Organoleptic Measurements Research Articles

Halitosis: Classification, Causes, and diagnostic as well as Treatment Approach-A Review

Objectives: This coverage reviews the current knowledge on classification, causes, and diagnostic as well as remedial line of attack on malodor of breath. Data: Halitosis, a condition that causes a severe social handicap to those who suffer from it, has a multifactorial etiology. It is anasty or offensive odor originating from the breath. The condition may encompass both oral and non-oral disorders. Sources: A private, monthly with keywords halitosis, malodor, etiology, measurement, and management from Medline and Pub med updated database of literature was reviewed. Conclusions: In majority of cases, halitosis is caused by oral conditions, defined as oral malodor. Oral malodor fallouts from tongue coating, periodontal disease, peri-implant disease, deep carious lesions, exposed necrotic tooth pulps, pericoronitis, mucosal ulcerations, healing (mucosal) wounds, impacted food or debris, imperfect dental restorations, unclean dentures, and factors causing decreased salivary flow rate. The basic progression is microbial degradation of organic substrates. Non-oral etiologies of halitosis include turbulences of the upper and lower respiratory tract, ailments of the gastrointestinal tract, some systemic maladies, metabolic disorders, medications, and carcinomas. Stressful situations are predisposing factors. There are three primary measurement approaches of halitosis. Organoleptic measurement and gas chromatography are very dependable, but not very simply clinically applied techniques. The use of organoleptic measurement is recommended as the ‘gold standard’. Gas chromatography is the preferable method if accurate measurements of specific gases are required. Sulphide monitoring is straightforwardly used method, but has the limitation that important odors are not detected. The scientific and practical value of additional or alternative measurement methods, such as BANA test, chemical sensors, salivary incubation test, quantifying s-galactosidase activity, ammonia monitoring, ninhydrin method, and polymerase chain reaction, has to be established. Last but not least, regarding the usage of probiotics, the oral administration of the probiotic lactobacilli not only seemed to improve the physiologic halitosis, but also showed beneficial effects on bleeding on probing from the periodontal pockets.

Detection and measurement of oral malodor in chronic periodontitis patients and its correlation with levels of select oral anaerobes in subgingival plaque.

Introduction:Oral malodor is generally ascribable to oral microbial putrefaction generating malodorous volatile sulfur compounds. The aim of the present study is to correlate organoleptic recordings with a small handheld portable volatile sulfide monitor and periodontal clinical parameters and correlate the levels of halitosis causing bacteria in plaque between baseline, 1-week, and 1-month.Materials and Methods:A total of 20 systemically healthy subjects with self-reported halitosis were subjected to organoleptic examination and FitScan®. Subgingival plaque samples for anaerobic culturing were harvested followed by an assessment of plaque index (PI), gingival bleeding index (GBI), and pocket probing depth. Data derived were subjected to statistical analysis using Wilcoxon signed rank test and Spearman's rank test (P < 0.05).Results:No correlation was seen between organoleptic measurements and portable volatile sulfide monitor at any time interval. There was a statistically significant (P < 0.05) correlation between the scores of PI, gingival index, GBI, and myeloproliferative disease with organoleptic readings at all-time intervals. Anaerobic culture has shown to identify Fusobacterium species, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythia. However, no correlation could be established in between total microbial load with organoleptic and FitScan® reading at any time interval (P < 0.05).Conclusion:Significant correlation could be established between organoleptic readings and periodontal parameters.

Comparison of Systemic Oral Malodor in Patients Undergoing Hemodialysis and Peritoneal Dialysis

Chronic renal failure is one of the major cause of systemic oral malodor depending on uremia. Hemodialysis(HD) and periotoneal dialysis (PD) are the important procedures in the management of patients with end-stage renal disease(ESRD). In this study it was aimed to compare the systemic oral malodor in patients undergoing HD and PD. 74 patients (40 HD and 34 PD) recently diagnosed with ESRD were selected. This study were not included the patients with poor oral hygiene and had oral malodor depending on any intraoral etiology such as caries, periodontal disease and impacted teeth. Oral hygiene index(OHI) scores of the patients were calculated in to order assess oral health. Systemic oral malodor of the patients were calculated in order assess oral health. Systemic oral malodor of the patients were evaulated using organoleptic method. All measurements were performed pre-dialysis and postdialysis (3 months after therapy) procedures. There were no statistically significant difference between the groups according to OHI scores (p>0.05). The Oral malodor scores were found lower at post dialysis measurement than the baseline measurements in both group(p<0.05). The results of the organoleptic measurements indicated that systemic oral malodor were higher in HD group (2.67±0.81) compared to PD group (1.98±0.57) (p<0.05). This study revealed that PD was more effective than HD in decreasing of systemic oral malodor in ESRD patients.

Volatile sulphur compound levels and related factors in patients with chronic renal failure.

To analyse specific volatile sulphur compound(VSC) levels in a group of chronic renal failure (CRF) patients and determine the relationship between these VSC levels and organoleptic measurements, blood urea nitrogen (BUN) levels, dental and periodontal conditions, salivary flow rate, and tongue coating scores. One examiner performed organoleptic and VSC measurements on fifty patients with CRF before and after haemodialysis (HD) and controls. DMFT and CPITN indexes, tongue coating scores, salivary flow rates were measured. Comparisons were performed using the Mann-Whitney U, Wilcoxon signed-ranks, and chi-square tests. Spearman correlation coefficient was used to analyse correlations. Before HD, the mean dimethyl sulphide level was 1.04 ± 1.20 in the CRF patients and 0.51 ± 0.65 in controls, with a significant difference. The mean hydrogen sulphide, methyl mercaptan and dimethyl sulphide levels in CRF patients were 1.47 ± 3.04, 1.03 ± 1.85, and 1.04 ± 1.20, respectively, before HD; and 0.53 ± 1.65, 0.48 ± 1.27, and 0.56 ± 0.85, respectively, after HD; with the differences being significant. Methyl mercaptan levels increased with an increase in HD duration. Tongue coating and organoleptic measurements were significantly correlated with methyl mercaptan. Dimethyl sulphide is the main VSC in extraoral blood-borne halitosis; but methyl mercaptan may also contribute to this type of halitosis. A decreased salivary flow rate and an increased pH of the biofilm matrix may be a significant parameter for VSC levels in CRF patients.

Halitosis: a review of the etiologic factors and association with systemic conditions and its management.

Halitosis is a general term defined as an unpleasant or offensive odor emanating from the breath, arising from either oral or nonoral sources. Extraoral factors, such as ear-nose-throat conditions or gastrointestinal, respiratory, and systemic diseases, may also contribute to oral malodor. Although, halitosis has a multifactorial etiology, local factors play an important role in the majority of cases. Halitosis may lead to significant personal discomfort and social embarrassment. Assessment of halitosis can be performed using organoleptic measurements, sulfide monitoring, gas chromatography, microbial testing and chemical test strips. Management approaches are based on masking oral malodor, reducing the levels of volatile organic compounds (VOCs) and volatile sulfur compounds (VSCs), and mechanical and/or chemical treatment. This review aims to identify the etiology of oral halitosis, describe the methods available for assessment and differential diagnosis and introduce a variety of management strategies. The importance of a multidisciplinary approach for the improvement of overall health and for the management and prevention of halitosis is highlighted.

Effectiveness of radiofrequency cryptolysis for the treatment of halitosis due to caseums

ObjectiveTo evaluate the effectiveness of radiofrequency (RF) cryptolysis for caseum-induced halitosis. Study designClinical retrospective study. SettingOtorhinolaryngology Head and Neck Surgery Department of Konya Training and Research Hospital in Turkey. Subjects and methodsThirty-four patients with caseum-induced halitosis were included. Eight were male (23.5%) and 26 were female (76.5%). Their mean age was 28.29±9.3 (range: 17–48) years. The mean duration of complaint of halitosis before RF cryptolysis was 53.41±42.6months (range: 6–182months). The Finkelstein test, organoleptic measurements, and visual analog scale (VAS) were performed before and 12months after RF cryptolysis. ResultsBefore RF cryptolysis, all patients had a positive Finkelstein's test result, organoleptic measurements revealed that three (8.82%) had serious halitosis, 24 (70.58%) had average halitosis, and seven (20.58%) had mild halitosis, and the mean VAS score was 6.82±1.45. The follow-up period after RF cryptolysis was 12months. After the single RF cryptolysis session, 26 patients (76.47%) were negative for Finkelstein's test, organoleptic assessments revealed that 26 (76.47%), six (17.64%), and two (5.88%) showed complete, partial, and no recovery, respectively, (p<0.001), and the mean VAS score was significantly better at 1.88±2.5 (p<0.001). Thirty-two patients (94.1%) exhibited a decrease in VAS score. ConclusionRF cryptolysis is a cost-effective, safe, and easily applicable modality for the treatment of halitosis due to caseums in the crypts of the palatine tonsils.

Effect of toothbrushing discontinuation on morning volatile sulfur compounds in periodontally healthy subjects.

To follow up the variations of early morning concentrations of oral volatile sulfur compounds (VSCs) in periodontally healthy subjects who refrained from toothbrushing during a period of 5 days while continuing with other hygiene procedures. Thirteen subjects volunteered for this study. At baseline, all subjects stopped brushing their teeth for 5 days, but continued using dental floss and a tongue scraper twice daily. Organoleptic measurements, VSC quantification and plaque index were recorded in all subjects at baseline and on days 3 and 5 of the study period. At baseline, the visible plaque index was significantly lower than that observed on days 3 and 5 (P = 0.0001). However, no significant differences in the amount of plaque were observed between days 3 and 5 (P > 0.05). The results of the organoleptic measurements and VSC quantifications did not show any statistically significant differences between baseline and day 3, or between days 3 and 5 (P > 0.05). However, a significant increase was observed in both VSCs (P = 0.008) and organoleptic scores (P = 0.032) when baseline values were compared to day 5. A positive correlation between VSCs and organoleptic scores was observed in all measurements (r = 0.67, P < 0.0001). The results of this study suggest that the lack of toothbrushing may affect VSC levels and the organoleptic perception of oral malodour due to the development of biofilm on buccal and lingual surfaces of teeth in healthy subjects.

Effects of tongue coating and oral health on halitosis among dental students.

To assess halitosis and determine the relationship between halitosis and tongue scores, periodontal status and DMFT among dental students. The study comprised 268 (178 female, 90 male) dental students. Halitosis was measured using a Halimeter and the organoleptic method. Halitosis was diagnosed with a mean volatile sulphur compounds (VSC) level of >=125 ppb and an organoleptic measurement of >= 2 on a 0- to 5-point scale. Tongue scores were obtained using a tongue coating index (TCI), periodontal status was measured and assessed using the Community Periodontal Index of Treatment Needs (CPITN) and DMFT indices were calculated. Halitosis occurred at higher rates among male students than female students (83% vs 71%, P = 0.02). No differences were found in halitosis rates among students in different academic years (P = 0.6) or age groups (P = 0.6). A relationship was found between halitosis and tongue scores (P < 0.001) and between halitosis and mean CPITN scores (P = 0.004). The mean DMFT was 4.02 (SD = 3). No relationship was found between halitosis and DMFT index (P = 0.5). Halitosis was prevalent among dental students. Given their responsibilities for diagnosing and improving oral health, they may benefit from increased awareness of the problem and encouragement to improve their own oral hygiene, especially male students.

Limited evidence suggests that mouthrinses may be effective in reducing oral malodour

Medline, The Cochrane Central Register of Controlled Trials (CENTRAL) and Embase databases were searched. Screening and selection of studies was conducted independently by two authors, with randomised controlled trials (RCTs) or controlled clinical trials (CCTs) conducted in adults 18 years or older being included. Studies used the outcome measures of volatile sulphur compounds (VSCs), organoleptic measurement (OM) and tongue coating (TC). Studies with a duration of greater than one day were included. Selection was restricted to English language papers. Study quality was assessed by two authors with studies being separated into short- term (< 3 weeks) and longer-term study period groups (≥3 weeks). Meta-analysis was not conducted because of heterogeneity in the study designs, products used, outcome measures and data presentation. Twelve RCTs were included (six cross-over studies and six parallel design). The short-term studies ranged from four days to two weeks and the long-term studies from three to four weeks. The risk of bias was assessed as high for two studies, moderate for three and low for seven. Nearly all mouthwashes with active ingredients had beneficial effects in reducing oral malodour in both short- and longer-term studies. The most compelling evidence was provided for chlorhexidine mouthwashes, and those that contained a combination of cetyl pyridinum chloride and zinc provided the best evidence profile on oral malodour. Little data with respect to tongue coating were available, and none of the studies showed a beneficial effect for this parameter.

The effect of mouthrinses on oral malodor: a systematic review

The objective of this study is to systematically review the literature regarding the impact of mouthrinses on oral malodor and present evidence for the treatment effects of mouthrinses on oral malodor. PubMed-MEDLINE, the Cochrane-CENTRAL and EMBASE were searched through February 10, 2012 to identify appropriate studies. Volatile sulphur compound measurements, organoleptic measurements and tongue coating were selected as outcome variables. SEARCH RESULTS: The independent screenings of 333 unique titles and paper abstracts revealed 12 publications (12 experiments) that met the eligibility criteria. Means and standard deviations were extracted. The results were separated into short-term (<3 weeks) and longer-term (≥3 weeks) studies. In this review, nearly all mouthwashes with active ingredients had beneficial effects in reducing oral malodor in both short- and longer-term studies. The most compelling evidence was provided for chlorhexidine mouthwashes, and those that contained a combination of cetyl pyridinum chloride and zinc provided the best evidence profile on oral malodor. Little data with respect to tongue coating were available, and none of the studies showed a beneficial effect for this parameter.

Spectrophotometric assessment of salivary β-galactosidases in halitosis

The aim of this work was to develop a spectrophotometric method for the measurement of salivary β-galactosidase for the evaluation of oral malodor. A comparison between different methods for estimating oral malodor has been conducted on 94 healthy adult volunteers. For organoleptic measurements, the subjects were instructed to exhale briefly through the mouth at a distance of approximately 10 cm from the noses of two trained judges. The evaluation of β-galactosidase activity was accomplished in unstimulated whole saliva of all participants through the colorimetric method and spectrophotometry. A significant association among spectrophotometric evaluation of β-galactosidase and organoleptic measurements was assessed by Spearman correlations. Although colorimetric and spectrophotometric assessments of β-galactosidases were estimated to have the same sensitivity, the last method is characterized by a higher specificity. The results suggest that the use of the UV-vis spectrophotometer increases the specificity of the evaluation of salivary β-galactosidases.

Effect of a Mouthwash Containing Cetylpyridinium and Zinc Chloride on Oral Malodor

The aim of this study is to clinically evaluate the effect of a mouthwash containing cetylpyridinium and zinc chloride on reduction of morning oral malodor in healthy subjects measured by organoleptic measurement and a portable sulfide monitor. A total of 8 healthy non-smoking male volunteers were enrolled in this study of crossover design consisting of two experimental phases. The subjects were instructed to rinse the mouth with 10 mL of the experimental mouthwash containing cetylpyridinium and zinc chloride for 30 seconds at the first phase. At the second phase after a one-week washout period, each subject rinsed with distilled water as a control. All experiments were conducted at around 8:30 a.m. and oral malodor was measured using organoleptic measurement and a portable sulfide monitor just before rinsing with the experimental mouthwash or control (baseline), 1 hr, 2 hrs, and 3 hrs after rinsing. The mouthwash containing cetylpyridinium and zinc chloride reduced morning oral malodor up to 3 hrs after rinsing. Organoleptic score and concentrations of volatile sulfur compounds after use of the experimental mouthwash significantly decreased with time, and the decreases were significantly different between the mouthwash and control. In conclusion, the mouthwash containing cetylpyridinium and zinc chloride is significantly effective on reduction of morning oral malodor in healthy subjects by 3 hrs.

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.

Effects of a mouthwash with chlorine dioxide on oral malodor and salivary bacteria: a randomized placebo-controlled 7-day trial

BackgroundPrevious research has shown the oxidizing properties and microbiological efficacies of chlorine dioxide (ClO2). Its clinical efficacies on oral malodor have been evaluated and reported only in short duration trials, moreover, no clinical studies have investigated its microbiological efficacies on periodontal and malodorous bacteria. Thus, the aim of this study was to assess the inhibitory effects of a mouthwash containing ClO2 used for 7 days on morning oral malodor and on salivary periodontal and malodorous bacteria.Methods/DesignA randomized, double blind, crossover, placebo-controlled trial was conducted among 15 healthy male volunteers, who were divided into 2 groups. Subjects were instructed to rinse with the experimental mouthwash containing ClO2 or the placebo mouthwash, without ClO2, twice per day for 7 days. After a one week washout period, each group then used the opposite mouthwash for 7 days. At baseline and after 7 days, oral malodor was evaluated with Organoleptic measurement (OM), and analyzed the concentrations of hydrogen sulfide (H2S), methyl mercaptan (CH3SH) and dimethyl sulfide ((CH3)2S), the main VSCs of human oral malodor, were assessed by gas chromatography (GC). Clinical outcome variables included plaque and gingival indices, and tongue coating index. The samples of saliva were microbiologically investigated. Quantitative and qualitative analyses were performed using the polymerase chain reaction-Invader method.Results and DiscussionThe baseline oral condition in healthy subjects in the 2 groups did not differ significantly. After rinsing with the mouthwash containing ClO2 for 7 days, morning bad breath decreased as measured by the OM and reduced the concentrations of H2S, CH3SH and (CH3)2S measured by GC, were found. Moreover ClO2 mouthwash used over a 7-day period appeared effective in reducing plaque, tongue coating accumulation and the counts of Fusobacterium nucleatum in saliva. Future research is needed to examine long-term effects, as well as effects on periodontal diseases and plaque accumulation in a well-defined sample of halitosis patients and broader population samples.Trial registrationClinicalTrials.gov NCT00748943

Patients’ self‐assessment of oral malodour and its relationship with organoleptic scores and oral conditions

The aim of this study was to compare patients' self-rating of oral malodour with organoleptic evaluation and to relate them to oral conditions. One hundred and eighty systemically healthy patients with a primary complaint of oral malodour participated in this cross-sectional study. They were asked to complete a questionnaire regarding family and social discomfort and type of halitosis complaint, and to score the degree of their own oral malodour. The quality of the mouth air was assessed organoleptically by a calibrated odour judge. Odour-judge scores and self-assessments of bad breath were compared with one another as well as with clinical parameters (plaque index, bleeding index, probing depth and tongue coating score). The organoleptic test revealed that 93.9% of the subjects were found actually to have halitosis. The self-rating of oral malodour varied widely among patients. In 37.8% of patients, there was a correspondence between subjective and organoleptic measurements. The better correspondence was evident at 2-3 scores. The organoleptic ratings were significantly related to clinical parameters, whereas patients' self-measurements did not. The bleeding index had the highest correlation coefficient among the periodontal parameters examined (r = 0.665, P < 0.001). Self-estimation of bad breath correlated well with the presence of oral malodour as determined by organoleptic examination. Patients with slight or moderate oral halitosis presented the highest correlation rate between self- and odour-judge assessment.

Efficacy of a new mouthrinse formulation on the reduction of oral malodour in vivo. A randomized, double-blind, placebo-controlled, 3 week clinical study

The present study was conducted to assess the efficacy of a new mouthrinse formulation in reducing oral malodour compared to that of commercially available products containing chlorhexidine (CHX) and a negative control. 174 healthy volunteers, each with an organoleptic score of at least 2 and an H2S level as part of the volatile sulfur compounds (VSC) higher than 50 ppb, were divided into four groups. Participants were stratified according to their organoleptic ratings (OR). Group I: mouthrinse I (250 ppm F− from amine fluoride/stannous fluoride (ASF), 0.2% zinc lactate, oral malodour counteractives); group II: mouthrinse II (0.05% CHX, 0.05% cetylpyridinium chloride, 0.14% zinc lactate); group III: mouthrinse III (0.12% CHX); group IV: tap water. All groups were instructed to perform standardized oral hygiene measures and to apply the respective test rinse twice daily after tooth brushing. Malodour was assessed by organoleptic measurement and by VSC levels at baseline, day 1, day 7, day 14 and day 21 into the study. To evaluate discolouration of the teeth, the colour was assessed at baseline and final visit. The ASF mouthrinse showed superior efficacy as compared to the negative control. A significant reduction in OR and VSC readings was achieved after single application as well as after 7 and 21 days of continuous use. Between test groups I–III no statistically significant differences were found at any time point. There was also a trend towards fewer side effects caused by the ASF product compared to the products containing CHX. The newly developed mouthrinse product significantly reduces oral malodour in patients with increased values both in OR and in VSC.

A randomized double blind crossover placebo-controlled clinical trial to assess the effects of a mouthwash containing chlorine dioxide on oral malodor

BackgroundPrevious research has shown the oxidizing properties and microbiological efficacies of chlorine dioxide (ClO2), however, its clinical efficacies on oral malodor have been evaluated only with organoleptic measurements (OM) or sulphide monitors. No clinical studies have investigated the inhibitory effects of ClO2 on volatile sulfur compounds (VSCs) using gas chromatography (GC). The aim of this study was to assess the inhibitory effects of a mouthwash containing ClO2 on morning oral malodor using OM and GC.MethodsA randomized, double blind, crossover, placebo-controlled clinical trial was conducted among 15 healthy male volunteers, who were divided into 2 groups. In the first test phase, the group 1 subjects (N = 8) were instructed to rinse with the experimental mouthwash containing ClO2, and those in group 2 (N = 7) to rinse with the placebo mouthwash without ClO2. In the second test, phase after a one week washout period, each group used the opposite mouthwash.Oral malodor was evaluated before rinsing, right after rinsing and every 30 minutes up to 4 hours with OM, and concentrations of hydrogen sulfide (H2S), methyl mercaptan (CH3SH) and dimethyl sulfide ((CH3)2S), the main VSCs of human oral malodor, were evaluated with GC.ResultsThe baseline oral condition in the subjects in the 2 groups did not differ significantly. The mouthwash containing ClO2 improved morning bad breath according to OM and reduced concentrations of H2S, CH3SH and (CH3)2S according to GC up to 4 hours after rinsing. OM scores with ClO2 were significantly lower than those without ClO2 at all examination times. Significant reductions in the concentrations of the three kinds of VSCs measured by GC were also evident at all examination times. The concentrations of the three gases with ClO2 were significantly lower than those without ClO2 at most examination times.ConclusionIn this explorative study, ClO2 mouthwash was effective at reducing morning malodor for 4 hours when used by healthy subjects.Trial registrationClinicalTrials.gov NCT00655772

Oral malodor associated with internal resorption

We report a case of oral malodor associated with internal resorption. A 39-year-old male attended our hospital complaining of oral malodor. Utilizing organoleptic measurement, the halimeter test and gas chromatography, it was diagnosed as a strong halitosis caused by oral origin. The pocket probing depth of tooth 21 was 10 mm, and X-ray examination revealed a vertical bone loss around this tooth. The patient had received periodontal treatment at two dental offices previously, but the periodontal conditions and oral malodor persisted. We performed an initial periodontal preparation, however a deep pocket remained. We therefore performed a surgical inspection including flap reflection, and found that the tooth had a large perforating defect in the distal surface. The extracted tooth had multiple perforating defects covered with granulation tissues on all root surfaces including the root apex. Taking into consideration the anamnesis and X-ray examination of the extracted tooth, internal absorption was considered to have been the cause of the multiple perforating defects. After extraction of the causative tooth, oral malodor dramatically decreased. To our knowledge, this is the first report of an oral malodor associated with internal resorption.

Oral malodor‐related parameters in the Chinese general population

To estimate the prevalence of halitosis in the Chinese population and to assess the relationships between halitosis and oral health, social and behavioural factors. The correlation between the incidence of oral malodor and oral health was surveyed in a sample of 2000 individuals (1000 males and 1000 females) aged 15-64 years residing in urban and rural areas. Malodor was measured with both organoleptic measurements and with a portable sulphide monitor. Assessment of oral health included decayed, missing and filled teeth (DMFT), periodontal status, dental plaque, and tongue coating. Behavioural and social factors related with oral health or halitosis were also investigated. The prevalence of halitosis was 27.5% according to the organoleptic score. The level of volatile sulphur compounds (VSCs) in mouth air was significantly lower in males and in some of the age groups after lunch. Age and location of residence (rural or urban areas) did not influence the VSCs concentration in mouth air. The amount of tongue coating played the most important role in increasing VSCs concentration in mouth air, followed by periodontal status and plaque index values. DMFT, social, and behavioural factors did not contribute to halitosis. Tongue coating score, modified sulcus bleeding index and calculus index were factors significantly related to oral malodor in this study.

P19 A study for the effect of tongue cleaning

The objective of this study was to evaluate breath odor reduction after giving tongue cleaning instruction to adults. The breath odor of 26 subjects (ages 19–77) was measured before and after tongue cleaning instruction. They were instructed to scrape away tongue coating with a Dental Pro multi‐tufted tongue brush (Jacks co. Ltd.) once or twice a day. They used the tongue brush until they could see no more plaque on their tongue. Oral malodor was evaluated using: two portable sulphide monitors (Halimeter RH‐17, Interscan Co.) and Brethtron, (Yoshida Co.), gas chromatography (GC‐8A, Shimazu) and organoleptic measurements. Organoleptic measurements were estimated on a scale of 0 to 5 as follows : 0 = no odor, 1 = barely noticeable odor, 2 = slight odor, 3 = moderate odor, 4 = strong odor, 5 = severe odor. The subjects were asked to refrain from brushing, eating, drinking, smoking and using mouthwash 2 h before each examination. Tongue coating status was evaluated in five grades by inspection, according to distribution area and thickness of tongue coating. Probing depth, bleeding on probing and dental plaque were assessed. One week of tongue cleaning resulted in reductions in tongue coating status and breath odor. As a result of the before and after measurements, no correlation was observed between tongue cleaning as instructed and bleeding on probing or dental plaque. According to a questionnaire given 1 week after the study, tongue coating status had reverted to pre‐cleaning condition in about 1 day. Therefore, we concluded that tongue cleaning should be done at least once a day to control breath odor.