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.

Determination of Volatile Sulfur Compounds in Seawater and Atmosphere / 分析化学

Volatile sulfur compounds ( VSCs) in the marine environment has significant implications for global climate change. In the present study, a gas chromatographic analytical method was set up to determine the concentrations of VSCs in seawater and atmosphere, and the optimized experimental conditions were established. For the analysis of VSCs in atmosphere, multistage traps and gas chromatography-mass spectrometry ( GC-MS ) were used, with the precisions of 7. 7% -15. 1% and the detection limits of 0. 23-4. 7 ng. Moreover, for the analyses of VSCs in seawater, pre-concentration and gas chromatography coupled with flame photometric detector ( GC-FPD) were utilized, with the precisions of 3. 5%-5. 3% and the detection limits of 2. 5-3. 5 ng. This method was applied to analyze the VSCs in Qingdao coastal seawater and atmosphere, and the average concentrations of carbonyl sulfide, dimethyl sulfide and carbon disulfide in the seawater were (268 ± 58 ) , ( 1264 ± 278 ) , ( 19 ± 2 ) pmol/L, and ( 543 ± 39 ) , ( 29 ± 9 ) , ( 56 ± 20 ) ( ×10-12 , V/V) in the atmosphere, respectively.

Determination of Volatile Sulfur Compounds in Seawater and Atmosphere / 分析化学

Volatile sulfur compounds ( VSCs) in the marine environment has significant implications for global climate change. In the present study, a gas chromatographic analytical method was set up to determine the concentrations of VSCs in seawater and atmosphere, and the optimized experimental conditions were established. For the analysis of VSCs in atmosphere, multistage traps and gas chromatography-mass spectrometry ( GC-MS ) were used, with the precisions of 7. 7% -15. 1% and the detection limits of 0. 23-4. 7 ng. Moreover, for the analyses of VSCs in seawater, pre-concentration and gas chromatography coupled with flame photometric detector ( GC-FPD) were utilized, with the precisions of 3. 5%-5. 3% and the detection limits of 2. 5-3. 5 ng. This method was applied to analyze the VSCs in Qingdao coastal seawater and atmosphere, and the average concentrations of carbonyl sulfide, dimethyl sulfide and carbon disulfide in the seawater were (268 ± 58 ) , ( 1264 ± 278 ) , ( 19 ± 2 ) pmol/L, and ( 543 ± 39 ) , ( 29 ± 9 ) , ( 56 ± 20 ) ( ×10-12 , V/V) in the atmosphere, respectively.

Beneficial Effects of Lactobacillus casei ATCC 334 on Halitosis Induced by Periodontopathogens

Halitosis is caused by consumption of certain foods or drinks and production of volatile sulfur compounds (VSCs) by periodontopathogens. VSCs-related halitosis is not easily removed using mechanical or chemical therapies such as dental floss, plaque control and mouth rinse. Lactobacillus are known to be probiotics and stimulate immune systems of human. Furthermore, L. casei ATCC 334 and L. rhamnosus GG have an effect on protection of dental caries in vitro studies. The aim of this study was to investigate effect of Lactobacillus on halitosis by Fusobacterium nucleatum- and Porphyromonas gingivalis- producing VSCs and to analyze inhibitory mechanism. The periodontopathogens were cultivated in the presence or the absence Lactobacillus, and the level of VSCs was measured by gas chromatograph. For analysis of inhibitory mechanisms, the susceptibility assay of the spent culture medium of Lactobacillus against F. nucleatum and P. gingivalis was investigated. Also, the spent culture medium of Lactobacillus and periodontopathogens were mixed, and the emission of VSCs from the spent culture medium was measured by gas chromatograph. L. casei and L. rhamnosus significantly reduced production of VSCs. L. casei and L. rhamnosus exhibited strong antibacterial activity against F. nucleatum and P. gingivalis. The spent culture medium of L. casei inhibited to emit gaseous hydrogen sulfide, methyl mercaptan and dimethyl sulfide from the spent culture medium of periodontopathogens. However, the spent medium of L. rhamnosus repressed only dimethyl sulfide. L. casei ATCC 334 may improve halitosis by growth inhibition of periodontopathogens and reduction of VSCs emission.

Relación entre los niveles de compuestos volátiles sulfurados con los niveles de RANKL y OPG en pacientes con periodontitis crónica moderada o severa: estudio transversal / Relationship between the levels of volatile sulfur compounds with the levels of RANKL and OPG in patients with moderate or severe periodontitis: A cross sectional study

Antecedentes: El efecto de los Compuestos Volátiles Sulfurados (CVS) sobre los tejidos periodontales, específicamente a nivel del eje RANKL/OPG, no ha sido dilucidado y en la actualidad existe escasa literatura al respecto publicada. Objetivo: Evaluar si los CVS medidos en la cavidad oral de pacientes con periodontitis crónica moderada a severa se relacionan con la expresión de RANKL y OPG a nivel de fluido gingival crevicular (FGC). Método: Se realizó un estudio transversal con 71 pacientes derivados de la Unidad de Diagnóstico de la Clínica Odontológica Docente Asistencial de la Universidad de los Andes. Posterior a la realización de un examen periodontal completo se tomaron muestra de los niveles de CVS de la boca de los pacientes mediante un monitor de sulfuros y muestras de FGC para evaluar los niveles de RANKL y OPG mediante test de ELISA. Los datos obtenidos fueron analizados mediante test de correlación de Spearman. Resultados: Al evaluar la correlación de los niveles de CVS con los niveles de RANKL, OPG y la razón RANKL/OPG, se observó un R de 0.098 con un p value = 0.41; -0.084 con un p value= 0.48 y 0.067 con un p value = 0.57 respectivamente. Conclusiones: El presente estudio no pudo demostrar si existe una relación entre los niveles de CVS con la expresión de RANKL y OPG en el FGC de pacientes con periodontitis crónica.

Background: The effect of the Volatile Sulfur Compounds (VSC) on the periodontal tissues, specifically at the RANKL/OPG level has not been elucidate and there is little literature published on this subject. Aim: To explore if the VSC levels measured in the oral cavity of patients with moderate or severe chronic periodontitis are correlated with the expression of RANKL and OPG at the gingival fluid level (GF). Method: A cross-sectional study was conducted with 71 patients referred by the Universidad de los Andes’s dentistry diagnosis department. After undergoing full-mouth periodontal exam, levels of CVS were recorded using a sulfur monitor and then GF was extracted to assess RANKL and OPG levels with ELISA. Data was analyzed with Spearman correlation test. Results: The correlation (R) between the VSC and the GF levels was 0.098 with a p value = 0.41; -0.084 with a p value = 0.48 y 0.067 with a p value = 0.57 respectively. Conclusions: This study could not demonstrate if there is a relation between the VSC levels and the expression of RANKL and OPG in the GF in patients with chronic periodontitis.

Efeito do tratamento periodontal full-mouth e convencional na redução da halitose / Effect of periodontal treatment full-mouth and conventional in the reduction of halitosis

A halitose se caracterizada pela emanação de um odor desagradável onde cerca de 90% de se origina dentro da cavidade oral. Estudos têm demonstrado uma relação direta entre a doença periodontal e o odor ofensivo do hálito. O presente estudo teve como objetivo avaliar a frequência e distribuição de halitose em um grupo de pacientes com doença periodontal em um estudo transversal observacional (n=112) e, em um estudo intervencionista, avaliar o efeito do tratamento periodontal full-mouth e convencional na redução da halitose em um grupo de pacientes com doença periodontal. Os pacientes responderam a uma anamnese, tiveram seu hálito mensurado pelo halímetro e teste organoléptico, além de realizados Índice de placa visível, Índice de sangramento gengival, Índice de saburra lingual e exame periodontal completo. No estudo 2, os pacientes foram submetidos a seis distintas formas de tratamento: terapia periodontal em sessão única, terapia convencional em quadrantes e, um grupo controle, com somente instrução de higiene oral. Todas as modalidades subdivididas: com e sem raspagem lingual diária. No primeiro estudo os resultados mostraram que, tanto para teste organoléptico quanto para o halímetro, houve maior grau de halitose nos grupos de idades mais avançadas, nos que relataram sangramento gengival e escovação menos que três vezes ao dia. Ainda no teste organoléptico a escovação de língua gerou diferença estatística. Não houve diferença estatística entre as medidas de halitose entre teste organoléptico e halímetro. Foram encontrados aproximadamente 75% de pacientes periodontais com halitose. No segundo estudo os resultados mostraram superioridade conforme análise do halímetro para 30, 60 e 90 dias para os grupos de raspagem em sessão única contra raspagem por quadrantes. Sendo todos os grupos superiores ao controle. Não houve diferença na abordagem com ou sem a raspagem de língua. De acordo com o teste ...

Halitosis is characterized by the emission of an unpleasant odor about 90% originates in the oral cavity. Studies have shown a direct relationship between periodontal disease and the offensive odor of breath. The present study aimed to determine the prevalence of halitosis in patients with periodontal disease in an observational cross-sectional study (n = 112) and, in an intervention study, the patients have had six distinct forms of treatment (n = 90) to verify the efficacy of full- vs. partial-mouth disinfection in the control of halitosis. Patients answered an interview, they have had their breath collected by halimeter, they have evaluated by organoleptic test, and visible plaque index, gingival bleeding index, index of tongue coating and periodontal examination. In the second step, patients have been submitted to six different forms of treatment: periodontal therapy in one session, conventional therapy in quadrants, and the control group, with only oral hygiene instruction. All types split: with and without tongue scraping daily. The first study results shown for both organoleptic test as halimeter, a greater degree of halitosis in the older age groups, we have reported that gum bleeding and brushing less than three times per day. Still in organoleptic test brushing of tongue generated statistical difference. There was no statistical difference between the measures between halitosis and organoleptic test halimeter. There was about 75% og periodontal patients with halitosis. In the second study the results shown the superiority analysis as halimeter for 30, 60 and 90 days for groups of scraping in single session against scraping by quadrants. Being all groups superior from control. There was no difference in approach with or without tongue scraping. According to the organoleptic test, there was no difference between the four types of periodontal treatment compared to the control groups. The same ...

Efeito do tratamento periodontal full-mouth e convencional na redução da halitose / Effect of periodontal treatment full-mouth and conventional in the reduction of halitosis

A halitose se caracterizada pela emanação de um odor desagradável onde cerca de 90% de se origina dentro da cavidade oral. Estudos têm demonstrado uma relação direta entre a doença periodontal e o odor ofensivo do hálito. O presente estudo teve como objetivo avaliar a frequência e distribuição de halitose em um grupo de pacientes com doença periodontal em um estudo transversal observacional (n=112) e, em um estudo intervencionista, avaliar o efeito do tratamento periodontal full-mouth e convencional na redução da halitose em um grupo de pacientes com doença periodontal. Os pacientes responderam a uma anamnese, tiveram seu hálito mensurado pelo halímetro e teste organoléptico, além de realizados Índice de placa visível, Índice de sangramento gengival, Índice de saburra lingual e exame periodontal completo. No estudo 2, os pacientes foram submetidos a seis distintas formas de tratamento: terapia periodontal em sessão única, terapia convencional em quadrantes e, um grupo controle, com somente instrução de higiene oral. Todas as modalidades subdivididas: com e sem raspagem lingual diária. No primeiro estudo os resultados mostraram que, tanto para teste organoléptico quanto para o halímetro, houve maior grau de halitose nos grupos de idades mais avançadas, nos que relataram sangramento gengival e escovação menos que três vezes ao dia. Ainda no teste organoléptico a escovação de língua gerou diferença estatística. Não houve diferença estatística entre as medidas de halitose entre teste organoléptico e halímetro. Foram encontrados aproximadamente 75% de pacientes periodontais com halitose. No segundo estudo os resultados mostraram superioridade conforme análise do halímetro para 30, 60 e 90 dias para os grupos de raspagem em sessão única contra raspagem por quadrantes. Sendo todos os grupos superiores ao controle. Não houve diferença na abordagem com ou sem a raspagem de língua. De acordo com o teste...

Halitosis is characterized by the emission of an unpleasant odor about 90% originates in the oral cavity. Studies have shown a direct relationship between periodontal disease and the offensive odor of breath. The present study aimed to determine the prevalence of halitosis in patients with periodontal disease in an observational cross-sectional study (n = 112) and, in an intervention study, the patients have had six distinct forms of treatment (n = 90) to verify the efficacy of full- vs. partial-mouth disinfection in the control of halitosis. Patients answered an interview, they have had their breath collected by halimeter, they have evaluated by organoleptic test, and visible plaque index, gingival bleeding index, index of tongue coating and periodontal examination. In the second step, patients have been submitted to six different forms of treatment: periodontal therapy in one session, conventional therapy in quadrants, and the control group, with only oral hygiene instruction. All types split: with and without tongue scraping daily. The first study results shown for both organoleptic test as halimeter, a greater degree of halitosis in the older age groups, we have reported that gum bleeding and brushing less than three times per day. Still in organoleptic test brushing of tongue generated statistical difference. There was no statistical difference between the measures between halitosis and organoleptic test halimeter. There was about 75% og periodontal patients with halitosis. In the second study the results shown the superiority analysis as halimeter for 30, 60 and 90 days for groups of scraping in single session against scraping by quadrants. Being all groups superior from control. There was no difference in approach with or without tongue scraping. According to the organoleptic test, there was no difference between the four types of periodontal treatment compared to the control groups. The same...

Flavoring agents present in a dentifrice can modify volatile sulphur compounds (VSCs) formation in morning bad breath

This study aimed to evaluate the effects of a flavor-containing dentifrice on the formation of volatile sulphur compounds (VSCs) in morning bad breath. A two-step, blinded, crossover, randomized study was carried out in 50 dental students with a healthy periodontium divided into two experimental groups: flavor-containing dentifrice (test) and non-flavor-containing dentifrice (control). The volunteers received the designated dentifrice and a new toothbrush for a 3 X/day brushing regimen for 2 periods of 30 days. A seven-day washout interval was used between the periods. The assessed parameters were: plaque index (PI), gingival index (GI), organoleptic breath scores (ORG), VSC levels (as measured by a portable sulphide monitor) before (H1) and after (H2) cleaning of the tongue, tongue coating (TC) wet weight and BANA test from TC samples. The intra-group analysis showed a decrease in ORG, from 3 to 2, after 30 days for the test group (p < 0.05). The inter-group analysis showed lower values in ORG, H1 and H2 for the test group (p < 0.05). There was no difference between the amount of TC between groups and the presence of flavor also did not interfere in the BANA results between groups (p > 0.05). These findings suggest that a flavor-containing dentifrice seems to prevent VSCs formation in morning bad breath regardless of the amount of TC in periodontally healthy subjects.

La Halitosis: Definición, clasificación y factores etiológicos / The halitosis. Definition, classification and etiologic factors

Halitosis es el término empleado para describir el aliento desagradable producto de factores fisiológicos o patológicos, de origen bucal o sistémico. Se ha clasificado en tres categorías: halitosis verdadera, pseudohalitosis y halitofobia. La halitosis verdadera se subclasifica en halitosis fisiológica y halitosis patológica, esta última, a su vez, se clasifica, según su origen, en bucal y extrabucal. Los factores etiológicos se describen a través de la relación entre el patógeno, el huésped y el sustrato. La causa principal de esta condición es la putrefacción de sustratos proteicos, principalmente, por parte de los microorganismos gramnegativos. Esto genera compuestos sulfúricos volátiles, que constituyen los componentes más fétidos del mal aliento. Actualmente, se cree que los compuestos sulfúricos volátiles son responsables de la halitosis. Existe evidencia que demuestra que los compuestos sulfúricos volátiles resultan altamente tóxicos para los tejidos, aún en bajas concentraciones. La alteración de los tejidos del huésped favorece el establecimiento de un círculo vicioso que perpetúa el problema.

Halitosis is the term used to describe the unpleasant product of physiologic or pathological factors, of buccal or systemic origin. It has been classified in three categories: true halitosis, pseudohalitosis and halitofobia. The true halitosis is classified in physiologic halitosis and pathological halitosis, this last one, in turn, is classified, according to their origin, in buccal and extrabucal. The etiologic factors are described through the relationship among the pathogen one, the guest and the basis. The main cause of this condition is the rot of bases proteicos, mainly, on the part of the microorganism gramnegativos. This generates compound sulfuric volatile that constitutes the most fetid components in the halitosis. At the moment, it is believed that the volatile sulfuric compounds are responsible for the halitosis. There is evidence that demonstrates that the volatile sulfuric compounds are highly toxic for the tissues, still in low concentrations. The alteration of the guest tissues favors the establishment of a vicious circle that perpetuates the problem.

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.