Clinical evaluation of 222 Iranian patients with halitosis

Abstract

The primary objectives of the study were to investigate the levels of volatile sulfur compounds (VSCs) in Iranian patients and to find the most prevalent class of halitosis among them. The secondary objective was to study the measures employed by the patients to reduce halitosis. 46.4% of the 222 patients were female (average 32.1 years) and 53.6% were male (average 32.1 years). Contrary to other reports, males were dominant in this study. All the subjects were evaluated through oral examination, gas chromatographic analysis, organoleptic assessment and mouth cleaning and rinsing test (MCART). Finally, each patient was classified according to current classification. The patients were also asked about the measures employed by them to reduce halitosis. The data were statistically analysed using SPSS software. Gas chromatographic analysis revealed that the median values for H(2)S, CH(3)SH and (CH(3))(2)S levels were 214 ppb, 64 ppb and 2 ppb, respectively. Average values of H(2)S, CH(3)SH and (CH(3))(2)S were 358.7 ppb, 143.0 ppb and 19.5 ppb, respectively. A correlation was demonstrated between organoleptic scores and the concentration of only H(2)S, CH(3)SH and the total of three gases. In 62.2% of the subjects, no oral pathologic condition was found, but tongue coating was observed. The patients were in only class I (genuine halitosis) and class II (pseudo-halitosis) halitosis. None of them was diagnosed as halitophobia. The percentages of classes I and II were 98.6% and 1.4%, respectively. The percentages of sub-classes of class I halitosis in total subjects were as follows: 60.8% physiologic halitosis, 37.8% oral pathologic halitosis and 0% extraoral pathologic halitosis. The mean value of organoleptic score for physiologic halitosis was 4.0 and those for oral pathologic halitosis and pseudo-halitosis were 4.3 and 1.6, respectively. MCART was a useful tool to distinguish oral halitosis from extraoral halitosis. Levels of VSCs were not as high as those measured in other countries. Although in most cases VSCs were a contributing factor to halitosis, VSCs levels were not useful diagnostic criteria for the minority of the patients. The most prevalent class and sub-class of halitosis in the patients were genuine halitosis and physiologic halitosis. Measures employed by the patients to reduce halitosis were mostly related to the oral cavity.

A study of sulfur-containing compounds in mouth- and nose-exhaled breath and in the oral cavity using selected ion flow tube mass spectrometry

“…Also note the relatively high level of methanthiol in the ambient laboratory air, but that the nose levels are generally lower than this, presumably indicating that the ambient methanthiol is not seriously disturbing the levels in the mouth-exhaled breath and in the mouth cavity. These levels are considerably lower than those in the breath of people suffering from halitosis [17,18]. The odour thresholds for these compounds are given in table 2, as taken from [35][36][37].…”

“…These SIFT-MS detections have only been possible at these low levels in the Keele and Prague laboratories due to major improvements in the sensitivity of their SIFT-MS instruments and the subsequent production of the Profile 3 instrument (Instrument Science Limited, Crewe, UK) using which the temporal concentration distributions of the abovementioned compounds have been constructed for a few healthy volunteers over periods of a few weeks [12]. With this enhanced sensitivity, additional compounds are now being detected in the exhaled breath of healthy volunteers [8], compounds that are known to be present at relatively high levels in the breath of halitosis sufferers [17,18]. Thus, using SIFT-MS we have initiated a search for some sulfurcontaining compounds, specifically hydrogen sulfide (H 2 S), methanthiol (CH 3 SH), dimethyl sulfide ((CH 3 ) 2 S), dimethyl disulfide ((CH 3 ) 2 S 2 ) and carbon disulfide (CS 2 ).…”

Identification of Salivary Microorganisms and Metabolites Associated with Halitosis

“…Moreover, the presence of alcohols, phenyl compounds, and polyamines can interfere with the readings [17]. In addition, in the assessment of IOH using the Halimeter, substances other than VSCs, but presumed to cause bad breath, such as putrescine, cadaverine, indole, and skatole, which are not detectable by a sulfide monitor, are often not considered [18][19][20][21].…”

The use of selected ion flow tube mass spectrometry to detect and quantify polyamines in headspace gas and oral air

“…This equates to a level of around 0.43 × 10 −9 mol/L, which is below the 1 × 10 −9 mol/L odour threshold for putrescine 32. It is important to note, however, that none of the subjects tested had clinically significant oral malodour, with hydrogen sulphide levels below the generally accepted 100 ppbv level indicative of sulphurous oral malodour 38. Previously, assessments of oral polyamines have utilised the surrogate marker of dissolved salivary polyamines, with a positive correlation reported between salivary cadaverine concentration and the severity of oral malodour 15.…”