LITERATURA CIENTÍFICA HALITOSISoralchroma.es/science/Informacion-cientifica-halitosis.pdf ·...

LITERATURA CIENTÍFICA HALITOSIS.

Título: Mouthwashes: the supply in Belgium reviewed on the basis of recent literature.

Autores: Marcelis K ; Dekeyser C ; Declerck D ; Quirynen M

Fuente: Revue Belge De Médecine Dentaire [Rev Belge Med Dent (1984)] 2010; Vol. 65 (1), pp. 12-‐38.

RESUMEN:

In recent days mouthrinses became a more and more popular tool in the oral hygiene regime. Different manufacturers commercialize their products in the grey area between cosmetics and medicine. However, one must realize that these products must be used within the limitations of their potential. The aim of this article is to present a complete overview of mouthrinses-‐-‐and their active components-‐-‐available on the Belgian market based on the recent literature. The focus is placed mainly on their antibacterial capacity, but also other indications such as anticariogenic activity, halitosis management, hypersensitivity management, anti-‐mucositis and anti-‐erosive actions are discussed.

Título: [Periodontitis: a hidden chronic infection].

Transliteración del título: Parodontitis: een verborgen chronische infectie.

Autores: van Winkelhoff AJ ; Winkel EG ; Vandenbroucke-‐Grauls CM

Fuente: Nederlands Tijdschrift Voor Geneeskunde [Ned Tijdschr Geneeskd] 2001 Mar 24; Vol. 145 (12), pp. 557-‐63.

RESUMEN:

Periodontitis is a chronic inflammatory disease of the tooth supporting tissues which has a prevalence of 35% in the adult population. Risk factors are dental plaque, calculus, smoking, diabetes mellitus, stress and genetic traits. In parallel with chronic intestinal inflammatory diseases and stomach cancer, gene polymorphisms in the interleukin-‐I gene family are associated with severity of periodontitis. Periodontitis is usually painless. Symptoms of the disease are bleeding, redness and swelling of the gums, suppuration and migration of teeth. Halitosis may be present. Treatment of periodontitis involves supra-‐ and subgingival mechanical debridement, oral hygiene instruction and surgical elimination of residual deepened and bleeding pockets on indication. Microbiological testing can be used to select patients who may benefit from additional systemic antimicrobial therapy. Periodontal lesions may act as a portal of entry for dissemination of periodontal bacteria into the blood stream, which may result in extraoral infections. For this reason it is recommended to include diagnosis of periodontitis in focal examination. Associations have been documented between periodontitis and cardiovascular diseases, arthritis and premature low birth weight infants.

Título: A combined therapeutic approach to manage oral halitosis: a 3-‐month prospective case series.

Autores: Roldán S ; Herrera D ; O'Connor A ; González I ; Sanz M

Fuente: Journal Of Periodontology [J Periodontol] 2005 Jun; Vol. 76 (6), pp. 1025-‐33.

RESUMEN:

Background: Clinical research assessing different therapeutic protocols aimed at treating oral halitosis is scarce. The aim of this study was to evaluate the effects of a combined mechanical and pharmacological approach to treat oral halitosis on clinical and microbiological outcomes on patients followed for 3 months. Methods: Nineteen subjects with oral malodor participated. At baseline, all subjects completed a questionnaire and carried out an examination including full-‐mouth organoleptic and volatile sulfur compound (VSC) levels and the Winkel tongue coating index. Standard periodontal outcome variables were assessed at six teeth. Standardized microbiological samples of subgingival plaque, unstimulated saliva, and tongue coating were obtained for culture analysis. The treatment protocol included supragingival prophylaxis; instructions in oral hygiene (toothbrushing, interproximal cleaning, and tongue scraping); and gargling with a mouthrinse containing chlorhexidine, cetylpiridinium chloride, and zinc lactate. The same outcome variables were registered 1 and 3 months after baseline. Results: Statistically significant reductions in organoleptic scores (P <0.001), VSC levels (P <0.05), and tongue coating index (P <0.05) were observed after 1 and 3 months. Mean probing depth and plaque levels also demonstrated significant reductions after 3 months (P <0.05). Total anaerobic counts were significantly reduced at all three locations after 1 month (P <0.05), and in samples from tongue coating and subgingival plaque at 3 months (P <0.05). Aerobic counts were significantly reduced in saliva at 1 month (P <0.05), and the anaerobic/aerobic ratio significantly increased in the tongue samples. Among the selected pathogens evaluated, Porphyromonas gingivalis was the most affected of the three microflora evaluated. Conclusions: The evaluated therapeutic approach demonstrated its efficacy in the management of oral halitosis, demonstrating statistically significant improvements in both organoleptic and VSC values at 1 and 3 months. The proposed clinical protocol significantly affected the microbial composition in tongue coating, saliva, and subgingival microflora.

Título: A digital tongue imaging system for tongue coating evaluation in patients with oral malodour.

Autores: Kim J ; Jung Y ; Park K ; Park JW

Fuente: Oral Diseases [Oral Dis] 2009 Nov; Vol. 15 (8), pp. 565-‐9. Date of Electronic Publication: 2009 Jun 25.

RESUMEN:

Objective: Several simple visual methods have been developed for assessing tongue coating, but it is difficult to eliminate biases associated with these. The digital tongue imaging system (DTIS) was designed to acquire tongue surface images using a digital camera under controlled conditions, and to calculate tongue coating area. The aim of this study was to evaluate the potential of DTIS for clinical use by comparing it with the Winkel tongue coating index (WTCI). Materials and Methods: Forty participants with oral malodour were rated on WTCI by two independent examiners, and photographs of their tongues were assessed using the DTIS. The photographs were also rated by the examiners (blinded to in vivo WTCI and DTIS statuses). Results: Agreements between in vivo WTCI ratings and DTIS assessments were relatively high at r = 0.561 for one examiner and r = 0.736 for the other (P < 0.01), while agreements between the in vivo WTCI ratings and tongue photograph-‐based ratings were also high at r = 0.645 for one examiner and r = 0.742 (P < 0.01) for the other. Conclusions: Digital tongue imaging system was found to be highly reliable and as having potential clinical applications. However, the algorithm for determining in vivo tongue coating status requires improvement.

Título: A novel and visual test for oral malodour: first observations.

Autores: Dadamio J ; Van Tornout M ; Van den Velde S ; Federico R ; Dekeyser C ; Quirynen M

Fuente: Journal Of Breath Research [J Breath Res] 2011 Dec; Vol. 5 (4), pp. 046003. Date of Electronic Publication: 2011 Aug 02.

RESUMEN:

Until now, the application of biogenic amines as bio-‐markers of oral malodour has been limited because of the complexity of their detection. This study explores the usability of a simple colorimetric reaction detecting amines in saliva as an adjunct test for the diagnosis of oral malodour. The colour reaction caused by a newly discovered enzyme capable of detecting amines in saliva was characterized in vitro. Two colour scales were developed by transforming the colours of selected dilutions of a mixture of cadaverine and putrescine into a 5-‐ and a 10-‐point pink-‐colour scale. Afterwards, this new enzymatic test was used to assess the amount of amines in saliva samples of 50 volunteers with different degrees of oral malodour. The enzymatic reaction was shown to be linear towards the concentration of amines and stable over a time of ≥4 h. Colour scores correlated well with organoleptic scores and the volatile sulfur compounds. More importantly differences between patients with and without oral malodour were significant. Based on these results, we conclude that this new enzymatic test, interpreted by means of a simple colour scale, has the potential to be used as an adjunct chair-‐side test for oral malodour diagnosis.

Título: A salivary incubation test for evaluation of oral malodor: a pilot study.

Autores: Quirynen M ; Zhao H ; Avontroodt P ; Soers C ; Pauwels M ; Coucke W ; van Steenberghe D

Fuente: Journal Of Periodontology [J Periodontol] 2003 Jul; Vol. 74 (7), pp. 937-‐44.

RESUMEN:

Background: Breath odor is scored by different techniques, each with its own shortcomings. Organoleptic ratings are uncomfortable for the patient, subjective, influenced by external parameters including food and cosmetics, and especially lack international calibration. Portable sulphide monitors are relatively expensive and neglect several major malodorous molecules (e.g., butyric and propionic acids, putrescine, and cadaverine). Gas chromatography necessitates expensive devices and experienced technicians. This pilot study explored the applicability of a new technique (saliva incubation) by comparing its discrimination power, in a morning bad breath inhibition study of antiseptics, to those of hydrogen sulphide (H2S) measurement devices and organoleptic ratings. Methods: After a professional cleaning, 8 periodontally healthy students abstained from all means of mechanical plaque control for 5 experimental periods of 7 days, with intervening washout periods of at least 2 weeks. During each experimental period, the students rinsed only twice daily with different antiseptics. At day 7, morning breath was scored clinically (volatile sulphide compound [VSC] level and organoleptic ratings), and 1.5 ml of saliva was collected and divided between 3 glass tubes that were sealed and incubated (37 degrees C, anaerobic chamber). Immediately after collection and after 3 and 6 hours of incubation, the headspace air in one of the tubes was examined for VSC production and organoleptic measurements. Results: The investigations of the incubated saliva correlated well with the 7-‐day intraoral VSC recordings and organoleptic ratings (P < or = 0.005). Moreover, evaluations showed a similar interproduct ranking for their efficacy in malodor control. The power analyses indicated a higher discrimination power for the saliva incubation test than for the intraoral registrations. Conclusions: The strong correlation between odor production of incubated saliva and clinical assessments suggests that the saliva incubation test may be used as an indirect method to measure oral malodor and can be employed to investigate the antimalodor effectiveness of oral hygiene products.

Título: Appropriate sample bags and syringes for preserving breath samples in breath odor research: a technical note.

Autores: Winkel EG ; Tangerman A

Fuente: Journal Of Breath Research [J Breath Res] 2008 Mar; Vol. 2 (1), pp. 017011. Date of Electronic Publication: 2008 Mar 07.

RESUMEN:

It is now generally accepted that the volatile sulfur compounds (VSCs) hydrogen sulfide, methyl mercaptan and dimethyl sulfide are the main contributors to halitosis when of oropharyngeal origin. The VSCs hydrogen sulfide and methyl mercaptan are the major causes of bad breath in oral malodour whereas dimethyl sulfide is generally the major cause of bad breath in extra-‐oral halitosis. To facilitate research in the field of halitosis, it is highly

advantageous to be able to preserve breath samples for longer periods of time before measurement of the VSCs, e.g. for sampling patients at home or when studying a large cohort of patients where an immediate measurement of the VSCs is not possible. After testing numerous sample bags, ultimately the foil balloons, coated inside with the synthetic polymer polyethylene, were the preferred ones. All the VSCs in breath remained quite stable for at least 3 days in these balloons. Besides the sampling bags, the use of an appropriate syringe for sampling mouth air and for injecting samples in e.g. a gas chromatograph is also of great importance. Usually, syringes with a rubber barrel seal are used. However, some rubbers quickly adsorb the VSCs in breath. When preserving breath samples for longer periods, the rubber also releases VSCs, especially methyl mercaptan. It was also found that these syringes release a compound which interferes with dimethyl sulfide, when using gas chromatographic measurements with the OralChroma. We now use all-‐plastic syringes (B/Braun Injekt), made of polypropylene and polyethylene, in which the VSCs in breath remain quite stable for at least 9 h.

Título: Assessing the relationship between concentrations of malodor compounds and odor scores from judges.

Autores: Greenman J ; El-‐Maaytah M ; Duffield J ; Spencer P ; Rosenberg M ; Corry D ; Saad S ; Lenton P ; Majerus G ; Nachnani S

Fuente:

Journal Of The American Dental Association (1939) [J Am Dent Assoc] 2005 Jun; Vol. 136 (6), pp. 749-‐57.

RESUMEN:

Background: The purpose of this review was to assess the relationship between mean organoleptic scores (using a 0-‐to-‐5 scale) and concentrations of putative odorants representative of those thought to be important in oral malodor, as well as to propose a simple model that explains the dose-‐response curves obtained from a group of odor judges. Methods: The model assumes that the scale is rooted at the detection threshold (0), the maximum score (5) is fully saturating and the brain and olfactory nervous system can act as a faithful transducer of the state of binding (occupancy) of the smell receptors in the nose. The authors predicted that the response would be exponential or sigmoidal in nature. They tested this using published empirical data based on seven odor judges and eight odor compounds. Results: Analysis of the data by different plotting methods showed the odorants to be significantly different from each other (P < .01 by regression analysis) with regard to thresholds and slopes. The lower the threshold, the stronger the inherent odor of the compound. The greater the slope, the greater the odor power. Volatile sulfur compounds had low smell thresholds and high odor power and were highly volatile, while indole was less volatile but had a very low threshold. Both compounds may be significant in human oral malodor. Conclusions: The authors found that the organoleptic scale was exponential in practice. These

findings imply that when inhibitory agents are tested against odor-‐generating bacteria, a given percentage inhibition of the volatile compound production rate by a treatment (such as an antimicrobial mouthwash) will result in an equal incremental reduction on the scale, regardless of the starting position on the scale. Understanding the scale enables dental professionals to develop better ways of training, calibrating and standardizing odor judges, along with better ways of designing clinical trials and interpreting data regarding the efficacy of antiodor treatments.

Título: Association among bad breath, body mass index, and alcohol intake.

Autores: Rosenberg M ; Knaan T ; Cohen D

Fuente: Journal Of Dental Research [J Dent Res] 2007 Oct; Vol. 86 (10), pp. 997-‐1000.

RESUMEN:

Bad breath is a common condition, difficult to assess in the general population. In the present study, we tested the hypothesis that a self-‐administered questionnaire can help identify factors associated with greater risk of oral malodor. Persons (n = 88) undergoing routine medical check-‐ups completed a questionnaire including 38 questions on general and oral health, dietary habits, and their own oral malodor levels. Oral malodor assessments included odor judge scores, volatile sulfide levels (via a Halimeter, Interscan Corp.), and salivary beta-‐galactosidase. Among the questionnaire results, 9 responses were significantly associated with odor judge scores (p < 0.05, unpaired t test), including questions on alcohol intake and body mass index (BMI). Predictions of odor judge scores based on these 9 questions (linear multiple regression analysis) yielded R = 0.601; when introduced together with Halimeter and beta-‐galactosidase scores, the correlation rose to R = 0.843. The results suggest that alcohol intake and BMI may be factors that help predict oral malodor.

Título: Association between oral malodour and periodontal disease-‐related parameters in a population of 71 Israelis.

Autores: Stamou E ; Kozlovsky A ; Rosenberg M

Fuente: Oral Diseases [Oral Dis] 2005; Vol. 11 Suppl 1, pp. 72-‐4.

RESUMEN:

The aim of the present study was to determine whether oral malodour and periodontal disease parameters are associated with one another in 71 Israeli subjects (mean age 36.2 +/-‐ 18.4; ages ranging from 15 to 65). Parameters measured included whole mouth odour judge scoring, Halimeter, OK to Kiss test, gingival index, plaque index and probing depth. Odour judge scores were significantly associated with Halimeter (r = 0.55; P < 0.001), as well as the OK to Kiss test (r = 0.52; P < 0.001). However, neither gingival index, plaque index nor probing depth was significantly associated with odour judge scores or Halimeter scores.

Logistic regression analysis showed that both Halimeter and OK to Kiss scores factored significantly (P = 0.005 and 0.018, respectively, odds ratios 14.9 and 2.7, respectively) in predicting the severity of oral malodour. Results suggest that in the population studied, periodontal health and oral malodour are not associated with one another.

Título: Bad breath and periodontal disease: how related are they?

Autores: Rosenberg M

Fuente: Journal Of Clinical Periodontology [J Clin Periodontol] 2006 Jan; Vol. 33 (1), pp. 29-‐30.

Título: Bad breath, diagnosis and treatment.


Fuente: University Of Toronto Dental Journal [Univ Tor Dent J] 1990 Spring; Vol. 3 (2), pp. 7-‐11.

Título: Bad breath: a brief update.


Fuente: The Alpha Omegan [Alpha Omegan] 2002 Oct; Vol. 95 (3), pp. 10-‐5.

Título: Bad breath-‐-‐a major disability according to the Talmud.

Autores: Shifman A ; Orenbuch S ; Rosenberg M

Fuente: The Israel Medical Association Journal: IMAJ [Isr Med Assoc J] 2002 Oct; Vol. 4 (10), pp. 843-‐5.

Título: Beta-‐galactosidase activity in saliva is associated with oral malodor.

Autores: Sterer N ; Greenstein RB ; Rosenberg M

Fuente: Journal Of Dental Research [J Dent Res] 2002 Mar; Vol. 81 (3), pp. 182-‐5.

RESUMEN:

Deglycosylation of oral mucins may be a critical initial step leading to their subsequent proteolysis and putrefaction. The present study was undertaken to determine whether activity in saliva of a major glycosidic enzyme (beta-‐galactosidase) is associated with oral malodor in a group of 64 subjects. Enzyme activity was detected by the use of a chromogenic substrate (X-‐Gal) impregnated on paper discs. Malodor-‐related measurements included two odor judges'

assessments of whole-‐mouth and tongue malodor, and volatile sulfide levels measured by a portable sulfide monitor (Interscan Corp.). Beta-‐galactosidase assay scores were significantly associated with both odor judges' scores for whole-‐mouth (p < or = 0.002; Spearman) and tongue malodor (p < or = 0.001; Spearman). Beta-‐galactosidase activity and sulfide monitor measurements both factored significantly into multiple regression equations for odor judge scores, yielding multiple r-‐values ranging from 0.47 (p = 0.0007) to 0.60 (p < 0.0001). Analysis of the data presented indicates that beta-‐galactosidase activity in saliva is correlated with oral malodor.

Título: Cadaverine as a putative component of oral malodor.

Autores: Goldberg S ; Kozlovsky A ; Gordon D ; Gelernter I ; Sintov A ; Rosenberg M

Fuente: Journal Of Dental Research [J Dent Res] 1994 Jun; Vol. 73 (6), pp. 1168-‐72.

RESUMEN:

Whereas previous studies have shown correlations between volatile sulphur compounds (VSC) and bad breath levels, it is probable that other compounds found in the oral cavity may contribute to oral malodor. In the present investigation, the possibility that diamines (cadaverine and putrescine) are associated with oral malodor parameters was assessed. Saliva samples from 52 subjects were analyzed for cadaverine and putrescine by HPLC. Oral malodor of whole mouth, tongue, and saliva of the subjects was recorded by an experienced judge on a continuous 10-‐cm scale; peak and steady-‐state VSC intraoral levels were measured by the Interscan 1170 sulphide monitor. Log-‐transformed VSC and diamine levels were compared with odor judge measurements by Pearson analysis and stepwise forward multiple regression. Putrescine scores were not significantly associated with odor judge parameters or with VSC levels (p > 0.1). However, highly significant correlations (p < or = 0.003) were found between cadaverine levels and all three odor judge assessments. In contrast, associations between cadaverine and VSC measurements were non-‐significant. In an attempt to correlate odor judge results in terms of both VSC and diamines, we carried out stepwise forward multiple regression. Results showed that VSC and cadaverine both factor significantly in explaining each of the odor judge measurements, with multiple r values ranging from 0.545 (p = 0.0002) to 0.604 (p < 0.0001). The results suggest that cadaverine levels are associated with oral malodor, and that this association may be independent of VSC.

Título: Characteristics of 2000 patients who visited a halitosis clinic.

Autores: Quirynen M ; Dadamio J ; Van den Velde S ; De Smit M ; Dekeyser C ; Van Tornout M ; Vandekerckhove B

Fuente: Journal Of Clinical Periodontology [J Clin Periodontol] 2009 Nov; Vol. 36 (11), pp. 970-‐5. Date of Electronic Publication: 2009 Oct 06.

RESUMEN:

Aims: The aim of this paper was to analyse the aetiology and characteristics of 2000 patients who visited a multidisciplinary bad breath clinic in Leuven, Belgium and to correlate organoleptic ratings with portable device measurements. Materials and Methods: The characteristics and aetiology of breath malodour of two thousand consecutive patients who visited a halitosis consultation were explored by means of a standard questionnaire and a clinical examination, including organoleptic scores provided by a trained and calibrated judge, and a portable bad breath detector (Halimeter). Results: Most patients came without referral and had complaints for several years (mean: 7 years, SD: 8 years). For 76% of the patients, an oral cause was found [tongue coating (43%), gingivitis/periodontitis (11%) or a combination of the two (18%)]. Pseudo-‐halitosis/halitophobia was diagnosed in 16% of the cases; and ear, nose and throat/extra-‐oral causes were found in 4% of the patients. Most patients had an organoleptic score <3 and a Halimeter value <240 p.p.b. Conclusions: Even though it was observed that halitosis has a predominantly oral origin, a multidisciplinary approach remains necessary to identify ear, nose and throat or extra-‐oral pathologies and/or pseudo-‐halitosis/halitophobia.

Título: Clinical assessment of bad breath: current concepts.


Fuente: Journal Of The American Dental Association (1939) [J Am Dent Assoc] 1996 Apr; Vol. 127 (4), pp. 475-‐82.

RESUMEN:

Bad breath typically originates in the mouth, often from the back of the tongue. Nasal problems also can cause bad breath; odor generated in this manner can be easily distinguished from mouth odor by comparing the odor exiting the mouth and nose. In most cases, good professional oral care combined with a daily regimen of oral hygiene-‐-‐including interdental cleaning, deep tongue cleaning and optional use of an efficacious mouthrinse-‐-‐-‐will lead to improvement. This article discusses common causes of oral malodor as well as methods to assess the extent of the problem.

Título: Clinical effects of a new mouthrinse containing chlorhexidine, cetylpyridinium chloride and zinc-‐lactate on oral halitosis. A dual-‐center, double-‐blind placebo-‐controlled study.

Autores: Winkel EG ; Roldán S ; Van Winkelhoff AJ ; Herrera D ; Sanz M

Fuente: Journal Of Clinical Periodontology [J Clin Periodontol] 2003 Apr; Vol. 30 (4), pp. 300-‐6.

RESUMEN:

Objectives: The aim of this double-‐blind, parallel study was to test the clinical efficacy of a newly developed mouthrinse in the treatment of oral halitosis in patients without

periodontitis. Material and Methods: Forty volunteers, recruited in two centers, participated in this study. Patients were selected on the basis of (1) halitosis of oral origin, (2) full-‐mouth organoleptic score>1, using an arbitrary 0-‐5 scale, (3) level of volatile sulfur compounds (VSC)>170 parts per billion (ppb) and (4) Winkel tongue coating index (WTCI)>4 (0-‐12). Intervention included gargling with a mouthrinse containing chlorhexidine (0.05%), cetylpyridinium chloride (0.05%) and zinc-‐lactate (0.14%) or with a placebo mouthrinse without active ingredients. At days 0 and 14 clinical variables were assessed in order of performance: (1) organoleptic assessments, (2) levels of VSC, and (3) WTCI. Results: Treatment with the active mouthrinse resulted in a significant mean reduction in the organoleptic score from 2.8 to 1.5 (p<0.005). In the placebo group, no significant reduction in the mean organoleptic score occurred. Consequently, this resulted, after 2 weeks, in a greater change of the organoleptic scores in the test group in comparison to the placebo group (p<0.005). The mean VSC scores were reduced from 292 to 172 ppb in the test group (p<0.005), whereas no reduction was observed in the placebo group. At the 2-‐week examination, the mean change of the VSC scores in the test group was significantly greater than the mean change in the placebo group (p<0.005). Neither in the test nor in the placebo group a significant reduction in tongue coating was observed. Conclusions: In conclusion, the tested mouthrinse is effective in the treatment of oral halitosis.

Título: Clinical reliability of non-‐organoleptic oral malodour measurements.

Autores: Vandekerckhove B ; Van den Velde S ; De Smit M ; Dadamio J ; Teughels W ; Van Tornout M ; Quirynen M

Fuente: Journal Of Clinical Periodontology [J Clin Periodontol] 2009 Nov; Vol. 36 (11), pp. 964-‐9.

RESUMEN:

Aim: Measurement of volatile sulphur compounds (VSC) by portable sulphur monitors (Halimeter, OralChroma) is a common practice for diagnosis of oral malodour. In this study, the clinical value of these devices was examined. Materials and Methods: Two hundred and eighty patients with bad breath complaints attending a halitosis consultation were enrolled. Organoleptic scores were given by a trained and calibrated judge, before measurement of the VSC levels (Halimeter, OralChroma), to avoid any bias. Results: Significant correlations were found between the organoleptic assessment, the Halimeter, and the OralChroma (R=0.74 for organoleptic versus Halimeter; 0.66 for organoleptic versus OralChroma; 0.63 for Halimeterversus OralChroma). The sensitivity and specificity (with regard to the organoleptic score) to detect patients with/without oral malodour for the Halimeter were 63% and 98%, respectively, and for the OralChroma 69% and 100% when using the cutoffs suggested by the manufacturer. By lowering these values, sensitivity could be improved without a significant decrease in specificity (both devices). Conclusions: We concluded that the measurement of the VSC levels can be used as an adjunct

to the organoleptic assessment. Thresholds should be revisited in order to improve their clinical utility. These devices can prove the absence of malodour in case of pseudo-‐halitosis.

Título: Clinical utility of a novel colorimetric chair side test for oral malodour.

Autores: Dadamio J ; Van Tornout M ; Vancauwenberghe F ; Federico R ; Dekeyser C ; Quirynen M

Fuente: Journal Of Clinical Periodontology [J Clin Periodontol] 2012 Jul; Vol. 39 (7), pp. 645-‐50. Date of Electronic Publication: 2012 May 22.

RESUMEN:

Aim: The aim of this study was to evaluate the utility of a simple colorimetric chair side test detecting amines in saliva as an adjunct test in the oral malodour diagnosis. Material and Methods: Non-‐stimulated saliva samples were collected from 100 volunteers with different degrees of oral malodour. The amount of amines detected by the test was estimated clinically (colorimetric test), confirmed semi quantitatively in the laboratory (standard addition method) and consequently compared with (i) the organoleptic score (OLS); (ii) the volatile sulphur compounds (VSCs) levels (OralChroma(™)) and (iii) the amount of amines detected by means of gas chromatography -‐ mass spectroscopy. Results: The chair side test correlated well (Spearman correlation coefficient: 0.46-‐0.77), with the OLS, the level of VSCs, and the amines determined by using gas chromatography -‐ mass spectroscopy. The results of the new test for patients with and without oral malodour were significantly different (Mann-‐Whitney U-‐test, p < 0.0001). The sensitivity, specificity, and positive and negative predictive value of this chair side test were similar to those of the VSCs evaluations. Conclusions: These results support the "fit for purpose" of the new chair side test as adjunctive diagnostic tool for oral malodour. (© 2012 John Wiley & Sons A/S.)

Título: Comparison of different treatment modalities for oral halitosis.

Autores: Erovic Ademovski S ; Lingström P ; Winkel E ; Tangerman A ; Persson GR ; Renvert S

Fuente: Acta Odontologica Scandinavica [Acta Odontol Scand] 2012 May; Vol. 70 (3), pp. 224-‐33. Date of Electronic Publication: 2011 Dec 12.

RESUMEN:

Objectives: To assess the effects on intra-‐oral halitosis by a mouth rinse containing zinc acetate (0.3%) and chlorhexidine diacetate (0.025%) with and without adjunct tongue scraping. Materials and Methods: Twenty-‐one subjects without a diagnosis of periodontitis were randomized in a cross-‐over clinical trial. Organoleptic scores (OLS) were assessed to define

intra-‐oral halitosis by total volatile sulfur compound (T-‐VSC) measurements and by gas chromatography. Results: Twenty-‐one subjects with a mean age of 45.7 years (SD: ±13.3, range: 21-‐66). The OLS were significantly lower following active rinse combined with tongue scraping (p < 0.001) at all time points. Immediately after, at 30 min, and at day 14, the T-‐VSC values were lower in the active rinse sequence than in the negative rinse sequence (p < 0.001, p < 0.001 and p < 0.05, respectively). At 30 min and at day 14, the hydrogen sulfide (H(2)S) and methyl mercaptan (MM) values were lower in the active rinse sequence compared to the inactive rinse sequence (p < 0.001). The inactive rinse sequence with tongue scraping reduced T-‐VSC at 30 min (p < 0.001) but not at 14 days. Similar reductions in T-‐VSC, H(2)S and MM were found in the active rinse sequence with or without tongue scraping. Conclusion: The use of a tongue scraper did not provide additional benefits to the active mouth rinse, but reduced OLS and tongue coating index.

Título: Correlation between the BANA test and oral malodor parameters.

Autores: Kozlovsky A ; Gordon D ; Gelernter I ; Loesche WJ ; Rosenberg M

Fuente: Journal Of Dental Research [J Dent Res] 1994 May; Vol. 73 (5), pp. 1036-‐42.

RESUMEN:

The purpose of the present investigation was to test the association between the BANA test (Perioscan, Oral-‐B), and oral malodor parameters. The subject population consisted of 52 Israeli adults, 43 of whom complained of oral malodor. Oral malodor measurements consisted of peak and steady-‐state volatile sulphide measurement by a portable sulphide monitor (Interscan Corp., model 1170), as well as organoleptic measurements of malodor from whole mouth, tongue, and saliva. Samples for the BANA test were obtained from four loci (shallow pocket, deep pocket, tongue dorsum, saliva); results were scored as negative (0), weak (1), or strong (2). BANA scores were significantly associated with odor-‐judge ratings, with the highest association obtained when BANA saliva scores and odor-‐judge saliva assessment were compared (r = 0.500; p < 0.001). BANA tests from the different loci were not significantly associated with sulphide monitor levels. Stepwise multiple-‐regression analysis of odor-‐judge measurements in terms of sulphide levels and average BANA scores showed that both log peak sulphide levels as well as BANA scores were significantly factored into the equations, yielding, in all cases, highly significant correlations (multiple r = 0.57, 0.50, and 0.59, respectively, with significance levels of 0.0001, 0.001, and < 0.0001, for whole mouth, tongue, and saliva malodor, respectively). The results suggest that the BANA scores are associated with a component of oral malodor which is independent of volatile sulphide measurements and suggest its use as an adjunct test to volatile sulphide measurement.

Título: Creation of oral care flavours to deliver breath-‐freshening benefits.

Autores: Bradshaw DJ ; Perring KD ; Cawkill PM ; Provan AF ; McNulty DA ; Saint EJ ; Richards J ; Munroe MJ ; Behan JM


RESUMEN:

Objective: Oral care products deliver breath freshening primarily via mechano-‐chemical cleaning or by antimicrobial active systems. Dental flavours provide taste benefits, and freshen breath mainly by sensorial masking. We aimed to determine whether flavours could deliver breath freshening in products by inhibiting bacterial volatile sulphide compound (VSC) production. Subjects and Methods: Flavour materials were screened for inhibition of hydrogen sulphide formation by Klebsiella pneumoniae in vitro, grouped by efficacy, and data provided to flavourists. Flavours were formulated to maximize the content of VSC-‐effective ingredients and re-‐screened to confirm performance. Extensive, iterative testing of flavours identified reliable creative rules to deliver efficient inhibition of H2S generation. Breath-‐freshening flavours in whole products were then tested in-‐house in a 'breath freshness panel'. Main Outcome Measures: Malodour of panellists (not preselected for malodour score) was scored before and after product use, on the 'Rosenberg' 0-‐5 scale, together with residual flavour score, by extensively trained judges. Products were tested in double-‐blind, crossover studies, and results analysed using ANOVA. Results and Conclusions: Products flavoured using these rules delivered significantly greater breath freshening at 2 h than control products, and equivalent benefits to products containing 0.1% (w/w) triclosan or 0.2% (w/w) zinc sulphate.

Título: Day-‐long reduction of oral malodor by a two-‐phase oil:water mouthrinse as compared to chlorhexidine and placebo rinses.

Autores: Rosenberg M ; Gelernter I ; Barki M ; Bar-‐Ness R

Fuente: Journal Of Periodontology [J Periodontol] 1992 Jan; Vol. 63 (1), pp. 39-‐43.

RESUMEN:

Few scientific investigations have addressed the ability of mouthrinses to reduce oral malodor for periods longer than 3 hours. In the present report, we have employed simple, recently described techniques to assess the day-‐long reduction in oral malodor of a novel 2-‐phase oil:water mouthrinse (TPM), as compared to a corresponding placebo rinse, and to a commercial 0.2% chlorhexidine mouthrinse. Sixty dental students were divided randomly into 3 groups, and instructed to use one of the rinses prior to bedtime and the following morning. Measurements carried out in the late afternoon, about 8 to 10 hours following rinsing, were compared with baseline measurements carried out in the late afternoon of the previous day. Volatile sulphide levels were measured using a portable industrial sulphide monitor. Microbial levels were estimated using a simple rinsing technique employing sterilized milk. These quantitative techniques were corroborated by organoleptic (hedonic) ratings of a single odor

judge. Both TPM and chlorhexidine brought about significant decreases in volatile sulphides (P less than 0.05) as compared to the placebo group. These results were corroborated by the organoleptic data. Similarly, both chlorhexidine and TPM were highly effective in reducing microbial levels as measured by the rinsing technique, in comparison to the placebo group. Chlorhexidine appeared to be more effective than TPM in all measurement categories, although only in the case of microbial activity was there a significant (P less than 0.05) difference between the two groups.

Título: Detection of odorous compounds in breath.

Autores: Van den Velde S ; van Steenberghe D ; Van Hee P ; Quirynen M


RESUMEN:

Previous studies have demonstrated that hydrogen sulfide and methyl mercaptan play a major role in oral malodor. In the present study, we tested the hypothesis that other compounds found in mouth air can also contribute to halitosis. Mouth air of 40 healthy volunteers and 40 persons with halitosis was analyzed and compared by gas chromatography-‐mass spectrometry, two sulfur monitors, and organoleptically. Nearly 700 different compounds were detected. Hydrogen sulfide, methyl mercaptan, dimethyl sulfide, di-‐ and trisulfide were increased in persons with breath odor. These compounds were all significantly correlated with the organoleptic score. We concluded that hydrogen sulfide, methyl mercaptan and, to a much lesser extent, dimethyl sulfide, di-‐ and trisulfide can contribute to oral malodor. The role of other compounds, such as amines and organic acids, seems insignificant.

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

Autores: Harvey-‐Woodworth CN

Fuente: British Dental Journal [Br Dent J] 2013 Apr 12; Vol. 214 (7), pp. E20.

RESUMEN:

Halitosis is a symptom and not a diagnosis. Rather, the topic represents a spectrum of disorders, including intra-‐oral, otorhinolaryngological, metabolic, systemic, pulmonary, psychological and neurological conditions. Halitosis may be the third most common trigger for patients to seek dental care and can cause significant impact on patient quality of life. About 10% of all genuine halitosis cases are attributed to extra-‐oral processes. Some authorities have reported that the nasal cavity and the oropharynx are the most common sites of origin of extra-‐oral halitosis. However, recent evidence appears to suggest that blood borne halitosis may be the most common subtype of extra-‐oral halitosis. Tangerman and Winkel report that dimethyl sulphide was the main volatile implicated in extra-‐oral blood borne halitosis. They

proposed a hitherto unknown metabolic condition by way of explanation for this finding, resulting in systemic presence of dimethyl sulphide in blood and alveolar breath. This paper reviews the knowledge base regarding the behaviour of dimethyl sulphide in physiological systems and those disorders in which blood borne halitosis secondary to dimethylsulphidemia is thought to have an aetiopathological role.

Título: Effect of deglycosylation of salivary glycoproteins on oral malodour production.

Autores: Sterer N ; Rosenberg M

Fuente: International Dental Journal [Int Dent J] 2002 Jun; Vol. 52 Suppl 3, pp. 229-‐32.

RESUMEN:

Unlabelled: Putrefaction of saliva is commonly used as an in-‐vitro assay in oral malodour investigations. Aim: To exam the hypothesis that deglycosylation of salivary glycoproteins promotes oral malodour production. Design: Porphyromonas gingivalis-‐mediated putrefaction of salivary glycoproteins was tested following preincubation of saliva in the presence of beta-‐galactosidase with or without glycosidic inhibitor (galactosamine), and in the presence of glucose with or without a non-‐glycosylated protein (bovine serum albumin). Methods: Malodour was determined by two odour judges, and volatile sulphides by using a sulphide monitor. Salivary glycoprotein degradation was measured densitometrically following electrophoresis on SDS-‐PAGE. Results: The addition of beta-‐galactosidase promoted salivary glycoprotein degradation and concomitant malodour production, whereas addition of a glycosidic inhibitor (D-‐galactosamine) inhibited this process. Glucose inhibited salivary glycoproteins putrefaction, but this inhibitory effect was mitigated when a non-‐glycosylated protein (BSA) was added. Conclusions: Deglycosylation of salivary glycoproteins may be an initial step in oral malodour production. This process exposes the protein core of the glycoprotein, which is then further degraded by Gram-‐negative microorganisms under anaerobic conditions.

Título: Effect of different mouthrinses on morning breath.

Autores: van Steenberghe D ; Avontroodt P ; Peeters W ; Pauwels M ; Coucke W ; Lijnen A ; Quirynen M

Fuente: Journal Of Periodontology [J Periodontol] 2001 Sep; Vol. 72 (9), pp. 1183-‐91.

RESUMEN:

Background: Morning breath odor is an often-‐encountered complaint. This double-‐blind, crossover, randomized study aimed to examine the bad breath-‐inhibiting effect of 3 commercially available mouthrinses on morning halitosis during an experimental period of 12

days without mechanical plaque control. Methods: Twelve medical students with a healthy periodontium refrained from all means of mechanical plaque control during 3 experimental periods of 12 days (with intervening washout periods of at least 3 weeks). A professional oral cleaning preceded each period. During each experimental period, as the only oral hygiene measure allowed, the students rinsed twice a day with one of the following formulations in a randomized order: CHX-‐Alc (a 0.2% chlorhexidine [CHX] solution); CHX-‐NaF (CHX 0.12% plus sodium fluoride 0.05%); or CHX-‐CPC-‐Zn (CHX 0.05% plus cetylpyridinium chloride 0.05% plus zinc lactate 0.14%). After 12 days, morning breath was scored via volatile sulfur compound (VSC) level measurements of the mouth air and organoleptic ratings of the mouth air, the expired air, and a scraping of the tongue coating. At the 12-‐day visit, a questionnaire (subjective ratings) was completed and samples taken from both the tongue coating and the saliva for anaerobic and aerobic culturing and vitality staining. The de novo supragingival plaque formation was also recorded. All parameters were correlated with the baseline registrations. Results: Although oral hygiene during the 3 experimental periods was limited to oral rinses, bad breath parameters systematically improved, with the exception of a slight increase in VSC levels while using CHX-‐Alc, a finding which was associated with the direct influence of the CHX on the sulfide monitor. The oral microbial load after the use of CHX-‐NaF remained unchanged, while for the CHX-‐Alc and CHX-‐CPC-‐Zn, significant reductions in both aerobic and anaerobic colony forming units (CFU)/ml were noticed in comparison with baseline data for both tongue coating and saliva samples. The composition of microflora, on the other hand, did not reveal significant changes. The supragingival plaque formation was inhibited, in descending order, by CHX-‐Alc, CHX-‐CPC-‐Zn, and CHX-‐NaF. The subjective scores for the rinses indicated a higher appreciation for CHX-‐CPC-‐Alc and CHX-‐NaF because of a better taste and fewer side effects. Conclusions: The results of this study demonstrate that morning halitosis can be successfully reduced via daily use of mouthrinses. CHX-‐Alc and CHX-‐CPC-‐Zn mouthrinses result in a significant reduction of the microbial load of tongue and saliva.

Título: Effectiveness of mechanical tongue cleaning on breath odour and tongue coating: a systematic review.

Autores: Van der Sleen MI ; Slot DE ; Van Trijffel E ; Winkel EG ; Van der Weijden GA

Fuente: International Journal Of Dental Hygiene [Int J Dent Hyg] 2010 Nov; Vol. 8 (4), pp. 258-‐68. Date of Electronic Publication: 2010 Sep 06.

RESUMEN:

Background: The objective of this review was to summarize the available evidence regarding the effects of mechanical tongue cleaning compared with no mechanical tongue cleaning on breath odour and tongue coating (TC). Methods: PubMed-‐MEDLINE, EMBASE and Cochrane-‐CENTRAL were searched to identify potentially relevant studies. The inclusion criteria included the following: randomized controlled clinical trials (RCTs) or controlled clinical trials (CCTs) conducted in humans in good general health (no systemic disorders) and a patient age of ≥17 years. For the intervention, we

considered tongue cleaning [the use of a tongue scraper (TS) or tongue brush (TB)] and for the control, brushing only (B) groups. Clinical parameters such as volatile sulphur compound concentration, organoleptic scores and TC were the outcome variables of interest. Study selection, quality assessment and data extraction were carried out by two independent reviewers. Results: After screening of the titles and abstracts and subsequent full text reading of the potential papers, we identified five publications that met the eligibility criteria and provided seven experiments. The five studies consisted of three RCTs and two CCTs. All experiments show a positive effect of mechanical tongue cleaning in addition to toothbrushing on various parameters of oral malodour. Conclusions: This review demonstrated that mechanical approaches, such as tongue brushing or tongue scraping to clean the dorsum of the tongue, have the potential to successfully reduce breath odour and TC. However, data concerning the effect of mechanical tongue cleaning on chronic oral malodour (halitosis) are insufficient. (© 2010 John Wiley & Sons A/S.)

Título: Efficacy of a 2-‐phase oil: water mouthrinse in controlling oral malodor, gingivitis, and plaque.

Autores: Kozlovsky A ; Goldberg S ; Natour I ; Rogatky-‐Gat A ; Gelernter I ; Rosenberg M


RESUMEN:

The purpose of the study was to examine the anti-‐malodor, anti-‐gingivitis, and plaque reducing properties of a 2 phase oil:water mouthrinse compared with a control mouthrinse. Fifty subjects rinsed with one of the two rinses for 30 seconds twice a day over 6 weeks, while continuing their normal oral hygiene habits. Measurements were made at time zero (prior to beginning the rinsing regimen), and > or = 9 hours following rinsing, at intervals of 1, 3, and 6 weeks. Malodor of whole mouth, as well as tongue dorsum anterior and posterior, was assessed on a 0 to 5 semi-‐integer scale by two odor judges. Volatile sulphide compounds (VSC) were determined using a sulphide monitor. Gingival, plaque, and bleeding indices were recorded for Ramfjord teeth. Oral microbial levels were assessed using the oratest. Salivary levels of diamines (putrescine and cadaverine) were analyzed by HPLC. Results were analyzed by 2-‐tailed covariant ANOVA, with the time zero value as covariant. Dramatic improvements were observed in parameters associated with malodor, periodontal health, plaque accumulation, and microbial levels in both groups. As compared to time zero scores, whole mouth odor, tongue dorsum anterior and posterior odors decreased continuously over time, attaining 80%, 79% and 70%, reductions, respectively following 6 weeks, in the 2-‐phase mouthrinse group, versus 70%, 77% and 59% for the control group. For whole mouth and tongue dorsum posterior, the reductions observed in the 2-‐phase mouthrinse group were significantly greater than those obtained with the control mouthrinse (P = 0.026 and P = 0.025, respectively), suggesting that the 2-‐phase mouthrinse is superior to the control mouthrinse in long-‐term reduction of oral malodor. For bleeding index, gingival index, oral microbial levels,

and VSC, differences between the groups were not significant. Diamine levels were not significantly reduced in either group. The control mouthrinse reduced plaque index more significantly than the 2-‐phase mouthrinse (P < 0.005). The results of this randomized clinical trial suggest that the 2-‐phase oil:water mouthrinse formulation is superior to the control mouthrinse in long-‐term reduction of oral malodor.

Título: Extra-‐oral halitosis: an overview.

Autores: Tangerman A ; Winkel EG


RESUMEN:

Halitosis can be subdivided into intra-‐oral and extra-‐oral halitosis, depending on the place where it originates. Most reports now agree that the most frequent sources of halitosis exist within the oral cavity and include bacterial reservoirs such as the dorsum of the tongue, saliva and periodontal pockets, where anaerobic bacteria degrade sulfur-‐containing amino acids to produce the foul smelling volatile sulfur compounds (VSCs), especially hydrogen sulfide (H(2)S) and methyl mercaptan (CH(3)SH). Tongue coating is considered to be the most important source of VSCs. Oral malodor can now be treated effectively. Special attention in this overview is given to extra-‐oral halitosis. Extra-‐oral halitosis can be subdivided into non-‐blood-‐borne halitosis, such as halitosis from the upper respiratory tract including the nose and from the lower respiratory tract, and blood-‐borne halitosis. The majority of patients with extra-‐oral halitosis have blood-‐borne halitosis. Blood-‐borne halitosis is also frequently caused by odorous VSCs, in particular dimethyl sulfide (CH3SCH3). Extra-‐oral halitosis, covering about 5-‐10% of all cases of halitosis, might be a manifestation of a serious disease for which treatment is much more complicated than for intra-‐oral halitosis. It is therefore of utmost importance to differentiate between intra-‐oral and extra-‐oral halitosis. Differences between intra-‐oral and extra-‐oral halitosis are discussed extensively. The importance of applying odor characterization of various odorants in halitosis research is also highlighted in this article. The use of the odor index, odor threshold values and simulation of bad breath samples is explained.

Título: First international workshop on oral malodor.



Título: GC-‐MS analysis of breath odor compounds in liver patients.

Autores: Van den Velde S ; Nevens F ; Van Hee P ; van Steenberghe D ; Quirynen M

Fuente: Journal Of Chromatography. B, Analytical Technologies In The Biomedical And Life Sciences [J Chromatogr B Analyt Technol Biomed Life Sci] 2008 Nov 15; Vol. 875 (2), pp. 344-‐8. Date of Electronic Publication: 2008 Sep 17.

RESUMEN:

Background: Liver diseases can cause a sweet, musty aroma of the breath, called fetor hepaticus. Even in a stage of cirrhosis, the disease can be asymptomatic for many years. Breath analysis might be helpful to detect occult liver pathology. Study Objective: This study examined whether specific breath odor compounds can be found in liver patients, suffering from cirrhosis, which might be useful for diagnosis. Materials and Methods: Fifty-‐two liver patients and 50 healthy volunteers were enrolled. Alveolar air was analyzed by gas chromatography-‐mass spectrometry. Using discriminant analysis a model for liver disease was built. Results: Dimethyl sulfide, acetone, 2-‐butanone and 2-‐pentanone were increased in breath of liver patients, while indole and dimethyl selenide were decreased. Sensitivity and specificity of the model were respectively 100% and 70%. Conclusions: Fetor hepaticus is caused by dimethyl sulfide and to a lower extent by ketones in alveolar air. Breath analysis by GC-‐MS makes it possible to discriminate patients with breath malodor related to hepatic pathologies.

Título: Halitosis and Helicobacter pylori infection.

Autores: Tangerman A ; Winkel EG ; de Laat L ; van Oijen AH ; de Boer WA

Fuente: Journal Of Breath Research [J Breath Res] 2012 Mar; Vol. 6 (1), pp. 017102. Date of Electronic Publication: 2012 Feb 27.

RESUMEN:

There is disagreement about a possible relationship between Helicobacter pylori (H. pylori) infection and objective halitosis, as established by volatile sulfur compounds (VSCs) in the breath. Many studies related to H. pylori used self-‐reported halitosis, a subjective and unreliable method to detect halitosis. In this study a possible relation between H. pylori and halitosis was evaluated, using an objective method (gas chromatography, GC) to detect the VSCs, responsible for the halitosis. The levels of the VSCs hydrogen sulfide (H(2)S), methyl mercaptan (MM) and dimethyl sulfide (DMS) were measured in mouth breath and in stomach air of 11 H. pylori positive patients and of 38 H. pylori negative patients, all with gastric pathology. Halitosis was also established by organoleptic scoring (OLS) of mouth-‐breath. The levels of H(2)S, MM and DMS in the mouth-‐breath and stomach air of the H. pylori positive patients did not differ significantly from those of the H. pylori negative patients. OLS of the mouth-‐breath resulted in 9 patients with halitosis, 1 out of the H. pylori positive group and 8 out of the H. pylori negative group, which is not statistically different. The concentrations of the VSCs in stomach air were in nearly all cases below the thresholds of objectionability of the various VSCs, indicating that halitosis does not originate in the stomach. The patients with gastric pathology were also compared with control patients without gastric pathology and with

normal volunteers. No significant differences in VSCs in mouth breath were observed between these groups. Thus, in this study no association between halitosis and H. pylori infection was found. Halitosis, as established by GC and OLS, nearly always originates within the oral cavity and seldom or never within the stomach.

Título: Halitosis associated volatiles in breath of healthy subjects.

Autores: van den Velde S ; Quirynen M ; van Hee P ; van Steenberghe D

Fuente: Journal Of Chromatography. B, Analytical Technologies In The Biomedical And Life Sciences [J Chromatogr B Analyt Technol Biomed Life Sci] 2007 Jun 15; Vol. 853 (1-‐2), pp. 54-‐61. Date of Electronic Publication: 2007 Mar 14.

RESUMEN:

Background: Halitosis can have an intra-‐ or extra-‐oral origin. In all cases, bad breath is caused by the presence of volatile organic compounds originating from the mouth or the expired air. They can be specific for certain diseases or infections. Study Objective: This study explored the presence and concentration of these volatile compounds normally associated with halitosis in the breath of healthy symptomless volunteers. Methods: Alveolar and mouth air of 40 healthy volunteers as well as environmental air were analyzed by gas chromatography-‐mass spectrometry (GC-‐MS) and by a commercially available GC device (OralChroma). Results: 14 compounds, associated with halitosis could be detected. All of them except carbon disulfide, appeared to be (partly) produced endogenously and/or in the mouth. Acetone, 2-‐butanone, 2-‐pentanone and 1-‐propanol were common to all volunteers in both alveolar and mouth air and indole and dimethyl selenide in alveolar air. Conclusions: GC-‐MS seems a promising tool for differential diagnosis of halitosis, with the possibility to detect extra-‐oral causes, which often remain undetected unless characterized by a specific smell.

Título: Halitosis in children.

Autores: Amir E ; Shimonov R ; Rosenberg M

Fuente: The Journal Of Pediatrics [J Pediatr] 1999 Mar; Vol. 134 (3), pp. 338-‐43.

RESUMEN:

Objective: To determine the relationship between oral parameters and halitosis in children whose parents complained of malodorous breath. Methods: Twenty-‐four children (ages 5 to 14) were examined at 3 appointments. After the second appointment oral hygiene instructions were given. Malodor-‐related parameters included odor judge scores (whole mouth, tongue, nose, and interdental areas), sulfide levels,

and microbiologic tests (Oratest and BANA). Dental-‐related parameters included plaque index, dental index (DMFT), food impaction, bleeding, and tongue coating. Statistical analyses included analysis of variance, paired t tests, Pearson correlations, and multiple regression. Results: Whole mouth odor was significantly associated with plaque index levels (r = 0.64, P =.001) and Oratest (r = -‐0.57, P =.003). Whole mouth malodor was significantly associated with tongue dorsum posterior odor (r = 0.641, P =.001) and was higher in subjects with interdental odor (P =.003). Tongue odor was also significantly associated with nasal malodor (r = 0.57; P =.004). Sulfide levels were correlated with oral malodor levels only at the second appointment (r = 0.46, P =.02). Conclusions: The data suggest that, as in adults, oral malodor in children is related primarily to oral factors. Correlations between nasal and oral malodor were evident, suggesting that postnasal drip plays a major role.

Título: Halitosis measurement by an industrial sulphide monitor.

Autores: Rosenberg M ; Septon I ; Eli I ; Bar-‐Ness R ; Gelernter I ; Brenner S ; Gabbay J

Fuente: Journal Of Periodontology [J Periodontol] 1991 Aug; Vol. 62 (8), pp. 487-‐9.

RESUMEN:

Previous studies have established that hydrogen sulphide and mercaptans are the primary components of halitosis (bad breath). In the present investigation, we report a simple, rapid technique for measurement of halitosis-‐related sulphides. The technique is based on a portable instrument generally used for environmental safety applications. Seventy-‐five volunteers were measured using this technique, and the results (in peak ppb hydrogen sulphide equivalents) compared with organoleptic assessment by 7 judges. A highly significant overall correlation (r = 0.603; P less than 0.001) was obtained between these 2 methods. Moreover, in most cases, the organoleptic ratings of the individual judges correlated more highly with sulphide monitor values than with one another. The simplicity of the technique suggests its use in clinical studies as well as in diagnosis and treatment of patients with this complaint.

Título: Halitosis.

Autores: Scully C ; Rosenberg M

Fuente: Dental Update [Dent Update] 2003 May; Vol. 30 (4), pp. 205-‐10.

RESUMEN:

Halitosis (oral malodour or breath odour) is a fairly common complaint. Halitosis is most often a consequence of oral bacterial activity, typically from anaerobes. Occasional causes include systemic disease, and some patients have a psychogenic background to the complaint. The management is outlined in this paper.

Título: Halitosis: a review of associated factors and therapeutic approach.

Autores: Cortelli JR ; Barbosa MD ; Westphal MA

Fuente: Brazilian Oral Research [Braz Oral Res] 2008; Vol. 22 Suppl 1, pp. 44-‐54.

RESUMEN:

Halitosis or bad breath is an oral health condition characterized by unpleasant odors emanating consistently from the oral cavity. The origin of halitosis may be related both to systemic and oral conditions, but a large percentage of cases, about 85%, are generally related to an oral cause. Causes include certain foods, poor oral health care, improper cleaning of dentures, dry mouth, tobacco products and medical conditions. Oral causes are related to deep carious lesions, periodontal disease, oral infections, peri-‐implant disease, pericoronitis, mucosal ulcerations, impacted food or debris and, mainly, tongue coating. Thus, the aim of the present review was to describe the etiological factors, prevalence data and the therapeutic mechanical and chemical approaches related to halitosis. In general, halitosis most often results from the microbial degradation of oral organic substrates including volatile sulfur compounds (VSC). So far, there are few studies evaluating the prevalence of oral malodor in the world population. These studies reported rates ranging from 22% to more than 50%. The mechanical and chemical treatment of halitosis has been addressed by several studies in the past four decades. Many authors agree that the solution of halitosis problems must include the reduction of the intraoral bacterial load and/or the conversion of VSC to nonvolatile substrates. This could be achieved by therapy procedures that reduce the amount of microorganisms and substrates, especially on the tongue.

Título: Halitosis: an overview of epidemiology, etiology and clinical management.

Autores: Rösing CK ; Loesche W

Fuente: Brazilian Oral Research [Braz Oral Res] 2011 Sep-‐Oct; Vol. 25 (5), pp. 466-‐71.

RESUMEN:

Halitosis is an unpleasant condition that causes social restraint. Studies worldwide indicate a high prevalence of moderate halitosis, whereas severe cases are restricted to around 5% of the populations. The etiological chain of halitosis relates to the presence of odoriferous substances in exhaled air, especially the volatile sulphur compounds (VSC) produced by bacteria. The organoleptic diagnosis is the gold standard and clinical management includes oral approaches, especially periodontal treatment and oral hygiene instructions, including the tongue. When oral strategies are not successful, referral to physicians is warranted.

Título: Halitosis: much beyond oral malodor.

Autores: Ongole R ; Shenoy N

Fuente: Kathmandu University Medical Journal (KUMJ) [Kathmandu Univ Med J (KUMJ)] 2010 Apr-‐Jun; Vol. 8 (30), pp. 269-‐75.

RESUMEN:

Oral malodor one of the most common complaints with which patients approaches us thinking it can be detrimental to his self-‐image and confidence. Even though majority of oral malodor is of oral origin, there are multiple other systemic causes that have to be addressed while we diagnose and treat this condition. Most of these patients look up to oral care physicians for expert advice, it is critical for us to have the knowledge base and communication techniques to provide quality clinical assessment and implement effective intervention programs. This article reviews the various causes and the diagnostic modalities which will help us treat this multifaceted condition.

Título: Halitosis-‐-‐a call for affirmative action.

Autores: Rosenberg M ; Gabbay J

Fuente: Refuʾat Ha-‐Shinayim (Tel Aviv, Israel: 1983) [Refuat Hashinayim] 1987 Apr; Vol. 5 (2), pp. 13-‐5.

Título: Halitosis-‐-‐a common medical and social problem. A review on pathology, diagnosis and treatment.

Autores: Zalewska A ; Zatoński M ; Jabłonka-‐Strom A ; Paradowska A ; Kawala B ; Litwin A

Fuente: Acta Gastro-‐Enterologica Belgica [Acta Gastroenterol Belg] 2012 Sep; Vol. 75 (3), pp. 300-‐9.

RESUMEN: Bad breath is a condition that has health and social implications. This paper provides a comprehensive review of the classification of halitosis, it's etiology, it's prevalence, diagnosis and treatment strategies for the condition. Halitosis is affecting about 25-‐30% of world's population. It includes categories of genuine halitosis, pseudo-‐halitosis and halitophobia. It is believed that in 80-‐90% of cases halitosis origins in the oral cavity and the most common causes are: gingival pathologies, caries and poor oral hygiene. Extraoral sources of halitosis are responsible for 10-‐20% of all cases and are caused by poor diet, alcohol abuse, tobacco smoking, certain drugs and diseases of other parts of digestive tract as well as some systemic conditions. Diagnostics of halitosis includes subjective methods (examiner's sense of smell) and objective methods (instrumental analysis). Simple, subjective examination is considered a "golden standard" in clinical practice. In case of pathological halitosis identifying the direct cause of halitosis is essential. After excluding, or after successful treatment, of all oral pathologies, in case of remaining fetor ex ore identification and treatment of halitosis often requires multidisciplinary approach. Many unknowns remain in causes and mechanisms

of halitosis. It can significantly impair quality of life, social interactions, lead directly to depression,low self-‐esteem or other mood disorders, therefore it is important to properly identify, treat and continue research on halitosis.

Título: Halitosis-‐-‐the need for further research and education.


Fuente: Journal Of Dental Research [J Dent Res] 1992 Feb; Vol. 71 (2), pp. 424.

Título: In vitro antimicrobial effects of two antihalitosis mouth rinses on oral pathogens and human tongue microbiota.

Autores: Raangs G ; Winkel E ; van Winkelhoff A

Fuente: International Journal Of Dental Hygiene [Int J Dent Hyg] 2013 Feb 1. Date of Electronic Publication: 2013 Feb 1.

RESUMEN:

OBJECTIVES: The aim of the study was to compare the antimicrobial activity of a mouth rinse containing chlorhexidine and cetylpyridinium chloride (MR1) with a stannous fluoride-‐based mouth rinse (MR2) in vitro. MATERIALS AND METHODS: Samples of the tongues from 10 subjects with and 10 subjects without halitosis were inoculated on blood agar plates. The agar was perforated, and the cylindrical holes were filled either with mouth rinse MR1 or with mouth rinse MR2. After incubation, inhibition zones of the whole tongue microbiota and Fusobacterium nucleatum were measured. In addition, MR1 and MR2 were applied in a short interval killing test (SIKT) on four oral pathogens Porphyromonas gingivalis, Prevotella intermedia, F. nucleatum and Aggregatibacter actinomycetemcomitans. Total viable cell counts were made after two minutes of incubation with increasing concentrations of MR1 and MR2. RESULTS: MR1 showed a significantly higher in vitro antimicrobial activity against the whole tongue microbiota and F. nucleatum than MR2 in both groups of subjects. In the SIK test, MR1 showed a significantly greater killing capacity than MR2. The results show that a mouth rinse with low concentrations of chlorhexidine and 0.05% cetylpyridinium chloride appears to be more effective in inhibiting growth of the human tongue microbiota in vitro than a fluoride/stannous fluoride-‐containing mouth rinse. CONCLUSION: This in vitro observation supports the use of chlorhexidine and cetylpyridinium chloride in the treatment of oral halitosis.

Título: In vitro effect of coffee on oral malodor-‐related parameters.

Autores: Gov Y ; Sterer N ; Rosenberg M

Fuente: Journal Of Breath Research [J Breath Res] 2010 Jun; Vol. 4 (2), pp. 026004. Date of Electronic Publication: 2010 Mar 19.

RESUMEN:

In the present investigation we examined the effect of three brands of coffee on microbial volatile sulfur compound (VSC) production using a decarboxylase incubation assay. Stimulated whole saliva was added to decarboxylase medium supplemented with 0.005% hemin. Incubation was carried out anaerobically for 72 h in the presence of powdered coffee at concentrations ranging from 0.5 to 2.0% (w/v), as compared with appropriate controls. VSC levels were determined using OralChroma™ and Halimeter™ and malodor was scored by an experienced odor judge. Experimental biofilm was grown with or without coffee and examined for VSC-‐producing bacteria using confocal laser scanning microscopy. Results showed that VSC and malodor levels were decreased by 85% in the presence of 2% coffee. The data suggest that coffee components reduce malodor production, VSC levels and experimental biofilm VSC-‐producing bacteria in vitro.

Título: In vitro volatile sulfur compound production of oral bacteria in different culture media.

Autores: Quirynen M ; Van Eldere J ; Pauwels M ; Bollen CM ; van Steenberghe D

Fuente: Quintessence International (Berlin, Germany: 1985) [Quintessence Int] 1999 May; Vol. 30 (5), pp. 351-‐6.

RESUMEN:

Objective: The purpose of this study was to detect the relative contribution of Porphyromonas gingivalis, Fusobacterium nucleatum, and Prevotella intermedia in the production of oral malodor. Method and Materials: The volatile sulfur compounds produced by these bacteria in vitro were measured semiquantitatively by a portable sulfide monitor. Results: Samples from the tongue, tonsils, and pharynx showed a significantly higher production (550 ppb) of volatile sulfur compounds during the first 6 hours after anaerobic incubation in broths (brain-‐heart infusion, Columbia, and Trypticase Soy) than after incubation in agar media (300 ppb) (P < 0.001). After 24 hours, values in broths and agars leveled off at 350 ppb (P = 0.3) and remained constant during the next 6 days. Measurement of separate pure cultures showed that maximal volatile sulfur compound production was reached 6 hours after incubation (450 ppb for the 3 bacteria). Higher volatile sulfur compound values were measured in brain-‐heart infusion. When measurements of mixed cultures of the 3 pathogens were performed every 15 minutes, the maximal value was reached after only 30 minutes of incubation (nearly 500 ppb). Conclusion: The in vitro volatile sulfur compound production of oral samples is preferably measured in broths. Maximal sulfur production from mixed cultures is reached after 30 minutes of incubation. Samples should always be inoculated at the same dilution.

Título: Intra-‐ and extra-‐oral halitosis: finding of a new form of extra-‐oral blood-‐borne halitosis caused by dimethyl sulphide.


Fuente: Journal Of Clinical Periodontology [J Clin Periodontol] 2007 Sep; Vol. 34 (9), pp. 748-‐55.

RESUMEN:

Aim: The aim of this study was to unravel the origen and cause of intra-‐oral and extra-‐oral halitosis. Material and Methods: We studied 58 patients complaining of halitosis, using gas chromatography of volatile sulphur compounds (VSCs) in mouth and nose breath, organoleptic scoring of mouth and nose breath, Halimeter readings of mouth air and tongue-‐coating inspection. Subjects had no precence or history of periodontitis. Result: Of 58 patients, 47 patients had halitosis of oral origin, six had halitosis of extra-‐oral origin and five had no halitosis (halitophobia). A strong correlation was found between the degree of intra-‐oral halitosis as measured by organoleptic scoring of mouth breath and the concentration of the VSCs hydrogen sulphide (H(2)S) and methyl mercaptan (CH(3)SH) in mouth breath. Taking into account the much larger odour index of CH(3)SH, it was concluded that CH(3)SH is the main contributor to intra-‐oral halitosis. In all six cases of extra-‐oral halitosis, halitosis was caused by the presence of elevated levels of dimethyl sulphide (CH(3)SCH(3)) in mouth and nose breath. Conclusion: Our study provides evidence that the VSC, CH(3)SH and to a lesser extent H(2)S are the main contributors to intra-‐oral halitosis and that CH(3)SCH(3) is the main contributor to extra-‐oral or blood-‐borne halitosis, due to a hitherto unknown metabolic disorder.

Título: Isolation of Enterobacteriaceae from the mouth and potential association with malodor.

Autores: Goldberg S ; Cardash H ; Browning H 3rd ; Sahly H ; Rosenberg M

Fuente: Journal Of Dental Research [J Dent Res] 1997 Nov; Vol. 76 (11), pp. 1770-‐5.

RESUMEN:

Bad breath is a common phenomenon, usually the result of bacterial metabolism in the oral cavity. It is generally accepted that Gram-‐negative bacteria are responsible for this problem, largely through degradation of proteinaceous substances. In initial experiments, screening of malodorous isolates following outgrowth of samples obtained from saliva, periodontal pockets, and the tongue dorsum yielded enterobacterial isolates. Clinical studies were conducted to examine the prevalence of such bacteria in four different populations: orthodontic patients, malodor clinic patients, complete-‐denture wearers, and a healthy young population. The prevalence of Enterobacteriaceae in the oral cavities of the denture-‐wearing population was very high (48.0%) as compared with the other groups: 27.1% in the malodor

clinic patients, 16.4% in the normal population, and 13% among orthodontic patients. Isolates of Klebsiella and Enterobacter emitted foul odors in vitro which resembled bad breath, with concomitant production of volatile sulfides and cadaverine, both compounds related to bad breath. When incubated on a sterile denture, enterobacterial isolates produced typical denture foul odor. Isolates exhibited cell-‐surface hydrophobic properties when tested for adhesion to acryl and aggregation with ammonium sulphate. The results, taken together, suggest that Klebsiella and related Enterobacteriaceae may play a role in denture malodor.

Título: Management of oral malodour.

Autores: Quirynen M

Fuente: Journal Of Clinical Periodontology [J Clin Periodontol] 2003; Vol. 30 Suppl 5, pp. 17-‐8.

RESUMEN:

Halitosis is a common problem. Its aetiology is multifactorial, but oral malodour is usually caused by microbial metabolism from the tongue, saliva or dental plaque. Mouthwashes are only effective against halitosis caused by intraoral factors. The principal causative agents of oral malodour are volatile sulphide compounds (VSCs), including hydrogen sulphide, methyl mercaptan and dimethyl sulphide. Data suggest that oral VSC levels correlate with the depth of periodontal pockets. Trials have shown that both mechanical oral care and mouthwash use can reduce halitosis levels. The majority of studies involving mouthwashes have investigated chlorhexidine and essential oil mouthwashes, although comparative studies are sparse.

Título: Measurement of oral malodor: current methods and future prospects.

Autores: Rosenberg M ; McCulloch CA

Fuente: Journal Of Periodontology [J Periodontol] 1992 Sep; Vol. 63 (9), pp. 776-‐82.

RESUMEN:

Measurement of oral malodor is complicated by a variety of parameters including complexity of gaseous molecular species, sampling difficulties, temporal variations, choice of suitable subject populations, and lack of agreement on reference standards. Since oral malodor is a perceived olfactory stimulus, direct sampling and assessment by human judges may be the most logical measurement approach. However, as with other psychophysical assessments, human malodor measurement by the human nose may vary widely among and between judges, and consequently cannot be confidently reproduced in other laboratories. Such shortcomings have led several investigators to propose quantitative approaches based on measurement of volatile sulfide compounds which are associated with oral malodor. Highly sensitive and discriminatory measurements of volatile sulfides can be made using gas chromatography although for rapid sampling of larger subject populations, portable sulfide monitors may be more appropriate. Future research in this field should consider: 1) improved

and simplified instrumentation for more rapid through-‐put and reliability; 2) development and definition of reference standards for oral malodor assessment; 3) formulation of clinical studies with appropriately sized, well-‐defined patient populations; and 4) further development of within mouth, site-‐specific measurements.

Título: Probiotics and oral healthcare.

Autores: Teughels W ; Van Essche M ; Sliepen I ; Quirynen M

Fuente: Periodontology 2000 [Periodontol 2000] 2008; Vol. 48, pp. 111-‐47.

Título: Proceedings of the Sixth International Conference on Breath Odor.

Autores: Greenman J ; Rosenberg M


Título: Reduction of oral malodor by oxidizing lozenges.

Autores: Greenstein RB ; Goldberg S ; Marku-‐Cohen S ; Sterer N ; Rosenberg M

Fuente: Journal Of Periodontology [J Periodontol] 1997 Dec; Vol. 68 (12), pp. 1176-‐81.

RESUMEN:

The main purpose of the study was to examine the anti-‐malodor properties of oxidizing lozenges, as compared to breath mints and chewing gum. Healthy, young adult volunteers (N = 123; mean age 24.5 years) were measured for oral malodor-‐related parameters (whole mouth odor measured by 2 judges; tongue dorsum posterior odor using the spoon test; volatile sulphide levels; salivary levels of cadaverine and putrescine; and 2 versions of an oral rinse test) on the first afternoon of the study. They were then assigned randomly to one of 6 groups (2 brands of breath mints, chewing gum with no active ingredients, regular and full-‐strength oxidizing lozenges, and a no-‐treatment control), and instructed to employ the treatment before bedtime, the next morning, and in the early afternoon 3 hours prior to measurements, which were carried out 24 hours following baseline measurements. Volunteers also estimated the level of their own whole mouth and tongue odors at baseline and post-‐treatment. The data showed that, among treatments, only the full-‐strength oxidizing lozenge significantly reduced tongue dorsum malodor, as determined by the spoon test. The full-‐strength lozenge also yielded a significant increase in the modified oral rinse test, presumably due, at least in part, to residual oxidizing activity retained in the oral cavity. Self-‐estimations of whole mouth and tongue malodor by volunteers were significantly correlated with corresponding-‐judge assessments, suggesting some degree of objectivity in assessing one's own oral malodor.

Título: Relationship of oral malodor to periodontitis: evidence of independence in discrete subpopulations.

Autores: Bosy A ; Kulkarni GV ; Rosenberg M ; McCulloch CA

Fuente: Journal Of Periodontology [J Periodontol] 1994 Jan; Vol. 65 (1), pp. 37-‐46.

RESUMEN:

Associations between oral malodor, measures of periodontal disease, and trypsin-‐like activity of periodontal pathogens on tongue and teeth were examined in 127 subjects. Volatile sulphur compound (VSC) measurements were made with a portable sulphide monitor; oral malodor was also estimated by organoleptic methods. Measurements repeated one week apart indicated that steady-‐state VSC levels (r = 0.72; P = 0.0001) and peak VSC levels (r = 0.63; P = 0.0001) were reproducible but these r values were not significantly different (P > 0.1). There was a significant correlation between tongue odor and peak VSC levels (r = 0.40; P = 0.0001) and between tongue odor and whole mouth organoleptic measures (r = 0.55; P = 0.0001). To study the effect of reducing microbial colonization on oral malodor, chlorhexidine gluconate (0.2%) rinsing was prescribed for 7 days. Reductions of VSC levels were significant for both peak (37%) and steady-‐state (41%) data (P = 0.0001). Anaerobic periodontal pathogens on the tongue estimated by the proportions of positive BANA tests were reduced 19% (P = 0.001) and this was concomitant with a 40% (P = 0.0001) decrease in organoleptic measurement of the tongue dorsum. Mean pH measurements of the tongue dorsum showed large reductions from 6.9 initially to 6.3 post-‐treatment (P = 0.0001). Subjects were divided into periodontitis/no periodontitis based on periodontal inflammation and probing depth (> or = 5 mm). Of the 37 subjects with periodontitis, 23 had oral malodor whereas 52 out of 90 periodontally healthy subjects exhibited malodor. Chi square analysis comparing halitosis in subjects with and without periodontitis showed no statistically significant association (chi 2 = 0.208; P 0.65) between these two factors although the intensity of malodor as based on VSC concentration in periodontally healthy subjects was 19% less (mean = 111 ppb) than in subjects with periodontitis (mean = 136 ppb). The odds ratio was 1.2, indicating that oral malodor was not associated with periodontitis. These data indicate that a large proportion of individuals with oral malodor are periodontally healthy and that the mucosal surface of the tongue is a major site of oral malodor production.

Título: Reproducibility and sensitivity of oral malodor measurements with a portable sulphide monitor.

Autores: Rosenberg M ; Kulkarni GV ; Bosy A ; McCulloch CA

Fuente: Journal Of Dental Research [J Dent Res] 1991 Nov; Vol. 70 (11), pp. 1436-‐40.

RESUMEN:

Forty-‐one subjects with bad breath were assessed for oral malodor and periodontal status on three occasions, at intervals of approximately one week. Oral malodor was assessed by

measurement of peak and steady-‐state volatile sulphide levels with a portable sulphide monitor and by organoleptic measurement of whole-‐mouth, tongue dorsum, and interproximal dental odors by two independent judges. Reproducibility of measurements, assessed by paired t tests and Kappa testing, demonstrated no significant differences between any of the test results from the first and second appointments. Steady-‐state sulphide levels were the most reproducible of all tests. The ability of the tests to detect an expected reduction of malodor following a 0.2% chlorhexidine mouthrinse regimen was investigated by comparison of test values between the second and third appointments. Following the mouthrinsing treatment, 43% reductions of peak, 47% reductions of steady-‐state volatile sulphide levels, and 15-‐58% reductions in all other measurement categories were observed. The majority of the participants (22/41) had no pockets greater than 5 mm and exhibited both moderate gingival inflammation (Mean Gingival Index = 1.17) and moderate plaque accumulation (Mean Plaque Index = 1.84). Plaque Index and presence of pockets greater than 7 mm were weakly related to sulphide measurements. Whereas assessment of steady-‐state sulphide levels by the sulphide monitor does not constitute a direct measure of oral malodor, its relation to organoleptic measurement, superior reproducibility, objectivity, and sensitivity support the use of the sulphide monitor in clinical studies.

Título: Review of the treatment strategies for oral malodour.

Autores: Quirynen M ; Zhao H ; van Steenberghe D

Fuente: Clinical Oral Investigations [Clin Oral Investig] 2002 Mar; Vol. 6 (1), pp. 1-‐10.

RESUMEN:

Breath malodour, a significant social and/or psychological handicap, may be caused by several intra-‐ and extraoral factors. Malodour of intraoral origin is the result of microbial putrefaction, during which volatile sulphur compounds (VSC) and other volatile compounds are produced. The treatment of oral malodour can therefore be focused on the reduction of the intraoral bacterial load and/or the conversion of VSC to nonvolatile substrates. This article outlines the efficacy and mechanisms of different antimalodour approaches. Most approaches were found to be inefficient and/or short lasting. The most successful treatment involves mechanical debridement (including toothbrushing, flossing, and tongue cleaning), possibly combined with the use of an antimicrobial mouthrinse.

Título: Self-‐assessment of oral malodor 1 year following initial consultation.

Autores: Rosenberg M ; Kozlovsky A ; Wind Y ; Mindel E

Fuente:Quintessence International (Berlin, Germany: 1985) [Quintessence Int] 1999 May; Vol. 30 (5), pp. 324-‐7.

RESUMEN:

Objective: In an initial study, subjects complaining of bad breath were generally unable to score the level of their own oral malodor in an objective fashion. Subjects were taught several techniques for self-‐measurement of bad breath. One year following the initial consultation, subjects were recalled to determine whether their ability to assess their own oral malodor had improved. Method and Materials: In the study, subjects were blinded to their own scores 1 year earlier, to the odor-‐judge scores, and to the results of the clinical laboratory tests. Thirty-‐two of 43 subjects in the original study who presented with a complaint of oral malodor agreed to participate in the follow-‐up study. Odor-‐judge scores and self-‐assessments of oral malodor (whole-‐mouth odor, tongue odor, and saliva odor) were compared with one another as well as with clinical parameters. Results: Objective improvements were noted in both oral health parameters and malodor levels of subjects. Despite this, self-‐assessments generally remained unrelated to objective parameters (odor-‐judge scores, clinical indices, and laboratory tests). Self-‐assessments were all significantly correlated with one another, and also were significantly associated with corresponding self-‐estimates made 1 year earlier. Conclusion: Subjects with a complaint of oral malodor remain largely unable to score their own bad breath in an objective fashion. In addition, they are not capable of sensing reductions in oral malodor 1 year following the original assessment, even though, from a clinical standpoint, improvements have taken place.

Título: Self-‐estimation of oral malodor.

Autores: Rosenberg M ; Kozlovsky A ; Gelernter I ; Cherniak O ; Gabbay J ; Baht R ; Eli I

Fuente: Journal Of Dental Research [J Dent Res] 1995 Sep; Vol. 74 (9), pp. 1577-‐82.

RESUMEN:

Bad breath (halitosis, oral malodor) is a common condition, usually the result of microbial putrefaction within the oral cavity. Often, people suffering from bad breath remain unaware of it, whereas others remain convinced that they suffer from foul oral malodor, although there is no evidence for such. The purpose of the present investigation was to determine whether objective self-‐measurement of oral malodors is possible. Each of 52 volunteers was asked to sample the odor from his/her mouth, tongue, and saliva. Results were compared with (i) self-‐assessments prior to (preconception) and following (post-‐measurement) self-‐measurements; (ii) odor judge scores; (iii) dental-‐measurements (plaque index, gingival index, and probing depth); (iv) volatile sulphide levels; (v) salivary cadaverine levels; and (vi) intra-‐oral trypsin-‐like activity. Among the self-‐measurements, only saliva self-‐scores yielded significant correlations with objective parameters. Despite the partial objectivity of saliva self-‐estimates, subsequent post-‐measurement self-‐assessments failed to correlate with objective parameters. The results suggest that (i) preconceived notions confound the ability to score one's own oral malodors in an objective fashion; and (ii) partial objectivity can be obtained in the case of saliva self-‐measurement, presumably because the stimulus is removed from the body proper.

Título: Self-‐perception of breath odor.

Autores: Eli I ; Baht R ; Koriat H ; Rosenberg M

Fuente: Journal Of The American Dental Association (1939) [J Am Dent Assoc] 2001 May; Vol. 132 (5), pp. 621-‐6.

RESUMEN:

Background: Bad breath, also known as halitosis, is a common concern for millions of people. Yet there is almost no reliable way for people to properly assess their breath odor. While many develop faulty perceptions about having bad breath that affect their entire lives, others who have halitosis are unaware of their condition. Overview: The authors discuss the issues affecting self-‐perception of breath odor in patients who complain of halitosis, as well as in a more general, "noncomplaining" population. The article presents self-‐perception of breath odor as a multifactorial, psychophysiological issue that is related closely to one's body image and psychopathological profile. Conclusions: Based on their data, the authors suggest that every patient has a breath odor self-‐image. This self-‐image ranges from little or no distortion to severe psychopathology. Because treating patients with a specific complaint of oral malodor primarily is the responsibility of the dental practitioner, several treatment approaches are outlined: collecting odor samples from the mouth to increase objectivity, involving a confidant in diagnosis and follow-‐up, corroborating odor judges' scores with objective measurements, increasing the patient's sense of control over the problem and obtaining guidance from mental health professionals, when necessary. Clinical Implications: Dentists increasingly are being called on to help patients with complaints of bad breath. In diagnosing and treating such cases, dentists should consider psychological and physiological factors.

Título: Self-‐perception of breath odor: role of body image and psychopathologic traits.

Autores: Eli I ; Koriat H ; Baht R ; Rosenberg M

Fuente: Perceptual And Motor Skills [Percept Mot Skills] 2000 Dec; Vol. 91 (3 Pt 2), pp. 1193-‐201.

RESUMEN:

Oral malodor is a common complaint in Western society and is an important reason why adults seek dental counsel. In the present study, an attempt was made to evaluate the contribution of psychopathologic traits and of body-‐image char acteristics on participants' self-‐perception of breath odor. 60 participants without any specific complaint concerning breath odor (55% men: M age 35.5 yr., SD= 10) were evaluated. Variables included self-‐evaluation of participants' own breath odor (gener ally and current), an organoleptic evaluation of an impartial judge of odor, measurement of the volatile sulfide level in the oral cavity, and

questionnaires referring to psychopathologic symptoms and body-‐image characteristics. Stepwise regression analysis showed that in addition to impartial measurements, self-‐perception of breath odor among noncomplaining subjects can be predicted by their feelings and attitudes toward the body and by their hostility.

Título: Standardization of clinical protocols in oral malodor research.

Autores: Yaegaki K ; Brunette DM ; Tangerman A ; Choe YS ; Winkel EG ; Ito S ; Kitano T ; Ii H ; Calenic B ; Ishkitiev N ; Imai T

Fuente: Journal Of Breath Research [J Breath Res] 2012 Mar; Vol. 6 (1), pp. 017101. Date of Electronic Publication: 2012 Feb 27.

RESUMEN:

The objective of this study is to standardize protocols for clinical research into oral malodor caused by volatile sulfur compounds (VSCs). To detect VSCs, a gas chromatograph (GC) using a flame photometric detector equipped with a bandpass filter (at 393 nm) is the gold standard (sensitivity: 5 × 10(-‐11) gS s(-‐1)). The baselines of VSC concentrations in mouth air varied considerably over a week. When the subjects refrained from eating, drinking and oral hygiene including mouth rinsing, the VSC concentrations remained constant until eating. Over a 6 h period after a meal, VSC concentrations decreased dramatically (p < 0.01). These results point to optimal times and conditions for sampling subjects. Several portable devices were compared with the measurements by the GCs. Portable GCs demonstrated capabilities similar to those of the GCs. We also applied the recommended protocols described below to clinical research testing the efficacy of ZnCl(2) products, and confirmed that using the recommended protocols in a randomized crossover design would provide very clear results. Proposed protocols include: (a) a short-‐term study rather than a long-‐term study is strongly recommended, since the VSC concentrations are constant in the short term; (b) a crossover study would be the best design to avoid the effects of individual specificities on each clinical intervention; (c) measurements of VSCs should preferably be carried out using either a GC or portable GCs.

Título: Streptococcus salivarius promotes mucin putrefaction and malodor production by Porphyromonas gingivalis.

Autores: Sterer N ; Rosenberg M

Fuente: Journal Of Dental Research [J Dent Res] 2006 Oct; Vol. 85 (10), pp. 910-‐4.

RESUMEN:

Although the contribution of the oral microbiota to oral malodor is well-‐documented, the potential role of Gram-‐positive micro-‐organisms is unclear. In the current study, we tested the hypothesis that Gram-‐positive micro-‐organisms contribute to malodor production by

deglycosylating oral glycoproteins, rendering them susceptible to subsequent proteolysis. To this end, we examined the effect of Streptococcus salivarius on Porphyromonas gingivalis-‐mediated putrefaction of a model glycoprotein (pig gastric mucin). Malodor was scored by two odor judges, and volatile sulfides were determined with the use of a sulfide monitor. Mucin degradation was followed by electrophoresis on SDS-‐PAGE. Results showed that the addition of S. salivarius or beta-‐galactosidase promoted mucin degradation and concomitant malodor production. Addition of glycosidic inhibitors (p-‐APTG and glucose) inhibited this process. These results suggest that Gram-‐positive micro-‐organisms such as S. salivarius contribute to oral malodor production by deglycosylating salivary glycoproteins, thus exposing their protein core to further degradation by Gram-‐negative micro-‐organisms.

Título: Study on the organoleptic intensity scale for measuring oral malodor.

Autores: Greenman J ; Duffield J ; Spencer P ; Rosenberg M ; Corry D ; Saad S ; Lenton P ; Majerus G ; Nachnani S ; El-‐Maaytah M

Fuente: Journal Of Dental Research [J Dent Res] 2004 Jan; Vol. 83 (1), pp. 81-‐5.

RESUMEN:

The 0-‐5 organoleptic scale is used widely in breath research and in trials to measure the efficacy of anti-‐odor agents. However, the precise relationship between odor scores and gas concentrations of target odorants is unknown. The purpose of this study was to relate mean organoleptic scores from odor judges (n = 7) for pure odorants (n = 8) representative of those found in oral malodor. Judges used a common 0-‐5 scale to report the odor intensity of sample sets in random order of concentration. Regression analysis of data showed that odor score was proportional to the log concentration of odorant, and comparison of slopes showed H(2)S to be the most significant in terms of odor power. Detection thresholds (mol.dm(-‐3)) were: Skatole (7.2 x 10(-‐13)) < methylmercaptan (1.0 x 10(-‐11)) < trimethylamine (1.8 x 10(-‐11)) < isovalerate (1.8 x 10(-‐11)) < butyrate (2.3 x 10(-‐10)) < hydrogen sulphide (6.4 x 10(-‐10)) < putrescine (9.1 x 10(-‐10)) < dimethyl disulphide (5.9 x 10(-‐8)). The study demonstrates the exponential nature of the olfactory response and shows that any single compound's contribution to malodor depends on odor power and threshold in addition to concentration.

Título: The complaint of oral malodor: possible psychopathological aspects.

Autores: Eli I ; Baht R ; Kozlovsky A ; Rosenberg M

Fuente: Psychosomatic Medicine [Psychosom Med] 1996 Mar-‐Apr; Vol. 58 (2), pp. 156-‐9.

RESUMEN:

Oral malodor (halitosis) is a common concern in Western society. As with other human perceptions, emotional as well as cognitive variables play a major role in one's sensation and

complaint. To study factors potentially associated with the complaint of oral malodor, periodontal and psychological evaluations were carried out on 38 subjects (66% female, mean age 43 years) with a complaint of oral malodor. Subjects underwent evaluation of their periodontal status, odor evaluation by an odor judge, and psychopathological symptom survey by means of the SCL-‐90 questionnaire. The patient's self-‐rating of oral odor was significantly higher than the evaluation of an objective odor judge and was not associated with their periodontal status. The SCL-‐90 profile of subjects was relatively higher than that of an age-‐ and gender-‐matched reference group of dental patients. The results suggest that the complaint of oral malodor may be related to psychopathological symptoms as recorded by the SCL-‐90 questionnaire.

Título: The effect of a 1-‐stage full-‐mouth disinfection on oral malodor and microbial colonization of the tongue in periodontitis. A pilot study.

Autores: Quirynen M ; Mongardini C ; van Steenberghe D

Fuente: Journal Of Periodontology [J Periodontol] 1998 Mar; Vol. 69 (3), pp. 374-‐82.

RESUMEN:

Oral malodor affects a large proportion of the population and may be the cause of a significant social and psychological handicap. This pilot study aimed to examine whether a 1-‐stage full-‐mouth disinfection in periodontitis patients (scaling and root planing of all pockets within 24 hours together with the application of chlorhexidine to all intra-‐oral niches followed by chlorhexidine mouth rinsing for 2 months) resulted in a significant improvement in malodor when compared to a fractionated periodontal therapy (consecutive root planings per quadrant, at a 1 to 2 week interval). The baseline and outcome data concerning oral malodor were linked to the presence of tongue coating and to its roughness (fissures). Twenty-‐four patients with severe periodontitis were randomly allocated to test and control groups. At baseline and after 1 and 2 months, the concentration of volatile sulfur compounds (VSC) in the mouth was measured and organoleptic ratings (expired air and total mouth air) were given. Plaque samples were collected from the dorsum of the tongue to calculate the number of colony forming units (CFU) per ml (anaerobic culturing) as well as the number of pigmented CFU/ml. Both the baseline organoleptic ratings and the VSC scores correlated well with the presence of tongue coating but not with the tongue roughness. Because a correlation between tongue coating and its microbial load could not be detected, it was hypothesized that the tongue coating per se, and not the bacteria, might be responsible for the malodor. The 1-‐stage full-‐mouth disinfection resulted in a faster and additional reduction in the organoleptic ratings of the oral malodor, even after 2 months. This might be explained by the improved periodontal outcome and/or the more significant reduction in the CFU/ml of pigmented species. In contrast to the organoleptic ratings, which were significantly reduced in both treatment groups (when compared to baseline), the VSC levels remained unchanged. This pilot study indicates that a 1-‐stage full-‐mouth disinfection has, in comparison to a standard periodontal therapy, additional beneficial effects in the treatment of oral malodor.

Título: The effect of mouthrinses on oral malodor: a systematic review.

Autores: Blom T ; Slot DE ; Quirynen M ; Van der Weijden GA

Fuente: International Journal Of Dental Hygiene [Int J Dent Hyg] 2012 Aug; Vol. 10 (3), pp. 209-‐22. Date of Electronic Publication: 2012 Mar 19.

RESUMEN:

Objective: 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. Material and Methods: 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. Conclusion: 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. (© 2012 John Wiley & Sons A/S.)

Título: The effects of a new mouthrinse containing chlorhexidine, cetylpyridinium chloride and zinc lactate on the microflora of oral halitosis patients: a dual-‐centre, double-‐blind placebo-‐controlled study.

Autores: Roldán S ; Winkel EG ; Herrera D ; Sanz M ; Van Winkelhoff AJ

Fuente: Journal Of Clinical Periodontology [J Clin Periodontol] 2003 May; Vol. 30 (5), pp. 427-‐34.

RESUMEN:

Aim: This study evaluated the microbial effects of a newly formulated mouthwash (Halita) on oral halitosis patients. Methods: Forty subjects were included in this dual-‐centre, double-‐blind, placebo-‐controlled parallel study. Inclusion and exclusion criteria were used to select patients. At baseline and at 2 weeks post-‐treatment, full-‐mouth organoleptic odor scores, level of volatile sulphur compounds (VSC) and the Winkel Tongue Coating Index were recorded. Standardized samples of tongue coating, saliva and subgingival plaque were microbiologically investigated.

Participants were randomly assigned to the test or placebo groups. Results: High prevalences were observed for Fusobacterium nucleatum, Prevotella intermedia and Porphyromonas gingivalis in tongue coating, saliva and subgingival plaque samples. A significant positive correlation between baseline total counts of P. gingivalis in saliva samples and organoleptic and VSC scores was found. Two weeks post-‐treatment there was a reduction in total anaerobic counts in all samples in the test group. A significant positive correlation was observed between the reduction in total counts in saliva samples and the reduction in organoleptic scores in the test group. Significant reductions in total counts and proportions of F. nucleatum and total counts of P. intermedia in tongue coating samples were observed in the test group. Conclusions: The test mouthwash demonstrated efficacy in reducing the microbiological parameters in three oral niches in moderate to severe halitosis patients without periodontitis, and this was correlated with the improvements in organoleptic and VSC scores but not with the tongue coating scores.

Título: The efficacy of amine fluoride/stannous fluoride in the suppression of morning breath odour.

Autores: Quirynen M ; Avontroodt P ; Soers C ; Zhao H ; Pauwels M ; Coucke W ; van Steenberghe D

Fuente: Journal Of Clinical Periodontology [J Clin Periodontol] 2002 Oct; Vol. 29 (10), pp. 944-‐54.

RESUMEN:

Background: Breath odour is a complaint encountered worldwide, often linked to microbial overload in the oral cavity. This double blind, crossover, randomised study assessed the efficacy of several antiseptic mouthrinses or slurry vs. a control solution in the prevention of morning bad breath during an experimental period of 7 days without mechanical plaque control. Methods: Sixteen dental students with a healthy periodontium abolished, after a thorough professional cleaning, all means of mechanical plaque control during five experimental periods of 7 days, interleaved by washout periods of at least 3 weeks. During each experimental period, as the only oral hygiene measure, the students rinsed twice a day with one of the following formulations (in a randomised order): a 0.2% chlorhexidine-‐alcohol mouthrinse (CHX-‐Alc), a 0.05% CHX + 0.05% cetylpyridinium chloride + 0.14% zinc lactate mouthrinse (CHX-‐CPC-‐Zn), an amine fluoride/stannous fluoride (125 ppm F-‐/125 ppm F-‐) containing mouthrinse (AmF/SnF2Mr), a slurry of a tooth paste (AmF/SnF2Sl) containing amine fluoride (350 ppm F-‐) and stannous fluoride (1050 ppm F-‐) and a placebo solution (placebo). At days 0, 3 and 7, morning breath was scored via VSC level measurements of the mouth air, and organoleptic ratings of the mouth air and tongue coating. At the same visits both the degree of gingival inflammation and the de novo plaque formation were rated. At the end of each period a questionnaire for subjective ratings was completed and microbiological samples were taken from the tongue dorsum, the saliva and the supragingival plaque for anaerobic and aerobic

culturing. Results: Although oral hygiene during the experimental periods was limited to rinsing, bad breath parameters systematically improved (P < 0.001) with the three mouthrinses (CHX-‐Alc, CHX-‐CPC-‐Zn, AmF/SnF2Mr), with a superiority of the CHX-‐CPC-‐Zn solution when only VSC values were considered (P < 0.003). The AmF/SnF2 slurry and the placebo solution showed only minor changes with time. The three mouthrinses reduced significantly (P < 0.001) the bacterial load (aerobic & anaerobic) in the saliva (>or= 0.5 log reduction with a superiority (P < 0.005) for the CHX-‐Alc when compared to the two others). Changes in the bacterial load on the tongue dorsum could only be detected for the CHX-‐Alc solution (0.5 log). The antibacterial effect of the placebo solution and the slurry were negligible. The composition of microflora on the other hand did not reveal significant changes. The de novo supragingival plaque formation was significantly (P < 0.05) inhibited by the three mouthrinses with a slight superiority for the CHX-‐Alc solution. The degree of gingival inflammation at day 7 remained low (< 0.16) for all products. The CHX-‐Alc solution scored significantly worse for the subjective evaluation (questionnaires) concerning taste and sensitivity of tongue). Conclusions: The results of this study demonstrate that morning breath odour can be successfully reduced by the sole twice daily use of CHX-‐Alc, CHX-‐CPC-‐Zn or AmF/SnF2Mr mouthrinses, which all significantly reduced the bacterial load in the saliva and retarded the de novo plaque formation.

Título: The impact of periodontal therapy and the adjunctive effect of antiseptics on breath odor-‐related outcome variables: a double-‐blind randomized study.

Autores: Quirynen M ; Zhao H ; Soers C ; Dekeyser C ; Pauwels M ; Coucke W ; Steenberghe Dv

Fuente: Journal Of Periodontology [J Periodontol] 2005 May; Vol. 76 (5), pp. 705-‐12.

RESUMEN:

Background: Bad breath is often caused by periodontitis and/or tongue coating. This study followed the impact of initial periodontal therapy on several halitosis-‐related outcome variables over a 6-‐month period. Organoleptic ratings are often uncomfortable for the patient and have several disadvantages. They are, for instance, influenced by external parameters (e.g., food intake and cosmetics) and need to be calibrated among researchers worldwide. A second aim was to evaluate the reliability of saliva incubation as an in vitro indirect test for breath recording. Methods: In this double-‐blind, randomized, medium-‐term, parallel study 45 moderate periodontitis patients without obvious tongue coating were enrolled. Besides a one-‐stage, full-‐mouth disinfection and oral hygiene improvement (including daily tongue scraping), patients were instructed to rinse daily for 6 months with one of the following products (randomly allocated): chlorhexidine (CHX) 0.2% + alcohol, CHX 0.05% + cetyl pyridinium chloride (CPC) 0.05% without alcohol (a new formulation), or a placebo solution. At baseline and 3 and 6 months, a series of parameters were recorded including: concentration of volatile sulfide compounds (VSC), tongue coating, and an estimation of the microbial load (at anterior and posterior parts of the tongue, saliva, dental plaque). The intraoral VSC ratings were compared

to in vitro VSC recordings and organoleptic evaluations of the headspace air from 1 and 2 hours incubated saliva (0.5 ml, 37 degrees C, anaerobic chamber). Results: Even though the initial VSC values were not high (+/-‐90 ppb with only 18 patients revealing more than 100 ppb), significant (P <0.05) reductions could be achieved in the CHX and CHX + CPC group, and to a lower extent in the placebo group (P = 0.10). Tongue scraping resulted in a significant reduction (P < or =0.05) of the tongue coating up to month 6 in the placebo and CHX + CPC group, but not in the CHX group (confusion due to staining). The CHX and CHX + CPC group showed, in comparison to baseline, significant (P <0.001) reductions in the number of anaerobic species in the supragingival plaque, in the saliva, and on the anterior part of the tongue. For the posterior part of the tongue the microbial changes remained < or =0.3 log values (P >0.05). For the placebo group, the microbial changes never reached a level of significance (< or =0.3 log values). A strong correlation was found between the intraoral VSC ratings and the 1-‐hour (r = 0.48, P <0.0001; r = 0.54, P = 0.0003 for baseline data only) and 2-‐hour (r = 0.43, P <0.0001) VSC production of incubated saliva. The latter also correlated very strongly (r = 0.71) with the number of anaerobic species in the saliva. The VSC values and organoleptic ratings of the incubated saliva also correlated strongly with each other (r = 0.64 for 1-‐hour and 0.73 for 2-‐hour incubation). Conclusions: The results of this study indicate that in patients with moderate periodontitis, initial periodontal therapy including tongue scraping did not have a significant effect on the microbial load of the tongue and had only a weak impact on the VSC level, except when combined with a mouthrinse. Saliva incubation can be used as an indirect way to score breath odor. It offers simplicity, objectivity, and is less invasive.

Título: The portable gas chromatograph OralChroma™: a method of choice to detect oral and extra-‐oral halitosis.



RESUMEN:

It is now generally accepted that the volatile sulfur compounds (VSCs) hydrogen sulfide, methyl mercaptan and dimethyl sulfide are the main contributors to halitosis when of oropharyngeal origin. Gas chromatography using a specific sulfur detector is the most appropriate method to detect halitosis of different origin (intra-‐oral and extra-‐oral halitosis) and should be considered as the gold standard. However, a gas chromatograph is an expensive apparatus and needs trained personnel. The less specific Halimeter is the most used apparatus in halitosis research. In this study a newly developed portable gas chromatograph, the OralChroma™ (Abilit Corporation, Japan), was evaluated for use in the field of halitosis. The results show that the OralChroma is a very sensitive apparatus for measuring VSCs. Just like standard gas chromatography, it can perfectly differentiate between intra-‐oral and extra-‐oral blood-‐borne halitosis, while the Halimeter can only detect intra-‐oral halitosis. The hardware of the OralChroma meets all the needs for becoming the apparatus of choice in the field of

halitosis. However, the software needs a major revision. Sometimes, the concentrations given for the different VSCs are completely incorrect due to a wrong assignment of the place of the VSCs in the chromatogram.

Título: The science of bad breath.


Fuente: Scientific American [Sci Am] 2002 Apr; Vol. 286 (4), pp. 72-‐9.

Título: The short-‐term treatment effects on the microbiota at the dorsum of the tongue in intra-‐oral halitosis patients-‐-‐a randomized clinical trial.

Autores: Ademovski SE ; Persson GR ; Winkel E ; Tangerman A ; Lingström P ; Renvert S

Fuente: Clinical Oral Investigations [Clin Oral Investig] 2013 Mar; Vol. 17 (2), pp. 463-‐73. Date of Electronic Publication: 2012 May 10.

RESUMEN:

Objectives: This study aims to assess the effects of rinsing with zinc-‐ and chlorhexidine-‐containing mouth rinse with or without adjunct tongue scraping on volatile sulfur compounds (VSCs) in breath air, and the microbiota at the dorsum of the tongue. Material and Methods: A randomized single-‐masked controlled clinical trial with a cross-‐over study design over 14 days including 21 subjects was performed. Bacterial samples from the dorsum of the tongue were assayed by checkerboard DNA-‐DNA hybridization. Results: No halitosis (identified by VSC assessments) at day 14 was identified in 12/21 subjects with active rinse alone, in 10/21 with adjunct use of tongue scraper, in 1/21 for negative control rinse alone, and in 3/21 in the control and tongue scraping sequence. At day 14, significantly lower counts were identified only in the active rinse sequence (p < 0.001) for 15/78 species including, Fusobacterium sp., Porphyromonas gingivalis, Pseudomonas aeruginosa, Staphylococcus aureus, and Tannerella forsythia. A decrease in bacteria from baseline to day 14 was found in successfully treated subjects for 9/74 species including: P. gingivalis, Prevotella melaninogenica, S. aureus, and Treponema denticola. Baseline VSC scores were correlated with several bacterial species. The use of a tongue scraper combined with active rinse did not change the levels of VSC compared to rinsing alone. Conclusions: VSC scores were not associated with bacterial counts in samples taken from the dorsum of the tongue. The active rinse alone containing zinc and chlorhexidine had effects on intra-‐oral halitosis and reduced bacterial counts of species associated with malodor. Tongue scraping provided no beneficial effects on the microbiota studied. Clinical Relevance: Periodontally healthy subjects with intra-‐oral halitosis benefit from daily rinsing with zinc-‐ and chlorhexidine-‐containing mouth rinse.

Título: Tongue coating: related factors.

Autores: Van Tornout M ; Dadamio J ; Coucke W ; Quirynen M

Fuente: Journal Of Clinical Periodontology [J Clin Periodontol] 2013 Feb; Vol. 40 (2), pp. 180-‐5. Date of Electronic Publication: 2012 Dec 20.

RESUMEN:

Aim: A clear relationship between tongue coating and oral malodour has been observed in many clinical trials. Why or when this coating is formed remains an open question. The aim of this study was to analyse possible factors related to the presence of tongue coating in a population complaining from oral malodour. Materials and Methods: Patients were recruited from a halitosis clinic (UZ Leuven). Medical history, dietary and oral hygiene habits were retrieved via a questionnaire. Data were recorded on organoleptic score and level of sulphur compounds in breath, anatomical features of the tongue dorsum, amount of tongue coating (according to three indices: Miyazaki, Winkel and modified Winkel), tongue coating wet weight and salivary flow. The correlation between the presence of tongue coating and a series of parameters was analysed. Results: The level of oral hygiene was the strongest determinant factor for the presence of tongue coating. Smoking, presence of a denture, periodontal status and dietary habits also correlated although less obvious. Conclusion: The presence of tongue coating appears to be related to several factors of which oral hygiene is the strongest. (© 2012 John Wiley & Sons A/S.)

Título: Use of n-‐butanol as an odorant to standardize the organoleptic scale of breath odour judges.

Autores: Saad S ; Greenman J ; Duffield J ; Sudlow K


RESUMEN:

Objective: The alcohol n-‐butanol has been recommended for use as a standard odorant by various groups for the training or standardization of breath odour judges and sensory evaluation panels. The objective of this study is to assess the use of n-‐butanol as a suitable odorant for organoleptic training of breath judges. Methods: One judge with full smell acuity was trained in the method of organoleptic assessment using odorant solutions of main chemical classes (acids, amines, indole and sulphides) with the exception of alcohols. The subject was proficient in scoring odorant solutions, standard gas mixtures and human breath using the Rosenberg 0-‐5 organoleptic scale. A wide range of n-‐butanol solutions were prepared from 0 to 90 000 ppm and dispensed as replicate 12-‐ml volumes in Universal bottles (24 ml) leaving a headspace of 12 ml. Sets of odorants were prepared, labelled by code, randomized and presented to the judge in a

completely blind fashion. The judge scored each concentration. This process was repeated on 32 occasions over a period of 12 weeks. Mean values of data for each determination for each concentration series were plotted against the log concentrations of odorant. Linear regression slope analysis was used to measure slope, the 95% CI of slope and the scatter of points (R2 value). Headspace concentrations of odorant were determined using gas chromatography (GC) analysis. Results: The n-‐butanol regression slope gave a high R(2) value (0.971) and low scatter. However, the data did not correspond to other published work using an ASTM method where the range of recommended butanol concentrations was insufficient at both the high and low ends to determine the top and threshold. Moreover, headspace analysis using GC confirmed the published gas concentrations to be in error by a factor of 100. It was also observed that high concentrations of odorants were irritant causing desensitization if used for prolonged periods. Conclusion: The published method had erroneous headspace calculations listed and n-‐butanol could not be recommended as a training odorant because of its irritancy.

Título: Volatile sulphur compounds in morning breath of human volunteers.

Autores: Snel J ; Burgering M ; Smit B ; Noordman W ; Tangerman A ; Winkel EG ; Kleerebezem M

Fuente: Archives Of Oral Biology [Arch Oral Biol] 2011 Jan; Vol. 56 (1), pp. 29-‐34. Date of Electronic Publication: 2010 Sep 24.

RESUMEN:

Objective: morning breath contains elevated concentrations of volatile sulphur components (VSCs). Therefore, morning breath is recognised as a surrogate target for interventions on breath quality. Nevertheless, factors influencing morning breath are poorly understood. Our aim was to evaluate concentrations of VSC at the time of awakening. Methods: a procedure was developed to collect breath samples at home. Intra-‐ and inter-‐person variations were determined in two small studies based on measurements of hydrogen sulphide, methyl mercaptan and dimethyl sulphide in healthy volunteers. Results: highest levels of VSC were found directly after waking up, followed by a significant decline afterward. Considerable day-‐to-‐day variation was found, but could not be linked to dietary intake. A significantly higher concentration of H(2)S and CH(3)SH was observed in the group of female subjects compared to males. Conclusions: when morning breath is used as a target for interventions, breath collected at the time of or shortly after waking up is preferred over breath collected later during the morning. Gender plays an important role in VSC levels, and should be taken into account. (2010 Elservier Ltd. All Rights reserved.)

Título: A combined therapeutic approach to manage oral halitosis: a 3-‐month prospective case series.

Autores: Roldán S ; Herrera D ; O'Connor A ; González I ; Sanz M


RESUMEN:

Background: Clinical research assessing different therapeutic protocols aimed at treating oral halitosis is scarce. The aim of this study was to evaluate the effects of a combined mechanical and pharmacological approach to treat oral halitosis on clinical and microbiological outcomes on patients followed for 3 months. Methods: Nineteen subjects with oral malodor participated. At baseline, all subjects completed a questionnaire and carried out an examination including full-‐mouth organoleptic and volatile sulfur compound (VSC) levels and the Winkel tongue coating index. Standard periodontal outcome variables were assessed at six teeth. Standardized microbiological samples of subgingival plaque, unstimulated saliva, and tongue coating were obtained for culture analysis. The treatment protocol included supragingival prophylaxis; instructions in oral hygiene (toothbrushing, interproximal cleaning, and tongue scraping); and gargling with a mouthrinse containing chlorhexidine, cetylpiridinium chloride, and zinc lactate. The same outcome variables were registered 1 and 3 months after baseline. Results: Statistically significant reductions in organoleptic scores (P <0.001), VSC levels (P <0.05), and tongue coating index (P <0.05) were observed after 1 and 3 months. Mean probing depth and plaque levels also demonstrated significant reductions after 3 months (P <0.05). Total anaerobic counts were significantly reduced at all three locations after 1 month (P <0.05), and in samples from tongue coating and subgingival plaque at 3 months (P <0.05). Aerobic counts were significantly reduced in saliva at 1 month (P <0.05), and the anaerobic/aerobic ratio significantly increased in the tongue samples. Among the selected pathogens evaluated, Porphyromonas gingivalis was the most affected of the three microflora evaluated. Conclusions: The evaluated therapeutic approach demonstrated its efficacy in the management of oral halitosis, demonstrating statistically significant improvements in both organoleptic and VSC values at 1 and 3 months. The proposed clinical protocol significantly affected the microbial composition in tongue coating, saliva, and subgingival microflora.

Título: Biofilms and the tongue: therapeutical approaches for the control of halitosis.

Autores: Roldán S ; Herrera D ; Sanz M

Fuente: Clinical Oral Investigations [Clin Oral Investig] 2003 Dec; Vol. 7 (4), pp. 189-‐97. Date of Electronic Publication: 2003 Sep 26.

RESUMEN:

Due to its location and functions, the tongue is one of the most important anatomic structures in the oral cavity. However, knowledge in regards to its role and implications in oral health and disease is scarce. Moreover, although the dorsum of the tongue seems to harbour one of the most complex microbiological niches in human ecology, the knowledge of the role of tongue

flora in health and disease is also very limited. Similarly, the nature of the tongue coating and the factors that influence its development and composition are almost unknown. The interest in the study of the tongue niche has increased in recent years due to its association with oral halitosis and to its role as a suitable reservoir for periodontal pathogens. The structure of the tongue favours a unique and complex bacterial biofilm, in which periodontal pathogens are frequently found. However, little is known about how to control this bacterial niche, and factors affecting tongue coating composition and aspect are not fully understood. Studies available on the influence of mechanical or antimicrobial approaches against tongue biofilm are very limited. Mechanical treatments showed a transient reduction in halitosis-‐related variables but were limited in time. Different antimicrobials agents have been evaluated: chlorhexidine, chlorine dioxide, metal ions, triclosan, formulations containing essential oils, and hydrogen peroxide. However, most studies were designed as short-‐term models. Some of these studies demonstrated that the reduction in halitosis-‐related variables was associated with significant changes in the tongue microflora.

Título: Comparative effects of different chlorhexidine mouth-‐rinse formulations on volatile sulphur compounds and salivary bacterial counts.

Autores: Roldán S ; Herrera D ; Santa-‐Cruz I ; O'Connor A ; González I ; Sanz M

Fuente: Journal Of Clinical Periodontology [J Clin Periodontol] 2004 Dec; Vol. 31 (12), pp. 1128-‐34.

RESUMEN:

Aim: To compare five different commercial mouth rinses with chlorhexidine (CHX) with respect to their anti-‐halitosis effect and anti-‐microbial activity on salivary bacterial counts, following a standardised research protocol. And secondly, to validate the study model proposed in the evaluation of patients suffering from halitosis. Patients and Methods: Ten volunteers, with a healthy oral status, were enrolled in a double-‐blind, cross-‐over design, using sterile saline as negative control and five CHX-‐containing mouth rinses: 0.12% CHX alone (CHX+NO), plus alcohol (CHX+ALC), plus 0.05% cetylpiridinium chloride (CHX+CPC), plus sodium fluoride (CHX+NaF), and 0.05% CHX plus 0.05% CPC, plus 0.14% zinc lactate (CHX+Zn). The levels of whole-‐mouth volatile sulphur compounds (VSCs) were measured by means of a sulphide monitor at baseline, 1 and 5 h after rinsing with the assigned product. Baseline measurements also included an organoleptic assessment and the recording of the tongue-‐coating index. Aerobic and anaerobic salivary bacterial counts were also obtained by collecting unstimulated saliva samples at the same evaluation times, and processed by culturing techniques. Analysis of variance was used to evaluate whether significant differences existed among groups, at each evaluation point, or in changes between evaluations. Results: No significant differences were detected at baseline, with VSC levels ranging between 190 and 227 parts per billion (p.p.b.) After rinsing, VSC levels were reduced with all products

(except saline), after 1 h. Significant differences at 1 h were detected (p=0.04), corresponding to a lower amount of p.p.b. (109) in (CHX+Zn) as compared with the other groups (except CHX+NO). At 5 h, VSC levels were lower for CHX+CPC and CHX+Zn (155 and 169, respectively), while the other groups showed levels higher than 220 p.p.b. With respect to aerobic salivary bacterial counts, CHX+CPC demonstrated the lowest percentage of survival (6% after 1 h and 18% after 5 h). For anaerobic bacterial counts, again CHX+CPC demonstrated the lowest percentage of survival (10% at 1 h and 23% at 5 h), together with CHX+ALC (18% of survival at 5 h). However, salivary counts and VSCs were only significantly correlated at baseline, but not after treatment. Conclusion: Important differences can be expected from different CHX formulations, in relation to both their anti-‐halitosis effect and anti-‐microbial activity in saliva. Formulations that combine CHX and CPC achieved the best results, and a formulation combining CHX with NaF resulted in the poorest.

Título: Fundamentals of breath malodour.

Autores: Sanz M ; Roldán S ; Herrera D

Fuente: The Journal Of Contemporary Dental Practice [J Contemp Dent Pract] 2001 Nov 15; Vol. 2 (4), pp. 1-‐17. Date of Electronic Publication: 2001 Nov 15.

RESUMEN:

Breath malodour is a condition that has health and social implications. The origin of breath malodour problems are related to both systemic and oral conditions. The advice of dental professionals for treatment of this condition occurs with regularity since 90% of breath odor problems emanate from the oral cavity. This paper provides a comprehensive review of the etiology of breath odor, its prevalence, diagnosis, and treatment strategies for the condition.

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