Physiological Halitosis Research Articles

Descriptive statistical analysis report on the results of questionnaire and observations on patients with physiological halitosis who visited the KUMC Halitosis Clinic

Descriptive statistical analysis report on the results of questionnaire and observations on patients with physiological halitosis who visited the KUMC Halitosis Clinic

The Measurement of Saliva and Tongue Coating pH in Patients with Physiological Halitosis before and after Using Selected Mouthwashes

Abstract. To analyze saliva and tongue coating pH in healthy patients with physiological halitosis before and after usage of 5 different types of mouthwash available in Malaysia. A quasi-experimental study was conducted among preclinical IIUM dental students aged 18 to 21 years old. Organoleptic evaluation was conducted by the operator to rank their organoleptic score followed by self-assessment by the participants. Saliva and tongue coating pH we measured respectively beforehand, immediately after and 30 minutes after rinsing with 5 different mouthwashes using a digital pH meter and pH strip indicator respectively; 100 participants were assigned into 5 groups, with 20 samples for each brand. Intraclass correlation coefficient between examiners ranged from 0.76-1.0. Data were analyzed statistically by repeated measure ANOVA test for each brand of mouthwash. Multivariate Analysis of Covariance (MANCOVA) + test was also used to statistically analyze different pH trends among the five brands of mouthwashes. Significant increase of salivary pH was observed after using MW2 (p<0.001) and MW4 (p=0.015). Significant reduction in salivary pH was observed when using MW5 (p=0.001). For tongue coating pH, significant reduction was observed after using MW2 (p<0.0010), MW3 (p=0.012), and MW4 (p=0.001). However, there was a significant increase in tongue coating pH after using MW5 (p=0.0125). Rinsing with mouthwashes MW2, MW3 and MW4 decreased tongue coating pH, which leads to reduced physiological halitosis

The Effect of Virgin Coconut Oil (VCO) on Physiological Halitosis. A Randomized Controlled Pilot Trial

Introduction: VCO oil pulling therapy has been used as a remedy for oral malodour in traditional Indian folk. Main objective for this research is to study on the effect of VCO oil pulling on physiological halitosis among IIUM Kuantan Campus students. The specific objectives are to evaluate the effect of VCO oil pulling on physiological halitosis and to compare the efficacy of VCO with conventional mouthwash in reducing physiological halitosis. Materials and method: 20 convenient samples were selected based on inclusion and exclusion criteria and divided into two groups, mouthwash and VCO based on single blind randomized controlled trial. Subjects required swishing oil pulling (group A) or rinsing with mouthwash (group B). Breathing analysis was recorded during pre-assessment, post assessment (on day 1short term and day 14-long term) using organoleptic 1, organoleptic 2 (selfassessment) and Tanita device. The results were analysed using paired t-test in SPSS version 22. IREC approval: 2018-061. Result: There were significant difference between pre and post assessment of mouthwash in short term (p<0.001) and long term (p=0.002) period of usage and between group VCO pre and post assessment in short term (p=0.001). However, there was no significant (p<0.05) between group of VCO and mouthwash. Conclusion: VCO has potential to reduce physiological halitosis in immediate observation after the oil pulling procedure. VCO oil pulling and gargling with commercial mouthwash had no significant difference in reducing physiological halitosis.

Halitosis syndrome in clinical practice

Definition of the medical term “halitosis” is presented in the article, historical aspects of its appearance are reviewed, probable prevalence of halitosis in the general population is indicated. Classification of halitosis with the allocation of its subtypes depending on the conditions of occurrence is given, the reasons for the development of true and false, physiological and pathological halitosis are analyzed. Various nosological items and pathological conditions are listed, the course of which may be accompanied by the appearance of bad breath. The influence of the emotional background on the occurrence of halitosis is described. The main substances, which metabolism is accompanied by the appearance of stomatodisodia, are named, the nature of unpleasant odors associated with the most common somatic diseases is indicated. The role of Helicobacter pylori, bacterial overgrowth and obesity syndrome in the development of halitosis is considered. The importance of a detailed collection of anamnesis and a thorough objective examination, as well as the exclusion of dental and otorhinolaryngological pathology in the implementation of a diagnostic search, were emphasized. The tactics of the doctor’s actions while treating patients with halitosis is outlined, the features of the intra-syndromic and nosological diagnostics are considered, the methods for performing the olfactory test, taking scrapings from the tonsils and the back of the tongue are described. The main directions of non-pharmacological and pharmacological treatment of halitosis are listed, hygiene of oral cavity and dentures, modification of the usual diet are emphasized, the appropriateness of timely application of combined antiseptic solutions and the possibility of systemic antibacterial therapy are stressed.

Halitosis Patients at a Newly Established Satellite Dental Hospital: Analysis of Patients and the Role of Dental Hygienists

Methods: Approximately 70% of the patients were female and most were in their 40s. We analyzed the possible causes of halitosis. Results: More than half of the patients exhibited a thick tongue coating. Low salivary flow was present in 23.6% of males and in 39.4% of females. Pocket depth ≥6 mm was found in 44.2% of males and in 16.7% of females. We also analyzed treatment provided after breath odor measurement. Most of the patients with physiological halitosis and pseudohalitosis did not receive further treatment, but some were treated at the COD with scaling and professional tooth cleaning. Many of the patients with genuine halitosis received dental treatment at the COD. We referred patients from other clinics and from distant locations to their local doctors for treatment. Conclusion: Halitosis had various causes, and the role of dental hygienists, including scaling, root planing, and tooth brushing instruction, are important in decreasing breath odor. Dental hygienists play an important role in communication with halitosis patients.

The management of physiological halitosis: A 20-year systematic review of the literature

Halitosis is a common problem. There are many assessment methods in the literature as well as treatment modalities. The objective of this systematic review is to evaluate the level of evidence for each treatment modality of halitosis. Electronic databases were searched in a systematic method according to preferred reporting items for systematic reviews and meta-analyses guidelines. The review included human clinical trials with or without randomization and excluded case reports and case series. Only articles written in English were included in the review. Forty-three articles were included in this review. It was found that treatment modalities can be classified into chemical compounds in mouthwashes, chemical compounds in dentifrices, chemical compounds in other products, herbal products and combinations of chemical and physical methods. The level of evidence ranged from I to IV for each class. This review suggests that mouthwashes and dentifrices are the best ways to combat halitosis. There is currently insufficient amount of level I evidence to support the efficacy of herbal products or mechanical modifications to oral hygiene practices and there is a need for a greater number of randomized controlled trials to study the efficacy of these methods.

P53‐Pathway activity and apoptosis in hydrogen sulfide‐exposed stem cells separated from human gingival epithelium

Hydrogen sulfide ( H₂S ) is a volatile sulfur compound responsible for physiological halitosis. H₂S was also reported as having periodontal pathologic activities. Gingival crevicular epithelium is the first barrier against periodontal pathogens and their products; oral keratinocyte stem cells OKSCs play key roles in maintaining this barrier. The p53 pathway is responsible for regulating key biological events. Increased apoptosis and cell-cycle arrest of DNA repair can affect keratinocyte stem cells, having a direct impact on the architecture of the oral epithelial tissue. However, the link between H₂S , p53 activity and OKSCs has not yet been fully explored. The main objective of the present study was to explore the implications of the p53 pathway in OKSCs following exposure to H₂S. OKSCs were isolated from human gingival epithelium and incubated with physiological levels of H₂S for 24 and 48 h. Apoptosis and the mitochondrial membrane potential were detected using flow cytometry. Cytochrome c, total p53, phosphorylated p53 and caspase activity were assessed using specific ELISAs. p53 Pathway gene activity was assayed using quantitative RT-PCR. The levels of apoptosis were significantly increased following incubation in the presence of H₂S, especially after 48 h (36.95 ± 1.91% vs. 4.77 ± 0.74%). Caspases 9 and 3 were activated, whereas caspase-8 activity remained low. Total p53 activity and particularly phosphorylated p53 at serine 46, were significantly enhanced compared with controls (47.11 ± 9.84 units/mL vs. 1.5 ± 0 units/mL and 32.22 ± 10.23 units/mL vs. 0.15 ± 0 units/mL, respectively, at 48 h). Among p53 pathway genes, apoptosis-related genes [i.e. phosphatase and tensin homolog ( PTEN ), B-cell CLL/lymphoma 2 ( BCL2), sirtuin 3 ( SIRT3) and caspases]) were dramatically increased when compared with controls. Moreover, cell-cycle progression genes [i.e. E2F transcription factor (E2F) family and histone deacetylase ( HDAC )] and DNA-repair genes [i.e. growth arrest and DNA-damage-inducible, gamma ( GADD45G ) family and serine/threonine-protein kinase Chk2 ( CHEK2)] were also increased. Following incubation with H2 S , OKSCs express multiple p53-associated genes, including programmed cell death, cell-cycle control and DNA-repair genes.

Prevalence et facteurs associes a l’halitose buccale : Etude dans une population generale senegalaise

Introduction: Halitosis is a common complain among dental patients, chronic among 50% of the adult population, and of oral origin in 90% of the cases. The objective of this study was to evaluate the prevalence and related factors of oral halitosis among a senegalese population. Material and method: This was a transversal descriptive study of 396 Senegalese adults using a 24-point self-assessment questionnaire on halitosis. All subjects were examined to estimate the organoleptic means and to measure the Sulfur Volatile Compounds (SVC), using a halimeter. Halitosis was diagnosed when the level of sulfur volatile Compound was ≥125 ppb and the organoleptic score ≥ 2. Data were statistically analyzed using the chi2 test. Results: The global prevalence of halitosis was 32.3 %. The difference was not statistically significant between male and female. Among the 396 patients suffering from bad breath, 128 had a permanent halitosis and 52 had a physiological halitosis. The means of the organoleptic scores were 3.12 and that of the (SVC) were 273.9 ppb. Conclusion: The results of the study showed a relation between the organoleptic tests and the level of sulfur volatile compounds (SVC). Keywords: Halitosis, organoleptic tests, sulfur volatile compound, epidemiology, and self-assessment.

Myrsinoic acid B inhibits the production of hydrogen sulfide by periodontal pathogens in vitro

Recently, we reported that myrsinoic acid B purified from Myrsine seguinii inhibited methyl mercaptan (CH3SH) production by Fusobacterium nucleatum JCM8532. Since hydrogen sulfide (H2S) is the main component of physiological halitosis, while CH3SH is involved in pathological oral halitosis, the objective of this study is to determine whether myrsinoic acid B inhibits H2S production by oral microorganisms. F. nucleatum, Porphyromonas gingivalis and Treponema denticola were incubated with myrsinoic acid B and a substrate such as l-cysteine or l-methionine. H2S or CH3SH concentration in the headspace air, was determined using a gas chromatograph. The concentration of myrsinoic acid B inhibiting 50% (IC50) of H2S production by F. nucleatum was 0.142 µg ml−1, and the IC50 of P. gingivalis and T. denticola were 2.71 µg ml−1 and 28.9 µg ml−1, respectively. The presence of pyruvate, a by-product of H2S production, was determined. The IC50 values of myrsinoic acid B for pyruvate production were 22.9 µg ml−1 for F. nucleatum, 87.7 µg ml−1 for P. gingivalis and 165 µg ml−1 for T. denticola. We concluded that myrsinoic acid B inhibited the production of both H2S and pyruvate by periodontal pathogens.

Relation between counts of periodontopathic bacteria in the tongue coat of healthy subjects and the concentration of volatile sulfur compounds in their breath

The substances that cause physiological halitosis have been found to be mainly volatile sulfur compounds (VSCs) [hydrogen sulfide (H 2 S), methylmercaptan (CH 3 SH) and dimethylsulfide (CH 3 ) 2 S] produced by putrefaction of anaerobic bacteria. In order to clarify the role of these periodontopathic bacteria in halitosis, we investigated the amounts of four species of bacteria, Prevotella intermedia , Fusobacterium nucleatum , Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans in 10 μl of the tongue coats of healthy people using quantitative PCR and examined the correlation with the concentrations of VSCs present in the subject's breath (physiological halitosis). The following results were obtained. 1. H 2 S in the oral breath of the subjects showed a positive correlation with the detected counts of A. actinomycetemcomitans , P. intermedia , P. gingivalis , F. nucleatum and the total bacteria. 2. CH 3 SH in the oral breath of the subjects showed a positive correlation with the detected count of P. gingivalis . 3. (CH 3 ) 2 S in the oral breath of the subjects showed a positive correlation with the detected counts of A. actinomycetemcomitans , P. intermedia and total bacteria. 4. The concentrations of VSCs in the oral breath of the subjects showed a positive correlation with the total count of bacteria. These results suggest that periodontopathic bacteria present in the tongue coat of healthy people might be the cause of physiological halitosis.

Oral malodorous compound triggers mitochondrial-dependent apoptosis and causes genomic DNA damage in human gingival epithelial cells

Volatile sulfur compounds are the main compounds causing halitosis. One of these compounds, hydrogen sulfide (H(2)S), which is responsible for physiological halitosis, is reported also to have periodontal pathogenic activities. Hydrogen sulfide has been shown to activate the apoptotic process in different tissues. Apoptosis plays an important role in the development of periodontitis. The aim of this study was to determine whether H(2)S causes apoptosis in human gingival epithelial cells and to examine the cellular signaling pathway initiating the process. Human gingival epithelial cells were incubated with 50 ng/mL H(2)S in air contining 5% CO(2) for 24, 48 or 72 h. To detect apoptosis, the cells were stained with annexin V and 7-amino actinomycin D, and analyzed using flow cytometry. Reactive oxygen species, mitochondrial membrane depolarization and release of cytochrome C into the cytosol were assessed using flow cytometry and enzyme-linked immunosorbent assay. Activity levels for the key apoptotic enzymes caspase-9, -8 and -3 were also determined. Genomic DNA damage was detected using single-cell gel electrophoresis. Apoptosis was significantly increased to 24.5 +/- 5.7 at 24 h and 41.5 +/- 8.9% at 48 h (p < 0.01). Reactive oxygen species were enhanced and mitochondrial membrane depolarization was collapsed. Cytochrome C release was dramatically increased (0.12 +/- 0.02 vs. 0.02 +/- 0.01 at 24 h and 0.21 +/- 0.02 vs. 0.02 +/- 0.01 ng/mL at 48 h; p < 0.05). Caspase-9 and -3 were strongly activated, while caspase-8 activity remained low. The percentage of DNA strand breaks increased, especially at 48 h. Hydrogen sulfide induces apoptosis in human gingival epithelial cells by activating the mitochondrial pathway.

Oral malodorous compound causes apoptosis and genomic DNA damage in human gingival fibroblasts

Volatile sulfur compounds are the main cause of halitosis. Hydrogen sulfide is one of these volatile sulfur compounds and the principal malodorous compound in physiological halitosis. Periodontally pathogenic activities of hydrogen sulfide have been previously reported. Hydrogen sulfide induces apoptotic cell death in aorta smooth muscle cells and in other tissues. Apoptosis plays an important role in the onset and progress of periodontitis. The objective of this study was to determine whether hydrogen sulfide causes apoptosis in human gingival fibroblasts. Necrotic cells were detected using a lactate dehydrogenase assay. Apoptosis was ascertained using a histone-complexed DNA fragment assay and flow cytometry. The level of caspase 3, a key enzyme in apoptotic signaling, was also measured, and the effects of hydrogen sulfide on reactive oxygen species and superoxide dismutase were assessed. DNA damage caused by hydrogen sulfide was examined by means of single-cell gel electrophoresis. After 72 h of incubation with 100 ng/mL of hydrogen sulfide, necrosis was found in less than 10% of human gingival fibroblasts, whereas apoptosis was significantly increased (p < 0.05). Superoxide dismutase activity was strongly inhibited, and reactive oxygen species production was enhanced, after 48 and 72 h of incubation. Caspase 3 activity was also increased after 72 h of incubation (p < 0.01). Tail length, percentage of DNA in tail, and tail moment, measured by single-cell gel electrophoresis, were also intensified after 72 h of incubation (p < 0.001). Hydrogen sulfide caused apoptosis and DNA damage in human gingival fibroblasts. An increased level of reactive oxygen species stimulated by hydrogen sulfide may induce apoptosis and DNA strand breaks.

ETIOLOGY CLASSIFICATION AND TREATMENT NEEDS (TN) FOR ORAL MALODOR

Background: Oral malodor, a generic descriptor term for foul smells emanating from the mouth can be classified as either pathological or physiological halitosis. Some problems are often confounded by the clinician's mismanagement. Objective: This paper reviews the etiology of classification and determination of treatment needs (TN) for oral malodor. Literature review and discussion: In the majority of cases the problem has been shown to originate in the oral cavity. Although oral malodor cases are often related to physiological aspects, sometimes they can be related to extra oral sources and psychological aspects. Classification methods of oral malodor with corresponding treatment needs (TN) have already been established. Although PTC & tongue brushing and appropriate mouthrinses are both important and basic treatment measures for halitosis, other dental treatments are sometimes required. Conclusion: Accurate screening and diagnosis of halitosis followed by appropriate TN may give better results and consequently reduce the risk of mismanagement.

Tongue brushing and mouth rinsing as basic treatment measures for halitosis

Tongue brushing and mouth rinsing are basic treatment measures for halitosis, and as such are categorised as treatment needs (TN)-1. Although TN-1 is used for treatment of physiologic halitosis treatment, pseudo-, extra oral pathologic or halitophobic patients must also be managed with TN-1 as well as other treatments. Since the origin of physiological halitosis is mainly the dorso-posterior region of the tongue, tongue cleaning is more effective than mouth rinsing. However, practitioners should always instruct their patients on how to brush their tongues to prevent harmful effects. Another approach using a chlorhexidine mouthwash is most effective in reducing oral malodour. However, chlorhexidine should not be used routinely; therefore, zinc-containing mouthwashes have been recommended for use. People can also use chewing gum to reduce oral malodour. Surprisingly, however, it has been noted that sugarless chewing gum increased methyl mercaptan, one of the principal components of oral malodour. Mint did not reduce the concentration of methyl mercaptan either, although these products are widely used for their ability to mask oral malodour. There is a need for the development of a novel food or chewing gum that could considerably reduce VSC levels in mouth air to complement TN-1.