esplintada. No grupo protocolo (P = 0,002) e no grupo overdenture (P = 0,002), a contagem que apresentou achado estatisticamente significativo foi odor forte ou intenso no momento da reabertura e 30 dias após a instalação da prótese. Quanto à sensibilidade ao toque, todos os grupos obtiveram resultados significativos do aumento da sensibilidade ao toque durante e após a instalação da prótese se comparados ao inicial(AU)

With implant dentistry, many problems related to rehabilitative treatments can be solved. When a patient loses a tooth element, nerve endings that decrease tactile function in that region are removed. Halitosis is a common factor in implant prostheses, due to greater difficulty in cleaning. The aim of the present study was to evaluate the sensitivity and halitosis of 48 patients (n = 48), in four distinct groups: Group 1 (unitary fixed prostheses); Group 2 (multiple fixed prostheses); Group 3 (overdenture type prosthesis); Group 4 (fixed protocol type prostheses). The measurement of halitosis in patients will be through a Halimeter (FitScan Breath Checker - Tanita, Japan) and the so-matosensory function in peri-implant soft tissues through the psychophysical test of light touch (LTS) using von frey monofilaments (Aesthesio ® - Exact). Measurements were taken in 4 different periods: at the time of placement of the healers (T1), 30 days after the installation of the healers (T2), at the time of installation of the prosthesis (T3) and 30 days after the installation of the prosthesis (T4) . After the collected data, a statistical and comparative analysis was performed between the groups. It was possible to observe that an interaction between the factors time, condition and type of prosthesis significantly interfered in the mean values of the sensation to touch using von frey monofilaments (P = 0.001). It was possible to verify that there was an association between the level of halitosis and the analysis time for the use of protocol prosthesis and for overdenture prosthesis. However, the same did not occur for single or multiple splinted prostheses. Without group protocol (P = 0.002) and without group overdenture (P = 0.002), the count that presented a statistically significant finding was strong or intense odor at the time of reopening and 30 days after prosthesis installation. As for sensitivity to touch, all groups obtained results obtained from increased sensitivity to touch during and after installation of the prosthesis compared to the initial one(AU)

Etiologia e fatores associados à halitose: uma revisão integrativa da literatura / Etiology and factors associated with halitosis: an integrative literature review

Objetivo: avaliar quais as possíveis causas e quais são os fatores associados ao surgimento da halitose. Métodos: foi realizada uma revisão nos bancos de dados PubMed e SciELO, utilizando os descritores e sinônimos MeSH organizados em lógica booleana: 'Halitosis' AND 'Risk Factors' OR 'Association' OR 'Etiologies', com as seguintes etapas: identificação dos artigos, triagem, elegibilidade e inclusão. Apenas artigos publicados entre os anos de 2015-2020, ensaios clínicos randomizados, estudos transversais ou de coorte foram incluídos na revisão. Foram excluídos protocolos de estudos e os artigos que não estavam nos critérios e objetivo desta revisão. Resultados: de 240 artigos encontrados, 22 foram inclusos. Desses, 50% demonstraram que a falta ou a deficiência dos hábitos de higiene oral se relacionam com a halitose. Ainda, 40,9% deles se referem à saburra lingual como um forte fator etiológico e 36,4% demonstram que a doença periodontal está diretamente associada com o mau hálito. Além disso, em relação a outras condições locais e sistêmicas, xerostomia (13,6%), doença gastrointestinal e refluxo laringofaríngeo (9,1%), rinite e diabetes (4,5%) também demonstraram associação. Considerações finais: a halitose pode estar associada com higiene bucal, saburra lingual, doença periodontal, alguns hábitos e quadros sistêmicos.(AU)

Objective: to evaluate the possible causes and what are the factors associated with the onset of halitosis. Methods: a review was performed in the PubMed and SciELO databases, using the descriptors and synonyms MeSH organized in Boolean logic: 'Halitosis' AND 'Risk Factors' OR 'Association' OR 'Etiologies', with the following steps: identification of articles, screening, eligibility and inclusion. Only articles published between 2015- 2020; randomized clinical trials; cross-sectional or cohort studies were included in the review. Study protocols and articles that were not in the criteria and objective of this review were excluded. Results: Of 240 articles found, 22 were included. Of those, 50% showed that the lack or deficiency of oral hygiene habits are related to halitosis. Furthermore, 40.9% of them refer to tongue coating as a strong etiological factor and 36.4% demonstrate that periodontal disease is directly associated with bad breath. Moreover, in relation to other local and systemic conditions, xerostomia (13.6%), gastrointestinal disease and laryngeal reflux (9.1%), rhinitis and diabetes (4.5%) also demonstrated an association. Final considerations: Halitosis may be associated with oral hygiene, lingualcoating, periodontal disease, some habits and systemic conditions.(AU)

Halitosis: Principios básicos sobre su origen y tratamiento Revisión narrativa / Halitosis: Basic Principles About its Origin and Treatment Narrative Review

RESUMEN Halitosis es la presencia de un olor desagradable que emana de la cavidad oral. La etiología de este mal olor es multifactorial, existiendo causas no orales, orales y extraorales. Los compuestos volátiles sulfurados (CVS): sulfuro de hidrógeno y metilmercaptano son los elementos prominentes del mal olor. Intraoralmente, existe una correlación significativa entre las concentraciones de CVS y bacterias periodontopatogénicas. En pacientes sin enfermedad periodontal el mal olor se origina principalmente de la cobertura del dorso de la lengua por lo que la limpieza o raspado de ésta es un método efectivo para prevenir o disminuir la halitosis. Existen múltiples opciones químicas para el abordaje del mal aliento que dependerán del origen y grado de severidad. Este artículo revisa el origen y los tratamientos tanto mecánicos como químicos que se tienen disponibles.

ABSTRACT Halitosis is the presence of an unpleasant smell that emanates from the oral cavity. The etiology of halitosis is multifactorial, existing non oral, oral and extraoral causes. The volatile sulphur compounds (VSC): hydrogen sulfide and methyl mercaptan are the prominent elements of malodour. Intraorally there is a significant correlation between VSC concentrations and periodontopathogenic bacteria. In patients with no gum disease the halitosis is originated mainly in the dorsal surface of the tongue, so cleaning or brushing it is an effective method to prevent or decrease halitosis. There are multiple chemical options for the treatment of the malodour that will depend on the origin and severity of it. This article reviews the origin and mechanical and chemical treatments that are available.

Validation of the Brazilian version of the Halitosis Associated Life-Quality Test (HALT)

Abstract The present study aimed to validate (cross-culturally adapt and test psychometric properties) the Brazilian version of the Halitosis Associated Life-Quality Test (HALT). A process of translation and cross-cultural adaptation was conducted by a group of dental researchers. The first draft of the Brazilian Portuguese version was pre-tested on a sample of 33 individuals leading up to the final version of the questionnaire. The Brazilian version of the HALT (B-HALT) was applied to 100 individuals with halitosis (organoleptic score ≥ 2) and 100 individuals without halitosis (organoleptic score < 2). Exploratory factor analysis (EFA) was performed to evaluate the dimensionality of B-HALT. Cronbach's alpha (α) and interclass correlation coefficient (ICC) were used to measure its reliability. For convergent validity, Spearman's correlation was conducted between the B-HALT and the organoleptic scores. The discriminant validity was evaluated through the Mann-Whitney and Kruskal-Wallis tests. EFA confirmed the unidimensionality of B-HALT, which has also demonstrated excellent internal consistency (α = 0.96) and test-retest reliability (ICC = 0.93). There was a positive correlation between B-HALT and organoleptic scores (r = 0.33; p < 0.001). B-HALT was able to discriminate between the groups with and without halitosis measured by the organoleptic method (p < 0.001) and self-reported halitosis (p < 0.001). B-HALT has demonstrated to be a reliable and valid tool to evaluate the oral health-related quality of life associated to halitosis in Brazilian adults.

Estudo longitudinal da halitose por meio da cromatografia gasosa / Longitudinal study of halitosis through gas chromatography

Objetivos: correlacionar os exames organolépticos (método subjetivo) e a cromatografia gasosa (método objetivo) para diagnóstico conclusivo da halitose e avaliar o comportamento dos compostos sulfurados voláteis (CSVs) durante o manuseio clínico desta patologia. Metodologia: estudo longitudinal com 19 pacientes submetidos ao diagnóstico de halitose, com exames organolépticos (EOt1) e cromatografia gasosa (ECGt1) realizados durante a consulta inicial, com todos os pacientes oriundos do município de Ijuí, Rio Grande do Sul. Todos os 38 exames complementares foram confrontados entre si, por meio do teste estatístico Qui-Quadrado de independência. Para acompanhamento clínico da efetividade do tratamento da halitose e, consequentemente, análise do comportamento dos CSVs, outros quatro exames de cromatografia gasosa (ECGt2, ECGt3, ECGt4 e ECGt5) foram realizados para cada paciente, e todos (95) comparados entre si, pelo teste de Wilcoxon. Resultados: a correlação entre EOt1 e ECGt1 obteve concordância em 78,9% dos casos, indicando forte associação (p = 0,002) entre ambos. Ao avaliar a monitorização dos compostos sulfurados H2S, CH3SH e (CH3)2S, todos envolvidos em alguma fase da gênese da halitose, houve significativa redução de todos os compostos. Conclusões: os exames de cromatografia gasosa (objetivo) e organoléptico (subjetivo) são equivalentes para diagnóstico inicial da halitose, pois apresentaram correlação estatística significante. Em relação à monitorização do tratamento da halitose, a cromatografia gasosa se mostrou eficiente, apresentando altos índices de redução de todos os CSVs. (AU)

Objectives: To correlate organoleptic evaluations (subjective method) and gas chromatography (objective method) for the conclusive diagnosis of halitosis and to examine the behavior of volatile sulfur compounds (VSC) during the clinical management of this pathology. Methodology: Longitudinal study with 19 patients diagnosed with halitosis through organoleptic evaluations (EOt1) and gas chromatography (ECGt1), both applied during the initial appointment. All patients were from the city of Ijuí, located in the state of Rio Grande do Sul, Brazil. All 38 complementary analyses were compared using the chi-square test of independence. Regarding the clinical follow-up on the effectiveness of halitosis treatment, and consequently the analysis of VSC behavior, four other gas chromatography tests (ECGt2, ECGt3, ECGt4, and ECGt5) were conducted with each patient, and all (95) were compared using the Wilcoxon test. Results: The correlation between EOt1 and ECGt1 showed concordance in 78.9% of cases, indicating a strong association (p=0.002). The evaluation of the monitoring of sulfate compounds H2S, CH3SH, and (CH3) 2S, which are all involved in some phase of the halitosis genesis, showed a significant reduction of all compounds. Conclusions: The gas and chromatography and organoleptic tests are equivalent for the initial diagnosis of halitosis because they presented significant statistical correlation. Regarding the monitoring of halitosis treatment, gas chromatography was efficient, presenting high reduction rates of all VSC. (AU)

Effect of Polyethylene Terephthalate Tongue Scraper on Oral Levels of Volatile Sulfur Compounds: a randomized clinical trial / Efeito do raspador de língua de polietilenotereftalato nos níveis orais de compostos sulfurados voláteis: um ensaio clínico randomizado

Objective: To evaluate the effect of Polyethylene Terephthalate (PET) tongue scraper on the volatile sulfur compound (VSC) levels. Material and Methods: A randomized, controlled, parallel design was used in this study. Out of the 48 volunteers from Dentistry Department of the Federal University of Sergipe, 40 subjects who met the inclusion criteria were randomly divided into 4 groups (n=10): G1 (control), rinsing of distilled water solution (WS); G2, WS and tongue coating removal (TCR) with toothbrush; G3, WS and TCR with a commercial tongue scraper; and G4, WS and TCR with PET tongue scraper. PET bottles were cut with a rectangular shape (1.0 cm wide x 20 cm long) to obtain PET tongue scraper. The VSC measurements were performed before (T0) and immediately after (T1) each therapy by portable sulfide monitor. Data (ppb) were submitted to Wilcoxon test (α=0.05). The differences between T0 and T1 were calculated and percentage values were assigned. Data (percentage) were submitted to ANOVA and Tukey test (α=0.05). Results: All 40 selected subjects completed the study. All groups reduced significantly the VSC levels after therapy (P<0.01). ANOVA indicated a significant difference among groups (P<0.001). The Tukey test showed that G1 (reduction of 21%) was similar to G2 (31%); G2 was similar to G3 (42%) and different from G4 (52%); G3 and G4 were similar. Conclusion: PET tongue scraper was similar to commercial tongue scraper and provided higher reductions of VSC levels than the toothbrush. (AU)

Objetivo: Avaliar o efeito do raspador de língua de polietilenotereftalato (PET) nos níveis de compostos sulfurados voláteis (CSVs). Material e Métodos: Um desenho paralelo, controlado e randomizado foi empregado neste estudo. Dos 48 voluntários do Departamento de Odontologia da Universidade Federal de Sergipe, 40 atenderam ao critério de inclusão e foram distribuídos aleatoriamente em 4 grupos (n=10): G1 (controle), bochecho com solução de água destilada (SA); G2, SA e remoção da saburra lingual (RSL) com escova dental; G3, SA e RSL com um raspador de língua comercial; e G4, SA e RSL com raspador de língua PET. Garrafas PET foram recortadas com uma forma retangular (1,0 cm de largura x 20 cm de comprimento) para obtenção dos raspadores de língua PET. As mensurações de CSVs foram realizadas antes (T0) e imediatamente após (T1) cada terapia usando um monitor portátil de enxofre. Os dados (ppb) foram submetidos ao teste de Wilcoxon (α=0,05). As diferenças entre T0 e T1 foram calculadas e transformadas em valores percentuais de redução. Os dados (percentuais) foram submetidos à ANOVA e ao teste de Tukey (α=0,05). Resultados: Todos os 40 indivíduos selecionados completaram o estudo. Em todos os grupos houve redução significante dos níveis de CSVs após terapia (P<0,01). ANOVA indicou uma diferença significante entre grupos (PP<0,001). O teste de Tukey mostrou que G1 (redução de 21%) foi semelhante a G2 (31%); G2 foi semelhante a G3 (42%) e diferente de G4 (52%); G3 e G4 foram semelhantes. Conclusão: O raspador de língua PET foi semelhante ao raspador de língua comercial e proporcionou maiores reduções de CSVs do que a escova dental. (AU)

Halitose: adaptação trascultural, validação do questionário e impacto emocional na qualidade de vida dos indivíduos / Halitosis: cross-cultural adaptation, questionnaire validation and emotional impact on individuals quality of life

Halitose é um termo geral para definir um odor desagradável que emana da cavidade bucal, que é perceptível por outras pessoas, muitas vezes causando constrangimento que podem afetar a comunicação e as relações sociais. Essa condição pode ser causada por problemas sistêmicos, psicológicos e, principalmente bucais, tais como gengivite, periodontite e saburra lingual. A qualidade de vida auto relatada relacionada à saúde bucal (Oral Health-Related Quality of Life ­ OHRQoL) visa a captação do aspecto subjetivo da saúde bucal, considerando a percepção do próprio indivíduo sobre sua condição, suas limitações e sua qualidade de vida. Assim, por meio de medidas de desfechos relatados pelos pacientes em questionários padronizados e validados, podemos medir opiniões e averiguar percepções do seu estado de saúde, nível de comprometimento, incapacidade e qualidade de vida relacionada à saúde. O questionário Halitosis Associated Life-Quality Test (HALT) foi desenvolvido no idioma inglês por Kizhner et al. (2011) como uma ferramenta específica para avaliar a qualidade de vida associada a halitose, com avaliação abrangente dos impactos físicos, sociais e psicossociais negativos da halitose em adultos. Escores mais altos do HALT indicam pior impacto da halitose na qualidade da vida. Neste cenário, o objetivo principal deste estudo foi adaptar transculturalmente o HALT para o idioma Português do Brasil, e testar a validade e a confiabilidade da versão brasileira do HALT (B-HALT). Assim, após tradução e adaptação transcultural o B-HALT foi aplicado em 100 indivíduos com halitose (escore organoléptico ≥2) e 100 indivíduos sem halitose (escore organoléptico <2). Dimensionalidade, confiabilidade, validade convergente e discriminante foram respectivamente testadas por: análise fatorial exploratória (AFE), alfa de Cronbach (α), coeficiente de correlação intraclasse (CCI), correlação de Spearman e testes de Mann-Whitney e Kruskal-Wallis. O B-HALT demonstrou excelente consistência interna (α=0,96) e confiabilidade teste-reteste (CCI=0,93). Houve correlação positiva entre escores do B-HALT e os escores pelo método organoléptico (r= 0,33; p<0,001). O B-HALT foi capaz de discriminar entre os grupos de halitose diagnosticada pelo método organoléptico (p<0,001), halitose autorrelatada (p<0,001) e renda familiar (p<0,001). O B-HALT demonstrou ser um instrumento válido e confiável para avaliar a qualidade de vida associada a halitose em adultos brasileiros. O segundo objetivo foi a aplicação da versão brasileira do HALT (B-HALT) em uma amostra de 200 indivíduos selecionados aleatoriamente, adultos de ambos os sexos, com 18 anos de idade ou mais, que frequentavam as clínicas de Odontologia da UFMG, para determinar os fatores associados à limitação emocional causada pela halitose. A percepção do impacto negativo da halitose na OHRQoL foi investigada, por meio de análise multivariada em uma abordagem hierárquica para a seguinte pergunta: Ficar preocupada (a) ou constrangido com o meu hálito. Os resultados do presente estudo indicaram que o modelo final totalmente ajustado para as variáveis independentes idade, renda familiar, hábito de fumar, IMC e halitose autorrelatada demonstraram que indivíduos que possuíam o hábito de fumar (RP=1,375; 95%IC=1,040-1,817; p= 0,025,) e autorrelataram halitose (RP=2,755; 95%IC=2,038- 3,777; p<0,001) tinham maior probabilidade de reportar limitação emocional. Concluise que à limitação emocional está associada ao tabagismo e ao autorrelato de halitose.

Halitosis is a general term to describe the malodor emanating from the oral cavity, being perceptible by others, and in many times creating personal discomfort that could affect communication and experience social embarrassment. This can be caused by psychological problems, as well as systemic and oral diseases, such as gingivitis, periodontitis and tongue coating. The self-reported Oral Health-Related Quality of Life (OHRQoL) aims to capture the subjective aspect of the oral health, taking into consideration the individual's own perception of their conditions, limitations and their quality of life. Through a validated and standardized patient-reported outcome measure questionnaire were we able to evaluate their opinion and investigate their own perceptions of their health condition, perceived level of compromising, incapacity and health-related quality of life. The Halitosis Associated Life-Quality Test (HALT) questionnaire was developed originally in English by Kizhner et al (2011) as a tool to evaluate the quality of life related to halitosis, with wide evaluation of physical, social and psychosocial negative impacts of halitosis in adults. Higher scores of HALT indicate worse impact of halitosis in the quality of life. In this scenario, the main aim of this study was to cross-culturally adapt HALT to a Brazilian Portuguese version (BHALT), and test its validity and reliability. After being translated and cross culturally adapted, B-HALT was applied to 100 individuals with halitosis (organoleptic score ≥2) and 100 individuals without halitosis (organoleptic score <2). It's dimensionality, reliability and convergent and discriminant validity were tested respectively by exploratory factor analysis (EFA), Cronbach's Alpha (α), Intraclass Correlation Coefficient (ICC), Spearman's correlations and the Mann-Whitney and Kruskal-Wallis tests. B-HALT has demonstrated excellent internal consistency (α=0.96) and testretest reliability (ICC=0.93). There was a positive correlation between B-HALT and organoleptic scores (r= 0.33; p<0.001). B-HALT was able to discriminate between the groups with organoleptic method diagnosed halitosis (p<0.001), self-reported halitosis (p<0.001) and family income (p<0.001). B-HALT has demonstrated to be a reliable and valid tool to evaluate the oral health-related quality of life associated to halitosis in Brazilian adults.The second aim of this study was to apply B-HALT on a randomly selected sample of 200 individuals that attended the dental clinics at the School of Dentistry from UFMG. They were all 18 years old or more from both genders, and were used to determine associated risk factors to the emotional limitation caused by halitosis. The perception of negative impact of halitosis in OHRQoL was investigated through a multi-investigated analysis on a hierarchical approach to the following question: Are you worried or embarrassed due to your bad breath? The results of this study have indicated that the totally-adjusted final model to independent variables such as age, family income, smoking, BMI and self-reported halitosis has shown that individuals who smoked (RP=1,375; 95%IC=1,040-1,817; p= 0,025,) and self-related halitosis (RP=2,755; 95%IC=2,038-3,777; p<0,001) had higher probability of reporting emotional limitation. We can conclude that emotional limitation is associated to smoking and self-reported halitosis.

A new technique for tongue brushing and halitosis reduction: the X technique

Abstract The tongue is one of the primary sources of halitosis. The manual or mechanical removal of biofilm is known to decrease oral malodor. Objective: To evaluate a new tongue hygiene technique hereby referred to as "the X technique" and its effects on both halitosis and the number of microorganisms based on microbiological parameters and diagnostic features of the breath. Material and Methods: The study included thirty patients divided into a control group (patients without systematized guidelines of lingual hygiene, but who performed the mechanical cleaning of tongue dorsum, each in its own way), the 3R group (instructed to perform the movements of the X technique for 3 repetitions at each brushing), and the 6R group (instructed to perform 6 repetitions of the technique at each brushing). After two weeks, a new data collection was performed. Results: Patients in the 6R group presented the lowest score on the organoleptic assessment scale at the second consultation, followed by the 3R group and the controls. Regarding the self-perception of breath by the method of Visual Analog Scale (VAS), the control group did not perceive improvements in oral malodor; the results of the 3R group and the 6R group were similar. Conclusion: These results indicate that the X technique improves both measurements and perceptions of halitosis. Microbiological analyses revealed greatest reduction in the 6R group. The findings show that the X technique reduces both organoleptic scores and the number of bacterial colonies, and improves users' perceptions of their breath.

Halitose autorrelatada: prevalência, fatores associados e acurácia diagnóstica / Self-reported halitosis: prevalence, associated factors and diagnostic accuracy

A halitose autorrelatada tem sido utilizada como uma ferramenta diagnóstica importante em estudos epidemiológicos por ser de fácil avaliação e refletir a percepção do indivíduo segundo sua condição. Entretanto, a prevalência e os fatores associados variam na literatura. O objetivo deste trabalho foi avaliar a prevalência de halitose autorrelatada e seus preditores associados, bem como determinar as estimativas de acurácia de medidas autorrelatadas com avaliação clínica da halitose. Foi realizado um estudo transversal com uma amostra de 5420 indivíduos que responderam, via e-mail, um conjunto de perguntas incluindo questões abertas e fechadas sobre dados socioeconômicos e demográficos, história médica e odontológica, hábitos de higiene bucal, parâmetros de saúde bucal e medidas de auto relato para halitose, sendo: medida 1 - "Coloque a palma da mão na frente da boca e sopre. Depois desse teste, você diria que tem mau hálito?"; medida 2 - "Você já foi diagnosticado pelo seu dentista com mau hálito?"; medida 3 - "Algum membro da sua família ou amigo já lhe disse que você tem mau hálito?". Posteriormente, foi realizado um exame clínico em uma subamostra de 159 indivíduos para determinação clínica da halitose através do método organoléptico. Os preditores de halitose autorrelatada foram determinados por meio de análises univariadas e multivariadas. Estimativas de acurácia diagnóstica do autorrelato foram avaliadas na subamostra. A prevalência da halitose autorrelatada para a medida 1 foi de 14,6% (n = 792), para a medida 2 de 4,1% (n = 221) e para medida 3 de 33,2% (n = 1799). A halitose autorrelatada esteve associada principalmente a variáveis socioeconômicas (idade, sexo, escolaridade), parâmetros de saúde bucal (sangramento gengival, infecções gengivais, saburra lingual, avaliação geral da saúde bucal) e impactos nas atividades cotidianas (ambiente familiar ou social e relação íntima). Os valores de especificidade para medidas de halitose autorrelatadas foram determinados como sendo altos para halitose clínica (escore organoléptico 2) e forte (escore organoléptico 4). No geral, combinações de medidas de autorrelato melhoraram o AROC dos modelos preditivos multivariados. Pode-se concluir que as taxas de prevalência de halitose autorreferida podem variar de acordo com a medida de autorrelato, mas no geral podem ser consideradas moderadas. Estimativas de acurácia diagnóstica foram determinadas como úteis e com boa predição para indivíduos não doentes.

Self-reported halitosis has been used as an important diagnostic tool in epidemiological studies that can be easily applied, demands less time and resources to be performed, and can reflect the individual's perception of their condition. However, its prevalence and associated factors vary in the literature. The aim of this study was to evaluate the prevalence of self-reported halitosis and its associated factors, as well as to determine accuracy estimates with clinical evaluation of halitosis. A cross sectional study was conducted in a sample of 5420 individuals who answered, via e mail, a set of closed questions that addressed socioeconomic and demographic data, medical and dental history, oral hygiene habits, parameters of oral health and self reported measures of halitosis, being: measure 1 - "Put the palm of the hand in front of the mouth and blow. After that test, would you say you have bad breath? "; measure 2 - "Have you ever been diagnosed with bad breath by your dentist "; measure 3 - "Has any member of your family or friend ever told you that you have bad breath?". Subsequently, a clinical examination was performed in a subsample of 159 individuals for the clinical diagnostic of halitosis through the organoleptic method. Predictors associated with self-reported halitosis were determined by means of univariate and multivariate analyzes. Accuracy estimates of self-report were evaluated in the subsample. Prevalence of self-reported halitosis for measure 1 was of 14.6% (n = 792), for measure 2 of 4.1% (n = 221) and for measure 3 of 33.2% (n = 1799). Self-reported halitosis was mainly associated with socioeconomic variables (age, gender, educational level), parameters of oral health, (gingival bleeding, gingival infections, tongue coating general evaluation of oral health) and impacts on daily activities (family or social environment and intimate relations). The specificity values for self-reported halitosis measures were determined to be high for clinical (organoleptic score ≥2) and strong (organoleptic score ≥4) halitosis. Overall, combinations of self-reported measures improved the AROC of multivariate predictive models. It can be concluded that prevalence rates of self-reported halitosis may vary according to the self-reported measure, but can be considerate moderate. Estimates of diagnostic accuracy were determined to be useful and with good prediction for non-diseased individuals.

Avaliação da qualidade de vida, força de mordida e halitose após reembasamento resiliente com diferentes métodos de polimerização / Influence of quality of life, satisfaction, bite force and halitosis after soft reline in edentulous patients, with different polymerization techniques

Os reembasadores resilientes têm sido amplamente utilizados em pacientes portadores de próteses totais para melhorar a adaptação da base de resina ao rebordo. Esses apresentam dois métodos de polimerização, um feito diretamente na boca do paciente e outro feito indiretamente em laboratório. Não há estudos na literatura que avaliem a percepção dos pacientes com relação a esse tratamento. Portanto o objetivo desse trabalho foi avaliar a satisfação a qualidade de vida, força de mordida e halitose de pacientes desdentados que tiveram suas próteses totais mandibulares reembasadas com material resiliente (Ufi Gel SC, Voco, Alemanha). Foram selecionados 20 pacientes desdentados seguindo critérios de inclusão e exclusão predefinidos para terem suas próteses mandibulares reembasadas. Estes foram divididos aleatoriamente nos grupos de reembasamento direto ou indireto (n=10). Os ensaios clínicos verificaram a qualidade de vida (OHIP Edent), a satisfação com o reembasamento, a força de mordida e também presença e etiologia de halitose. Os testes clínicos foram realizados inicialmente com as próteses totais sem intervenção, após o reembasamento, aos 30, 60, 90 e 180 dias após o reembasamento. A análise de variância ANOVA (significância de 5%) demonstrou que houve uma diferença estatisticamente significante para o fator tempo para todos os testes, mas a técnica de reembasamento não. Observamos que a qualidade de vida, a satisfação, a força de mordida e halitose melhoraram após o reembasamento. A halitose foi influenciada pelo reembasamento e pela higiene bucal dos pacientes. Apesar de não ter demonstrado diferença estatisticamente entre os métodos de polimerização, foi um resultado favorável tanto para o clínico como para o paciente. Portanto, se não houver diferença entre os métodos de polimerização a longo prazo, não há porque submeter o paciente ao reembasamento indireto. Independentemente do método de polimerização escolhido, o reembasamento com material resiliente a base de silicone demonstrou ser uma alternativa viável para melhorar os aspectos funcionais e a satisfação em pacientes que apresentem dificuldades em utilizar próteses totais mandibulares(AU)

Resilient reliners have been widely used for patients wearing complete dentures to improve the adaptation of the base. They present two polymerization methods, one done directly in the patient's mouth and another done indirectly in the laboratory. There are no studies in the literature that assess the perception of patients regarding this treatment. Therefore, the purpose of this paper was to assess, the satisfaction, quality of life of edentulous patients who had their total mandibular prostheses rebased with resilient material (Ufi Gel SC, Voco, Germany). 20 edentulous patients were selected according to predefined inclusion and exclusion criteria. These were randomly divided into the direct or indirect soft reline groups (n = 10). The clinical trial evaluated the quality of life (OHIP Edent), the satisfaction regarding the treatment, the bite force and presence and prevalence of halitosis. The assays were performed in six phases during the treatment: initially with the total prostheses without intervention, after the reline procedure, 30, 60, 90 and 180 days after the reline. The analysis of variance ANOVA (5% significance) demonstrated a statistically significant difference for period in all parameters, but the technique did not influence any of the parameters (P ≤ 0.05). We observed that the QoL, satisfaction, bite force and halitosis increased after the reline. The halitosis was influenced by patients' oral hygiene and the reline procedure. Although it has not demonstrated a statistical difference between polymerization methods, it was a favorable result for both clinicians and patients. The direct polymerization method is simpler, less time consuming and less costly for the patient. Therefore, if there is no long-term difference between polymerization methods, there is no need to perform an indirect procedure. Regardless of the method of polymerization chosen, relining with resilient silicone-based material is a viable alternative to improve the quality of life, satisfaction, bite force and halitosis in patients who have difficulties wearing mandibular dentures(AU)

Two mechanisms of oral malodor inhibition by zinc ions

Abstract Objectives The aim of this study was to reveal the mechanisms by which zinc ions inhibit oral malodor. Material and Methods The direct binding of zinc ions to gaseous hydrogen sulfide (H2S) was assessed in comparison with other metal ions. Nine metal chlorides and six metal acetates were examined. To understand the strength of H2S volatilization inhibition, the minimum concentration needed to inhibit H2S volatilization was determined using serial dilution methods. Subsequently, the inhibitory activities of zinc ions on the growth of six oral bacterial strains related to volatile sulfur compound (VSC) production and three strains not related to VSC production were evaluated. Results Aqueous solutions of ZnCl2, CdCl2, CuCl2, (CH3COO)2Zn, (CH3COO)2Cd, (CH3COO)2Cu, and CH3COOAg inhibited H2S volatilization almost entirely. The strengths of H2S volatilization inhibition were in the order Ag+ > Cd2+ > Cu2+ > Zn2+. The effect of zinc ions on the growth of oral bacteria was strain-dependent. Fusobacterium nucleatum ATCC 25586 was the most sensitive, as it was suppressed by medium containing 0.001% zinc ions. Conclusions Zinc ions have an inhibitory effect on oral malodor involving the two mechanisms of direct binding with gaseous H2S and suppressing the growth of VSC-producing oral bacteria.

Assessment of the accuracy of portable monitors for halitosis evaluation in subjects without malodor complaint. Are they reliable for clinical practice?

Abstract Halitosis is defined as a foul odor emanated from the oral cavity, with great impact in quality of life and social restraints. Recently, the use of Breath Alert™ in research increased significantly. Halimeter™, another portable device, is often used in clinical practice. Nevertheless, not many studies have verified the accuracy and compared the results of both devices simultaneously. Objective: To verify the accuracy of Breath Alert™ and Halimeter™ in patients without chief complaint of halitosis, using the organoleptic test (OT) as "gold standard." The second aim was to verify whether their concomitant use could enhance the diagnostic accuracy of halitosis. Material and Methods: A cross-sectional analytical study was performed. The quality of expired air of 34 subjects without chief complaint of halitosis was assessed. Two experienced examiners carried out the OT. Afterward, a third blinded examiner performed Halimeter™ (HT) and Breath Alert™ (BA) tests. Results: The OT identified halitosis in 21 subjects (62%). The area under the ROC curve (95% confidence interval) was 0.67 (0.48-0.85) and 0.54 (0.34-0.75) for HT and BA, respectively. The accuracy for HT and BA was 59% and 47%, respectively. The combined usage of HT and BA provided 11 positive results, being 9 subjects (43%) out of the total of 21 positive cases. Conclusions: Halimeter™ and Breath Alert™ were not able to diagnose halitosis in non-complainer subjects at the same level as the organoleptic examination, since their accuracy were low. Our results suggest that such portable devices are not reliable tools to assess halitosis and may neglect or misdiagnose a considerable number of patients in clinical practice.

In vitro effects of Melaleuca alternifolia essential oil on growth and production of volatile sulphur compounds by oral bacteria

ABSTRACT Objective Halitosis can be caused by microorganisms that produce volatile sulphur compounds (VSCs), which colonize the surface of the tongue and subgingival sites. Studies have reported that the use of natural products can reduce the bacterial load and, consequently, the development of halitosis. The aim of this study was to evaluate the antimicrobial activity of the essential oil of Melaleuca alternifolia on the growth and volatile sulphur compound (VSC) production of oral bacteria compared with chlorhexidine. Material and Methods The effects of these substances were evaluated by the Minimum Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (MBC) in planktonic cultures of Porphyromonas gingivalis and Porphyromonas endodontalis. In addition, gas chromatography analyses were performed to measure the concentration of VSCs from bacterial cultures and to characterize M. alternifolia oil components. Results The MIC and MBC values were as follows: M. alternifolia - P. gingivalis (MIC and MBC=0.007%), P. endodontalis (MIC and MBC=0.007%=0.5%); chlorhexidine - P. gingivalis and P. endodontalis (MIC and MBC=1.5 mg/mL). M. alternifolia significantly reduced the growth and production of hydrogen sulfide (H2S) by P. gingivalis (p<0.05, ANOVA-Dunnet) and the H2S and methyl mercaptan (CH3SH) levels of P. endodontalis (p<0.05, ANOVA-Dunnet). Chlorhexidine reduced the growth of both microorganisms without altering the production of VSC in P. endodontalis. For P. gingivalis, the production of H2S and CH3SH decreased (p<0.05, ANOVA-Dunnet). Conclusion M. alternifolia can reduce bacterial growth and VSCs production and could be used as an alternative to chlorhexidine.

Percepção e nível de conhecimento sobre halitose entre estudantes e pacientes / Perception and level of knowledge about halitosis among students and patients

O presente estudo analisou a percepção e o nível de conhecimento de estudantes e pacientes sobre halitose. Dois grupos de voluntários de ambos os gêneros, entre 18 e 60 anos, totalizando 225 participantes, responderam a um questionário que continha oito questões relativas à percepção, às causas e ao tratamento da halitose. O grupo de pacientes (P) consistiu-se de 150 indivíduos que procuraram os serviços odontológicos da Faculdade de Farmácia, Odontologia e Enfermagem da Universidade Federal do Ceará, Brasil, e o grupo de estudantes (S), de 75 alunos de Odontologia da mesma Universidade. No grupo P, 45,3% dos participantes acreditava ter halitose, já no grupo S, esse percentual foi de apenas 16,2%. Em relação às causas e aos tratamentos da halitose, encontrou-se que o grupo P assinalou mais opções relacionadas com o correto conhecimento sobre halitose quando comparados com o grupo S. É possível concluir que os pacientes relataram maior percepção da halitose do que os estudantes, bem como têm demonstrado maior conhecimento sobre a origem e tratamento da halitose.

This study aimed to assess individual perception and level of knowledge of students and patients about halitosis. Two groups of volunteers of both genders between 18 and 60 years old, totaling 225 subjects, answered a questionnaire containing eight questions relating to perception, causes, and treatment of halitosis. The group of patients (P) consisted of 150 individuals seeking dental services at the School of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Brazil, and the Group of students (S) consisted of 75 students of Dentistry at the same University. In Group P, 45.3% of participants believed they had halitosis, while in Group S, this percentage was only 16.2%. In matters relating to the causes and treatment of halitosis, it was found that the Group P marked more options related to the correct knowledge about halitosis when compared to Group S. It is possible to conclude that patients reported greater halitosis perception than students, and also that they showed a better knowledge about the halitosis etiology and treatment.

Eficácia de um agente cimentante e antisséptico no controle bacteriano nas conexões dos implantes / Efficacy of a cementing and antiseptic agent in preventing contamination and bacterial flow at the dental implant connection

Objetivo: avaliar a eficácia de um antisséptico de longa duração no controle microbiano dos espaços entre o implante e o parafuso de cobertura (PC), pela contagem das unidades formadoras de colônias (UFCs) no ato da reabertura. Material e métodos: foram selecionados 70 sítios em 17 pacientes, para instalação de implantes dentais, e divididos aleatoriamente em dois grupos. No grupo experimental (n=35), o antisséptico foi aplicado na rosca do PC, imediatamente antes de sua instalação. No grupo-controle, a instalação do PC foi feita sem o antisséptico. A reabertura foi realizada após seis meses e os PCs foram removidos e armazenados em frascos assépticos contendo solução salina. Cada amostra foi centrifugada, diluída seriadamente até 10-10, semeada e encubada em microaerofi lia para a cultura de UFCs. Após a contagem, as análises estatísticas comparativas foram feitas pelo teste de Kruskal-Wallis (p < 0,05). Resultados: o grupo-controle apresentou média de 7,18 x 107 UFC/ml, enquanto no experimental a média foi de 2,12 x 105 UFC/ml. O crescimento bacteriano foi significativamente menor no grupo experimental (p=0,0003). Conclusão: o antisséptico reduziu signifi cativamente o crescimento bacteriano entre implante e parafuso de cobertura, tendo sido eficaz no controle microbiano destes espaços.

Objective: to evaluate the effi cacy of a long-term antiseptic in bacterial control of the spaces between the implant and the cover screw (PC), by counting colony-forming units (UFC) at the time of the re-entry surgery. Material and methods: seventy sites for implant placement were selected in 17 patients referred for dental implants, and divided randomly into two groups. In the experimental group (n=35), the antiseptic was applied on the thread of the PC immediately before installation. In the control group, the PC was installed with no antiseptic. The re-entry was performed after six months, the PCs removed and stored in asseptic recipients containing saline solution. Each sample was centrifuged, diluted serially up to 10-10, seeded and incubated in microaerophilic conditions for CFU culture. After counting, statistical comparative analyzes were performed by Kruskal-Wallis test (p < 0.05). Results: the control group had a mean of 7.18 x 107 CFU/mL, while the experimental average was 2.12 x 105 CFU/mL. Bacterial growth was significantly lower in the experimental group (p=0.0003). Conclusion: the antiseptic reduced, significantly, the bacterial contamination in the spaces between the implant and the cover screw, being effective in the microbial control of those spaces.