Epidemiological data on halitosis are rare. In this study we evaluated the prevalence of halitosis in the population of the city of Bern, Switzerland, using a standardized questionnaire and clinical examination. First of all, a standardized questionnaire was filled out by all 419 participants. In the clinical examination, 'objective' values for halitosis were gathered through two different organoleptic assessments and by the measurement of volatile sulfur compounds (VSC). Additionally, tongue coating and the modified periodontal screening index (PSI) were evaluated for each participant. The questionnaire revealed that 32% of all subjects sometimes or often experienced halitosis. The organoleptic evaluation (grade 0-5) identified 48 persons with grade 3 and higher. Measurement of VSC identified 117 subjects (28%) with readings of >or= 75 parts per billion (ppb). Tongue coating, modified PSI, and smoking were significantly associated with higher organoleptic scores, and tongue coating and smoking were associated with higher VSC values. For about one-third of the Bernese city population, halitosis seems to pose an oral health problem. Only a weak correlation between self-reported halitosis and either organoleptic or VSC measurements could be detected.

Background Vaginal epithelium thins during the luteal phase of the menstrual cycle, increasing susceptibility to vaginal infection. Exogenous oestrogen thickens vaginal epithelium in ovariectomized monkeys and protects against SIV transmission. While topical oestrogen has beneficial effects on vaginal health in postmenopausal women, its effects in pre-menopausal women are uncertain. This randomised controlled trial evaluated thickening and maturation effects of estriol cream on vaginal epithelium and changes in microflora in premenopausal women. Methods Eligible women made visits in follicular and luteal phases before and after randomization to estriol cream (1mg estriol/1ml cream) or matching placebo. Women applied 4mg cream 3 times weekly for approximately 6 weeks before follow-up visits. Vaginal biopsies were collected for analysis of epithelial thickness and cell layers. Swabs were collected for Gram stain (scored by Nugent's criteria) and for aerobic and anaerobic bacterial culture. Pearson's t-test was used to compare means, Fishers exact test to compare proportions, and generalised estimating equations to compare person-weeks of cream use to pre-cream person-weeks. Results 102 eligible women were enrolled; 83% (85) completed the study. With estriol, average epithelial thickness increased (27.5 μm, 95% CI 9.7-45.4), as did transitional cell layers (1.3, 95% CI 0.6-2.0), compared to baseline, with no changes among placebo users. E. coli colonisation increased among placebo users compared to baseline (OR 4.9, 95% CI 2.7-8.9), but not among estriol users (OR 0.98, 95% CI 0.4-2.2). The presence of white blood cells decreased only with estriol cream relative to baseline . No serious adverse events were reported and adverse events did not differ by study group. Conclusion Vaginally-applied estriol cream safely increases epithelial thickness in luteal phase, mitigates the E. coli colonisation associated with use of other vaginal products, and has favourable immunological effects. Estriol holds promise to enhance vaginal infection prevention.