Halitosis and Associated Risk Factors in Children: A Cross-sectional Study.

AIM: To investigate risk factors associated with halitosis in children using OralChroma™. MATERIALS AND METHODS: Sixty-seven children between the ages of 3 and 8 who attended a pre-general anesthesia assessment at the Dental University Hospital at King Saud University, Riyadh, Saudi Arabia, were enrolled in this study after satisfying the inclusion criteria. Demographic data, medical history, and oral hygiene practices were obtained by a standardized questionnaire completed by the parents of each child. Clinical dental examination was conducted to record the following: caries index (dmft/DMFT), simplified debris index (DI-S), modified gingival index (MGI), and Winkel tongue coating index (WTCI). Clinical halitosis was assessed using the OralChroma™ device that measures the concentration of volatile sulfur compounds (VSCs) including hydrogen sulfide (H2S), methyl mercaptan (CH3SH), and dimethyl sulfide (CH3SCH3). Statistics were completed using Spearman's correlation coefficient and Mann-Whitney U-test to assess the association with the VSC scores with continuous and binary variables, respectively. Then, multivariate linear regression analysis was performed to detect the degree of association. RESULTS: High VSC measures were detected in 58 children (87%). The dmft/DMFT was significantly associated with H2S level (ß = 26.84, p = 0.034) and CH3SH level (ß = 19.96, p = 0.016) after controlling possible confounders. There was no significant association of DI-S, MGI, and WTCI with the VSC measures. CONCLUSION: The result suggested that dmft/DMFT score (children's caries experience) is associated significantly with high levels of H2S and CH3SH in the sample studied. CLINICAL SIGNIFICANCE: Caries experience in children is a significant risk factor for halitosis and should be considered during the management of halitosis.

The effect of a tooth/tongue gel and mouthwash regimen on morning oral malodour: A 3-week single-blind randomized clinical trial.

AIM: To compare the effects of a regimen consisting of a tooth/tongue gel, tongue cleaner and mouthwash with the effects of using standard fluoride dentifrice on the organoleptic oral malodour score (ORG) and volatile sulphur compounds (VSCs). MATERIALS AND METHODS: A total, 66 non-dental students participated in a 3-week parallel, single-blind, randomized, controlled clinical trial. The test group used a tongue cleaner, a tooth/tongue gel and mouthwash containing amine fluoride/stannous fluoride and zinc lactate as oral malodour counteractive. The control group used a standard fluoride dentifrice. Measurements were taken in the morning at baseline, at days 1, 7 and 21. The primary outcome was the ORG score. The secondary outcome, the VSC measurement, was assessed using OralChroma™ (H2 S, CH3 SH, (CH3 )2 S) and Halimeter® . Tongue coating thickness and tongue discoloration were scored. At baseline and day 21, the participants' self-perceptions were assessed. RESULTS: At day 1 for the ORG, H2 S, CH3 SH and Halimeter® readings, a significant decrease was observed in the test group. At day 21, the decrease in H2 S and the Halimeter® outcomes were maintained for the test group, and a significant increase in tongue surface discoloration was observed. The test group evaluated their "morning breath upon awakening" as significantly better (P=.001) after 21 days. CONCLUSION: A significant overnight effect on morning oral malodour was observed for most of the parameters in favour of the test group. At day 21, the effect of prolonged use was significant for H2 S and the Halimeter® readings, although not for the primary ORG outcome parameter.

Subjective and objective halitosis among patients with Parkinson's disease.

OBJECTIVES: Parkinson's disease (PD) affects oral health, but prevalence of subjective and objective halitosis and the influence of hyposalivation remain unclear. We aimed to explore whether patients with PD suffer from halitosis and to define correlations between halitosis and hyposalivation. We hypothesised that patients with PD suffer more often from halitosis compared to healthy controls, influenced by dry mouth. MATERIALS AND METHODS: Subjective (halitosis, xerostomia visual analogue scale [VAS], short German Oral Health Impact Profile [OHIPG]-14) and objective scales (e.g., organoleptic score, volatile sulphur compounds [VSCs], stimulated whole saliva [SWS]) were assessed from 26 patients with PD and 26 healthy controls. RESULTS: The mean organoleptic score was 0.7 (SD: 0.7) in all patients, and VSCs were either comparable or significantly lower (dimethyl sulphide, P = .010) in PD patients compared with controls, yet more patients with PD perceived halitosis to be stronger (77% vs 54%, respectively; P = .059). Dry mouth was significantly more likely in patients with PD than controls: mean xerostomia VAS 4 (SD: 2) vs 1 (SD: 2), P = .010; SWS 0.4 (SD: 0.4) vs 0.7 (SD: 0.6) mL/min, P < .05); SWS did not correlate with subjective or objective halitosis. Oral health-related quality of life (OHRQoL) was lower in patients with PD than controls (mean OHIPG-14 score 12 (SD: 0.2) vs 5 (SD: 7.0), respectively; P < .05). CONCLUSIONS: Patients with PD suffer from subjective and objective halitosis, dry mouth and impaired OHRQoL. Dry mouth problems do not correlate with prevalence or intensity of halitosis.

Halitosis associated volatile sulphur compound levels in patients with laryngopharyngeal reflux.

Previous reports have suggested that laryngopharyngeal reflux (LPR) may cause halitosis. However, it remains unclear if LPR is a risk factor for halitosis. The aim of this study was to investigate if patients diagnosed with LPR have an increased probability of halitosis compared to a normal population. Fifty-eight patients complaining of LPR symptoms and 35 healthy subjects were included in the study. A LPR diagnosis was made using an ambulatory 24-h double pH-probe monitor, which is the gold standard diagnostic tool for LPR. Additionally, halitosis was evaluated by measuring the levels of volatile sulphur compounds using OralChroma™ and an organoleptic test score. The result of the final diagnosis of the 58 patients after the 24 h ambulatory pH monitoring was that 42 patients had LPR. Significant correlations were observed between the organoleptic test score and hydrogen sulfide (H2S) and methyl mercaptan (CH3SH) levels. These were also significantly correlated with LPR. We found a strong positive association between LPR and volatile sulphur compound levels. The H2S and CH3SH levels differed significantly between the LPR and control groups (p < 0.0001 and p < 0.0001, respectively). Halitosis was significantly associated with the occurrence and severity of LPR. The present study provides clear evidence for an association between halitosis and LPR. Halitosis has a high frequency in patients with LPR and reflux characteristics are directly related to their severity and therefore could be considered as a manifestation of LPR.

The effect of water on morning bad breath: a randomized clinical trial.

OBJECTIVES: To assess the effects of water on the parameters of 'morning bad breath' (MBB) and to evaluate whether there is a difference between rinsing with water and drinking a glass of water. MATERIALS AND METHODS: A total of 50 participants were recruited and were randomly divided into two equal groups. One group rinsed with 15 ml of water for 30 s, and another group drank 200 ml of water within 30 s. Clinical assessments were carried out during one visit between 7:30 am and 12:00 pm. Pre- and post-intervention measures were assessed organoleptically as primary outcome parameters, and a secondary outcome parameter was assessed using both the Halimeter(®) and OralChroma(™) apparatuses to evaluate volatile sulphur compounds (VSCs), hydrogen sulphide (H2 S), methyl mercaptan (CH3 SH) and dimethyl sulphide ((CH3 )2 S). In addition, the presence of tongue coating (discoloration/thickness) and tongue fissures was assessed. RESULTS: All 50 participants completed the study. In both groups, a significant reduction in the organoleptic score and the OralChroma(™) H2 S and CH3 SH readings was obtained after the intervention. Both regimens resulted in a CH3 SH reduction of approximately 60%, whereas the reduction in H2 S was between 30% and 50%. The acceptable change between pre- and post-assessments of the clinical parameters was not significantly different between the drinking and rinsing groups. CONCLUSION: Rinsing with water or drinking a glass of water had a statistically significant effect on the MBB parameters. No significant difference was obtained between the two regimens.

Characteristics of extra-oral halitosis induced by functional constipation: a prospective cohort study.

Characteristics of extra-oral halitosis induced by functional constipation (FC) have never been revealed. To address this, this prospective cohort was conducted with 100 FC patients, who were divided into a halitosis group and a negative group. Organoleptic score (OLS) ⩾ 2 in nose breath was diagnosed as extra-oral halitosis. Concentration of overall volatile sulfur compounds (VSCs) measured by Halimeter, concentration of hydrogen sulfide (HS), methanethiol (MT), dimethyl sulfide (DMS) and their total amount measured by OralChroma in nose breath was recorded asC-VSC,C-HS,C-MT,C-DMS andC-sum respectively. We found that 82% (82/100) of the FC patients had extra-oral halitosis. However, only 12.5% (3/82) and 1.22% (1/82) of halitosis group were correctly diagnosed with the current diagnostic threshold ofC-VSC ⩾ 110 parts per billion (ppb) and ⩾150 ppb.C-VSC,C-DMS andC-sum were significantly higher in the halitosis group compared to the negative group (allP< 0.001), with ratios of about 2.2 times, 3.1 times and 2.1 times respectively.C-HS andC-MT were low and not significantly different between the groups. Positive correlations were observed among OLS,C-VSC,C-DMS andC-sum. The area under curve of receiver operating characteristics ofC-VSC, C-DMS andC-sum for predicting FC-induced halitosis was 0.909, 0.9073 and 0.962 respectively, with the threshold values of ⩾36 ppb, ⩾52 ppb and ⩾75 ppb respectively. Therefore, we conclude that: (1) DMS is the primary contributor to FC-induced extra-oral halitosis. (2) OLS, Halimeter and OralChroma are consistent in detecting FC-induced extra-oral halitosis. (3) The diagnostic threshold for Halimeter should be adjusted toC-VSC ⩾ 36 ppb and the diagnostic threshold for OralChroma should be set asC-DMS ⩾ 52 ppb for diagnosing FC-induced extra-oral halitosis.

The effect of a commercial probiotic drink containing Lactobacillus casei strain Shirota on oral health in healthy dentate people.

BACKGROUND: In the past decade, the use of probiotic-containing products has been explored as a potential alternative in oral health therapy. A widely available probiotic drink, Yakult, was evaluated for oral health applications in this longitudinal study. Selected oral health parameters, such as levels and composition of salivary and tongue plaque microbiota and of malodorous gases, in dentate healthy individuals were investigated for changes. The persistence of the probiotic strain in the oral cavity was monitored throughout the study period. METHODS: A three-phase study (7 weeks) was designed to investigate simultaneously the effect of 4-week consumption of the probiotic-containing milk drink Yakult on the microbiota of saliva and dorsum tongue coating in healthy dentate people (n = 22) and levels of volatile sulphur compounds (VSCs) in morning breath. Study phases comprised one baseline visit, at which 'control' levels of oral parameters were obtained prior to the probiotic product consumption; a 4-week period of daily consumption of one 65 ml bottle of Yakult, each bottle containing a minimum of 6.5×10(9) viable cells of Lactobacillus casei strain Shirota (LcS); and a 2-week washout period. The microbial viability and composition of saliva and tongue dorsum coating were assessed using a range of solid media. The presence of LcS in the oral cavity was investigated using a novel selective medium, 'LcS Select'. Portable sulphur monitors Halimeter(®) and OralChroma(TM) were used to measure levels of VSCs in morning breath. RESULTS: Utilization of the LcS Select medium revealed a significant (p < 0.05) but temporary and consumption-dependent presence of LcS in saliva and tongue plaque samples from healthy dentate individuals (n = 19) during the probiotic intervention phase. LcS was undetectable with culture after 2 weeks of ceasing its consumption. Morning breath scores measured with Halimeter and OralChroma were not significantly affected throughout the trial, except in a small number of individual cases where Halimeter scores were significantly reduced during the probiotic intervention period. Natural fluctuations in resident acidogenic populations, and numbers of Candida and anaerobic species, including malodourous Gram-negative anaerobes, were unaffected. CONCLUSION: While no broad ecological changes in the mouth were induced by consumption of Yakult in healthy dentate individuals, findings of this study confirm the temporary and intake-dependent presence of LcS. Future studies could focus on subjects at greater risk of oral infection, where ill-defined microbiota (e.g. an increased presence of periopathogens) or clinically diagnosed halitosis might be significantly affected by consumption of this probiotic.

An objective assessment of halitosis in children with adenoid vegetation during pre- and post-operative period.

OBJECTIVES: Although most specialists in otorhinolaryngology and pediatrics find halitosis to be a common problem in children with adenoid hypertrophy, there are no objective data on this topic in the literature. Whether adenoid hypertrophy is a risk factor for halitosis or whether halitosis is a sign of adenoid hypertrophy remains unclear. Thus, the aim of this study was to investigate whether children diagnosed with adenoid hypertrophy have a higher probability of halitosis than do children in the normal population and whether adenoidectomy can decrease oral malodor. METHODS: Forty children with adenoid hypertrophy and 40 healthy subjects aged 5-15 years were included in the study. The children with adenoid hypertrophy underwent adenoidectomy operations and were followed for 3 months. We measured volatile sulfur compounds (VSCs), hydrogen sulfide (H2S), methyl mercaptan (CH3SH), and dimethyl sulfide (CH3)2S using an objective method, a portable gas chromatograph (OralChroma; AbiMedical, Osaka, Japan). RESULTS: The mean CH3SH and (CH3)2S levels were significantly different (p < 0.05) between the adenoid hypertrophy group and the controls. The H2S, CH3SH, and (CH3)2S levels in the third postoperative month were significantly lower (p < 0.05) than those in the preoperative period, and there was no significant difference postoperatively between the patients with adenoid hypertrophy and controls. There was a positive correlation between age and VSC levels, and CH3SH levels were significantly higher in patients with ventilation tube insertion, rather than just adenoidectomy. CONCLUSIONS: There was a statistically significant association between halitosis and adenoid hypertrophy, and a significant improvement in halitosis was obtained following adenoidectomy. The present study provides an association between halitosis and adenoid hypertrophy. If there is no other oral pathology causing halitosis, halitosis can be a sign of adenoid hypertrophy in children.

Evaluation of halitosis using OralChroma™ in patients with allergic rhinitis.

OBJECTIVE: The objective of this study was to evaluate the occurrence of halitosis in patients with allergic rhinitis (AR). MATERIALS AND METHODS: In this study, we enrolled 53 patients with AR and 34 participants as controls. Halitosis was evaluated by measuring volatile sulphur compound (VSC) levels. VSCs, which consist of hydrogen sulphide (HS), methyl mercaptan (MM), and dimethyl sulphide (DMS), were measured using a portable gas chromatograph (OralChroma™; AbiMedical, Osaka, Japan). RESULTS: Patients with AR exhibited significantly higher levels of MM and DMS that did control subjects. Specifically, MM levels showed a greater increase than DMS levels in patients with AR than in controls. We observed no significant changes in the levels of HS between the groups. CONCLUSION: This study demonstrated that AR is likely to result in halitosis. Several studies have overlooked the relationship between halitosis and AR. In light of our results, we suggest that halitosis should be further investigated in patients with AR.