Extra-oral Halitosis Research Articles

Extraoral halitosis in functional dyspepsia and its association with small intestinal bacterial overgrowth.

Small intestinal bacterial overgrowth (SIBO) and extraoral halitosis are often observed in functional dyspepsia (FD). We aimed to identify their associations for the first time. In this study, extraoral halitosis was diagnosed and assessed through the organoleptic score (OLS). Total symptom score (TSS) of FD, small intestinal bacterial overgrowth (SIBO), gastric Helicobacter pylori (H. pylori) infection, and three exhaled volatile sulfur compounds (VSCs) (hydrogen sulfide, methyl mercaptan, and dimethyl sulfide [DMS]), were evaluated. Finally, 63 non-halitosis patients and 45 halitosis patients with extraoral halitosis were identified. Compared to non-halitosis patients, halitosis patients exhibited significantly higher TSS (86 [56, 123] vs. 43 [34, 57], P < 0.001) and SIBO positivity rate (66.67% vs. 11.11%, P < 0.001), but similar H. pylori positivity rate. The adjusted odds ratios of TSS and SIBO were 1.06 and 5.02, respectively. The area under curve (AUC) of the combination of TSS and SIBO for predicting extraoral halitosis was 0.89. Positive correlations were observed between TSS and OLS (r = 0.64), and between TSS and exhaled DMS level (r = 0.86), respectively. The other two VSCs were undetectable or of little value. We conclude that: (1) Extraoral halitosis is closely associated with FD and SIBO; (2) DMS is its primary contributing VSC; (3) FD patients with SIBO as opposed to gastric H. pylori infection are more prone to extraoral halitosis; (4) Clinicians should be aware of SIBO in the management of extraoral halitosis in FD.

Job Stress Can Lead to Intestinal Inflammation and Subsequent Gut-Originated Extraoral Halitosis.

Reports on stress-associated halitosis are scarce and have only focused on intraoral halitosis. This work aimed to study stress-associated extraoral halitosis (EOH) and further investigate its potential association with stress-induced intestinal inflammation. This retrospective study included 664 white-collar employees with self-reported stress-associated halitosis. They underwent the organoleptic score (OLS) to assess halitosis, modified Brief Job Stress Questionnaire (BJSQ) score to assess job stress, OralChroma breath test to measure volatile sulfur compounds (VSCs) in breath, and hydrogen/methane breath test (HMBT) and nitric oxide breath test (NOBT) to detect intestinal inflammation. They were classified into high-stress and low-stress groups based on their modified BJSQ score. Totally, 106 eligible patients were identified as having stress-associated EOH, and 61 of them had high stress. Additionally, 70 (66.04%) and 73 (68.87%) of them tested positive for HMB and NOBT, respectively. Dimethyl sulfide (DMS) was found to be the predominant VSC in breath. High-stress patients had significantly higher positivity rates for HMBT and NOBT, OLS, and exhaled DMS levels compared to low-stress patients. HMBT-positive patients and NOBT-positive patients had significantly higher OLS and exhaled DMS levels compared to their respective negative counterparts. Job stress can lead to intestinal inflammation and subsequent gut-originated EOH.

MASLD can cause halitosis by small intestinal bacterial overgrowth.

Patients with metabolic dysfunction-associated steatotic liver disease (MASLD) exhibit varying degrees of halitosis. The author speculated that small intestinal bacterial overgrowth (SIBO) might lead to MASLD and subsequent extra-oral halitosis and aimed to test this hypothesis. This retrospective cross-sectional study reviewed 885 extra-oral halitosis patients. Halitosis and exhaled dimethyl sulfide (DMS) were measured by organoleptic score (OLS) (0-5) and OralChroma, respectively. SIBO and MASLD were diagnosed by hydrogen breath test and Fibroscan combined with cardiometabolic criteria. In this study, 133/885 (15.05%) of the halitosis patients otherwise healthy had MASLD, while 87/133 (65.41%) of the MASLD patients were SIBO-positive. No significant differences were observed in physical parameters such as age, serum biochemical parameters such as lipids, or Fibroscan parameters between the SIBO-positive and SIBO-negative patients. However, the OLS was 4 (interquartile range: 3-4) and exhaled DMS level was 56 (43-75) parts per billion (ppb) in the SIBO-positive patients, significantly greater than 2 (2-3) and 43 (25-51) ppb in the SIBO-negative patients (both p < 0.001). Exhaled hydrogen levels positively correlated with the OLS and exhaled DMS levels (r = 0.774, r = 0.740, both p < 0.001). MASLD can cause halitosis by SIBO.

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 as C-VSC, C-HS, C-MT, C-DMS and C-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 of C-VSC ⩾ 110 parts per billion (ppb) and ⩾150 ppb. C-VSC, C-DMS and C-sum were significantly higher in the halitosis group compared to the negative group (all P < 0.001), with ratios of about 2.2 times, 3.1 times and 2.1 times respectively. C-HS and C-MT were low and not significantly different between the groups. Positive correlations were observed among OLS, C-VSC, C-DMS and C-sum. The area under curve of receiver operating characteristics of C-VSC, C-DMS and C-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 to C-VSC ⩾ 36 ppb and the diagnostic threshold for OralChroma should be set as C-DMS ⩾ 52 ppb for diagnosing FC-induced extra-oral halitosis.

Enterogenous extra-oral halitosis has a more severe impact on quality of life in females compared to males.

Some studies have examined the impact of intra-oral halitosis on quality of life (QOL), but the impact of enterogenous extra-oral halitosis (EOH) on QOL has not been previously studied. We conducted a retrospective analysis of data from 88 patients with enterogenous EOH who visited our online halitosis clinic. A specialized halitosis associated life-quality test (HALT) questionnaire was used to assess QOL of these patients. Spearman correlation analysis was performed to investigate the relationship between HALT score and age. We found that 21 (23.86%) patients were male and 67 (76.14%) patients were female. HALT scores in females were significantly higher than in males (57.6 ± 13.6vs.45.5 ± 11.9,P< 0.001). Additionally, 13 of the 20 items of the HALT questionnaire showed significant differences between the sexes. No correlation was identified between HALT score and age. Therefore, we conclude that: (1) enterogenous EOH has a more severe impact on QOL in females compared to males. (2) More females with EOH visit the offline halitosis clinic compared to males. (3) The QOL of patients with enterogenous EOH does not decline with age.

Gastric Helicobacter pylori infection does not contribute to extraoral halitosis and its eradication cannot achieve substantial reduction of halitosis

AbstractBackgroundSome researchers have suggested that Helicobacter pylori (H. pylori) infection is attributed to extraoral halitosis. However, this viewpoint is increasingly challenged by clinical practice. This study was conducted with the aim of investigating changes of extraoral halitosis before and after H. pylori eradication.Materials and MethodsData of patients who had H. pylori infection and extraoral halitosis were retrospectively collected. H. pylori infection was diagnosed by positive 13C urea breath test (UBT). Extraoral halitosis was diagnosed by organoleptic score (OLS) ≥2 in nose breath. A 14‐day bismuth‐based quadruple therapy was administered for H. pylori eradication. Extraoral halitosis was examined before eradication (T1), on the first day after eradication (T2), 1 month after eradication (T3), and 3 months after eradication (T4). Eradication effect was checked by UBT at T3.ResultsA total of 100 patients were included. Eradication was successful in 74 out of 100 (74%) patients (success group) and failed in 26 out of 100 (26%) patients (failure group). 32 out of 74 (43.24%) patients in success group and 10 out of 26 (38.46%) patients in failure group had reduced halitosis at T2, 9 out of 74 (12.16%) patients in success group and 2 out 26 (7.69%) patients in failure group had relapsed halitosis at T3, and 23 out of 74 (31.08%) patients in success group and 8 out of 26 (30.77%) patients in failure group had relapsed halitosis at T4, without significant difference between groups at any time (p = 0.918, p = 0.808, and p = 0.808 respectively).ConclusionsHelicobacter pylori infection does not contribute to extraoral halitosis. H. pylori eradication can achieve sustained but slight reduction of extraoral halitosis, probably due to its antibiotic effects on the gut microbiota rather than H. pylori.

Selenium-binding protein 1 (SELENBP1) is a copper-dependent thiol oxidase

Selenium-binding protein 1 (SELENBP1) was reported to act as a methanethiol oxidase (MTO) in humans, catalyzing the conversion of methanethiol to hydrogen peroxide, hydrogen sulfide and formaldehyde. Here, we identify copper ions as essential to this novel MTO activity. Site-directed mutagenesis of putative copper-binding sites in human SELENBP1 produced as recombinant protein in E. coli resulted in loss of its enzymatic function. On the other hand, the eponymous binding of selenium (as selenite) was no requirement for MTO activity and only moderately increased SELENBP1-catalyzed oxidation of methanethiol. Furthermore, SEMO-1, the SELENBP1 ortholog recently identified in the nematode C. elegans, also requires copper ions, and MTO activity was enhanced or abrogated, respectively, if worms were grown in the presence of cupric chloride or of a Cu chelator. In addition to methanethiol, we identified novel substrates of SELENBP1 from the group of volatile sulfur compounds, ranging from ethanethiol to 1-pentanethiol as well as 2-propene-1-thiol. Gut microbiome-derived methanethiol as well as food-derived volatile sulfur compounds (VSCs) account for malodors that may contribute to extraoral halitosis in humans, if not metabolized properly. As SELENBP1 is particularly abundant in tissues exposed to VSCs, such as colon, liver, and lung, it appears to contribute to copper-dependent VSC degradation.

Periodontitis, Halitosis and Oral-Health-Related Quality of Life-A Cross-Sectional Study.

We aimed to explore the association between volatile sulfurous compounds (VSCs) and periodontal epithelial surface area (PESA) and periodontal inflamed surface area (PISA) on a cohort of periodontitis patients. Consecutive patients were assessed for periodontitis and halitosis. A full-mouth periodontal status assessment tested probing depth (PD), clinical attachment loss (CAL), gingival recession (REC), bleeding on probing (BoP), PISA and PESA. A halitosis assessment was made using a VSC detector device. Periodontal measures were regressed across VSC values using adjusted multivariate linear analysis. From a total of seventy-two patients (37 females/35 males), the PESA of posterior-lower regions was found to be significantly higher in halitosis cases than their non-halitosis counterparts (p = 0.031). Considering all patients, the PESA of the posterior-lower region (B = 1.3, 95% CI: 0.2–2.3, p = 0.026) and age (B = −1.6, 95% CI: −3.1–0.2, p = 0.026) showed significant association with VSCs. In halitosis patients, the PESA of the posterior-lower region (B = 0.1, 95% CI: 0.0–0.1, p = 0.001), PISA Total (B = −0.1, 95% CI: −0.1–0.0, p = 0.008) and the OHIP-14 domain of physical disability (B = −2.1, 95% CI:−4.1–0.1, p = 0.040) were the most significant variables in this model. The PESA from the posterior-lower region may be associated with VSCs when other causes of extra-oral halitosis are excluded. Further intervention studies are needed to confirm this association.

A coupled enzyme assay for detection of selenium-binding protein 1 (SELENBP1) methanethiol oxidase (MTO) activity in mature enterocytes

Methanethiol, a gas with the characteristic smell of rotten cabbage, is a product of microbial methionine degradation. In the human body, methanethiol originates primarily from bacteria residing in the lumen of the large intestine. Selenium-binding protein 1 (SELENBP1), a marker protein of mature enterocytes, has recently been identified as a methanethiol oxidase (MTO). It catalyzes the conversion of methanethiol to hydrogen sulfide (H2S), hydrogen peroxide (H2O2) and formaldehyde. Here, human Caco-2 intestinal epithelial cells were subjected to enterocyte-like differentiation, followed by analysis of SELENBP1 levels and MTO activity. To that end, we established a novel coupled assay to assess MTO activity mimicking the proximity of microbiome and intestinal epithelial cells in vivo. The assay is based on in situ-generation of methanethiol as catalyzed by a bacterial recombinant l-methionine gamma-lyase (MGL), followed by detection of H2S and H2O2. Applying this assay, we verified the loss and impairment of MTO function in SELENBP1 variants (His329Tyr; Gly225Trp) previously identified in individuals with familial extraoral halitosis. MTO activity was strongly enhanced in Caco-2 cells upon enterocyte differentiation, in parallel with increased SELENBP1 levels. This suggests that mature enterocytes located at the tip of colonic crypts are capable of eliminating microbiome-derived methanethiol.

Protocol for treating the psychological consequences of halitosis complaint

INTRODUCTION: People with halitosis suffer various consequences, incurring social, professional, and affective limitations that impair their confidence, spontaneity, and self-esteem. However, the existing treatment protocols focus on treating halitosis alone, rather than its psychological consequences. OBJECTIVE: The objective of this study is to present a new protocol for treating the consequences of halitosis, as well as investigating its clinical application. METHODS: After briefly reviewing existing halitosis classifications and their limitations, this paper presents new classifications and techniques appropriate for the present protocol, such as the use of in vivo exposure, adequate to halitosis treatment. A total of 156 people complaining of halitosis were selected. The participants breath was evaluated using the organoleptic test and Halimeter®. The psychological consequences of halitosis were assessed using the Halitosis Consequences Inventory (ICH). The symptoms of Social Anxiety Disorder (SAD) were measured using the Social Phobia Inventory (SPIN) and its short version (Mini-SPIN). RESULTS: The results showed that all participants had tongue coating or tongue biofilm. Of the 156 volunteers, 74.38% had halitosis (n=116), of whom 100% had oral halitosis, and 3.21% had oral halitosis simultaneous with extraoral halitosis (n=5). A comparison between the pre- and post-treatment results indicated that the protocol was effective to treat bad breath as well as the feeling of insecurity, since significantly decreased the psychological consequences of halitosis and SAD symptoms; 62.6% of participants reported a significant improvement in their confidence and spontaneity at the end of treatment. CONCLUSION: Taken together, these findings were most effective for those who followed the treatment guidelines strictly.

Extraoral Halitosis due to Exhaled Acetone in Patients Undergoing Sleeve Gastrectomy

Introduction: Bariatric surgery is widely used and considered as one of the most effective treatments for morbid obesity, but it can be associated with medical and dental adverse side-effects. It is frequently associated with major metabolic changes that may lead to extraoral halitosis. Aim: To assess the role of exhaled acetone produced as a result of weight loss in the production of extra-oral halitosis in patients undergoing bariatric surgery. Materials and Methods: A prospective longitudinal cohort study was designed from October 2018 to November 2019 and monitored for six months postsurgery. The subjects were patients undergoing sleeve gastrectomy surgery with a Body Mass Index (BMI) of 35-50 kg/m2. Subjects were divided into two groups of low BMI loss (&lt;5 Kg/m2) and high BMI loss (≥5 Kg/m2) postsurgery, Breath samples were collected with a portable breath ketone analyser for measurement of acetone concentrations, and blood samples were taken for measurement of 3-hydroxybutyrate levels. Breath and blood samples were taken at baseline then at one month, three months, and six months postsurgery. All statistical analysis were performed using the SPSS version 22.0 with a significance value of p-value set at p&lt;0.05. Results: Out of 43 patients enrolled initially, eventually 39 patients completed the study. The mean level of breath acetone was 4.1, 3.4, and 3.8 ppm at one month, three months, and six months, respectively (p=0.018). There was a statistically significant increase in breath acetone at one month in patients with a high rate of BMI loss. At one month, the mean blood level of 3-hydroxybutyrate was higher in patients with a high rate of BMI loss than in those with a low rate of BMI loss (1.9 vs. 1.2 mmol/L; p=0.049). The levels of breath acetone and blood 3-hydroxybutyrate were significantly correlated at one month (r=0.6, p&lt;0.05). Conclusion: Rapid weight loss one month after gastric sleeve surgery resulted in high acetone levels suggestive of increased extraoral halitosis in such patients. Increased Acetone levels in breath and 3-hydroxybutyrate in blood are suggestive of increased extraoral halitosis in patients undergoing gastric sleeve surgery particularly within a month after surgery.

The Role of Oral Microbiota in Intra-Oral Halitosis.

Halitosis is a common ailment concerning 15% to 60% of the human population. Halitosis can be divided into extra-oral halitosis (EOH) and intra-oral halitosis (IOH). The IOH is formed by volatile compounds, which are produced mainly by anaerobic bacteria. To these odorous substances belong volatile sulfur compounds (VSCs), aromatic compounds, amines, short-chain fatty or organic acids, alcohols, aliphatic compounds, aldehydes, and ketones. The most important VSCs are hydrogen sulfide, dimethyl sulfide, dimethyl disulfide, and methyl mercaptan. VSCs can be toxic for human cells even at low concentrations. The oral bacteria most related to halitosis are Actinomyces spp., Bacteroides spp., Dialister spp., Eubacterium spp., Fusobacterium spp., Leptotrichia spp., Peptostreptococcus spp., Porphyromonas spp., Prevotella spp., Selenomonas spp., Solobacterium spp., Tannerella forsythia, and Veillonella spp. Most bacteria that cause halitosis are responsible for periodontitis, but they can also affect the development of oral and digestive tract cancers. Malodorous agents responsible for carcinogenesis are hydrogen sulfide and acetaldehyde.

Drug-related Halitosis: A Systematic Review.

Halitosis is an unpleasant breath odor which can be bothersome to individuals. Extra-oral halitosis is a type of halitosis caused by systemic conditions, bloodborne diseases, or pharmaceutical therapy. It is not related to local factors in the oral cavity. This systematic review aimed to identify the medications that can cause extra-oral halitosis. This study was conducted in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA). We searched online databases and also included hand searching to find relevant articles. Two authors independently performed the screening, data extraction and quality assessment of the included articles using the Cochrane Collaboration assessment tool. Thirty-four studies met the eligibility criteria. The medications which can cause extra-oral halitosis were categorised into 10 groups: acid reducers, aminothiols, anticholinergics, antidepressants, antifungals, antihistamines and steroids, antispasmodics, chemotherapeutic agents, dietary supplements, and organosulfur substances. Pharmaceutical therapy is a potential source of extra-oral halitosis. This finding can help clinicians detect the probable causes of halitosis. Further studies are needed to definitely determine the role of various medications in causing extra-oral halitosis.

Etiology and characteristics of halitosis in patients of a halitosis center in Northern Italy.

As there are few studies in Europe describing characteristics of breath malodor for large groups of patients, this retrospective study was designed to analyse the etiology of halitosis among patients attending a breath malodor center in Northern Italy. Clinical records of 547 consecutive patients were reviewed and data on self-perceived halitosis, organoleptic scores, volatile sulphur compound (VSC) levels, and oral health condition were extracted and analysed. The prevalence of intra-oral halitosis was 90.7%. In 21 patients no objective signs of breath malodor could be found. Periodontitis and gingivitis were the main cause of bad breath in 33.9% of subjects and in combination with tongue coating in 55.2%. Only eight subjects have tongue coating as the only cause of halitosis. Ear, nose and throat (ENT)/extra-oral causes were found in 5.2% of the patients. VSC concentrations were lower in the psychogenic halitosis group, whereas no statistically significant differences were detected when comparing intra-oral and extra-oral halitosis except for (CH3)2S. Psychogenic halitosis is a rare condition among subjects complaining of suffering from bad breath. The most prevalent cause of halitosis is intra-oral, in particular a combination of tongue coating and periodontal disease. Tongue coating is rarely the primary cause of oral malodor.

Microporous ceramics (Zeolite or Hydrotalcite) materials for bad breath control

Bad breath (which is also known as halitosis) is something the vast majority of people around the world are familiar with. We have all likely encountered somebody with halitosis in our lives and many of the people reading this might even suffer from it. There are a range of causes of halitosis, including eating or drinking strong-smelling food and drinks, gum disease or problems with the teeth, smoking and particular medical conditions, such as tonsillitis. The best method for preventing halitosis is to perform adequate oral care, such as brushing your teeth and gums regularly, cleaning the tongue, flossing, using antibacterial mouthwash, and having regular dental check-ups. While much of this can be considered common knowledge, it is perhaps less well known that halitosis is subdivided into intraoral and extraoral halitosis, depending on the place where it originates. Dr Masato Hotta, from the Graduate School of Dentistry, Asahi University, is interested in exploring this topic in more detail. He explains that approximately 90 per cent of halitosis is intraoral, where it originates from within the oral cavity and is caused by volatile sulphur compounds (VSCs), such as hydrogen sulfide (H2S), methyl mercaptan and dimethyl sulfide. 'These VSCs are brought about through the bacterial putrefaction of food debris, cells, saliva and blood,' Hotta clarifies. 'VSCs are malodorous materials and, in addition to causing bad breath, can cause secondary tooth decay, the discoloration of teeth and dental prosthetic alloys, and periodontal disease.' While brushing and flossing are effective ways of removing biofilm and bacteria, they often have little effect on VSCs. Thus, finding a means of removing them from a patient's mouth - and alleviating bad breath - would be considered a significant breakthrough for patients with halitosis.

Whether Chinese Medicine Have Effect on Halitosis: A Systematic Review and Meta-Analysis.

Object Halitosis has great adverse impact on personal and social life. There is no strong evidence for the effect of Chinese medicine (CM) and combined Chinese and western medicine (CWM) on halitosis. The aim of the present study is to evaluate the effective rate of CM and CWM on halitosis. Materials and Methods Literature search in English and Chinese was conducted in PubMed, Embase, CNKI, CBM, and Wanfang database. Study selection and data collection were conducted. Risks of bias were assessed by the Cochrane tool. Synthesis of results was done by RevMan 5.3. p<0.05 was considered significant difference. Subgroup analysis by classification of halitosis and sensitivity analysis were also conducted. Results Seventeen studies were included. The follow-up length ranged from five days to eight weeks. CM had significantly better effect than WM on intraoral halitosis (I2 =24%; RR=1.21 (95% CI, 1.04, 1.40), P=0.01) and extraoral halitosis (I2 =0; RR=1.39 (95% CI, 1.19, 1.63), P<0.0001). CWM had significantly better effect than WM on intraoral halitosis (I2 =0; RR=1.25 (95% CI, 1.16, 1.35), P<0.00001) and extraoral halitosis (I2 =0; RR=1.19 (95% CI, 1.08, 1.31), P=0.0004). Subgroup analysis and sensitivity analysis showed insignificant results. Conclusion With the limitation of our study, both CM and CWM have significantly better effect on halitosis than WM. More effort should be made to explore long-term effect of CM and CWM on halitosis. This study was registered with the PROSPERO (ID: CRD42018107229).

Mutations in SELENBP1, encoding a novel human methanethiol oxidase, cause extraoral halitosis.

Selenium binding protein1 (SELENBP1) has been associated with several cancers. Its exact role was unknown. We show that SELENBP1 is a methanethiol oxidase (MTO), related to MTO of methylotrophic bacteria, converting methanethiol to H2O2, formaldehyde and H2S, an activity not known to exist in humans. Mutations in SELENBP1 were found in five patients with a cabbage-like smelling breath. Increased levels of methanethiol and dimethylsulfide are the main odorous compounds in their breath and responsible for the malodor. Increased urinary excretion of dimethylsulfoxide is a diagnostic biomarker of MTO-deficiency. Patient fibroblasts showed reduced amounts of SELENBP1 protein and deficient MTO enzymatic activity which could be restored by lentiviral-mediated expression of the wild-type SELENBP1 gene. A knockout mouse line showed the same biochemical characteristics. Our data define a novel inborn error of metabolism caused by MTO-deficiency leading to a malodor syndrome. MTO deficiency may be a frequent inborn error of metabolism.

Rhinosinusitis in oral medicine and dentistry.

Rhinosinusitis is a very common condition which is normally readily recognizable. Given the intimate anatomic relationship between the antrum and the posterior maxillary teeth, maxillary sinusitis can present as odontalgia. Distinguishing between odontogenic orofacial pain and pain associated with maxillary sinusitis is important to prevent unnecessary dental intervention and to direct patients to medical colleagues. Conversely, odontogenic infection can spread to involve the antrum, termed odontogenic sinusitis, or maxillary sinusitis of dental origin. Odontogenic sinusitis accounts for about 10-40% of all cases of sinusitis, and usually requires combined dental and medical treatment. Maxillary sinusitis can also be a complication of exodontia, resulting from tuberosity fractures, displaced teeth or root fragments and the creation of oroantral communications and fistulae. Dental implants and endodontic materials can also impinge on the maxillary sinus, and are rare causes of sinusitis. Often it is stated that rhinosinusitis may contribute to a halitosis complaint, and widely used diagnostic protocols for rhinosinusitis sometimes list halitosis as a minor criterion. However, gold standards in halitotosis research such as organoleptic assessment or gas chromatography have not been used to validate a correlation between objective (genuine) halitosis and sinusitis. The pathophysiology of this mechanism is unclear, and the relative importance of this alongside other causes of extraoral halitosis is debated.

Volatile Sulfur Compounds as The Cause of Bad Breath: A Review

Bad breath or halitosis is a concern for millions of people. Halitosis is subdivided into intraoral and extraoral halitosis, depending on the place where it originates. About 90% of halitosis originates within the oral cavity and includes bacterial reservoirs such as the dorsum of the tongue, where anaerobic bacteria degrade the sulfur containing amino acids cysteine and methionine into the foul smelling volatile sulfur compounds (VSCs) hydrogen sulfide (H2S) and methyl mercaptan (CH3SH). Tongue coating is considered to be the most important source of VSCs. Intraoral halitosis can be treated effectively by cleaning the tongue with a tongue-scraper and by using special mouthrinses. Extraoral halitosis can be subdivided into non-blood-borne halitosis such as halitosis from the nose and the respiratory tract, and into blood-borne halitosis. The majority of patients with extraoral halitosis have blood-borne halitosis, frequently caused by the odorous VSC dimethyl sulfide (CH3SCH3). Extraoral halitosis, covering about 5–10% of all cases of halitosis, might be a manifestation of a serious disease. It is of utmost importance to differentiate between intraoral and extraoral halitosis, which can easily be done by comparing mouth breath with nose breath. The importance of applying odor characteristics in halitosis research is also highlighted.

Dimethylsulphidemia: the significance of dimethyl sulphide in extra-oral, blood borne halitosis

Halitosis is a symptom and not a diagnosis. Rather, the topic represents a spectrum of disorders, including intra-oral, otorhinolaryngological, metabolic, systemic, pulmonary, psychological and neurological conditions. Halitosis may be the third most common trigger for patients to seek dental care and can cause significant impact on patient quality of life. About 10% of all genuine halitosis cases are attributed to extra-oral processes. Some authorities have reported that the nasal cavity and the oropharynx are the most common sites of origin of extra-oral halitosis. However, recent evidence appears to suggest that blood borne halitosis may be the most common subtype of extra-oral halitosis. Tangerman and Winkel report that dimethyl sulphide was the main volatile implicated in extra-oral blood borne halitosis. They proposed a hitherto unknown metabolic condition by way of explanation for this finding, resulting in systemic presence of dimethyl sulphide in blood and alveolar breath. This paper reviews the knowledge base regarding the behaviour of dimethyl sulphide in physiological systems and those disorders in which blood borne halitosis secondary to dimethylsulphidemia is thought to have an aetiopathological role.