Intra-oral Halitosis Research Articles

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.

Tongue coating metabolic profiles of intra‐oral halitosis patients

AbstractObjectiveThis study focused on the metabolic characteristics of tongue coating in patients with intra‐oral halitosis (IOH) to investigate potential diagnostic biomarkers for IOH.MethodsOral healthy participants were enrolled in this study. Halitosis was evaluated with an organoleptic assessment, a Halimeter®, and an OralChroma™. Tongue coating samples were collected from 18 halitosis patients and 18 healthy controls. Liquid chromatography–mass spectrometry was conducted to reveal the IOH‐related metabolic variations in tongue coating.ResultsA total of 2214 metabolites were obtained. Most metabolites were shared between the two groups. A total of 274 upregulated metabolites, such as paramethasone acetate and indole‐3‐acetic acid, and 43 downregulated metabolites, including deoxyadenosine and valyl‐arginine, were detected in the halitosis group. Functional analysis indicated that several metabolic pathways, including arginine biosynthesis, arginine and proline metabolism, histidine metabolism, and lysine degradation were significantly enriched in the IOH group. The least absolute shrinkage and selection operator logistic regression analysis revealed that paramethasone acetate, {1‐[2‐(4‐carbamimidoyl‐benzoylamino)‐propionyl]‐piperidin‐4‐yloxy}‐acetic acid, indole‐3‐acetic acid, and valyl‐arginine were remarkably associated with IOH.ConclusionsThis study revealed the metabolites present in tongue coating and identified effective biomarkers, providing essential insights into the prediction, pathogenesis, and diagnosis of IOH.

Hyperpure chlorine dioxide versus chlorhexidine in intra-oral halitosis (ODOR trial) – protocol of a double-blinded, double-arm, parallel non-inferiority pilot randomized controlled trial

IntroductionIntra-oral halitosis (IOH) is the most common type of bad breath; its consequences impair quality of life. However, evidence-based treatment protocols and guidelines are lacking. Our aim is to investigate the effectiveness of chlorine dioxide as an applicable complementary treatment modality in IOH after tongue cleaning.Methods and analysisThe ODOR trial will be a single-center, double-blinded, parallel-group, double-armed pilot randomized controlled trial with a non-inferiority design. The efficacy of hyperpure chlorine dioxide will be compared to chlorhexidine mouthwash. We plan to investigate the short-term effects of the intervention over a 3-h period. The primary endpoint will be changes in organoleptic test scores. At the end of the pilot investigation of the first 30 patients each, sample size calculation will be performed. If feasible, the investigators will continue the study by enrolling more patients.Trial registrationThe trial has been registered at ClinicalTrials.gov (NCT06219226).

Oral microbiota transplantation for intra-oral halitosis: a feasibility analysis based on an oral microbiota colonization trial in Wistar rats

BackgroundIntra-oral halitosis (IOH) is bad breath produced locally by the mouth in addition to systemic diseases and is one of the main causes of interpersonal communication and psychological disorders in modern society. However, current treatment modalities still only alleviate IOH and do not eradicate it. Therefore, based on the differential performance of oral microecology in IOH patients, we propose a microbiota transplantation treatment aimed at restoring oral microecological balance and analyze its feasibility by oral flora colonization test in Wistar rats.ObjectiveSaliva flora samples were collected from IOH patients and healthy subjects to analyze the feasibility of oral microbiota transplantation (OMT) for the treatment of IOH by the Wistar rat oral flora colonization test.MethodsSeven patients with IOH who visited the First Affiliated Hospital of Xinjiang Medical University from June 2017 to June 2022 with the main complaint of halitosis and three healthy subjects were randomly selected. A Halimeter portable breath detector was used to record breath values and collect saliva flora samples. Sixteen SPF-grade male Wistar rats were housed in the Animal Experiment Center of Xinjiang Medical University and randomly divided into an experimental group (Group E) and a control group (Group C) for the oral flora colonization test. Species composition and associated metabolic analysis of oral flora during the Wistar rat test using 16SrRNA sequencing technology and PICRUSt metabolic analysis. Also, the changes in the breath values of the rats were recorded during the test.ResultsThe proportion of Porphyromonas, Fusobacterium, Leptotrichia, and Peptostreptococcus was significantly higher in group E compared to group C after colonization of salivary flora of IOH patients (all P < 0.05), and the abundance with Gemella was zero before colonization, while no colonization was seen in group C after colonization compared to baseline. PICRUSt metabolic analysis also showed significantly enhanced IOH-related metabolic pathways after colonization in group E (all P < 0.05), as well as significantly higher breath values compared to baseline and group C (all P < 0.0001). After colonization by salivary flora from healthy subjects, group E rats showed a decrease in the abundance of associated odor-causing bacteria colonization, a reduction in associated metabolism, and a significant decrease in breath values. In contrast, group C also showed differential changes in flora structure and breath values compared to baseline after salivary flora colonization of IOH patients.ConclusionsOMT for IOH is a promising green treatment option, but the influence of environmental factors and individual differences still cannot be ignored.

Tongue-Coating Microbial and Metabolic Characteristics in Halitosis

Halitosis is a common oral condition, which leads to social embarrassment and affects quality of life. Cumulative evidence has suggested the association of tongue-coating microbiome with the development of intraoral halitosis. The dynamic variations of tongue-coating microbiota and metabolites in halitosis have not been fully elucidated. Therefore, the present study aimed to determine the tongue-coating microbial and metabolic characteristics in halitosis subjects without other oral diseases using metagenomics and metabolomics analysis. The participants underwent oral examination, halitosis assessment, and tongue-coating sample collection for the microbiome and metabolome analysis. It was found that the microbiota richness and diversity were significantly elevated in the halitosis group. Furthermore, species from Actinomyces, Prevotella, Veillonella, and Solobacterium were significantly more abundant in the halitosis group. However, the Rothia and Streptococcus species exhibited opposite tendencies. Eleven Kyoto Encyclopedia of Genes and Genomes pathways were significantly enriched in the halitosis tongue coatings, including cysteine and methionine metabolism. Functional genes related to sulfur, indole, skatole, and cadaverine metabolic processes (such as serA, metH, metK and dsrAB) were identified to be more abundant in the halitosis samples. The metabolome analysis revealed that indole-3-acetic, ornithine, and L-tryptophan were significantly elevated in the halitosis samples. Furthermore, it was observed that the values of volatile sulfur compounds and indole-3-acetic abundances were positively correlated. The multiomics analysis identified the metagenomic and metabolomic characteristics to differentiate halitosis from healthy individuals using the least absolute shrinkage and selection operator logistic regression and random forest classifier. A total of 19 species and 39 metabolites were identified as features in halitosis patients, which included indole-3-acetic acid, Bacillus altitudinis, Candidatus Saccharibacteria, and Actinomyces species. In conclusion, an evident shift in microbiome and metabolome characteristics was observed in the halitosis tongue coating, which may have a potential etiological significance and provide novel insights into the mechanism for halitosis.

An intra-oral infection Halitosis and its Causes, Diagnosis, and Treatment Strategies – A Systematic Review

Halitosis, commonly known as foul breath, affects a substantial portion of the population and often goes unaddressed for an extended period before individuals seek help from specialized clinics. This condition can have significant social and psychological implications. While halitosis can stem from various underlying causes, the oral cavity is responsible for the majority of cases (about 90%). Factors such as bacterial buildup on the tongue and inflammation of the gums or surrounding tissues contribute significantly to oral halitosis. Dentists frequently encounter patients with halitosis in their practice and must possess effective strategies to manage it. Utilizing established methodologies, dentists can achieve considerable therapeutic efficacy. Despite the prevalence of halitosis, many individuals endure its effects for prolonged periods before seeking assistance from dedicated clinics. The literature provides numerous recognized methods for diagnosing and treating halitosis, and this article comprehensively explores these aspects.

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.

ORGANOLEPTIC AND HALITOMETRIC ASSESSMENTS DO NOT CORRELATE WELL IN INTRA-ORAL HALITOSIS: A SYSTEMATIC REVIEW AND META-ANALYSIS.

The gold standard method for diagnosing oral halitosis is the subjective organoleptic measurement. Device-supported methods are also widespread worldwide. The challenges and safety concerns around performing organoleptic measurements during pandemics and the diversity of measuring device alternatives raised our clinical question: which halitometer is the most suitable for diagnosing halitosis? This systematic review was registered in PROSPERO (ID CRD42022320024). The search was performed on March 23, 2022 in the following electronic databases: MEDLINE, Embase, Scopus, Web of Science, and CENTRAL. Adult populations with or without halitosis were included, and patients with systemic diseases were excluded. Organoleptic (subjective) measurement and the device-supported (objective) methods were compared; the primary outcome was the correlation coefficient, and the secondary was the specificity and sensitivity of the devices. QUADAS-2 and QUADAS-C were used to evaluate the risk of bias in the studies. Random-effects meta analyses were performed on the outcomes, and the secondary outcomes were plotted on a common ROC plot. A total of 1231 records were found in the 5 databases. After the selection process, 76 articles were eligible for the systematic review, and 14,635 patients were involved in the qualitative analysis. The pooled Spearman's correlation coefficient (c.c.) for sulfide monitors was 0.65; 95% CIs: [0.53-0.74]; I2 = 95%, P < .01. The pooled Spearman's c.c. for portable gas chromatographs was 0.69; 95% CIs: [0.63-0.74]; I2 = 12%, P < .01. The pooled Spearman's c.c. for gas chromatographs was 0.76; 95% CIs: [0.67-0.83]; I2 = 0%, P < .01. None of the most commonly used halitometers proved to be significantly superior to the others. Halimeter and OralChroma measurements did not correlate well with the organoleptic level of oral halitosis in adults. Therefore, better halitometers need to be developed as an alternative to organoleptic measurements.

The tongue coating metabolomic profiling variations of intraoral halitosis subjects

The tongue coating metabolomic profiling variations of intraoral halitosis subjects

STATUS OF TONGUE COATING AND PERCEIVED HALITOSIS AMONG THE PATIENTS SEEKING ORAL TREATMENT

Background: Tongue coating is accountable for various oral and systemic diseases. It is the prime cause of intraoral halitosis. Oral cleaning has primarily been focused on tooth cleaning, leaving the tongue neglected. Studies on tongue coating status have not been conducted in Nepal. Therefore, this study aimed to assess the tongue coating status and perceived halitosis among the patients seeking oral treatment in a tertiary care centre of Lalitpur, Nepal. Methods: A cross-sectional study was conducted among 392 randomly selected patients above 18 years of age attending the Oral Medicine and Radiology department of KIST Medical College and Teaching Hospital. Demographic details, tooth brushing, tongue cleaning, and tobacco consumption habits and self perception of halitosis were recorded. Amount of tongue coating and plaque was assessed using Winkel tongue coating index and Silness and Loe plaque index respectively. Results: The mean value of tongue coating was 5.06±3.35. Tongue cleaning was performed by 240(61.2%) participants and daily tongue cleaning was practiced by 142(36.2%) participants. Prevalence of oral malodor was 65.8%(n=258). Twenty three (5.9%) participants suffered from halitosis on a regular basis. Tongue coating was related with gender (p=.03) and tongue cleaning frequency (p=0.02). No relationship was observed between tongue coating and perceived halitosis. Conclusions: Mean value of tongue coating was lower but higher percentage of people suffered from halitosis. Halitosis reduction and other health benefits can be motivating factors for people to clean their tongue. Oral health professionals should raise the awareness of tongue cleaning among general population.

Effects of thyme on halitosis in gingivitis patients: Can thyme mouthwash prevent halitosis-A randomized trial.

Bad breath is a condition that negatively affects people's social interactions and quality of life. The aim of this study was to evaluate the effect of thyme mouthwash on intraoral halitosis, gingival index (GI) and plaque index (PI) in patients with gingivitis. In this retrospective study, 60 gingivitis patients (30 women/30 men) received initial periodontal treatment followed by oral hygiene instructions (OHI) and then were divided into four groups: The control group (C) received only OHI, while chlorhexidine (CHX) mouthwash was prescribed to the CHX group, Zinc acetate and CHX diacetate mouthwash was prescribed to the zinc acetate and CHX diacetate (ZnA) group, and the thyme (T) group was instructed to use thyme mouthwash. GI, PI and volatile sulfur compound (VSC) values were recorded at baseline and at the first week of treatment. The initial values of the recorded parameters did not differ significantly between the groups. In all groups, VSCs, GI and PI decreased after treatment (p=0.001). There was no significant difference between the PI values of the groups after treatment (p=0.188). On the contrary, the GI and VSC values after treatment were significantly different between the groups (p=0.001). GI values were highest in the control group and lowest in the CHX group. In terms of VSCs, a significant difference was found between groups T and C, and between groups T and ZnA (p=0.001). This study showed that the use of thyme mouthwash after periodontal treatment was effective in improving bad breath and gingivitis in gingivitis patients.

Non-Surgical Periodontal Treatment Impact on Subgingival Microbiome and Intra-Oral Halitosis.

The purpose of this study was to characterize and compare subgingival microbiome before and after periodontal treatment to learn if any changes of the subgingival microbiome were reflected in intra-oral halitosis. We tested the hypothesis that intra-oral halitosis (Volatile sulfur compounds levels) correlates with corresponding subgingival bacterial levels before and after periodontal treatment. Twenty patients with generalized periodontitis completed the study. Subgingival plaque samples were collected at baseline and 6-8 weeks after nonsurgical periodontal therapy. Full-mouth periodontal status assessed probing depth (PD), clinical attachment loss (CAL), gingival recession (REC), bleeding on probing (BoP), PISA and PESA. Halitosis assessment was made using a volatile sulfur compounds (VSC) detector device. Periodontal measures were regressed across VSC values using adjusted multivariate linear analysis. The subgingival microbiome was characterized by sequencing on an Illumina platform. From a sample of 20 patients referred to periodontal treatment, 70% were females (n = 14), with a mean age of 56.6 (±10.3) years; full-mouth records of PD, CAL, BOP (%) allowed to classify the stage and grade of periodontitis, with 45% (n = 9) of the sample having Periodontitis Stage IV grade C and 95% (n = 19) had generalized periodontitis. The correlation of bacterial variation with VSCs measured in the periodontal diagnosis and in the reassessment after treatment were evaluated. Fusobacterium nucleatum, Capnocytophaga gingivalis and Campylobacter showaei showed correlation with the reduction of VSC after periodontal treatment (p-value = 0.044; 0.047 and 0.004, respectively). Capnocytophaga sputigena had a significant reverse correlation between VSCs variation from diagnosis (baseline) and after treatment. Microbial diversity was high in the subgingival plaque on periodontitis and intra-oral halitosis participants of the study. Furthermore, there were correlations between subgingival plaque composition and VSC counting after periodontal treatment. The subgingival microbiome can offer important clues in the investigation of the pathogenesis and treatment of halitosis.

Halitosis. Multidisciplinary approach

Halitosis is a common complaint among patients. Up to 50% of people worldwide claim to have persistent or intermittent bad breath. Often, bad breath not only disrupts the social life of patients, but is also a symptom of systemic diseases. An important step in the treatment of halitosis is the localization of the source and possible cause of the unpleasant smell. Most often, the problem of halitosis is solved by dentists, because intraoral halitosis accounts for up to 90% of all cases, but doctors of many specialties should deal with the differential diagnosis of its causes. This article considers the main causes of halitosis in patients with diseases of various organ systems.

The tongue biofilm metatranscriptome identifies metabolic pathways associated with the presence or absence of halitosis

Intra-oral halitosis usually results from the production of volatile sulfur compounds, such as methyl mercaptan and hydrogen sulfide, by the tongue microbiota. There are currently no reports on the microbial gene-expression profiles of the tongue microbiota in halitosis. In this study, we performed RNAseq of tongue coating samples from individuals with and without halitosis. The activity of Streptococcus (including S. parasanguinis), Veillonella (including V. dispar) and Rothia (including R. mucilaginosa) was associated with halitosis-free individuals while Prevotella (including P. shahi), Fusobacterium (including F. nucleatum) and Leptotrichia were associated with halitosis. Interestingly, the metatranscriptome of patients that only had halitosis levels of methyl mercaptan was similar to that of halitosis-free individuals. Finally, gene expression profiles showed a significant over-expression of genes involved in L-cysteine and L-homocysteine synthesis, as well as nitrate reduction genes, in halitosis-free individuals and an over-expression of genes responsible for cysteine degradation into hydrogen sulfide in halitosis patients.

Aetiology, diagnosis and management of halitosis – a narrative review

Objectives&#x0D; The present study aimed to present an overview of the aetiology of oral malodour and the diagnostic and treatment procedures.&#x0D; Design&#x0D; A comprehensive review of scientific literature (up to December 2021) was conducted using Medline and PubMed databases and Google Scholar, including checking reference lists of journal articles by hand-searching. Results are presented descriptively for halitosis's aetiology, diagnosis and clinical management.&#x0D; Results&#x0D; The origin of the foul odour problem is mainly due to intra-oral causes, while only a proportion of cases result from additional systemic problems. In some cases, the problem can be caused by co-existing oral and extraoral problems. Evidence suggests that the leading cause of intra-oral halitosis is the anaerobic microorganisms present in the tongue plaque. Less commonly, the foul odour is due to poor oral hygiene and periodontitis.&#x0D; Conclusion&#x0D; The origin of the foul odour problem is mainly due to intra-oral causes, while only a proportion of cases result from additional systemic problems. Dentists need to analyse and treat the oral problems that may be responsible for the patient's malodour, as well as inform the patient about the causes of the foul odour and oral hygiene procedures (flossing, tongue cleaning, selection and use of appropriate mouthwash and toothpaste). If the problem persists, they should know whom to refer the patient to for further diagnosis. It is reasonable to organise consultations on halitosis in a multidisciplinary setting - periodontists, otolaryngologists (ENT specialists), internal medicine specialists, gastroenterologists, psychiatrists, psychologists and others.

The efficacy of probiotics in the management of intra-oral halitosis: a systematic review.

To evaluate the efficacy of probiotics in reducing halitosis of dental origin. MEDLINE, EMBASE, and CENTRAL were searched up to and including June 2020. Randomised placebo-controlled, double-blinded clinical trials in systemically healthy adult patients who were given any form of probiotics to manage halitosis of dental origin were included. Primary outcome measures were organoleptic scores and volatile sulphur concentration levels. Secondary outcome measures were microbiologic parameters and quality of life (QOL). Of the 301 potentially relevant articles, eight articles were selected for the review. The risk of bias assessment showed that two studies were of low risk of bias, four studies had some concerns, and two studies had a high risk of bias. The beneficial effect of probiotics could neither be confirmed in periodontally treated patients administered with up to 8weeks of probiotics, nor in periodontitis patients who received both non-surgical periodontal therapy and adjunctive probiotics up to 90days. Microbiological findings 1month after probiotics administration and QOL measures showed no significant differences compared to control. Considerable heterogeneity was observed among probiotic administration protocols. The available evidence suggests no convincing benefit for the use of probiotics in the management of halitosis. Standardised protocols on recruitment of halitosis subjects and organoleptic measurements are required for future studies on probiotics as an intervention. The lack of well-conducted studies with a low risk of bias precludes any clinical recommendation. Further research is needed to verify the efficacy of probiotics in the management of intra-oral halitosis.

Clinical Trial Evaluating Quality of Life in Patients with Intra-Oral Halitosis.

Halitosis is considered to be extremely unattractive in the context of social interactions. The main research objective of this study was to evaluate whether intra-oral halitosis may impact patients’ quality of life (QOL). One hundred generally healthy adult participants complaining about oral malodor and diagnosed with intra-oral halitosis were enrolled in this study. For halitosis diagnosis, a gas chromatography (GC) analysis by the Oral Chroma portable device was used. QOL assessment was based on the Short Form 36-item Health Survey (SF-36). The respondents had the highest scores in the physical functioning (PF), activity limitations caused by emotional problems (RE) and activity limitations caused by physical problems (RP) domains, and the weakest in the general health perception (GH), vitality (VT) and emotional wellbeing (MH) ones. The total volatile sulfur compounds (VSCs) level was negatively correlated with SF-36 domains. The SF-36 domains’ scores decreased the higher the level of VSC was. The respondents assessed their QOL to be at its best in physical functioning and activity limitations caused by emotional and physical problems and the worst in general health perception, vitality and emotional wellbeing. The strongest correlation between halitosis and decreased QOL was found in the social functioning (SF), vitality, emotional wellbeing and general health perception domains.

A Literature Review and Framework Proposal for Halitosis Assessment in Cigarette Smokers and Alternative Nicotine-Delivery Products Users.

Halitosis is a health condition which counts cigarette smoking (CS) among its major risk factors. Cigarette smoke can cause an imbalance in the oral bacterial community, leading to several oral diseases and conditions, including intraoral halitosis. Although the best approach to decrease smoking-related health risks is quitting smoking, this is not feasible for many smokers. Switching to potentially reduced-risk products, like electronic vapor products (EVP) or heated tobacco products (HTP), may help improve the conditions associated with CS. To date, there have been few systematic studies on the effects of CS on halitosis and none have assessed the effects of EVP and HTP use. Self-assessment studies have shown large limitations owing to the lack of reliability in the participants' judgment. This has compelled the scientific community to develop a strategy for meaningful assessment of these new products in comparison with cigarettes. Here, we compiled a review of the existing literature on CS and halitosis and propose a 3-layer approach that combines the use of the most advanced breath analysis techniques and multi-omics analysis to define the interactions between oral bacterial species and their role in halitosis both in vitro and in vivo. Such an approach will allow us to compare the effects of different nicotine-delivery products on oral bacteria and quantify their impact on halitosis. Defining the impact of alternative nicotine-delivery products on intraoral halitosis and its associated bacteria will help the scientific community advance a step further toward understanding the safety of these products and their potentiall risks for consumers.

Efficacy of a Zinc Lactate Mouthwash and Tongue Scraping in the Reduction of Intra-Oral Halitosis: A Single-blind, Controlled, Crossover Clinical Trial-A Pilot Study.

Intra-oral halitosis is defined as an unpleasant odor that comes out of the mouth. The aim of this study was to investigate the effect of zinc lactate mouthwash and tongue scraping on intra-oral halitosis. The study was conducted on 60 volunteers that were divided into two groups and fol-lowed two types of 14-day oral hygiene protocols on a cross-over basis after a 7-day wash-out period. One protocol was based on tooth brushing only, while the other was based on additional mouth rinsing with a zinc lactate product and tongue scraping. Morning mouth breath was as-sessed organoleptic and by volatile sulfur compound concentrations. The highest mean organo-leptic and volatile sulfur compound measurement values were found in the tooth brushing without mouth washing and tongue scraping oral hygiene protocol (p < 0.05). The zinc lactate mouthwash combined with tongue scraping appears to be an important hygienic procedure to reduce breath odor.

The Problem of Halitosis in Prosthetic Dentistry, and New Approaches to Its Treatment: A Literature Review.

The aim of this work is a review of recent scientific literature about intra-oral halitosis among patients using dentures. Halitosis is a condition in which an unpleasant smell comes out of the oral cavity, which is caused mainly by volatile sulfur and non-sulfured compounds. The etiology of halitosis may be intra- or extra-oral; in most patients, however, it is due to the activity of microorganisms in the oral cavity. The problem of the occurrence of intra-oral halitosis has accompanied patients for many years. In dental prosthetics, the problem of halitosis occurs in patients using removable or fixed dentures. In both cases, new niches for the development of microorganisms may be created, including those related to intra-oral halitosis. It should be noted that dentures—both fixed and removable—are a foreign body placed in the patient’s oral cavity which, in case of insufficient hygiene, may constitute a reservoir of microorganisms, causing this unpleasant condition. Conventional treatment of intraoral halitosis reduces microbial activity via chemical and/or mechanical action. Currently, the search for new strategies in the treatment of halitosis is in progress. One idea is to use photodynamic therapy, while another is to modify poly(methyl methacrylate) (PMMA) with silver and graphene nanoparticles. Additionally, attempts have been made to combine those two methods. Another unconventional method of treating halitosis is the use of probiotics.