Short term effect of antimicrobial photodynamic therapy and probiotic L. salivarius WB21 on halitosis: A controlled and randomized clinical trial.

OBJECTIVE: This study aimed to evaluate the effect of antimicrobial photodynamic therapy (aPDT) and the use of probiotics on the treatment of halitosis. METHODS: Fifty-two participants, aged from 18 to 25 years, exhaling sulfhydride (H2S) ≥ 112 ppb were selected. They were allocated into 4 groups (n = 13): Group 1: tongue scraper; Group 2: treated once with aPDT; Group 3: probiotic capsule containing Lactobacillus salivarius WB21 (6.7 x 108 CFU) and xylitol (280mg), 3 times a day after meals, for 14 days; Group 4: treated once with aPDT and with the probiotic capsule for 14 days. Halimetry with gas chromatography (clinical evaluation) and microbiological samples were collected from the dorsum of the tongue before and after aPDT, as well as after 7, 14, and 30 days. The clinical data failed to follow a normal distribution; therefore, comparisons were made using the Kruskal-Wallis test (independent measures) and Friedman ANOVA (dependent measures) followed by appropriate posthoc tests, when necessary. For the microbiological data, seeing as the data failed to follow a normal distribution, the Kruskal-Wallis rank sum test was performed with Dunn's post-test. The significance level was α = 0.05. RESULTS: Clinical results (halimetry) showed an immediate significant reduction in halitosis with aPDT (p = 0.0008) and/or tongue scraper (p = 0.0006). Probiotics showed no difference in relation to the initial levels (p = 0.7530). No significant differences were found in the control appointments. The amount of Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola were not altered throughout the analysis (p = 0.1616, p = 0.2829 and p = 0.2882, respectively). CONCLUSION: There was an immediate clinical reduction of halitosis with aPDT and tongue scraping, but there was no reduction in the number of bacteria throughout the study, or differences in the control times, both in the clinical and microbiological results. New clinical trials are necessary to better assess the tested therapies. TRIAL REGISTRATION: Clinical Trials NCT03996044.

Phyllanthus emblica fruit extract alleviates halitosis and reduces the inflammatory response to oral bacteria.

OBJECTIVE: To assess the efficacy of Phyllanthus emblica extract in alleviating halitosis and reducing the inflammatory response to halitosis-related bacteria. METHODOLOGY: This investigation, using Phyllanthus emblica fruit extract (PE), involved four aspects. First, we evaluated the effect on growth and aggregation of halitosis-related bacteria, including Fusobacterium nucleatum, Porphyromonas gingivalis, and Solobacterium moorei, using a microdilution assay and scanning electron microscopy. Second, volatile sulfur compound (VSC) levels were measured on individuals with halitosis in randomized short-term (26 participants) and double-blind randomized long-term trials (18 participants in each group) after rinsing with PE for 3, 6, and 12 h, and 28 days. Third, we analyzed pro-inflammatory cytokine expression in TR146 cells using quantitative real-time PCR and enzyme-linked immunosorbent assays. Lastly, we assessed pro-inflammatory cytokine secretion and Toll-like receptor (TLR) 2 mRNA expression via the same experimental methods in a three-dimensional oral mucosal epithelial model (3D OMEM). RESULTS: PE extract dose-dependently inhibited the growth of F. nucleatum (50% inhibition concentration [IC50]=0.079%), P. gingivalis (IC50=0.65%), and S. moorei (IC50=0.07%) and effectively prevented bacterial aggregation. Furthermore, VSC contents decreased significantly at 3, 6, and 12 h after rinsing with 5% PE compared with those in the control. Long-term use of mouthwash containing 5% PE for 28 days led to a significant decrease in VSC contents. PE attenuated the F. nucleatum- or P. gingivalis-stimulated mRNA expression and protein release of interleukin (IL)-6 and IL-8 in TR146 cells. It also suppressed IL-8 and prostaglandin E2 secretion and TLR2 mRNA expression in F. nucleatum-induced OMEMs. CONCLUSION: Our findings support the use of PE in oral care products to alleviate halitosis and it may reduce inflammation.

Factors associated with halitosis reported by parents/caregivers in individuals with Down syndrome.

AIMS: Data on halitosis among individuals with Down syndrome (DS) are scarce. The aim was to evaluate factors associated with the occurrence of halitosis reported by parents/caregivers (P/Cs) in individuals with DS. METHODS AND RESULTS: A cross-sectional study was conducted in non-governmental assistance institutions in the State of Minas Gerais-Brazil. P/Cs have answered an electronic questionnaire with sociodemographic, behavioral and oral health data. Factors associated with halitosis were evaluated by multivariate logistic regression. The sample comprised 227 P/Cs (age 48.8 ± 13.2 years; 82.9% mothers) of individuals with DS (age 20.8 ± 13.5 years). The prevalence of halitosis in the total sample was 34.4% (n = 78) and its occurrence was associated: 1) in individuals with DS ≤18 years old (26.2%; n = 27)-negative perception of oral health (OR = 3.91); 2) in individuals with DS > 18 years (41.1%; n = 51)-gingival bleeding (OR = 4.53), absence of tongue brushing (OR = 4.50), negative perception of oral health (OR = 2.72). CONCLUSIONS: The occurrence of halitosis in individuals with DS reported by P/Cs was relevant and associated with dental factors, having a negative impact on the perception of oral health. Oral hygiene practices, especially tongue brushing, should be reinforced to prevent and control halitosis.

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)

Halitosis and Pain Threshold of Peri-Implant Tissues: An Observational Cohort Study.

In this study, we aimed to evaluate the halitosis and pain threshold of the peri-implant soft tissues in individuals rehabilitated with implant-supported prostheses. Forty-eight subjects were divided into four groups (n = 12) according to their prosthetic rehabilitation: single-tooth fixed prosthesis, multi-tooth fixed prosthesis, overdentures, and the Brånemark protocol. Halitosis was measured using a halimeter, whereas the pain threshold was measured using Von Frey monofilaments. Measurements were taken before (t0) and 30 days after (t1) placement of healing caps, and at the time of (t2) and 30 days after (t3) prosthetic placement. Halitosis data were analyzed using the chi-square test and Bonferroni correction (p < 0.05). Two-way ANOVA and Tukey's test (p < 0.05) were used to analyze pain threshold data. We noted an association between halitosis and time for the Brånemark protocol [X2(6) = 18.471; p = 0.005] and overdenture groups [X2(6) = 17.732; p = 0.007], and between halitosis and type of prosthesis only at t0 [X2(6) = 12.894; p = 0.045]. The interaction between time and the type of prosthesis significantly interfered with the mean pain threshold values (p = 0.001). At most time points, the majority of participants in each group had clinically unacceptable halitosis. After 30 days of using the prostheses, the overdenture group had a lower pain threshold compared to the Brånemark protocol group.

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.

Accuracy of two methods to detect the presence of halitosis: the volatile sulfur compounds concentration in the mouth air and the information from a close person.

This study aimed to analyze the accuracy of two methods for detecting halitosis, the organoleptic assessment by a trained professional (OA) with volatile sulfur compounds (VSC) measurement via Halimeter® (Interscan Corporation) and information obtained from a close person (ICP). Participants were patients and companions who visited a university hospital over one year period to perform digestive endoscopy. A total of 138 participants were included in the VSC test, whose 115 were also included in the ICP test. ROC curves were constructed to establish the best VSC cut-off points. The prevalence of halitosis was 12% (95%CI: 7% to 18%) and 9% (95%CI 3% to 14%) for the OA and ICP, respectively. At the cut-off point >80 parts per billion (ppb) VSC, the prevalence of halitosis was 18% (95%CI: 12% to 25%). At the cut-off point >65 ppb VSC, sensitivity and specificity were 94% and 76%, respectively. At the cut-off point >140 ppb, sensitivity was 47% and specificity 96%. For the ICP, sensitivity was 14% and specificity 92%. VSC presents high sensitivity at the cut-off point of >65 ppb and high specificity at the cut-off point of >140 ppb. ICP had high specificity, but low sensitivity. The OA can express either occasional or chronic bad breath, whereas the ICP can be a potential instrument to detect chronic halitosis.

Comparative study between photodynamic therapy and the use of probiotics in the reduction of halitosis in mouth breathing children: Study protocol for a randomized controlled clinical trial.

INTRODUCTION: Halitosis is a term that defines any odor or foul smell the emanates from the oral cavity, the origin of which may be local or systemic. One of the causes of local or oral halitosis is low salivary flow and dry mouth, which is also one of the complaints of individuals with the mouth-breathing habit. The aim of this study is to determine the effectiveness of antimicrobial photodynamic therapy (aPDT) and the use of probiotics for the treatment of halitosis in mouth-breathing children. METHODS: Fifty-two children between 7 and 12 years of age with a diagnosis of mouth breathing and halitosis determined through an interview and clinical examination will be selected. The participants will be divided into 4 groups: Group 1-treatment with brushing, dental floss and tongue scraper; Group 2-brushing, dental floss and aPDT applied to the dorsum and middle third of the tongue; Group 3-brushing, dental floss and probiotics; Group 4-brushing, dental floss, aPDT and probiotics. The use of a breath meter and microbiological analysis of the tongue coating will be performed before, immediately after treatment and 7 days after treatment. The quantitative analysis will involve counts of colony-forming bacteria per milliliter and real-time polymerase chain reaction. The normality of the data will be determined using the Shapiro-Wilk test. Parametric data will be submitted to analysis of variance and nonparametric data will be compared using the Kruskal-Wallis test. The results of each treatment in the different periods of the study will be compared using the Wilcoxon test. DISCUSSION: Due to the low level of evidence, studies are needed to determine whether treatment with aPDT using annatto as the photosensitizer and blue led as the light source is effective at diminishing halitosis in mouth-breathing children.

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.

Evaluation of halitosis parameters in patients undergoing head and neck radiotherapy.

OBJECTIVES: To assess halitosis parameters using OralChroma™ and the correlation with salivary flow, oral hygiene index, radiation dose, and tongue-coating index among irradiated head and neck cancer patients compared to patients without cancer. MATERIALS AND METHODS: This cross-sectional study enrolled irradiated and non-irradiated patients divided into two groups. Hydrogen sulfide, methyl mercaptan, and dimethyl sulfide (DMS) levels were measured using a gas chromatograph, and sialometry was performed. The tongue-coating index and simplified oral hygiene index were also assessed. RESULTS: Thirty-eight patients were allocated to each group. Volatile sulfur compound levels were above the thresholds in both groups. Non-irradiated individuals showed higher levels of hydrogen sulfide and dimethyl sulfide. Patients with asialia had an inexpressive tongue-coating index and increased dimethyl sulfide levels. A decrease in salivary flow rate was followed by a significant increase in volatile sulfur compound levels. Higher doses of radiation to the submandibular salivary glands were associated with higher concentrations of sulfide and methyl mercaptan. CONCLUSIONS: Head and neck radiotherapy may be important in the development of halitosis. Irradiated patients with asialia presented insignificant lingual biofilm. Consequently, lower levels of volatile sulfur compounds were detected in this group. Asialia, a severe radiation-induced hyposalivation, impacted the levels of DMS (extraoral origin).

Oral conditions associated with oral health related quality of life: A population-based cross-sectional study in Brazil.

AIM: To investigate the association between 11 oral conditions and oral health related quality of life (OHRQoL). MATERIALS AND METHODS: This cross-sectional study used a multistage sampling strategy to draw a representative sample of adults aged ≥35 years living in Porto Alegre, Brazil. OHRQoL was assessed using OHIP-14. Oral examinations were conducted to assess gingivitis, dental calculus, tooth loss, gingival recession (GR), dentine hypersensitivity (DHS), dental caries (DFT), dental erosion, and non-carious cervical lesions (NCCL). Questionnaires recorded the following self-reported oral variables: xerostomia, halitosis, and perceived need for dental treatment. Structural Equation Models were used to assess the associations adjusting to demographic and behavioral variables. RESULTS: 1022 individuals were analyzed. The overall OHIP mean equaled 9.2 ± 9.7 points. Xerostomia [coefficient (coef)=0.10], halitosis (coef=0.28), DFT (coef=0.16), and DHS (coef=0.19) were significantly and directly associated with negative impacts of OHIP-14. GR was significantly and indirectly associated with poor OHRQoL due to higher DHS. Perceived need for dental treatment was significantly and directly associated with higher OHIP-14 (coef=0,40). CONCLUSIONS: Poor OHRQoL was observed in a sample of Brazilian adults and old people. Five important oral conditions were associated to poor OHRQoL. Tooth loss, gingivitis, calculus, dental erosion and NCCL did not associate with OHRQoL. CLINICAL SIGNIFICANCE: Poorer oral health related quality of life is observed in a Brazilian urban area compared to other parts of the world. Xerostomia, halitosis, dental caries, gingival recession, and dentine hypersensitivity may be targeted to improve oral health and consequently oral health related quality of life.

Prevalence and associated factors of self-reported halitosis among institutionalized adolescents: Cross-sectional study.

OBJECTIVE: To assess the prevalence and associated factors of self-reported halitosis in institutionalized adolescents in a city in southern Brazil. METHODS: This cross-sectional study involved male institutionalized adolescents, aged 15-19 years old, at the Socio-Educational Assistance Center in the city of Passo Fundo, Brazil. Data collection was performed by a research team composed of two interviewers, two clinical examiners of oral health and two examiners of salivary flow. A structured questionnaire was applied, which included demographical, socioeconomical, general health behaviour, presence of health problems and oral health self-perception variables. Decayed, Missing, Filled Index was used for the clinical examination. The salivary flow collection was performed using the mechanically stimulated total saliva method, in which only the liquid component was measured. RESULTS: The prevalence of self-reported halitosis in this sample was 51.5% (n = 35). In the final multivariate analysis, halitosis was significantly associated with the non-white racial group (prevalence ratio [RP]:1.703; 95% confidence interval [95%CI]:1.101-2.634), use of crack (RP:1.857; 95%CI:1.270-2.714) and number of decayed teeth (PR: 1.123; 95%CI:1.008-1.252). The use of alcohol and access to dental care in the last 12 months were not significantly associated with self-reported halitosis. CONCLUSION: It was concluded that non-white and crack-user youngsters had a high occurrence of self-reported halitosis. Higher rates of dental caries are also associated with halitosis.

El hábito de fumar y su relación con afecciones bucales en adolescentes / Smoking and its relationship with oral conditions in adolescents

RESUMEN Introducción: El hábito de fumar está asociado a una gran variedad de cambios perjudiciales en la cavidad bucal, pues altera su microambiente y lo predispone para que se presenten diversas afecciones. Objetivo: Determinar la posible relación del hábito de fumar con las afecciones bucales en adolescentes. Método: Se realizó un estudio observacional en adolescentes del Centro Mixto «Pepito Tey» de San Diego del Valle, Cifuentes, en el período comprendido entre septiembre de 2016 y octubre de 2018. La población de estudio, conformada por 208 adolescentes, se organizó en dos estratos: grupo estudio y grupo control. Se seleccionaron dos muestras probabilísticas por muestreo aleatorio simple (60 adolescentes en cada grupo). Resultados: Predominaron adolescentes de 12 años, fumadores leves, del sexo masculino, con inicio del hábito entre 14-15 años y práctica de este hábito de menos de 6 meses. Se asociaron al hábito de fumar: la caries dental, la enfermedad periodontal, las manchas dentales, las lesiones de la mucosa bucal y la halitosis. Conclusiones: Predominaron adolescentes fumadores masculinos de 12 años. La gran mayoría de los fumadores fueron clasificados como leves, con inicio del hábito entre los 14-15 años de edad, y con práctica desde hace menos de seis meses. Existió asociación significativa entre el hábito de fumar y las afecciones bucales (enfermedad periodontal, caries dental, mancha dental, halitosis y lesión de la mucosa bucal).

ABSTRACT Introduction: smoking is associated with a wide variety of harmful changes in the oral cavity, since it alters its microenvironment and predisposes it to the occurrence of various conditions. Objective: to determine the possible relationship between smoking and oral conditions in adolescents. Method: an observational study was carried out in adolescents from "Pepito Tey" Mixed Center, in San Diego del Valle, Cifuentes between September 2016 and October 2018. The study population, made up of 208 adolescents, was organized into two strata: study group and control ones. Two probabilistic samples were selected by simple random sampling (60 adolescents in each group). Results: 12-year-old male light smokers, who started smoking between 14 and 15 years of age and practiced this habit for less than 6 months, predominated. Dental caries, periodontal disease, dental stains, oral mucosal lesions and halitosis were associated with smoking. Conclusions: 12-year-old male adolescent smokers predominated. Most smokers were classified as light, started smoking between 14 and 15 years of age and practiced this habit for less than 6 months. There was a significant association between smoking and oral conditions (periodontal disease, dental caries, dental stains, halitosis and oral mucosal lesions).

Case-control study related to the use of L-cysteine in the differential diagnosis of oral halitosis.

Oral halitosis is characterized by a foul, unpleasant breath that emanates from the oral cavity due to local or systemic conditions. Approximately 90% of offensive odors are caused by volatile sulfur compounds (VSCs). L-cysteine, used as a test solution to control bad breath, induces the formation of VSCs and serves as a preliminary rinse. The study aim was to investigate the effectiveness of L-cysteine solution in differentiating the origin of oral halitosis using a gas chromatography apparatus. Methods: In total, 37 patients with an average age of 49.56 years were evaluated and divided into two groups: halimetry before the use of L-cysteine (n= 37) and halimetry after the use of L-cysteine (n= 37). Patients over 18 years of age, without severe systemic health impairment or infectious/contagious diseases, and who did not use medicines that influenced their breath were included. Halimetry was performed using the OralCroma™ device. In the halimetry before the use of L-cysteine group, 5.40%, 5.40%, and 64.86% of the patients had high levels of sulfide, methyl mercaptan, and dimethyl sulfide, respectively. After the use of L-cysteine, 48.64%, 8.10%, and 37.84% of the patients had high levels of sulfide, methyl mercaptan, and dimethyl sulfide. In this study, L-cysteine proved to be important for the assessment of oral halitosis and effective in differentiating the origin of oral halitosis; therefore, this compound could be used for the differential diagnosis of oral halitosis origin using the OralChroma™ device.

Effect of Photodynamic Therapy on Halitosis: A Systematic Review of Randomized Controlled Trials.

BACKGROUND: This systematic review aimed to assess the effectiveness and safety of aPDT for the treatment of halitosis. METHODS: Search strategies were conducted in October 2021 without language or data restrictions, on the following databases: MEDLINE, EMBASE, CENTRAL, LILACS and BBO, as well as a manual search. Randomized clinical trials (RCTs) with parallel design were considered for inclusion, assessing individuals (adolescents and adults) with a clinical diagnosis of halitosis treated with photodynamic therapy (aPDT). Primary outcomes assessed were halitosis measurements, adverse events and quality of life. The risk of bias for each included study was evaluated with the Cochrane Risk of Bias tool and the certainty of the body of the evidence was assessed with the GRADe approach. RESULTS: Six RCTs (total of 225 participants) were included and due to clinical diversities it was not possible to group the outcome data in meta-analyses. Based on very low-certainty evidence (GRADE) the results showed that, when compared to tongue scraper, aPDT seems to promote a little to no difference in reducing halitosis and in the microbiological analysis. No adverse events were reported. Considering aPDT combined with tongue scraper, better outcome results were observed when compared to tongue scraper alone. CONCLUSIONS: Based on very low-certainty evidence, the findings of this review are uncertain about the effects of aPDT for halitosis control. Further RCTs with higher number of participants and long term assessments need to be conducted to support the use of this intervention. The protocol was registered in the PROSPERO database (number: CRD42020215319) on 19 November 2020-retrospectively registered.

Self-perceived and self-reported breath odour and the wearing of face masks during the COVID-19 pandemic.

OBJECTIVES: To assess the self-perception of breath odour (SPBO) and oral hygiene habits (OHHs) while the wearing of face masks during the COVID-19 pandemic. SUBJECTS AND METHODS: This cross-sectional study included 4647 individuals who answered a structured questionnaire containing demographic, medical and dental variables and self-perceived breath odour. Variables associated with changes in self-perceived breath odour, self-perceived halitosis and changes in OHHs were assessed through multivariate logistic regression. RESULTS: Changes in self-perceived breath odour were reported by 1572 individuals and were associated with smoking, systemic conditions, dry mouth, tongue coating, the period of face mask use and its interaction with prior thinking of having bad breath. Likewise, 645 individuals started to consider having bad breath. This was associated with the interaction between prior family/friends saying they have bad breath and period of face mask use. Changes in OHHs were strongly associated with changes in SPBO and starting to consider having bad breath. CONCLUSION: Changes in one's SPBO was associated with the wearing of face masks and was significant for changes in OHHs. Findings may be important to guide comprehensive preventive and therapeutic strategies in relation to oral health care.

Effect of antimicrobial photodynamic therapy with red led and methylene blue on the reduction of halitosis: controlled microbiological clinical trial.

To determine the effect of antimicrobial photodynamic therapy (aPDT) using a red light-emitting diode (LED) on the reduction of halitosis and microbiological levels in the tongue coating immediately after irradiation, 7, 14, and 30 days after treatment. Forty-five young adults diagnosed with halitosis were allocated to three groups: G1, aPDT with 0.005% methylene blue and red LED (660 nm, four irradiation points, 90 s per point, power of 400 mW, 36 J per point, radiant exposure of 95 J/cm2, continuous wave); G2, tongue scraping; and G3, tongue scraping and aPDT. Gas chromatography was performed before and immediately after treatment, as well as at the different follow-up times. Microbiological samples were collected at the same times from the dorsum of the tongue, and bacteria were quantified in the samples using real-time PCRq. The Wilcoxon test was used for the intragroup analyses, and the Kruskal-Wallis test was used for the intergroup analyses. In the intragroup analyses, differences were found before and immediately after treatment in all groups (p < 0.05). The effect was maintained after 7 days only in the tongue scraping group (p < 0.05). In the intergroup analysis, no statistically significant differences were found among the groups (p > 0.05). For the microbiological analyses, no statistically significant differences were found in the groups/bacteria that were analyzed (p > 0.05). aPDT using a red LED and 0.005% methylene blue caused an immediate reduction in halitosis, but the effect was not maintained after 7, 14, or 30 days. No reduction occurred in the number of bacteria investigated or the quantification of universal 16S rRNA. ClinicalTrials.gov Identifier: NCT03656419.

The effect of Brazilian propolis type-3 against oral microbiota and volatile sulfur compounds in subjects with morning breath malodor.

OBJECTIVES: To evaluate propolis type-3 mouthrinse effects on the concentration of volatile sulfur compounds (VSCs) and on tongue dorsum microbial profile. MATERIALS AND METHODS: A three-step double-blind, crossover, randomized study with 10 individuals divided into three groups: I-placebo (P); II-ethanolic extract of propolis type-3 3% (EEP); and III-chlorhexidine 0.12% (CHX) and instructed to rinse twice daily for 5 days. Each experimental period was followed by a 21-day washout interval. Morning mouth breath was assessed by VSC concentrations and microbiological samples were obtained from tongue dorsum at baseline and the end of period of rinses and analyzed using checkerboard DNA-DNA hybridization technique for 39 bacterial species. RESULTS: CHX and EEP presented the lowest VSC concentration when compared with placebo (p < 0.05). Even in the absence of mechanical plaque control, CHX and EEP treatments reduced VSC levels and there were no statistical differences for VSC measurement between CHX and EEP. There was a significant reduction in mean counts of 10 species including some VSC producers (Prevotella intermedia, Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia) by EEP. Total counts of organisms, gram-negative and gram-positive bacterial species showed a decrease for EEP and CHX (p < 0.05). In addition, no statistical difference was observed between EEP and CHX (p > 0.05). A positive correlation was observed between decrease of bacterial counts and decrease of VCSs concentration for the EEP and CHX. CONCLUSIONS: The use of a 3% propolis type-3 mouthrinse is an effective way to prevent morning bad breath. Thus, propolis may be a promising agent for the treatment of halitosis. CLINICAL RELEVANCE: Propolis type-3 may be used as adjuvant treatment for morning breath malodor.

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