Effectiveness of Glutamine Oral Care in Reducing Oral Mucositis and Improving Oral Health After Neurosurgery: A Randomized Controlled Trial with Microbiome Analysis.

BACKGROUND Hospital-acquired infections negatively impact the health of inpatients and are highly costly to treat. Oral care reduces the microorganism number in the mouth and lungs and is essential in preventing postoperative oral inflammation, lung infection, and other complications. This study was designed to determine the effects of oral care with glutamine on oral health, oral flora, and incidence of pneumonia in patients after neurosurgery. MATERIAL AND METHODS This was a parallel, double-blind, randomized trial. Patients admitted to the Neurosurgery Department of the hospital from July to October 2021 were selected. Three hundred patients who met the inclusion criteria were randomized into 3 groups. The control group (n=100) received oral care with routine oral nursing methods with saline, whereas the experimental group (n=100) received oral care with 5% glutamine. A compound chlorhexidine group (n=100) was set as a positive control. All patients, care providers, and investigators were blinded to the group assignment. The incidence of local debris, oral mucositis, halitosis, dryness, oral mucositis disorders, and oral flora types were collected and analyzed in all groups. RESULTS The incidence of local debris, oral mucositis, halitosis, dryness, and other oral mucositis disorders in the glutamine oral care group was significantly decreased, compared with that of the control group. Oral flora types in the glutamine and chlorhexidine groups were significantly reduced. CONCLUSIONS Oral care with 5% glutamine after neurosurgery is associated with a lower incidence of oral disorders and pneumonia, and a significant reduction in oral flora.

Is bad breath associated with dyspepsia? An association and an equivalence study.

Halitosis affects all populations worldwide. The presence of chronic halitosis may be related to a health problem. Patients with bad breath usually seek a gastroenterologist and, in some cases, invasive and expensive exams, such as digestive endoscopy, are performed to investigate the etiology of halitosis. This study aimed to investigate whether the prevalence of bad breath in patients diagnosed with dyspepsia (any pain or discomfort in the upper abdomen) is higher than or equivalent to that in non-dyspeptic patients. This is a cross-sectional study that included 312 patients from university hospitals in the city of Rio de Janeiro (141 dyspeptic patients and 171 non-dyspeptic ones). The presence of halitosis was defined based on different cutoff points. Association analyses were performed using a log-binomial model and 95% confidence intervals were calculated for the coefficients, adjusting for sex and age. The equivalence test (Westlake) was used to test the hypothesis of equivalence between the proportions of patients with bad breath in the two groups (dyspeptic vs. non-dyspeptic), considering an equivalence band of ± 15%. The prevalence of bad breath ranged from 30% to 64% according to the definition of bad breath. Dyspepsia was not associated with bad breath in any of the three definitions of bad breath (two specific ones and a sensitive one). The proportion of patients with marked bad breath was equivalent in patients with and without dyspepsia.

Is it worth applying self-irrigation after third molar extraction? A randomised controlled trial.

In this study, we aimed to examine the effectiveness of self-irrigation following the extraction of mandibular third molars. A randomised controlled clinical trial was conducted with 155 patients who had undergone extraction of a mandibular third molar. The irrigation group was instructed to self-irrigate the extraction socket with tap water using a syringe three times a day, starting seven days after the tooth extraction. The incidence of complications and mouth opening, halitosis, plaque/gingival index, and oral health-related quality of life (OHRQoL) were measured. The irrigation group showed a lower incidence of complications than the non-irrigation group. The halitosis, plaque, and gingival scores were lower by mean (SD) 19.66 (5.19), 0.58 (0.06), and 0.62 (0.08), respectively, in the irrigation group than in the non-irrigation group (p = 0.0001). A greater amount of food packing was associated with higher halitosis, plaque, and gingival scores and poorer OHRQoL (p < 0.05). Further, more frequent irrigation was associated with lower halitosis, plaque, and gingival scores and better OHRQoL (p ≤ 0.016). Self-irrigation of the extraction socket using a syringe containing tap water is a very effective method for keeping the extraction socket clean. This technique reduced halitosis, improved plaque and gingival indices, and increased OHRQoL.

Hematological biomarkers of systemic inflammation in genuine (physiologic and pathologic) halitosis.

Halitosis is an unpleasant odor discharged through the oral cavity with a prevalence as high as 30%-50% of the general population. Conventional diagnostic methods have been focused on mouth air analysis measuring the amount of sulfur compounds which does not directly reflect the cause of halitosis. Also, the possible role of halitosis as an indicator of general health status has been steadily suggested and inflammation has been constantly associated with aversive body odor. Therefore, this study aimed to search for inter-relationships between hematologic indicators, clinical characteristics, and halitosis measurement that can predict the presence of pathologic halitosis and its intensity. Furthermore, the tentative relationship between halitosis and the presence of systemic inflammation was investigated. A total of 125 patients were divided into 103 patients in the genuine halitosis group (value ⩾80 ppb) and 22 patients in the pseudo halitosis group (value <80 ppb) based on portable sulfide monitor measurements. Clinical examination and hematological indices including inflammatory prognostic factors and halitosis measurements including organoleptic testing, portable sulfide monitor, and gas chromatography were evaluated. The genuine halitosis group showed a significantly higher white blood cell (WBC) count (p< 0.01) compared to the pseudo halitosis group. Erythrocyte sedimentation rate (ESR,ß= 0.341,p< 0.05) values and duration of halitosis (ß= 0.353,p< 0.05) showed a significant association with halitosis intensity and neutrophil to lymphocyte ratio (NLR) values (ß= 3.859,p< 0.05) were significantly related to genuine halitosis diagnosis. A new WBC cut-off value of 5575µl-1showed near to fair discriminative power in predicting genuine halitosis (area under the curve 0.661,p< 0.05). The results of this study showing an increased WBC count in genuine halitosis and its strong association with hematologic indices of subclinical inflammation including ESR and NLR suggest inflammatory hematologic markers as potential diagnostic tools in the diagnosis of genuine halitosis.

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).

Comparative Evaluation of the Effects of Adenotonsillar Hypertrophy on Oral Health in Children.

We aimed to investigate the oral health of children in terms of the presence of dental caries, periodontal health, halitosis, and dentofacial changes in patients who had adenotonsillar hypertrophy related to mouth breathing and compared these findings with nasal breathing healthy and adenotonsillectomy-operated children. The patient group comprised 40 mouth-breathing children who were diagnosed with adenotonsillar hypertrophy, while the control group consisted of 40 nasal breathing children who had no adenotonsillar hypertrophy. Forty children who had undergone an adenotonsillectomy operation at least 1 year prior to the study were included in the treatment group. Oral examinations of all children were conducted, and the parents were asked about medical and dental anamnesis, demographic parameters, toothbrushing and nutrition habits, oral health-related quality of life (OHRQoL), and symptoms of their children. Demographic parameters, toothbrushing and nutrition habits, and the presence of bad oral habits did not differ between groups (p > 0.05). Adenotonsillectomy is associated with a remarkable improvement in symptoms; however, some symptoms persist in a small number of children. The salivary flow rate, dmft/s, DMFT/S index, plaque, and gingival index scores did not differ between groups (p > 0.05). The patient group showed higher rates of halitosis when compared with the treatment and control groups (p < 0.001). Mouth breathing due to adenotonsillar hypertrophy caused various dentofacial changes and an increase in Class II division 1 malocclusion (p < 0.001). It was shown that adenotonsillar hypertrophy does not negatively affect OHRQoL, it could be a risk factor for dental caries, periodontal diseases, and halitosis, but by ensuring adequate oral health care, it is possible to maintain oral health in children with adenotonsillar hypertrophy. Also, it is recommended that orthodontic treatment should start as soon as possible if it is required. In this context, otorhinolaryngologists, pedodontists, and orthodontists should work as a team in the treatment of children with adenotonsillar hypertrophy.

Oral health and halitosis among type 1 diabetic and healthy children.

AIM: To evaluate the oral health status, oral health related habits and halitosis of children with and without type 1 diabetes. MATERIALS AND METHODS: In this study the oral health status of children with and without type 1 diabetes were evaluated by using different indices (dmft/DMFT, International Caries Detection and Assessment System(ICDAS) II, pufa, gingival and periodontal indices). Halitosis was determined by organoleptic assessment and sulfur monitoring. RESULTS: One hundred children with the age range between 6-13 years, 50 type 1 diabetics (24 boys,26 girls) with mean age (±sd) of 10.3 ± 2.1 years and 50 healthy (30 boys, 20 girls) with mean age (±sd) of 9.9 ± 1.5 years, participated in the study. The median values of dmft and dmfs was lower in children with type 1 diabetes, while for DMFT and DMFS indices were similar with the healthy group. Cavitated caries lesions were observed in 60.0% of children with diabetes and in 58.0% of healthy children. According to the ICDAS II index, 42.0% of children with diabetes and 56.0% of healthy children had severe decay. The mean plaque index was statistically significantly less in diabetic children (p = 0.04). In 12.0% of children with type 1 diabetes and in 18.0% of healthy children, volatile sulfur compounds (VSC) were determined to be ≥150 ppb and the most diagnosed score was 1 in both groups. In diabetic children with the cut off value of 7.5% HbA1c, there was no statistically significant difference in oral health indices results and VSC scores. CONCLUSION: Findings of the present study are insufficient to support a significant effect of diabetes on increasing the risk of oral and periodontal diseases. Nonetheless, it is important to emphasize the importance of oral and dental health, regular oral care and dental visits both to the patients with type 1 diabetes and their parents.

Periodontitis and self-reported halitosis among young adults from the 1982 Pelotas Birth Cohort.

OBJECTIVE: To investigate the association between periodontitis and self-reported halitosis among young adults, and whether there is an interaction between the effects of smoking and periodontitis on halitosis. METHODS: Data from the 1982 Pelotas birth cohort, Brazil, were used. The controlled direct effect of periodontitis on self-reported halitosis, not mediated by tongue coating, was estimated using marginal structural modeling. In addition, an interaction between the effects of smoking and periodontitis on halitosis was also tested. Confounders comprised sociodemographic information, obesity, diabetes, and oral hygiene habits. RESULTS: The controlled direct effect of periodontitis on halitosis not mediated by tongue coating showed that individuals with periodontitis had 90% higher risk of self-reporting halitosis (RR 1.90) compared to healthy individuals. Individuals with mild periodontitis had twice the risk of reporting halitosis than periodontally healthy individuals (RR 2.31). We also found an interaction between the effects of smoking and periodontitis on halitosis, as noted among smokers with mild (RR 2.91) and moderate-to-severe periodontitis (RR 5.84). CONCLUSION: There is a controlled direct effect of periodontitis on halitosis not mediated by tongue coating. Additionally, an interaction between the effects of smoking and periodontitis on halitosis was also detected.

Laryngoscopic techniques modulate anaesthesiologists' perception of halitosis in patients: A randomised controlled trial.

BACKGROUND: Perception of halitosis in patients during intubation is a common and additional stressor for anaesthesiologists and may lead to potential health risks. OBJECTIVES: We hypothesised that intubation with videolaryngoscopy could help reduce the anaesthesiologists' perception of patients' oral malodor during intubation. DESIGN: A single-blinded, randomised controlled trial. SETTING: Single centre general hospital, Guangdong Province, China. PARTICIPANTS: A total of 440 patients who underwent intubation under general anaesthesia for elective surgery, aged 18 to 60 years old, American Society of Anaesthesiologists class I to III, without upper airway abnormality or airway infection were enrolled. INTERVENTION: Patients were randomly assigned to receive either UE videolaryngoscopy (UE) or Macintosh's direct laryngoscopy (Macintosh) group. All intubations were performed by one of six very experienced anaesthesiologists. MAIN OUTCOME MEASURES: The patient's oral odour score was measured prior to induction of anaesthesia. The anaesthesiologists' perception of the patient's oral malodor during intubation was recorded. The shortest distance from patient's mouth to the anaesthesiologist's nose (MN distance), the exertion rating and discomfort were also measured. RESULTS: The oral malodor score did not differ in the UE and Macintosh groups prior to the induction of anaesthesia. However, the incidence of the anaesthesiologists' perception of halitosis during intubation was significantly lower in the UE group compared with the Macintosh group (P < 0.001). Similarly, the MN distance was significantly greater in the UE group compared with the Macintosh group (P < 0.001). The first-attempt success rate was higher in the UE group compared to the Macintosh group (P < 0.001). However, the exertion scores were considerably higher in the Macintosh group. After intubation, anaesthesiologists experienced more waist and shoulder discomfort with the Macintosh than the UE technique of intubation. CONCLUSION: Compared with direct laryngoscopy, videolaryngoscopy might reduce the anaesthesiologists' perception of the patients' oral malodor, help improve first-attempt success rate, as well as alleviate the anaesthesiologists' waist and shoulder discomfort. TRIAL REGISTRATION: Clinicaltrials.gov (ChiCTR-IOR-15007038).

[Is there any relation between type 1 halitosis and oral candida colonisation?] / Tip 1 agiz kokusu ile agizda kandida kolonizasyonu arasinda iliski var mi?

Pathologic halitosis has been classified into 5 types: oral, airway, gastroesophageal, blood-borne and subjective, respectively. Type 1 (oral) halitosis mostly takes origin from anaerobic bacterial activities on oral surfaces. The role of anaerobic bacterial activities is clearly demonstrated, but despite the large number of anectodal claims, the role of Candida in patients with halitosis has not been adequately investigated. The aim of this study was to confirm the relationship between Candida and halitosis. A total of 136 subjects were enrolled and divided into two groups. The study group comprised of 69 patients with halitosis who had over 0.7 ppm H2S concentration in their oral cavity and the control group comprised of 67 healthly subjects. Self assesment scores for halitosis, Candida colony counts in saliva samples, oral NH3, SO2, H2S, H2 and volatile organic gas concentrations were recorded. H2S producing capacity of subjects was quantified by applying cysteine challenge test. Candida samples were taken from the mouths of the patients with and without halitosis, and Candida albicans isolates were inoculated into broth medium. After 3 days of incubation at 37oC, gas concentrations of the headspace of the flasks were read by a portable multigas detector. The rate of Candida positivity was 44.9% in the study group while it was 46.3% in the control group. There was no statistical significant difference between the groups according to the Candida growth (p= 0.561). The oral gas concentrations were comparable in both groups (p< 0.05). Oral H2S concentration increased 9.65 fold with 20 mM cysteine rinse in patients with halitosis while it was increased 5.8 fold in controls. Self assesment for halitosis were well correlated with clinical signs (p= 0.001, r= 0.8). Concentrations of hidrogen and organic gases were found to be increased in all Candida culture media. In this study, no relationship between the presence of Candida and oral halitosis was detected. As a result, there is no need for diets similar to Candida diet in the treatment of halitosis. On the other hand, cysteine challenge can be a useful diagnostic tool. In addition, portable gas detectors can be used as a convenient and practical halitometer to quantify halitosis.

Effect of rapid maxillary expansion on halitosis.

INTRODUCTION: The objective of this study was to evaluate the effect of rapid maxillary expansion (RME) on halitosis. METHODS: Thirty children (11-15 years old) were randomly divided into RME and control groups. The RME group consisted of 15 children treated with hyrax appliances, and the control group included 15 children without treatment. Halitosis was evaluated with the halimeter and the organoleptic method. Plaque index and gingival index scores were recorded. Acoustic rhinometry was used to measure the nasal volume. Measurements were obtained at 2 times: before RME, and after retention at 4 months. The Wilcoxon signed rank test and the paired t test were used for intragroup comparisons, and the Mann-Whitney U test and the Student t test were used for intergroup comparisons. RESULTS: Halitosis (halimeter and organoleptic values) decreased significantly in the RME group (P <0.001). Insignificant changes of halitosis were observed in the control group. Intragroup and intergroup comparisons showed no statistically significant differences for the plaque index. Gingival index values were significantly decreased with RME (P ≤0.05). Nasal cavity volume increased significantly in the RME group (P <0.01). CONCLUSIONS: RME was shown to lower halitosis values. RME could be a treatment option for patients with maxillary transverse deficiency and halitosis.

Effect of photodynamic therapy in the reduction of halitosis in patients with multiple sclerosis: clinical trial.

Smell and odours play a vital role in social interaction. Halitosis is a social problem that affects one third of the population, causing a negative impact on the quality of life. There is little knowledge on the prevalence and management of halitosis in multiple sclerosis (MS) patients. The present study aims to evaluate the presence of halitosis in patients with MS when compared to a control group, and also evaluate treatment of the problem with antimicrobial photodynamic therapy (aPDT). This is a case-control clinical study in which 60 patients were evaluated: 30 MS patients in treatment at the Specialties Clinic School of Medicine, and 30 healthy patients, matched in age and gender for the control group. Data was collected on the duration of the disease as well as the degree of disability and medication use in the MS group. For all patients, halitosis was assessed with Oral Chroma™. Individuals with halitosis underwent treatment with tongue scraping and aPDT. The photosensitizer was methylene blue (0.005%) and a THERAPY XT-EC® laser (660 nm, 9 J, 100 mW for 90 s per point, 320 J cm-2, 3537 mW cm-2) was used. Six points 1 cm apart from each other were irradiated in the tongue dorsum. There was a positive correlation between the disability and disease duration. No parameter was correlated with halitosis. Patients with MS have higher levels of SH2 compounds when compared to the control group (p = 0.003, Mann-Whitney), but after aPDT both groups significantly reduced the levels to under the halitosis threshold. The aPDT scraping treatment was effective in the immediate reduction of halitosis in both groups.

Oral health impact of halitosis in Chinese adults.

OBJECTIVES: To compare differences in oral health-related quality of life (OHRQoL) between halitosis and non-halitosis patients and to explore relationships between halitosis and OHRQoL. METHODS: Patients who visited the halitosis clinic at the Ninth People's Hospital and were diagnosed with halitosis were included in the halitosis group. The control group consisted of patients without halitosis. All participants were assessed for halitosis (volatile sulphur compound measurements with a portable sulphide monitor, Oral Chroma and organoleptic tests), underwent a clinical oral examination (dental caries status and periodontal condition) and completed a questionnaire. Oral health-related quality of life was measured using the Oral Health Impact Profile (OHIP-14, Chinese version). RESULTS: A total of 204 patients (102 halitosis and 102 controls) were included. The halitosis group had significantly higher OHIP-14 scores (severity) than the control group (15.7 versus 7.9, P < 0.001). The mean number of items with negative impact (extent) was significantly different between the halitosis and control groups (1.8 versus 0.3, P < 0.001). Around 56% of participants in the halitosis group reported at least one item with 'fairly often' or 'very often' (prevalence), while 21% did so in the control group (P < 0.001). In halitosis patients, the most commonly reported negative impacts were within the domains of 'psychological discomfort' and 'psychological disability'. CONCLUSIONS: Oral health-related quality of life status was significantly poorer in halitosis patients than in non-halitosis patients. Halitosis patients may experience some degree of psychological discomfort and disability.

The effect of oil pulling with rice bran oil, sesame oil, and chlorhexidine mouth rinsing on halitosis among pregnant women: A comparative interventional study.

CONTEXT: Rice bran oil, owing to its potential antioxidant benefits, could be an effective and novel alternative to sesame oil for oil pulling. As it is safe and a growingly popular edible oil, it may be acceptable during pregnancy, especially in the Indian context where women may be hesitant to use chemical plaque control methods for preventing halitosis. AIMS: The present study was conducted to compare the effects of oil pulling with rice bran oil, oil pulling with sesame oil, and oil pulling with chlorhexidine mouth rinsing on reducing halitosis among pregnant women. SETTINGS AND DESIGN: Thirty pregnant women who attended the Gynecology Outpatient Department (OPD) of Muslim Medical Hospital, Haran Khana Road, Pani Gate, Vadodara, Gujarat, India, were recruited in the present randomized double-blind interventional study. SUBJECTS AND METHODS: Eligible pregnant women individuals who gave consent for the study were randomly allocated to receive the interventions under investigation. Halitosis was measured at baseline and after 14 days of intervention using TANITA breath checker HC-212M-BL. STATISTICAL ANALYSIS USED: Data entry was done in Microsoft Excel 2007, and statistical analysis was performed using SPSS version 17. Wilcoxon signed rank tests were used to interpret the differences in baseline and postintervention halitosis levels. One-way ANOVA was done to compare the mean reduction in halitosis scores of the three intervention groups. RESULTS: There was a statistically significant reduction in the grades of halitosis at baseline and 14 days after intervention for all the three groups. There was no statistically significant difference between chlorhexidine mouth rinsing, oil pulling with sesame oil, and oil pulling with rice bran oil in halitosis reduction. CONCLUSIONS: Rice bran oil when used in oil pulling was effective in reducing halitosis. It performed comparably and marginally superior to other agents tested in the study when change in halitosis postintervention was considered.

Respuesta a: Síndrome de Sjögren y halitosis: descripción de un caso clínico / Response to: Sjögren's syndrome and halitosis: a case report

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Halitosis severa como forma de presentación de un divertículo epifrénico / Severe halitosis as presentation of epiphrenic diverticulum

La halitosis es una condición común cuya principal etiología no responde a enfermedades del sistema gastrointestinal. Los divertículos epifrénicos son una causa rara de esta manifestación, de hecho estos son poco frecuentes y suelen ser asintomáticos. Sin embargo, pueden llegar a producir síntomas con incapacidad para el paciente. Se presenta un paciente con halitosis severa, en cuyo estudio se diagnostica un divertículo epifrénico, al cual se le realizó diverticulectomía por vía laparascópica abdominal con completa resolutividad de la sintomatología (AU)

Halitosis is a common condition, whose main etiology does not respond to diseases of the gastrointestinal system. Epiphrenic diverticula are a rare cause of this manifestation, thus they are not frequent and they are usually asymptomatic. However, they may produce symptoms with inability for patient. A patient with severe halitosis is presented. In his study, an epiphrenic diverticulum is diagnosed and the laparoscopic abdominal diverticulectomy is performed with a complete resolution of symptomatology (AU)

Gastroesophageal reflux disease and dental erosion correlation; a new theory from ancient time

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Reacciones adversas a medicamentos en la cavidad oral / Side effects of drugs on the oral cavity

A pesar de que los fármacos son la herramienta terapéutica más potente de la que disponemos para mejorar la calidad de vida de la población, su uso no está exento de efectos adversos. Hoy en día son muchos los pacientes polimedicados, siendo complicado encontrar la causa de los efectos adversos generados por la medicación y aumentando estos de manera exponencial cuando se combinan más de 4 fármacos. Existe un amplio número de fármacos que pueden dar lugar a numerosos efectos adversos en la cavidad bucal. Los más frecuentes son la xerostomía, las alteraciones del gusto, el agrandamiento gingival y las mucositis producidas por el tratamiento oncológico. También se revisan otras alteraciones de las glándulas salivales, las alteraciones de la mucosa oral, las pigmentaciones, la halitosis, la osteonecrosis, las infecciones oportunistas y las diátesis hemorrágicas (AU)

Although drugs are the most powerful therapeutic tools we have for improving the quality of life of the population, their use is not free of adverse effects. Today there are many polymedicated patients, and it is difficult to find the cause of their adverse effects that increase exponentially when more than 4 drugs are combined. There are a large number of drugs that can result in numerous adverse effects in the oral cavity. The most common are xerostomia, altered taste, gingival enlargement and mucositis caused by cancer treatment. We also review other disorders of the salivary glands, oral mucosal changes, pigmentations, halitosis, osteonecrosis, opportunistic infections and bleeding diathesis (AU)

Relationship between genuine and pseudohalitosis and social anxiety disorder.

Halitosis is described as offensive breath caused by various factors such as periodontal diseases, bacterial coating of tongue, systemic disorders and different types of foods. Pseudohalitosis is a situation that patients complain of oral malodor even though they do not have offensive odour. The purpose of this study was to compare the relationships between social anxiety estimations and both pseudohalitosis and genuine halitosis cases. Liebowitz Social Anxiety Scale (LSAS) and questionnaire regarding halitosis were applied to 100 participants. Halitosis was determined using organoleptic method, gas chromatography and portable sulphur monitor. anova test and 2-tailed Spearman's rank-order correlation coefficient were used to determine the differences and relations between groups. With reference to LSAS, 62% of participants had anxiety. Among these patients, 98% had genuine halitosis (P < 0·05). The mean measurements of VSC values were 248·65 ppm in halimeter, 298·02 ppm of H2 S, 95·33 ppm of CH3 SH and 47·00 ppm of (CH3 )2 S in gas chromatography. Halitosis was present in 90% of participants, and it was absent in 10% by organoleptic assessment. There was a significant correlation between organoleptic and halimeter measurements. Moreover, statistically significant relationship was detected between anxiety and halitosis. Genuine halitosis patients exhibit social anxiety, so it can be said that there is a causal relationship between halitosis and anxiety. Comparison of the results of objective measurements (sulphur monitor, gas chromatography, organoleptic method) was statistically significant; therefore, it can be said that these methods can be used in diagnosis of halitosis with high accuracy.

Halitosis: could it be a predictor of stroke?

Stroke is a medical emergency and can cause permanent neurological disability and death. Halitosis (bad breath) has been reported in many stroke patients. We speculated that this phenomenon may be present before as well as after a stroke. Moreover, many studies have shown that most of the causes of halitosis are also associated with an increased risk of stroke. Therefore, we hypothesized that the severity of halitosis could be a predictor of stroke. We hope that this hypothesis can be confirmed by further investigations, and that if confirmed it can be used as a tool to monitor disease control and/or early diagnosis and intervention of newly developed diseases related to both halitosis and stroke.