Halitosis en otorrinolaringología: una revisión de la literatura / Halitosis in otolaryngology: a review of the literature

RESUMEN La halitosis es un motivo de consulta frecuente y que puede repercutir de gran manera en la calidad de vida de quien la presenta. Puede dividirse en halitosis genuina, pseudohalitosis y halitofobia. De las halitosis genuinas, cerca del 90% son secundarias a patología de la cavidad oral. En otorrinolaringología, las principales causas responden a tonsilolitiasis, patología rinosinusal y cuerpos extraños nasales. Existen distintos métodos diagnósticos que permiten medir e identificar la halitosis, con sus beneficios y desventajas. Las medidas generales de higiene oral, así como intervenciones específicas deben estar basadas en la evidencia a cargo de un equipo multidisciplinario que permita garantizar mejores resultados.

ABSTRACT Halitosis is a frequent health problem, that can have a huge impact in the quality of life of those affected. It can be classified as genuine halitosis, pseudohalitosis and halitophobia. Of genuine halitosis, approximately 90% is originated from the oral cavity. In otorhinolaryngology, most frequent causes are tonsiloliths, rhinosinusitis and nasal foreign bodies. There are different diagnostic methods, each one with its benefits and disadvantages. General measures of oral hygiene, as specific interventions must be evidence-based in charge of a multidisciplinary team that guarantees better results.

Percutaneous ethanol injection as a promising and minimally invasive treatment for axillary osmidrosis: Double-blinded randomized controlled trial

Background: Axillary osmidrosis is a common problem with a strong negative impact on the professional and social quality of life. Several options are available for its treatment. But there are no treatment guidelines. The objective of this study was to evaluate efficacy and safety of percutaneous ethanol injection for treatment of axillary osmidrosis. Methods: A randomized, double-blind, placebo-controlled clinical trial to assess clinical efficacy and postoperative complications of percutaneous ethanol injection was performed among 60 patients (12–35 years of age) with axillary osmidrosis. The active agent used in the experimental group (n = 30) was sterile 90% ethanol and the placebo used in the control group (n = 30) was sterile normal saline administered in an identical syringe. The results of malodor elimination were graded by the patients as excellent, good, fair, and poor. All patients were followed-up for 10 months. Results: Malodor elimination was graded as good by 15 (50%) patients treated with percutaneous ethanol injection. A significant difference in the improvement of axillary osmidrosis was found between the experimental and control groups (P < 0.001). The most common post-procedure complication was transient subjective skin stiffness in the experimental group, which regressed spontaneously. There were no serious permanent side effects. Limitations: Relatively short duration of follow-up; and lack of histopathological evidence of destruction of the apocrine glands after treatment in most patients. Conclusions: Percutaneous ethanol injection is an effective and safe treatment method for axillary osmidrosis and does not have permanent side effects.

Oral malodor-reducing effects by oral feeding of Weissella cibaria CMU in Beagle dogs / 대한수의학회지

This study assessed the effects of Weissella cibaria (W. cibaria) CMU on oral health in male and female beagles (n = 18) by measuring oral malodor and periodontal disease-related parameters (calculus, plaque, and gingivitis indices). Oral malodor and indicators of periodontal disease were assessed in five treatment groups: negative control (scaling and 0.24 mg of maltodextrin, n = 3), positive control (0.24 mg of maltodextrin, n = 3), and W. cibaria CMU groups (each n = 4) at low (CMU-L, 2 × 10⁷ colony forming unit [CFU]), medium (CMU-M, 2 × 10⁸ CFU), and high (CMU-H, 2 × 10⁹ CFU) concentrations. After feeding with W. cibaria CMU for 6 weeks, total volatile sulfur compound concentrations in the CMU-L (2.0 ± 1.04 ng/10 mL), CMU-M (2.4 ± 1.05 ng/10 mL), and CMU-H (2.6 ± 1.33 ng/10 mL)groups were significantly lower than in the positive control group (3.2 ± 1.65 ng/10 mL). Also, CMU-L (1.4 ± 0.83 ng/10 mL) and CMU-H (1.9 ± 1.14 ng/10 mL) groups had methyl mercaptan levels lower than that in the positive control group (2.4 ± 1.21 ng/10 mL) at week 2. The plaque index was significantly lower in the CMU-H group (4.5 ± 0.28) than in the positive control group (5.9 ± 1.08) at week 6. W. cibaria CMU could be useful as a novel oral hygiene probiotics for reducing volatile sulfur compounds production and inhibiting plaque growth in companion animals.

Two mechanisms of oral malodor inhibition by zinc ions

Abstract Objectives The aim of this study was to reveal the mechanisms by which zinc ions inhibit oral malodor. Material and Methods The direct binding of zinc ions to gaseous hydrogen sulfide (H2S) was assessed in comparison with other metal ions. Nine metal chlorides and six metal acetates were examined. To understand the strength of H2S volatilization inhibition, the minimum concentration needed to inhibit H2S volatilization was determined using serial dilution methods. Subsequently, the inhibitory activities of zinc ions on the growth of six oral bacterial strains related to volatile sulfur compound (VSC) production and three strains not related to VSC production were evaluated. Results Aqueous solutions of ZnCl2, CdCl2, CuCl2, (CH3COO)2Zn, (CH3COO)2Cd, (CH3COO)2Cu, and CH3COOAg inhibited H2S volatilization almost entirely. The strengths of H2S volatilization inhibition were in the order Ag+ > Cd2+ > Cu2+ > Zn2+. The effect of zinc ions on the growth of oral bacteria was strain-dependent. Fusobacterium nucleatum ATCC 25586 was the most sensitive, as it was suppressed by medium containing 0.001% zinc ions. Conclusions Zinc ions have an inhibitory effect on oral malodor involving the two mechanisms of direct binding with gaseous H2S and suppressing the growth of VSC-producing oral bacteria.

The effect of oil pulling with rice bran oil, sesame oil, and chlorhexidine mouth rinsing on halitosis among pregnant women: A comparative interventional study.

Context: Rice bran oil, owing to its potential antioxidant benefits, could be an effective and novel alternative to sesame oil for oil pulling. As it is safe and a growingly popular edible oil, it may be acceptable during pregnancy, especially in the Indian context where women may be hesitant to use chemical plaque control methods for preventing halitosis. Aims: The present study was conducted to compare the effects of oil pulling with rice bran oil, oil pulling with sesame oil, and oil pulling with chlorhexidine mouth rinsing on reducing halitosis among pregnant women. Settings and Design: Thirty pregnant women who attended the Gynecology Outpatient Department (OPD) of Muslim Medical Hospital, Haran Khana Road, Pani Gate, Vadodara, Gujarat, India, were recruited in the present randomized double-blind interventional study. Subjects and Methods: Eligible pregnant women individuals who gave consent for the study were randomly allocated to receive the interventions under investigation. Halitosis was measured at baseline and after 14 days of intervention using TANITA breath checker HC-212M-BL. Statistical Analysis Used: Data entry was done in Microsoft Excel 2007, and statistical analysis was performed using SPSS version 17. Wilcoxon signed rank tests were used to interpret the differences in baseline and postintervention halitosis levels. One-way ANOVA was done to compare the mean reduction in halitosis scores of the three intervention groups. Results: There was a statistically significant reduction in the grades of halitosis at baseline and 14 days after intervention for all the three groups. There was no statistically significant difference between chlorhexidine mouth rinsing, oil pulling with sesame oil, and oil pulling with rice bran oil in halitosis reduction. Conclusions: Rice bran oil when used in oil pulling was effective in reducing halitosis. It performed comparably and marginally superior to other agents tested in the study when change in halitosis postintervention was considered.

Malodor reductions and improved oral hygiene by toothbrushing and mouthrinsing.

Objective: This clinical study compared the effects of an antibacterial regimen, comprising a triclosan toothpaste and a 0.075% cetylpyridinium chloride (CPC) mouthrinse, on malodor, self‑reported malodor, and oral hygiene measures such as dental plaque, gingivitis, and bleeding relative to brushing with a fluoride toothpaste. Materials and Methods: At baseline, 36 subjects were evaluated for malodor (9‑point organoleptic scale [OLT]), dental plaque (Turesky modification of Quigley‑Hein; PI), gingivitis (Löe‑Silness; GI) and bleeding (Ainamo and Bay; BI) and randomized to (1) tooth brushing with fluoride toothpaste, or (2) a regimen comprising tooth brushing with a triclosan toothpaste and mouth rinsing with CPC mouthrinse. After the first use of assigned treatments, subjects were evaluated for malodor 2 h after breakfast (OLT‑2 h) and used provided treatments for the next 14 days. On the 7th and 14th days, subjects refrained from oral hygiene for 12 h before evaluations (OLT, PI, GI, and BI) and then performed oral hygiene at the dental clinic. Subjects were evaluated for malodor 2 h after breakfast (OLT‑2 h) and self‑assessed their malodor on a 100 mm visual analog scale (VAS). Results: Treatment groups demonstrated no significant differences in OLT, PI, GI, BI at baseline (P > 0.05). OLT‑2 h scores after the first use of regimen and after tooth brushing alone were 5.94 and 6.21, respectively, and were statistically significantly different (P < 0.05). Correspondingly, the regimen demonstrated progressive reductions in OLT and OLT‑2 h on the 7th and 14th day evaluations (5.81, 4.88, and 5.09, 4.20, respectively) and were significantly lower than after tooth brushing alone (6.49, 6.18, and 6.35, 5.99, respectively) (P < 0.05). From the 7th to 14th days, the regimen also demonstrated progressively lower PI, GI, BI, and self‑reported malodor (VAS scores) which were significantly lower than tooth brushing alone (P < 0.05). Conclusions: Results from this study demonstrated that a regimen comprising a triclosan toothpaste and CPC mouthrinse demonstrated significant malodor reductions 2 h after the first use and progressively increasing reductions in malodor, dental plaque, gingivitis, bleeding and self‑reported malodor from the 7th to 14th days than tooth brushing alone.

Effects of Kaki (Persimmon) Extract-containing Diet on Levels of Volatile Sulfur Compounds in Oral Gas and Feces, as well as on Subjective Fecal Odor, in Healthy Adults / 日本補完代替医療学会誌

<b>Objectives:</b> To examine in two tests the potential of kaki (persimmon) extract-containing diet (KE diet) to reduce malodorous volatile sulfur compounds (VSC), such as hydrogen sulfide (H₂S), methyl mercaptan (CH₃SH) and dimethyl sulfide (CH₃SCH₃), as well as on subjective fecal odor on healthy adults.<br> <b>Methods:</b> In the first test, 11 subjects were given garlic-containing soup. For a period of time, they were given a single dose of KE diet (150 mg as kaki extract) with water, and only water for the rest of the study period. Two hours after the administration, oral gas samples were collected from individual subjects and analyzed for VSC. In the second test, 14 subjects were given a single dose of KE diet for 7 days. Fecal samples were collected from individual subjects before and after the 7-day KE diet intervention. Levels of VSC were determined and the magnitude of subjective fecal odor was estimated based on ratings in the self-administered questionnaire.<br> <b>Results:</b> Levels of CH₃SCH₃ in oral gas were significantly lowered when subjects were on a KE diet. On the other hand, although decreases in the level of any VSC in feces before and after the 7-day KE diet intake did not reach a statistical significance, subjective fecal odor significantly improved by the KE diet intake.<br> <b>Conclusion:</b> KE diet appears to have a beneficial effect on VSC-associated oral malodor and subjective fecal odor.<br>

Using a portable sulfide monitor as a motivational tool: A clinical study.

Aims and Objectives: Bad breath has a significant impact on daily life of those who suffer from it. Oral malodor may rank only behind dental caries and periodontal disease as the cause of patient's visit to dentist. An aim of this study was to use a portable sulfide monitor as a motivational tool for encouraging the patients towards the better oral hygiene by correlating the plaque scores with sulfide monitor scores, and comparing the sulfide monitor scores before and after complete prophylaxis and 3 months after patient motivation. Materials and Methods : 30 patients with chronic periodontitis, having chief complaint of oral malodor participated in this study. At first visit, the plaque scores (P1) and sulfide monitor scores before (BCR1) and after complete oral prophylaxis (BCR2) were taken. Then the patients were motivated towards the better oral hygiene. After 3 months, plaque scores (P2) and sulfide monitor scores (BCR3) were recorded again. Statistical Analysis: It was done using SPSS (student package software for statistical analysis). Paired sample test was performed. Results: Statistically significant reduction in sulfide monitor scores was reported after the complete oral prophylaxis and 3 months after patient motivation. Plaque scores were significantly reduced after a period of 3 months. Plaque scores and breathchecker scores were positively correlated. Conclusion : An intensity of the oral malodor was positively correlated with the plaque scores. The portable sulfide monitor was efficacious in motivating the patients towards the better oral hygiene.

Oral Malodor-A Menace To Periodontist.

Oral malodor significantly affects our daily social life. It affects a large population and is a psychological setback to those suffering from it. This common disease has been really ignored for too long by periodontists, even though the most common cause is related to subgingival microbiota and coating of the tongue. It has been proved that a link exists between oral malodor and periodontal disease. Similar processes exist for the development of oral malodor and the progression of periodontitis. Compounds associated with oral malodor like volatile sulfur compounds (VSC’s) are mainly produced by the gram negative, anaerobic bacteria associated with periodontitis. These VSC may further contribute to the etiology and pathogenesis of periodontal disease, so the purpose of this review article was to correlate the relationship between oral malodor and adult periodontitis.

Unmasking oral malodor: A review.

Oral malodor is one of the major growing concern of patients today as it is fundamental to their overall personality. Although the majority of malodor is of oral origin, there are multiple other systemic causes that have to be addressed. Correct diagnosis of the cause of the malodor and prompt treatment can render the patient satisfied. There have been newer developments in faster and more efficient detection of the levels of malodor, and an array of treatment options are present in the market today. It is crucial for the dentist to have a sound understanding of this prevalent oral condition and provide effective intervention programs. This article reviews the various causes and the diagnostic modalities which will help us treat this multifaceted condition.

Successful management of intractable malodor of a malignant fungating wound with the clindamycin-cadexomer iodine ointment

<b>Purpose</b>: Since malodor of a malignant fungating wound decreases quality of life of patients, its management is important. Metronidazol ointment, clindamycin ointment, and cadexomer iodine ointment have been used for treatment of malodor of a malignant fungating wound because they have antibacterial activity for anaerobic bacteria. Nevertheless, management of malodor of a malignant fungating wound has been unsatisfactory and it needs improvement. <b>Methods</b>: A mixture ointment of clindamycin and cadexomer iodine was employed in a case with malodor of a malignant fungating wound that had not been successfully controlled by cadexomer iodine ointment. <b>Results</b>: Malodor and exudate of a malignant fungating wound reduced. In addition, no adverse event such as skin troubles was observed and it was used safely. <b>Conclusions</b>: It was suggested that the clindamycin-cadexomer iodine ointment was more effective for treatment of refractory malodor of a malignant fungating wound than cadexomer iodine ointment.

Detection of odoriferous subgingival and tongue microbiota in diabetic and nondiabetic patients with oral malodor using polymerase chain reaction.

Background: Halitosis has been correlated with the concentration of volatile sulfur compounds (VSCs) produced in the oral cavity by metabolic activity of bacteria colonizing the periodontal pockets and the dorsum of the tongue. It has been assumed that there is a relationship between periodontal disease and diabetes mellitus. Objectives: The aim of the study was to assess the malodor using the organoleptic method and tanita device; to quantify odoriferous microorganisms of subgingival plaque and tongue coating, such as P. gingivalis (Pg), T. forsythia (Tf), and F. nucleatum (Fn) using polymerase chain reaction (PCR) in nondiabetic and diabetic chronic periodontitis patients. Patients and Methods: Thirty chronic periodontitis patients (with and without diabetes) with 5-7 mm pocket depth, radiographic evidence of bone loss, and presence of oral malodor participated in this study. Subjective assessment of mouth air was done organoleptically and by using a portable sulfide monitor. Tongue coating was also assessed. Results: The scores of plaque index, gingival index, gingival bleeding index, VSC levels, and tongue coating between the nondiabetic and diabetic patients were not significant (P>0.5). In nondiabetic patients, Fn was found to be significantly (P<0.5) more in tongue samples, whereas Pg and Tf have not shown significant values (P>0.5). In diabetic patients, Fn and Tf have shown significant (P<0.5) an increase in subgingival and tongue samples, respectively, whereas Pg has not shown significant difference between subgingival and tongue samples. Interpretation and Conclusion: The results confirm that there is no difference in clinical parameters between nondiabetic and diabetic periodontitis patients, but the odoriferous microbial profiles in tongue samples of diabetic patients were found to be high. However, there is a weak positive correlation between VSC levels, clinical parameters, and odoriferous microbial profiles.

A patient in whom metronidazole was effective for cancerous malodor related to pleural metastasis, involving the thoracic wall, from gastric cancer

Dermal ulcers related to infiltration of advanced cancer often release destruction-associated effluvia (cancerous malodor). We encountered a patient in whom metronidazole (MTZ) was effective for cancerous malodor at the dermal ulcer site related to pleural metastasis, involving the thoracic wall, from gastric cancer. The patient was a male in his 60's. As left subphrenic abscess associated with suture failure at the anastomotic site after surgery for gastric cancer led to pyothorax via the transdiaphragmatic route, a thoracic drain was inserted. Furthermore, bilateral pulmonary metastases and pleural dissemination were detected. Subsequently, the metastatic pleural focus infiltrated the thoracic wall via the space between the thoracic drain and chest wall. Its destruction resulted in fetid ulcer formation. The application of MTZ ointment relieved cancerous malodor. In addition to assessment using an odorimeter, the patient's subjective evaluation-based score confirmed the efficacy of this agent. Palliat Care Res 2009; 4(2): 339-345

Halitosis: a review of basic principles

Halitosis, also known as bad breath or oral malodor, is the general term used to describe any disagreeable odor in expired air, regardless of whether the odorous substances originate from oral or non-oral sources. Bad breath can be detrimental to one’s self-image and confidence, causing social, emotional and psychological anxiety. This paper provides a comprehensive review of the historical background, prevalence, social aspects and pathological causes of halitosis as well as the dental professional’s responsibility.

The effect of tongue cleaner-equipped manual toothbrush on tooth and tongue cleanness and malodor index / 대한치주과학회지

PURPOSE: The aim of this study was to investigate the effect of tongue cleaner-equipped manual toothbrush on tooth cleanness, tongue cleanness and malodor index. MATERIALS AND METHODS: 504 subjects were included in this study. At 1st visit, basic information such as age, sex, smoking amount and alcohol consumption was recorded. Self assessment by individual subjects was performed regarding satisfaction to old toothbrush and toothbrushing habit. Tooth cleanness, tongue cleanness and malodor index was assessed by professional researcher. Tongue cleaner-equipped manual toothbrush was given to each subject with proper toothbrushing instruction. After 1 month passed, self assessment and researcher assessment regarding the same index were performed and analyzed statistically by chi-square test. RESULTS: At 1st visit subjects seem to ignore tongue cleansing and showed poor tooth cleanness index, tongue cleanness index and malodor index, however the same subjects were motivated to clean their tongue and teeth and presented statistically improved distribution pattern in tooth cleanness index, tongue cleanness index and malodor index after using tongue cleaner-equipped manual toothbrush(p<0.01). Satisfaction to tongue cleaner-equipped manual toothbrush was 98%. CONCLUSION: Tongue cleaner-equipped manual toothbrush would be an effective tool for maintaining good oral hygiene through improving tooth and tongue cleanness and preventing malodor formation.

Clinical efficacy of the external preparation Metronidazole in the treatment of malodor associated with advanced and recurrent breast cancer

The external preparation Metronidazole (MTZ) is reported to be useful in controlling the malodor associated with advanced and recurrent breast cancer patients. We prepared two different MTZ external preparations, a 1% MTZ Hydrophilic Ointment and a 0.8% MTZ Carbopol Gel. These preparations were then used to control malodor associated with breast cancer and the results were clinically evaluated. Malodor disappeared within 1 week of administration of either preparation and no adverse reactions were observed. These MTZ external preparations were thus found to be useful in the elimination of malodor as part of the treatment of those patients with advanced and recurrent breast cancer.

The change of oral volatile sulfur compounds(VSC) concentration after periodontal treatment / 대한치주과학회지

Oral malodor may cause a significant social or psychological handicap to those suffering from it. Oral malodor has been correlated with the concentration of volatile sulfur compounds (VSC) produced in the oral cavity. Specific bacteria identified in the production of VSC have been reported and many of these bacteria are commonly suspected periodontal pathogens. The aim of this study was to estimate the change of the VSC concentration after periodontal treatment. Twenty subjects with probing depth (PD) > or =5mm (experimental group) and 20 subjects with PD <5mm (control group) participated. VSC concentration measurement was made with gas chromatography. VSC concentration was measured at pre-treatment, 2 weeks after scaling and 1 month after periodontal treatment(root planning and flap operation). Maximum probing depth and bleeding on probing(BOP) were also examed at pretreatment and 1 month after periodontal treatment. The conclusions were as follow: 1. In the experimental group VSC concentration and CH3SH/H2S ratio were higher than control group. (p<0.05) 2. Both VSC concentration and CH3SH/H2S ratio showed decrease after periodontal treatment. But only CH3SH/H2S ratio after 1 month periodontal treatment was statistically significantly different from pre-treatment. (p<0.05) 3. CH3SH/H2S ratio tended to be on increase according to maximum probing depth and bleeding on probing. Periodontal disease could be a factor that caused oral malodor and oral malodor could be decreased after periodontal treatment.

The effect of a full mouth disinfection on oral malodor in chronic periodontitis patients / 대한치주과학회지

Halitosis, defined as an unpleasant oral odor, is a commonly experienced condition with a variety of etiological factors and may cause a significant social or psychological handicap to those suffering from it. In most cases, halitosis originates within the oral cavity itself and patients with periodontal disease often suffer from oral malodor. The most common cause of this disease is related to microbiota which reside on the tongue and in the periodontal pocket. This study was undertaken to examine the effect of full mouth disinfection including tongue scraping on oral malodor in a group of patients with chronic periodontitis. The relationship between halitosis and oral health status was also investigated. The volatile sulfur compounds (VSC) scores were significantly correlated with Plaque Index, Bleeding Index, pocket depth, and tongue coating score. The organoleptic ratings were significantly associated with Plaque Index, Bleeding Index, and tongue coating score. The VSC scores and organoleptic ratings correlated strongly with each other. Full mouth disinfection resulted in a significant reduction in the VSC scores, organoleptic ratings, and self-perception of malodor up to 12 weeks. This study indicates that in patients with chronic periodontitis, a full mouth disinfection including tongue scraping has a significant effect in the treatment of oral malodor.