Genuine halitosis in patients with dental and laryngological etiologies of mouth odor: severity and role of oral hygiene behaviors.

The aims of the study were to determine the severity of halitosis and the association between oral hygiene practices and the severity of malodor in patients with dental and laryngological etiologies of genuine halitosis. Thirty-five laryngological and 40 dental patients with halitosis completed a structured interview and underwent laryngological and dental examinations. Halitosis was assessed using organoleptic and halimeter tests. Greater halitosis severity in laryngological patients was associated with worse clinical status of the palatine tonsils, less frequent toothbrushing, less frequent use of tongue cleaners, fewer daily meals, and increased use of mouthrinses. Among dental patients, more severe halitosis was associated with worse clinical status of the periodontium, more tongue coating, less saliva secretion, and less frequent use of dental floss, interdental toothbrushes, and tongue cleaners. Oral hygiene was found to be a key moderator of the relationship between status of the periodontium or tonsils and severity of halitosis. The severity of halitosis in laryngological patients and dental patients is essentially similar; however, oral hygiene routines are associated with different effects in each group. Consequently, individual recommendations for patients with halitosis should be adjusted for the underlying disease and emphasize the role of effective specific hygiene behaviors.

Halitosis: a new definition and classification.

BACKGROUND: There is no universally accepted, precise definition, nor standardisation in terminology and classification of halitosis. OBJECTIVE: To propose a new definition, free from subjective descriptions (faecal, fish odour, etc), one-time sulphide detector readings and organoleptic estimation of odour levels, and excludes temporary exogenous odours (for example, from dietary sources). Some terms previously used in the literature are revised. RESULTS: A new aetiologic classification is proposed, dividing pathologic halitosis into Type 1 (oral), Type 2 (airway), Type 3 (gastroesophageal), Type 4 (blood-borne) and Type 5 (subjective). In reality, any halitosis complaint is potentially the sum of these types in any combination, superimposed on the Type 0 (physiologic odour) present in health. CONCLUSION: This system allows for multiple diagnoses in the same patient, reflecting the multifactorial nature of the complaint. It represents the most accurate model to understand halitosis and forms an efficient and logical basis for clinical management of the complaint.

Supervised machine learning-based classification of oral malodor based on the microbiota in saliva samples.

OBJECTIVE: This study presents an effective method of classifying oral malodor from oral microbiota in saliva by using a support vector machine (SVM), an artificial neural network (ANN), and a decision tree. This approach uses concentrations of methyl mercaptan in mouth air as an indicator of oral malodor, and peak areas of terminal restriction fragment (T-RF) length polymorphisms (T-RFLPs) of the 16S rRNA gene as data for supervised machine-learning methods, without identifying specific species producing oral malodorous compounds. METHODS: 16S rRNA genes were amplified from saliva samples from 309 subjects, and T-RFLP analysis was carried out with the DNA fragments. T-RFLP analysis provides information on microbiota consisting of fragment lengths and peak areas corresponding to bacterial strains. The peak area is equivalent to the frequency of a specific fragment when one molecule is selected from terminal fragments. Another frequency is obtained by dividing the number of species-containing samples by the total number of samples. An SVM, an ANN, and a decision tree were trained based on these two frequencies in 308 samples and classified the presence or absence of methyl mercaptan in mouth air from the remaining subject. RESULTS: The proportion that trained SVM expressed as entropy achieved the highest classification accuracy, with a sensitivity of 51.1% and specificity of 95.0%. The ANN and decision tree provided lower classification accuracies, and only classification by the ANN was improved by weighting with entropy from the frequency of appearance in samples, which increased the accuracy to 81.9% with a sensitivity of 60.2% and a specificity of 90.5%. The decision tree showed low classification accuracy under all conditions. CONCLUSIONS: Using T-RF proportions and frequencies, models to classify the presence of methyl mercaptan, a volatile sulfur-containing compound that causes oral malodor, were developed. SVM classifiers successfully classified the presence of methyl mercaptan with high specificity, and this classification is expected to be useful for screening saliva for oral malodor before visits to specialist clinics. Classification by a SVM and an ANN does not require the identification of the oral microbiota species responsible for the malodor, and the ANN also does not require the proportions of T-RFs.

Effect of bracket type on halitosis, periodontal status, and microbial colonization.

OBJECTIVE: To determine the effect of bracket type on halitosis, periodontal status, and microbial colonization. MATERIALS AND METHODS: Forty-six patients scheduled for fixed orthodontic treatment (age 11-16 years) were selected from the orthodontic department of Suleyman Demirel University. Patients were divided into two groups with random distribution of brackets; 23 patients were treated with self-ligating brackets (group SLBs), the others with conventional brackets (group CBs). Halitosis measurements and periodontal and microbial records were obtained before the placement of brackets (T0), 1 week later (T1), and 5 weeks after bonding (T2). Periodontal parameters, including plaque index (PI), gingival index (GI), and bleeding on probing index (BOP), were obtained from all the bonded teeth. Halitosis measurements were performed at the same time. Microbial samples were obtained from the buccal surfaces of all the bonded teeth. Data were analyzed by using a repeated-measurement analysis of variance test for the comparison of parameters between groups and times. RESULTS: Periodontal parameters and halitosis results were higher in the CBs group than in the SLBs group (P<.05). In the SLBs group, halitosis and BOP values revealed no pronounced changes between T1 and T2 (P>.05). Intra- and intergroup comparisons showed that there were no statistically significant differences for microbial colonization between all the time intervals (P>.05). CONCLUSION: Bracket type has an effect on halitosis and periodontal status. Therefore, self-ligating brackets may be advised in order to prevent patients from developing halitosis and to increase the likelihood of good oral hygiene during orthodontic treatment.

A new indicator of the oral hygiene habits of disabled persons: relevance of the carer's personal appearance and interest in oral health.

OBJECTIVE: To investigate whether there is a relationship between the oral hygiene habits of individuals with severe disability the carer's personal appearance and interest in oral health. PATIENTS AND METHODS: The study group was formed of 60 disabled persons and their respective carers who came for the first time to consultation in the Special-Needs Dentistry Unit of the University of Santiago de Compostela, Spain. All the carers answered a standardised questionnaire of 28 questions divided into four sections: disabled individual's demographic data, disabled individual's general medical details, social aspects of the carer (personal appearance of the carer and interest in oral health), and disabled individual's oral hygiene habits. The personal appearance of the carers and their interest in the disabled individual's oral health were evaluated using independent scales designed specifically for the study, with five binary items in each scale. RESULTS: The carer's personal appearance and interest in the disabled individual's oral health showed a statistically significant relationship with the individual's oral hygiene habits, particularly with respect to the frequency and duration of toothbrushing, need for physical restraint during toothbrushing, use of a manual toothbrush and use of toothpaste. CONCLUSIONS: The carer's personal appearance and interest in the disabled individual's oral health are good indicators of the oral hygiene habits of an individual with severe disability. Consideration should be given to the inclusion of these aspects as a complementary element of the dental record.

Effects of tongue coating and oral health on halitosis among dental students.

PURPOSE: To assess halitosis and determine the relationship between halitosis and tongue scores, periodontal status and DMFT among dental students. MATERIALS AND METHODS: The study comprised 268 (178 female, 90 male) dental students. Halitosis was measured using a Halimeter and the organoleptic method. Halitosis was diagnosed with a mean volatile sulphur compounds (VSC) level of >=125 ppb and an organoleptic measurement of >= 2 on a 0- to 5-point scale. Tongue scores were obtained using a tongue coating index (TCI), periodontal status was measured and assessed using the Community Periodontal Index of Treatment Needs (CPITN) and DMFT indices were calculated. RESULTS: Halitosis occurred at higher rates among male students than female students (83% vs 71%, P = 0.02). No differences were found in halitosis rates among students in different academic years (P = 0.6) or age groups (P = 0.6). A relationship was found between halitosis and tongue scores (P < 0.001) and between halitosis and mean CPITN scores (P = 0.004). The mean DMFT was 4.02 (SD = 3). No relationship was found between halitosis and DMFT index (P = 0.5). CONCLUSION: Halitosis was prevalent among dental students. Given their responsibilities for diagnosing and improving oral health, they may benefit from increased awareness of the problem and encouragement to improve their own oral hygiene, especially male students.

[Clinical importance and diagnosis of halitosis]. / A halitózis klinikai jelentosége és diagnosztikája.

The origin of halitosis comes from the Latin word "halitus" meaning 'breath, exhaled air', and in the Hungarian terminology it means bad and smelly breath. The human body emits a number of volatile molecules, which have a peculiar odour. Their presence is influenced by several factors, such as genetic, nutritional and psychological factors. Since bad breath belongs to taboo subjects, halitosis can often lead to social isolation. To determine the incidence of halitosis, an exact diagnosis is needed which sometimes predestinates the possible treatment as well. Investigators estimate the incidence about 50% in the whole population. The male/female ratio is the same and the incidence is growing with age. The diagnosis can be genuine halitosis, pseudo halitosis and halitophobia. We can divide the genuine type into physiological and pathophysiological subtypes. The cause of the halitosis usually can be found in the oral cavity. The volatile sulfur compounds (VSC) produced by some of the oral bacteria are responsible for its development. Only 10% of the causes are extraoral, mostly inflammation of airways or gastrointestinal disorders. The judgment of halitosis is based on three objective methods: the organoleptic, the sulphide monitoring and the gas cromatography methods. Since the origin of the halitosis is mainly the oral cavity, dentists should treat them. Beyond the dental treatments the enhancement of the oral hygiene, the continuous motivation and monitoring are also very important, such as the use of tongue cleansing and special anti-malodour rinses.

Self-reported oral health and dental service-use of rangatahi within the rohe of Tainui.

OBJECTIVES: To investigate the self-reported oral health and use of oral health services by rangatahi (teenagers) residing within the Waikato rohe (region) of the Waikato-Tainui tribal area. METHODS: A cross-sectional study of self-reported oral health and use of dental services by Maori teenagers. The 14-item short-form Oral Health Impact Profile (OHIP-14) was used to collect data on oral-health-related quality of life (OHRQoL). RESULTS: Just over half of the 238 survey participants (who were aged 16 to 18 years old) were male. Most brushed at least once daily. One-quarter reported hiding their smile, and just over one-fifth reported suffering from bad breath. Awareness of their current entitlement to free dental care was high, but it was lower among males. Just over one-third of participants had experienced one or more OHIP-14 impacts; that was higher among females than males, with the largest difference being apparent with the physical disability subscale, where the prevalence of impacts among females was twice that among males. The prevalence of OHIP impacts was higher among those who reported experiencing bad breath often, and significant differences were observed in all seven OHIP domains (as well as in the mean overall OHIP-14 score and in the mean number of different impacts experienced often). CONCLUSIONS: The data provide some important insghts into the oral health perceptions and concerns of young Maori.

The effects of professional oral health care on patients in the subacute stage of emergent neurosurgical disorders.

This study evaluated the effectiveness of professional oral health care (POHC) on patients who were in the subacute stage of neurosurgical disorders. Forty subjects (26 male, 14 female) with acute cerebrovascular disorders or neurotrauma were randomly divided into two groups. The intervention group (n = 21) received POHC treatment by dental hygienists, and the control group (n = 19) did not. To evaluate the change in oral health status of the subjects, an oral examination was carried out at baseline and four weeks later. For the subjects in the intervention group, periodontal condition, oral hygiene status, and oral function improved statistically significantly. The detection rate for methicillin-resistant Staphylococcus aureus (MRSA) was statistically significantly lower in the intervention group than in the control group. These results suggest that POHC performed by dental hygienists in collaboration with nurses plays an important role in the promotion not only of oral health but also of general health.

The delusion of halitosis: experience at an eastern Nigerian tertiary hospital.

BACKGROUND: Halitosis is a recognized problem in dental practice. Some individuals have the belief that they have offensive mouth odour which neither the dental clinician nor any other person can perceive. This condition is known as delusional halitosis. Delusional halitosis can be classified as either Pseudo halitosis or Halitophobia depending on the response to initial treatment. Halitophobia is an olfactory reference syndrome and is a psychological condition that the dental surgeon is ill equipped to treat alone. This study aimed to analyse patients diagnosed with delusional halitosis, highlight our experiences and make suggestions for improved management of such patients. METHODOLOGY: All patients who presented at the dental clinics of University of Nigeria Teaching Hospital between January 2005 and December 2009 with a primary complaint of oral malodour were examined organoleptically. Those with obvious halitosis and known psychological conditions were excluded from the study Once a diagnosis of delusional halitosis was made, each patient was educated on the nature of halitosis, its causes and prevention. They then received oral prophylaxis and oral hygiene instructions. They were then recalled at one week, four week and six week intervals to establish a definitive classification. RESULT: 18 out of the 25 patients who presented were diagnosed with delusional halitosis. 61% of them male and 39% of them female with an average age of 30yrs. Pseudo halitosis comprised a majority of the cases seen (13). Halitophobia was seen in the minority (5). Reasons sited for believing that they had mouth odour by the patients studied included, peoples reaction when they were in close proximity and how people tended to avoid them (94.4%), ability to self perceive the foul odour from their mouths (55%) and 27.8 % said they had been told by another person that they had bad breath. All the patients had very good oral hygiene, with a tendency to over indulge on oral care products and tended to use mouthwash, breath mints and sweets in an attempt to mask the perceived odour with a few having excessive tooth brushing habits. Most had visited 2 or more other physicians within the year of presentation at the clinic with the same complaint. The patients were embarrassed (55.6%) frustrated (27.6%), self conscious (11.1%) or felt helpless (5.6%) by their perceived foul mouth odour, but none claimed to have suicidal thoughts. CONCLUSION: In all cases of delusional halitosis, there is usually an underlying psychosomatic problem, which can range from an over valued belief to a frank delusional disorder where the individual can hardly be dissuaded from their belief of mouth odour. A multidisciplinary approach to treatment between the dental surgeons and the psychological specialists may present the best approach for the patients.

Halitosis: much beyond oral malodor.

Oral malodor one of the most common complaints with which patients approaches us thinking it can be detrimental to his self-image and confidence. Even though majority of oral malodor is of oral origin, there are multiple other systemic causes that have to be addressed while we diagnose and treat this condition. Most of these patients look up to oral care physicians for expert advice, it is critical for us to have the knowledge base and communication techniques to provide quality clinical assessment and implement effective intervention programs. This article reviews the various causes and the diagnostic modalities which will help us treat this multifaceted condition.

Halitose: etiologia, diagnóstico e classificação / Halitosis: etiology, diagnostic and classification

A halitose é uma condição bastante comum e que pode ocorrer de forma transitória ou persistente em qualquer período da vida do indivíduo. A maioria dos casos, classificados como patológicos, originam-se de alterações na cavidade bucal como saburra lingual e doença periodontal ou de alterações extrabucais como problemas respiratórios, desordens gastrointestinais e metabólicas. Uma minoria dos casos, classificados como pseudo-halitose ou halitosefobia, caracteriza-se pela inexistência de evidências objetivas da presença de mau hálito, apesar da queixa frequente do indivíduo. Para identificação desses diferentes tipos de halitose, vários recursos diagnósticos podem ser utilizados. Dessa forma, o objetivo deste trabalho foi revisar a literatura a respeito da etiologia, métodos diagnósticos e classificação da halitose, a fim de facilitar o seu reconhecimento e a elaboração de seu plano de tratamento pelos profissionais da saúde bucal

The relationship between alcohol consumption and oral malodour.

OBJECTIVE: To analyse the relationship between alcohol consumption and oral malodour. SUBJECTS: 235 individuals, aged 46.5 +/- 15.3 years (mean +/- SD), who complained of oral malodour. METHODS: An organoleptic test (OLT) was used to estimate the degree of oral malodour, gas chromatography was used to measure volatile sulphur compounds (VSCs), and a questionnaire was used to gather data about the subjects' habits related to alcohol consumption. RESULTS: Of the 55 individuals who consumed alcohol daily, 17 (30.9%) had strong malodour (OLT score, 4), and there were significant differences among the 'daily', 'sometimes', and 'no alcohol' groups (Kruskal-Wallis test, p < 0.01). The daily group also had a higher VSC concentration than the 'sometimes' and 'no alcohol' groups (t-test, p < 0.05), and there was no difference in the VSC concentration among the subjects with strong malodour. Analyses of the relationships between drinking habits and the clinical factors causing oral malodour revealed that daily drinking was positively associated with a probing pocket depth > or = 5 mm (chi2 test, p < 0.01). CONCLUSION: This study found an association between daily alcohol consumption and strong malodour, especially related to periodontal disease.

Relationship between halitosis and psychologic status.

OBJECTIVE: To examine the psychosomatic aspects of patients complaining of halitosis. STUDY DESIGN: Breath malodor in 165 patients was measured using an organoleptic test (OLT), sulfide monitoring, and gas chromatography. Clinical evaluation included oral examination, OLT, and volatile sulfur compound measurement. The psychologic condition of patients was assessed using the Cornell Medical Index (CMI). RESULTS: Every item in the CMI questionnaire was negatively correlated with the OLT scores. Nine of 21 subjects (42.9%) diagnosed with pseudohalitosis and approximately 20% of subjects diagnosed with genuine halitosis were considered to be provisionally neurotic. Subjects with pseudohalitosis reported significantly higher physical scores, but not mental scores, than those with genuine halitosis. Subjects with physiologic halitosis showed significantly higher symptoms of depression than those with oral pathologic halitosis. CONCLUSION: The psychologic condition of patients complaining of halitosis was associated with the actual degree of malodor and the clinical characteristics.

Effects of oral health behaviors and socioeconomic factors on a group of Turkish adolescents.

OBJECTIVE: To investigate the effects of socioeconomic factors and oral health behaviors on adolescents in Turkey. METHOD AND MATERIALS: Data were collected through a self-administered questionnaire. The sample consisted of 582 randomly selected adolescents, 309 boys and 273 girls, who presented over a 3-month period with various complaints to the Hacettepe University Medical Faculty Adolescent Clinic. RESULTS: Halitosis complaints were higher in the 11-, 12-, and 13-year-old groups than in other age groups (P < .05). When the sex factor was examined, prevalence of dental fear was found to be higher among girls, while irregular toothbrushing was seen more among boys. In parallel to the increase in the education levels of the parents, an increase was seen in the regular dental visits by the adolescents (P < .05). As the socioeconomic status of the family increased, frequency of dental visits, rate of dental floss usage, and number of teeth with restorations increased. In parallel with the dental visit increase, the rate of restored teeth increased. Of those who did not have regular dental visits because of financial difficulties, however, the rate of teeth with restorations was low. CONCLUSION: A strong correlation exists between the oral health behaviors, socioeconomic and sociodemographic factors, and the oral health status of Turkish adolescents.

La halitosis: revisión de la literatura. Primera parte / Halitosis: literature review. First part

La halitosis es un trastorno capaz de condicionar la calidad de vida, particularmente en lo que atañe a las relaciones sociales. Mediante una atenta revisión de la literatura se han puesto de relieve las hipótesis etiológicas,tanto orales como extraorales, de la halitosis y el correspondiente enfoque diagnóstico-terapéutico por parte del odontólogo y del higienista dental (AU)

Halitosis is a problem that may affect the quality of life, social relations in particular. Through a careful literature review, aetiological hypotheses, both oral and extraoral, on halitosis are highlighted as well as the dianostic and therapeutic approach that should be adopted by the dentist and the dental hygienist (AU)