Halitosis, bad breath or oral malodour are all synonyms for the same pathology. Halitosis has a large social and economic impact. For the majority of patients suffering from bad breath, it causes embarrassment and affects their social communication and life. Moreover,halitosis can be indicative of underlying diseases. Only a limited number of scientific publications were presented in this field until 1995. Ever since, a large amount of research is published, often with lack of evidence. In general, intraoral conditions, like insufficient dental hygiene, periodontitis or tongue coating are considered to be the most important cause (85%) for halitosis. Therefore, dentists and periodontologists are the first-line professionals to be confronted with this problem. They should be well aware of the origin, the detection and especially of the treatment of this pathology. In addition, ear-nose-throat-associated (10%) or gastrointestinal/endocrinological (5%) disorders may contribute to the problem. In the case of halitophobia, psychiatrical or psychological problems may be present. Bad breath needs a multidisciplinary team approach: dentists, periodontologists, specialists in family medicine, ear-nose-throat surgeons, internal medicine and psychiatry need to be updated in this field, which still is surrounded by a large taboo.Multidisciplinary bad breath clinics offer the best environment to examine and treat this pathology that affects around 25% of the whole population. This article describes the origin, detection and treatment of halitosis, regarded from the different etiological origins.

/pdf/halitosis-the-multidisciplinary-approach-59xkqxawn8.pdf

Halitosis: the multidisciplinary approach.

Objective The objective of this study was to evaluate whether oral administration of lactobacilli alters the degree of halitosis and clinical conditions associated with halitosis. Study design Twenty patients with genuine halitosis were given 2.0 × 109Lactobacillus salivarius WB21 and xylitol in tablet form daily. Oral malodor and clinical parameters were evaluated at the same time of day for each patient after 2 and 4 weeks. Results All 20 patients were positive for L. salivarius DNA in their saliva at 2 weeks, although 12 patients were negative for this organism at baseline. Oral malodor parameters significantly decreased at 2 weeks in the subjects with physiologic halitosis. The scores of an organoleptic test and bleeding on probing significantly decreased at 4 weeks in the subjects with oral pathologic halitosis. Conclusions Oral administration of probiotic lactobacilli primarily improved physiologic halitosis and also showed beneficial effects on bleeding on probing from the periodontal pocket.

http://tanabe-hozonshika.jp/images/pdf/20100301.pdf

Effects of probiotic Lactobacillus salivarius WB21 on halitosis and oral health: an open-label pilot trial.

Continuous monitoring of hydrogen sulfide (H2S) in human breath for early stage diagnosis of halitosis is of great significance for prevention of dental diseases. However, fabrication of a highly selective and sensitive H2S gas sensor material still remains a challenge, and direct analysis of real breath samples has not been properly attempted, to the best of our knowledge. To address the issue, herein, we introduce facile cofunctionalization of WO3 nanofibers with alkaline metal (Na) and noble metal (Pt) catalysts via the simple addition of sodium chloride (NaCl) and Pt nanoparticles (NPs), followed by electrospinning process. The Na-doping and Pt NPs decoration in WO3 grains induces the partial evolution of the Na2W4O13 phase, causing the buildup of Pt/Na2W4O13/WO3 multi-interface heterojunctions that selectively interacts with sulfur-containing species. As a result, we achieved the highest-ranked sensing performances, that is, response (Rair/Rgas) = 780 @ 1 ppm and selectivity (RH2S/REtOH) = 277 against 1 ppm ethanol, among the chemiresistor-based H2S sensors, owing to the synergistic chemical and electronic sensitization effects of the Pt NP/Na compound cocatalysts. The as-prepared sensing layer was proven to be practically effective for direct, and quantitative halitosis analysis based on the correlation (accuracy = 86.3%) between the H2S concentration measured using the direct breath signals obtained by our test device (80 cases) and gas chromatography. This study offers possibilities for direct, highly reliable and rapid detection of H2S in real human breath without the need of any collection or filtering equipment.

Surface Activity-Tuned Metal Oxide Chemiresistor: Toward Direct and Quantitative Halitosis Diagnosis.

Background: The mouth cavity hosts various types of anaerobic bacteria including Porphyromonas gingivalis, which causes periodontal inflammatory diseases. P. gingivalis is a gram-negative oral anaerobe and is considered as a main etiological factor in periodontal diseases. Several studies have reported a relationship between P. gingivalis in individuals with periodontal diseases and a critical role of this bacterium in the pathogenesis of periodontal diseases. The present study aimed at estimating this probability using a meta-analysis. Methods: We searched several databases including PubMed, Scopus, Google Scholar, and Web of Science to identify case-control studies addressing the relationship between P. gingivalis with periodontal diseases. A total of 49 reports published from different countries from 1993 to 2014 were included in this study. I² (heterogeneity index) statistics were calculated to examine heterogeneity. Data were analyzed using STATA Version 11. Results: After a detailed analysis of the selected articles, 49 case-control studies with 5924 individuals fulfilled the inclusion criteria for the meta-analysis. The healthy controls included 2600 healthy individuals with a Mean±SD age of 36.56±7.45 years. The periodontal diseases group included 3356 patients with a mean age of 43.62±8.35 years. There was a statistically significant difference between P. gingivalis in periodontal patients and healthy controls; 9.24 (95% CI: 5.78 to 14.77; P = 0.000). In the other word, there was a significant relationship between the presence of P. gingivalis and periodontal diseases. Conclusion: Analyzing the results of the present study, we found a strong association between the presence of P. gingivalis and periodontal diseases. This result suggests that another research is needed to further assess this subject.

/pdf/study-of-porphyromonas-gingivalis-in-periodontal-diseases-a-5bihbfsuuw.pdf

Study of Porphyromonas gingivalis in periodontal diseases: A systematic review and meta-analysis.

BACKGROUND: Halitosis is a common human condition for which the exact pathophysiological mechanism is unclear. It has been attributed mainly to oral pathologies. Halitosis resulting from gastrointestinal disorders is considered to be extremely rare. However, halitosis has often been reported among the symptoms related to Helicobacter pylori infection and gastroesophageal reflux disease.

/pdf/the-gastrointestinal-aspects-of-halitosis-57rel6z45i.pdf

The gastrointestinal aspects of halitosis

Helicobacter pylori infection, which causes peptic ulcers and gastric cancer, is considered a possible cause of halitosis. Recently, the oral cavity was identified as a possible H. pylori reservoir, particularly in the presence of periodontal disease, which is a cause of halitosis. The purpose of this study was to evaluate by PCR the prevalence of oral H. pylori in the saliva of subjects complaining of halitosis. Samples were obtained from 326 non-dyspeptic subjects, comprising 251 subjects with actual malodour and 75 subjects without halitosis. DNA was extracted from the samples, and the presence of H. pylori and periodontopathic bacteria including Porphyromonas gingivalis, Treponema denticola and Prevotella intermedia was examined by PCR. H. pylori was detected in 21 (6.4 %) of 326 samples. The methyl mercaptan concentration and periodontal parameters including tooth mobility, periodontal pocket depth (PPD) and occult blood in the saliva were significantly greater in the H. pylori-positive subjects. Each of the periodontopathic bacteria was also detected at a significantly higher frequency in the H. pylori-positive subjects. Among those patients with a PPD of ≥5 mm and a tongue coating score of ≤2, no difference was observed in oral malodour levels between the H. pylori-positive and -negative subjects. However, the presence of occult blood in the saliva and the prevalence of Prevotella intermedia were significantly greater in the H. pylori-positive subjects. H. pylori was detected in 16 (15.7 %) of 102 subjects with periodontitis, suggesting that progression of periodontal pocket and inflammation may favour colonization by this species and that H. pylori infection may be indirectly associated with oral pathological halitosis following periodontitis.

/pdf/detection-of-helicobacter-pylori-dna-in-the-saliva-of-2j9p8e1psa.pdf

Detection of Helicobacter pylori DNA in the saliva of patients complaining of halitosis.

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Detection of Helicobacter pylori DNA in the saliva of patients complaining of halitosis.