Usefulness of a new malodour-compound detection portable device in oral malodour diagnosis.

A new device (BB Checker) able to detect malodour compounds has recently been made available. This retrospective analysis aimed at evaluating the usefulness of this device as adjunct tool for the diagnosis of oral malodour. Data from 100 consecutive volunteers with bad breath complaints attending their first consultation at a halitosis clinic were analysed. In addition to the standard protocol (organoleptic ratings from mouth and nose air, and from tongue coating when present; OralChroma and Halimeter measurements from mouth air; and intra-oral examinations), oral, exhaled and nasal air samples were examined with the BB Checker. We could not establish a correlation between the BB Checker values and the organoleptic scores, or the sulfur-compound levels determined by the OralChroma or the Halimeter (R < 0.3, p > 0.05). The overall sensitivity and specificity of the new device did not exceed the 50%. The correlations between the organoleptic scores and the OralChroma and the Halimeter measurements were good and in line with previous reports (R between 0.56 and 0.73). Our results do not favour the use of the BB Checker as adjunct tool in the diagnosis of oral malodour.

The role of Solobacterium moorei in oral malodour.

This study aims to analyze the correlation between Solobacterium moorei (S. moorei), both on the tongue and in saliva, and several oral malodour- and clinical parameters. Data from 193 patients visiting a halitosis clinic were used for analysis. A questionnaire assessed their general health, allergies, medication, smoking habits and oral hygiene. Following halitosis parameters were recorded: organoleptic score (OLS) (0-5), total concentration of volatile sulfur compounds (VSC) (Halimeter), individual concentrations of VSC (Oral Chroma), tongue coating (MTCI, WTCI and mWTCI), salivary parameters (flow rate and pH), oral hygiene, tonsil health and periodontal health. In all subjects, microbiological samples were collected from the tongue coating and from the saliva, and a quantitative polymerase chain reaction was performed to detect S. moorei. A significant correlation could be established between S. moorei, from both tongue and saliva, and several breath parameters (OLS, H2S, CH3SH, (CH3)2S and total VSCs), tongue coating indices and periodontal indices (gingivitis, periodontitis and oral hygiene). This study suggests a strong association between the presence of S. moorei and oral malodour (s54747).

The role of toothpastes in oral malodor management.

One out of four people suffers from persistent bad breath. In most of the cases, the cause can be found in the mouth, with the presence of tongue coating as the leading factor, followed by gingivitis and periodontitis, and it is referred to as oral malodor. Because oral malodor is the result of the degradation of organic substrates by anaerobic bacteria of the oral cavity, the management is mostly done by masking the odorous compounds or eliminating the cause (bacteria and their substrates) either mechanically or chemically. Toothpaste formulations have been modified to carry antimicrobial and oxidizing agents with an impact on the process of oral malodor formation. We performed extensive literature search regarding the effect of dedicated toothpastes in the management of oral malodor. The main characteristics of the in vitro and in vivo investigations and their most relevant findings are presented for discussion. Even though the amount of publications regarding this topic is far smaller than for others such as caries, plaque control and whitening, antibacterial ingredients such as triclosan and metal ions like stannous and zinc appear to be effective in the control of oral malodor. On the other hand, data supporting the use of hydrogen peroxide, baking soda, essential oils and flavors in the management of oral malodor are rather few and inconclusive.

Efficacy of different mouthrinse formulations in reducing oral malodour: a randomized clinical trial.

AIMS: The aim of this study was to assess the efficacy of mouthrinses formulations in oral malodour. MATERIAL & METHODS: This single-centre, double-blind, randomized, parallel group clinical trial compared the efficacy of Halita™ and meridol(®) with and without zinc lactate versus negative and positive control. Volunteers with confirmed oral malodour (18/group) rinsed with one mouthrinse during 7 days (15 ml, 2x/day for 1 min.). 15 min. after a first rinse (masking effect), and after 7 days (therapeutic effect) the change in organoleptic scores and level of sulphur compounds was recorded. RESULTS: All rinses showed a masking effect (OLS 1 to 2 values reduced), only the rinses with antimicrobial ingredients showed a therapeutic effect (OLS 1 to 1.5 value less). The addition of zinc resulted in a more pronounced masking effect. Halita™ and meridol(®) with zinc showed the best therapeutic effect. CONCLUSION: Although the masking effect of the rinses can be attributed partially to a dilution and the effect of aromas, the therapeutic effect should be linked to the anti-microbial action of active ingredients and counter action of zinc ions on VSC. A complete resolution of the unpleasant breath by additional mechanical intervention remains to be proven.

Tongue coating: related factors.

AIM: A clear relationship between tongue coating and oral malodour has been observed in many clinical trials. Why or when this coating is formed remains an open question. The aim of this study was to analyse possible factors related to the presence of tongue coating in a population complaining from oral malodour. MATERIALS AND METHODS: Patients were recruited from a halitosis clinic (UZ Leuven). Medical history, dietary and oral hygiene habits were retrieved via a questionnaire. Data were recorded on organoleptic score and level of sulphur compounds in breath, anatomical features of the tongue dorsum, amount of tongue coating (according to three indices: Miyazaki, Winkel and modified Winkel), tongue coating wet weight and salivary flow. The correlation between the presence of tongue coating and a series of parameters was analysed. RESULTS: The level of oral hygiene was the strongest determinant factor for the presence of tongue coating. Smoking, presence of a denture, periodontal status and dietary habits also correlated although less obvious. CONCLUSION: The presence of tongue coating appears to be related to several factors of which oral hygiene is the strongest.

Breath biomarkers of liver cirrhosis.

The diagnosis of asymptomatic cirrhosis in patients with liver disease is of importance to start screening for complications in due time. Liver biopsy is neither sensitive nor practical enough to be used as a frequent follow-up test in patients with chronic liver disease. The volatile organic compounds present in exhaled breath offer the possibility of exploring internal physiologic and pathologic process in a non invasive way. This study examined whether a specific pattern of biomarkers can be found in breath samples of patients with cirrhosis. To this aim samples of alveolar breath from patients with cirrhosis and healthy volunteers were analyzed using gas chromatography-mass spectrometry. When linear discriminant analysis was used to search for a model(s)/pattern of compounds characteristic for liver cirrhosis, 24 models of 8 independent compounds could distinguish between the groups. The sensitivity and specificity (between 82% and 88%, and 96% and 100%, respectively) of the models suggest that a specific pattern of breath biomarkers can be found in patients with cirrhosis, which may allow detecting this complication of chronic liver disease in an early stage.

Clinical utility of a novel colorimetric chair side test for oral malodour.

AIM: The aim of this study was to evaluate the utility of a simple colorimetric chair side test detecting amines in saliva as an adjunct test in the oral malodour diagnosis. MATERIAL AND METHODS: Non-stimulated saliva samples were collected from 100 volunteers with different degrees of oral malodour. The amount of amines detected by the test was estimated clinically (colorimetric test), confirmed semi quantitatively in the laboratory (standard addition method) and consequently compared with (i) the organoleptic score (OLS); (ii) the volatile sulphur compounds (VSCs) levels (OralChroma(™)) and (iii) the amount of amines detected by means of gas chromatography - mass spectroscopy. RESULTS: The chair side test correlated well (Spearman correlation coefficient: 0.46-0.77), with the OLS, the level of VSCs, and the amines determined by using gas chromatography - mass spectroscopy. The results of the new test for patients with and without oral malodour were significantly different (Mann-Whitney U-test, p < 0.0001). The sensitivity, specificity, and positive and negative predictive value of this chair side test were similar to those of the VSCs evaluations. CONCLUSIONS: These results support the "fit for purpose" of the new chair side test as adjunctive diagnostic tool for oral malodour.

A novel and visual test for oral malodour: first observations.

Until now, the application of biogenic amines as bio-markers of oral malodour has been limited because of the complexity of their detection. This study explores the usability of a simple colorimetric reaction detecting amines in saliva as an adjunct test for the diagnosis of oral malodour. The colour reaction caused by a newly discovered enzyme capable of detecting amines in saliva was characterized in vitro. Two colour scales were developed by transforming the colours of selected dilutions of a mixture of cadaverine and putrescine into a 5- and a 10-point pink-colour scale. Afterwards, this new enzymatic test was used to assess the amount of amines in saliva samples of 50 volunteers with different degrees of oral malodour. The enzymatic reaction was shown to be linear towards the concentration of amines and stable over a time of ≥4 h. Colour scores correlated well with organoleptic scores and the volatile sulfur compounds. More importantly differences between patients with and without oral malodour were significant. Based on these results, we conclude that this new enzymatic test, interpreted by means of a simple colour scale, has the potential to be used as an adjunct chair-side test for oral malodour diagnosis.

Clinical reliability of non-organoleptic oral malodour measurements.

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

Characteristics of 2000 patients who visited a halitosis clinic.

AIMS: The aim of this paper was to analyse the aetiology and characteristics of 2000 patients who visited a multidisciplinary bad breath clinic in Leuven, Belgium and to correlate organoleptic ratings with portable device measurements. MATERIALS AND METHODS: The characteristics and aetiology of breath malodour of two thousand consecutive patients who visited a halitosis consultation were explored by means of a standard questionnaire and a clinical examination, including organoleptic scores provided by a trained and calibrated judge, and a portable bad breath detector (Halimeter). RESULTS: Most patients came without referral and had complaints for several years (mean: 7 years, SD: 8 years). For 76% of the patients, an oral cause was found [tongue coating (43%), gingivitis/periodontitis (11%) or a combination of the two (18%)]. Pseudo-halitosis/halitophobia was diagnosed in 16% of the cases; and ear, nose and throat/extra-oral causes were found in 4% of the patients. Most patients had an organoleptic score <3 and a Halimeter value <240 p.p.b. CONCLUSIONS: Even though it was observed that halitosis has a predominantly oral origin, a multidisciplinary approach remains necessary to identify ear, nose and throat or extra-oral pathologies and/or pseudo-halitosis/halitophobia.

Desarrollo y evaluación de una muestra para control de calidad en Microbiología / Development and assessment of a sample for quality control in Microbiology

El laboratorio de microbiología clínica requiere, en cada una de las etapas del procesamiento de las muestras, un adecuado control de calidad. Debido a que no se encuentran disponibles localmente esquemas interlaboratorio que evalúen etapas iniciales del análisis microbiológico, el objetivo del trabajo fue desarrollar y evaluar mediante una "prueba piloto" la utilización de una muestra liofilizada como material de control de aislamiento e identificación de microorganismos. Para la elaboración de la muestra se utilizó un líquido de diálisis peritoneal inoculado con bacilos gram negativos (BGN) y cocos gram positivos (CGP) aislados de muestras clínicas. Las muestras se fraccionaron por 2 mL y se liofilizaron según el protocolo provisto por el ProgBA. Treinta y cuatro laboratorios recibieron un vial de la muestra y una planilla con las instrucciones para su manejo e informe del resultado. La tasa de respuesta fue del 44%. El porcentaje de aciertos en la evaluación microscópica fue 100% y 79% para BGN y CGP respectivamente. El 70% de los laboratorios recuperó e identificó correctamente ambos microorganismos, el 100% recuperó los BGN. Considerando un valor mayor del 80% de concordancia en la recuperación de microorganismos, los resultados obtenidos fueron aceptables para BGN. Este protocolo podría ser utilizado para la preparación de un esquema interlaboratorio a mayor escala.

The microbiology laboratory requires an appropriate quality control in each stage of the sample procedure. To date, interlaboratory studies that evaluate the initial stages of microbiologic analysis procedures have not been reported. The development of a lyophilized sample for isolation control and identification of microorganisms (mo) was performed with that purpose. For the sample's elaboration a peritoneal dialysis liquid was inoculated with gram negative bacilli (GNB) and gram positive cocci (GPC). The samples were divided into 2 mL vials and lyophilized according to the protocol provided by ProgBA. Thirty four laboratories received the sample with instructions for its handling and results report. The rate of response was of 44%. The percentage of success in microscopic evaluation was 100% and 79% for BGN and CGP respectively. Seventy per cent of the laboratories succeeded in isolating and identifying both microorganisms correctly; 100% of them identified the GNB. Considering an 80% of agreement in mo recovery a validity criterion, the results obtained were acceptable for GNB. This protocol could be used for the preparation of an interlaboratory quality control scheme on a greater scale.