Halitosis In Patients Research Articles

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

Perception of halitosis in patients during intubation is a common and additional stressor for anaesthesiologists and may lead to potential health risks. We hypothesised that intubation with videolaryngoscopy could help reduce the anaesthesiologists' perception of patients' oral malodor during intubation. A single-blinded, randomised controlled trial. Single centre general hospital, Guangdong Province, China. 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. 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. 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. 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. 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. Clinicaltrials.gov (ChiCTR-IOR-15007038).

Oral probiotics reduce halitosis in patients wearing orthodontic braces: a randomized, triple-blind, placebo-controlled trial

Orthodontic braces can impede oral hygiene and promote halitosis. The aim of the study was to investigate the effect of the oral probiotic Streptococcus salivarius M18 on oral hygiene indices and halitosis in patients wearing orthodontic braces. The study was a prospective, randomized, triple-blind, placebo-controlled trial. Patients undergoing fixed orthodontic treatment were randomly allocated to a probiotic group (n = 32) and a placebo group (n = 32). Patients consumed 2 lozenges d−1 for one month. Assessments were taken at baseline, at the end of the intervention, and at a 3 month follow-up. The outcome measures were plaque index (PI), gingival index (GI) and halitosis-causing volatile sulfur compound (VSC) levels. The dental biofilms before and after the intervention were analyzed utilizing next-generation sequencing of bacterial 16S rRNA genes. PI and GI scores were not significantly influenced by the probiotic intervention (intervention × time: p > 0.05). The level of VSCs decreased significantly in both the probiotic group (VSC reduction = −8.5%, 95%CI = −7.4% to −9.1%, p = 0.015) and the placebo group (−6.5%, 95%CI = −6.0% to −7.4%, p = 0.039) after 1 month intervention. However, at the 3 month follow-up, the VSC levels in the placebo group returned to baseline levels whereas those in the probiotic group decreased further (−10.8%, 95%CI = −10.5% to −12.9%, p = 0.005). Time, but not treatment, was associated with the decrease in microbial community alpha diversity and a modest effect on beta diversity. Oral probiotic S. salivarius M18 reduced the level of halitosis in patients with orthodontic braces, but had minimal effects on PI, GI and dental biofilm microflora.

Effects of new type oral nursing on oral status among patients with orotracheal intubation in ICU

Objective To explore the effects of new type oral nursing on oral status among patients with orotracheal intubation in intensive care unit (ICU) . Methods Based on convenience sampling, we selected 51 patients with orotracheal intubation and mechanical ventilation in ICU at First People's Hospital of Shangqiu in control group from June 2017 to January 2018, and 55 patients in observation group from February 2018 to October 2018. Control group carried out traditional oral nursing, while observation group adopted the new type oral nursing which used Bass brushing method combined with scrubbing by gauze. Before and after intervention, we compared the score of Beck Oral Assessment Scale, score of halitosis and oral bleeding of patients between two groups. Results There were no statistical differences in the scores of Beck Oral Assessment Scale and halitosis of patients between two groups on admission in ICU (P>0.05) . One week after nursing, the scores of Beck Oral Assessment Scale and halitosis of patients in observation group were lower than those in control group with statistical differences (P 0.05) . Conclusions The new type oral nursing can improve oral status, halitosis and quality of oral nursing among ICU patients with orotracheal intubation. Key words: Intensive care units; Oral nursing; Tracheal intubation; Oral status

Do fixed orthodontic appliances cause halitosis? A systematic review

ObjectiveTo examine: (I) the current evidence of the impact of fixed orthodontic appliances on the development of halitosis in patients undergoing orthodontic treatment, and (II) the influence of different orthodontic bracket systems on halitosis.Material and methodsThree electronic databases (PubMed, Scopus, and Cochrane Library) were searched prior to March 15, 2018. The review was systematically conducted and reported according to the Cochrane Handbook and the PRISMA statement. Only Randomised Clinical Trials (RCTs) were considered. Selected full-text papers were independently assessed by four investigators and any disagreements were resolved by consensus. The Cochrane Handbook was used to grade the risk of bias and the quality of evidence was rated according to GRADE.ResultsOut of 363 identified studies, three RCTs on halitosis and fixed orthodontic appliances met the inclusion criteria. The risk of bias in the three studies was rated as high and the quality of evidence was rated as very low.Conclusions/clinical implicationsThere is a lack of scientific evidence that subjects with fixed orthodontic appliances develop halitosis during treatment. Additional well-conducted RCTs with extended periods of assessment are needed as well as consensus concerning cut-off values for the diagnosis of halitosis.

Halitosis as an indication for tonsillectomy in chronic hypertrophy tonsillitis

Main purpose: This paper aimed to confirm a relationship between chronic hypertrophic tonsillitis (CHT) and bad mouth odour. To this end, detailed identification of the microbial flora inhabiting affected tonsils was carried out. The results obtained might be helpful in specifying indications for tonsillectomy. Materials and method: From among 247 patients with clinically diagnosed CHT, 33 generally healthy individuals aged 18- 40 (10 male and 23 female) were selected. Patients in whom other causes could be the possible reason for their fetor ex ore (halitosis) were not included. Before and 2 to 3 months after tonsillectomy, organoleptic and halimeter testing was undertaken for each patient. A swab was collected from the interior of the enucleated tonsils in a sterile manner, and was inoculated onto surfaces enabling the culture of aerobic and anaerobic bacteria and fungi. A histopathological examination was subsequently performed. Results: Fetor ex ore was initially found in 95% of the patients with CHT. In 90% of cases with confirmed halitosis, after tonsillectomy a significant reduction in its intensity was observed. On average, the concentration of VSC in the patient decreased by approximately 75 ppb (62%), which was statistically significant (p < 0.0001). It was also shown that the concentration of VSC in carriers of anaerobic bacteria, compared to carriers of only aerobic bacteria, was significantly reduced (p < 0.05). The results obtained confirm the role of CHT in the pathogenesis of halitosis. Conclusions: Halitosis in patients with CHT requires a number of laboratory tests and specialist consultations to exclude other possible causes of fetor ex ore. A dental examination plays an important role in the differential diagnosis. Performing targeted microbiological testing to determine the patient’s carrier state for anaerobes should eventually be considered. When these conditions are met, halitosis can be considered an independent indication for tonsillectomy.

Halitosis: Helicobacter pylori or oral factors.

Halitosis is a common complaint among people which has various socioeconomic effects. The prevalence of halitosis includes a variety of 22% up to 50% in different societies. According to studies, there have been reports of remarkable improvements in halitosis after Helicobacter pylori eradication treatment. In studies on the relationship between H.Pylori and halitosis, the role of oral factors as the most important cause of halitosis has been neglected. This study was conducted with the aim of investigating the effect of oral factors on halitosis in patients with H.Pylori. A total of 100 dyspeptic patients who had H.pylori-positive serologic test were examined by an organoleptic method for the presence of halitosis. DMFT index was used in order to record the dental status. Oral hygiene was evaluated using the simplified oral hygiene index (OHI-S). The mean DMFT index was 9.09±3.97. The score of simplified oral hygiene index was 1.79±0.949. There was a direct and significant relationship between halitosis with DMFT, OHI-S (P<0.01). There was no significant relationship between halitosis and coated tongue (P>0.01). According to the results of this study, there is a relation between oral factors and halitosis in patients with positive H.pylori test. Due to the lower level of all these indices in patients with halitosis, we cannot attribute halitosis in patients with H.pylori infection to the presence of this microorganism with certainty.

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

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

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.

The effect of professional tooth cleaning or non-surgical periodontal therapy on oral halitosis in patients with periodontal diseases. A systematic review.

The aim of this systematic review was to give the best available evidence on the impact of professional tooth cleaning (PTC) and scaling and root planing (SRP) on oral halitosis in patients with periodontal diseases. Three databases were screened for relevant studies. Only randomized controlled trials (RCTs) or controlled clinical trials (CCT) were included. The primary outcome in all included studies was volatile sulphur compounds (VSC) measured by Halimeter or OralChroma and organoleptic scores as secondary outcome. Only studies investigating healthy adults except for periodontitis or gingivitis were included. The considered intervention strategies were professional tooth cleaning and non-surgical periodontal treatment. For both strategies, additional oral hygiene instructions (OHI) were possible. Two independent reviewers performed the study selection and quality assessment. After abstract and title screening and subsequent full-text reading of potential papers, a placebo-controlled RCT could not be found. However, eight studies or particular arms used PTC or SRP as sole interventions and were included in this review. All trials or study arms included showed a positive effect on VSC levels or organoleptic scores after intervention. Based on best available evidence, PTC and SRP in combination with oral hygiene instructions reduced VSC values in patients with oral halitosis and/or periodontal diseases, independent of tongue cleaning and the use of mouth rinses.

Dorsal Lingual Surface and Halitosis: a Morphological Point of View.

The interest in the study of the tongue papillary niches and the related biofilm has increased in recent years because they form a suitable source of periodontal microorganisms and are associated with development of halitosis. Tongue dorsum structure represents a factor favoring a particular and complex bacterial biofilm where periodontal pathogens are frequently found. The aim of this preliminary study was to associate the tongue papillary structure with the biofilm causing halitosis by means of a new clinical protocol. In this study, one subject affected by oral malodor was selected and included. A photograph of lingual dorsum was taken to spot the areas with visible lingual coating. A tongue dorsum impression was obtained, divided and cut with a blade in six parts, according to Winkel Tongue Coated Index by means of the 2-step double-mix impression technique. The contours of the six parts were observed by the stereomicroscope LEICA LED2000 and analyzed by ImageJ software. The results showed that the depth of papillae was associated with visible presence of the tongue biofilm and indirectly correlated with halitosis in patients.. The morphological papillary structure of the tongue dorsal surface influences the presence of the tongue biofilm. The presented protocol can be further considered in clinical application for a correct diagnosis and a personalized treatment of halitosis.

Evaluation of halitosis using OralChroma™ in patients with allergic rhinitis

ObjectiveThe objective of this study was to evaluate the occurrence of halitosis in patients with allergic rhinitis (AR). Materials and methodsIn 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). ResultsPatients 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. ConclusionThis 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.

Microscopic evaluation of tongue dorsum biofilm from halitosis patients: an ex vivo study using confocal laser scanning microscopy (CLSM)

A category of oral biofilm which is still not well understood is the one coating the tongue, although various reports have associated its presence with halitosis in patients (1). The aim of the study was to visualize the three-dimensional bacteria distribution within the biofilm in order to better understand the ecological balance which regulates it. Tongue plaque samples from four halitosis-diagnosed patients and four healthy volunteers were analysed and compared. The biofilm was collected using a 0.1ml sterile inoculating loop. The visualization of the tongue dorsum biofilm was performed combining fluorescence in situ hybridization (FISH) and confocal laser scanning microscopy (CLSM) (2). Eubacteria, Streptococcus spp. and Fusobacterium nucleatum were stained using specific fluorescent genetic probes. Morphological analysis by CLSM illustrated the different distribution of the species which were tracked: Streptococcus spp. appeared immerged within the samples, while F. nucleatum was found in the peripheral areas of the samples. Furthermore, F. nucleatum appeared to exist without the presence of the Streptococcus spp. in the halitosis group. This study showed the architecture of tongue dorsum biofilm by means of imaging techniques, highlighting the distribution of the tracked bacterial species within the biofilm sample of the plaque.The authors are grateful to Dr. A. Zurcher and to Mr. G. Heuzeroth, University of Basel, for their help in the recruiting and sampling procedures.

Effect observation of Solidago decurrens gargle treating halitosis of patients with general anesthesia

Objective To explore the effects of Solidago decurrens gargle to reduce halitosis of patients with general anesthesia,and improve the life quality.Methods Using random sampling method,80 cases of general anesthesia patients with laparoscopic cholecystectomy were randomly divided into two groups with 40 cases in each.The observation group adopted Solidago decurrens gargle for oral care,the control group adopted 0.9％ of saline for regular oral care.Two groups were compared with the incidence of halitosis.Results The incidence of halitosis in the observation group was significantly lower than that in the control group (P ＜ 0.05).Conclusions Solidago decurrens gargle can obviously reduce the occurrence of halitosis after general anesthesia. Key words: Solidago decurrens; General anesthesia operation; Halitosis

Does Peritoneal Dialysis Affect Halitosis in Patients with End-Stage Renal Disease?

There are various causes of halitosis, one of which is chronic renal failure. The objective of this study was to investigate halitosis levels in end-stage renal disease (ESRD) patients before and after peritoneal dialysis (PD) therapy. 42 subjects with ESRD were included in this study. The presence of halitosis was assessed using an organoleptic measurement and compared with blood urea nitrogen (BUN) levels and salivary flow rates. Decayed, missing, and filled teeth (DMFT) index and Community Periodontal Index (CPI) were calculated. All measurements were done before and after patients had received 3 months of PD therapy. Mean serum BUN level was found to be lower (46.05 ± 13.30 vs 91.24 ± 31.28 mg/dL), salivary flow rate higher (0.34 ± 0.07 vs 0.26 ± 0.04 mL/minute), and halitosis level lower (2.39 ± 0.60 vs 3.90 ± 0.37) at the end of 3 months of PD therapy than at the beginning of PD therapy. There was no significant difference in CPI or DMFT index before and after PD therapy (p > 0.05). There was statistically significant positive correlation between the presence of halitosis and BUN levels (r = 0.702, p = 0.001 before PD; r = 0.45, p = 0.002 after PD) and a negative correlation between the presence of halitosis and salivary flow rates (r = -0.69, p = 0.000 before PD; r = -0.37, p = 0.01 after PD). High BUN levels and low salivary flow rates were found to be associated with halitosis. PD may play an important role in decreasing the level of halitosis in ESRD patients.

Relationship between the presence of tonsilloliths and halitosis in patients with chronic caseous tonsillitis

To study the volatile sulphur compounds (VSC) halitometry profile in a population with chronic caseous tonsillitis (CCT) and halitosis and to evaluate the relationship between the presence of a tonsillolith and abnormal halitometry in this population. Clinical prospective non-randomised study. Forty-nine patients with halitosis and CCT, 17 male (35%) and 32 female (65%), were selected among patients referred for CO(2) laser cryptolysis. Anamnesis, physical examination and VSC halitometry were carried out. Halitometry values less than 150 ppb of VSC were considered normal. Patients were divided in two groups: Group A - normal halitometry (41 patients - 83.7%) and Group B - abnormal halitometry (8 patients - 16.3%). Halitometry results in Group B were 5.2 times (429%) higher than in Group A and the majority of the patients with abnormal halitometry presented with a tonsillolith at the moment of examination. A tonsillolith was present in 75% of the patients with abnormal halitometry and only 6% of patients with normal halitometry values. The presence of a tonsillolith represents a tenfold increased risk of abnormal VSC halitometry and can be considered as a predictable factor for abnormal halitometry in patients with CCT.

CO2 Laser Cryptolysis by Coagulation for the Treatment of Halitosis

The aim of this study was to evaluate the impact of CO(2) laser cryptolysis by coagulation (LCC) treatment in the volatile sulphur compounds (VSC) halitometry in patients with chronic caseous tonsillitis (CCT). Caseum retention and halitosis characterize CCT. Failure of clinical treatment indicated tonsillectomy. Recently, a conservative new treatment, CO(2 )LCC, has been introduced. It is painless and opens the crypt ostium, thus avoiding caseum retention. Halitometry is an objective new method for halitosis diagnosis. It measures VSC in parts per billion (ppb) in breathed air. Thirty-eight patients with CCT and complaints of halitosis were selected, underwent physical examination and halitometry measurements, and then received four sessions of LCC. The laser technique consisted of 6-W applications, in scanned and unfocused mode, around crypts, following the shape of their openings (fluence 54.5 joules/cm(2)) and, afterwards, over the entire tonsillar surface (fluence 18 joules/cm(2)). Halitometries were done before each LCC session. LCC was well tolerated by all patients, and all patients showed improvement in halitosis after LCC treatment. Eight patients (21%) had abnormal halitometry (>150 ppb) before treatment, but after LCC sessions their halitometry values became normal. These patients had caseum at examination. VSC measurement was reduced by 30.1%, and caseum retention was significantly decreased in this group. Abnormal halitometry in this population is related to the presence of caseum. LCC is safe, well tolerated, and improves complaints of halitosis in patients with CCT. Improvement was related to a decrease in caseum retention. Patients with abnormal halitometry had VSC halitometry improvement of approximately 30%.

P12 Halitometry in patients with chronic caseous tonsilitis prior to CO2 laser treatment

Objective Halitosis is a very common complaint at the ENT clinics. The aim of this study is to assess a population with chronic caseous tonsilitis (CCT) and complaint of halitosis prior to criptolisis with CO2 laser treatment.Methods Thirty patients were selected for CO2 laser criptolisis. All patients underwent anamnesis, physical examination and halitometry prior to laser treatment. Halitometry technique followed the HalimeterInterscanTM manufacturer's instructions. Results &lt;150 ppb of Volatile Sulphidric Compounds (VSC) were considered normal.Results Thirty patients, nine male (30%) and 21 female (70%), average age 27.7 years (±10.4) underwent halitometry. The patients were divided into two groups: Group A – abnormal halitometry (&gt;150 ppb) – five patients (16.66%); Group B – normal halitometry (&lt;150 ppb) – 25 patients (83.33%). Group A results: one male, four female, average age 25.2 (±5.6). Halitometry was 315.8 ppb (±164), three patients had caseum at examination (60%). Group B results: eight male, 17 female, average age 28.7 (±11.2). Halitometry was 47.9 ppb (±18.6), three patients had caseum at examination (12%).Discussion Halitosis is a very common complaint among patients with CCT. Only 16% of the patients with CCT and complaint of oral malodor had abnormal halitometry. Nevertheless this population had a high incidence of tonsillary caseum (60%) comparing to a normal halitometry population (12%).Conclusions Halitometry of VSC is useful to detect halitosis in patients with CCT. The presence of caseum at the examination is a predictor factor of abnormal halitometry. Further studies must be done to assess how CO2 laser criptolisis could benefit this population.

6. 歯周病患者の口臭と歯周病原性細菌との関連性について(口頭発表,第65回九州歯科学会総会講演抄録)

6. 歯周病患者の口臭と歯周病原性細菌との関連性について(口頭発表,第65回九州歯科学会総会講演抄録)

Halitosis in patients with Helicobacter pylori-positive non-ulcer dyspepsia: an indication for eradication therapy?

Background: The aims of this study were to investigate the frequency of halitosis before and after eradication therapy and to determine whether halitosis is a valid indication for eradication therapy in patients with Helicobacter pylori ( H. pylori)-positive non-ulcer dyspepsia. Methods: Dyspepsia, related symptoms, and halitosis were investigated by way of a questionnaire. Only H. pylori-positive patients who showed no organic lesions on endoscopic examination and no atrophy histopathologically were included. A total of 148 patients fulfilled the above criteria and completed the study. Four weeks after the end of eradication treatment, the symptoms were re-evaluated and repeat endoscopy was done to check for H. pylori in the gastric mucosa. Results: H. pylori eradication was successful in 109 patients (73.6%). Prior to treatment, bloating was the most frequent symptom (74.3%), followed by diurnal pain (62.2%) and halitosis (61.5%). The most successfully resolved symptoms in the group as a whole, regardless of eradication status, were halitosis, diurnal pain, and hunger-like pain, respectively. In the patients with confirmed H. pylori eradication, the most successfully resolved symptoms were halitosis and hunger-like pain, respectively. Conclusion: Halitosis is a frequent, but treatable, symptom of H. pylori-positive non-ulcer dyspepsia and may be a valid indication for eradication therapy.