Prevalence of halitosis in young male adults: a study in swiss army recruits comparing self-reported and clinical data

BACKGROUND: Sound epidemiologic data on halitosis are rare. We evaluated the prevalence of halitosis in a young male adult population in Switzerland using a standardized questionnaire and clinical examination. METHODS: Six hundred twenty-six Swiss Army recruits aged 18 to 25 years (mean: 20.3 years) were selected as study subjects. First, a standardized questionnaire focusing on dental hygiene, self-reported halitosis, smoking, and alcohol consumption was filled out by all participants. In the clinical examination, objective values for the presence of halitosis were gathered through an organoleptic assessment of the breath odor and the measurement of volatile sulfur compounds (VSCs). Additionally, tongue coating, plaque index, and probing depths were evaluated for each recruit. RESULTS: The questionnaire revealed that only 17% of all included recruits had never experienced halitosis. The organoleptic evaluation (grades 0 to 3) identified eight persons with grade 3, 148 persons with grade 2, and 424 persons with grade 1 or 0. The calculation of the Pearson correlation coefficient to evaluate the relationship among the three methods of assessing halitosis revealed little to no correlation. The organoleptic score showed high reproducibility (kappa = 0.79). Tongue coating was the only influencing factor found to contribute to higher organoleptic scores and higher VSC values. CONCLUSIONS: Oral malodor seemed to pose an oral health problem for about one-fifth of 20-year-old Swiss males questioned. No correlation between self-reported halitosis and organoleptic or VSC measurements could be detected. Although the organoleptic method described here offers a high reproducibility, the lack of correlation between VSC values and organoleptic scores has to be critically addressed. For further studies assessing new organoleptic scores, a validated index should always be included as a direct control.

The short-term treatment effects on the microbiota at the dorsum of the tongue in intra-oral halitosis patients-a randomized clinical trial

OBJECTIVES This study aims to assess the effects of rinsing with zinc- and chlorhexidine-containing mouth rinse with or without adjunct tongue scraping on volatile sulfur compounds (VSCs) in breath air, and the microbiota at the dorsum of the tongue. MATERIAL AND METHODS A randomized single-masked controlled clinical trial with a cross-over study design over 14 days including 21 subjects was performed. Bacterial samples from the dorsum of the tongue were assayed by checkerboard DNA-DNA hybridization. RESULTS No halitosis (identified by VSC assessments) at day 14 was identified in 12/21 subjects with active rinse alone, in 10/21 with adjunct use of tongue scraper, in 1/21 for negative control rinse alone, and in 3/21 in the control and tongue scraping sequence. At day 14, significantly lower counts were identified only in the active rinse sequence (p < 0.001) for 15/78 species including, Fusobacterium sp., Porphyromonas gingivalis, Pseudomonas aeruginosa, Staphylococcus aureus, and Tannerella forsythia. A decrease in bacteria from baseline to day 14 was found in successfully treated subjects for 9/74 species including: P. gingivalis, Prevotella melaninogenica, S. aureus, and Treponema denticola. Baseline VSC scores were correlated with several bacterial species. The use of a tongue scraper combined with active rinse did not change the levels of VSC compared to rinsing alone. CONCLUSIONS VSC scores were not associated with bacterial counts in samples taken from the dorsum of the tongue. The active rinse alone containing zinc and chlorhexidine had effects on intra-oral halitosis and reduced bacterial counts of species associated with malodor. Tongue scraping provided no beneficial effects on the microbiota studied. CLINICAL RELEVANCE Periodontally healthy subjects with intra-oral halitosis benefit from daily rinsing with zinc- and chlorhexidine-containing mouth rinse.

Organoleptic assessment of halitosis for dental professionals - general recommendations

An organoleptic assessment of an odor is defined as a method that can measure the strength of target odors and expresses the value in terms of a point or number with reference to a pre-defined organoleptic scale. Organoleptic assessments are performed using different scales and are used widely in industry (e.g. for measuring the effectiveness of anti-odor agents), in research (to discover relationships between bad breath and microbiology of the tongue, or the generation of particular volatile compounds), but it is also a prerequisite for the diagnosis of halitosis in individual patients required before directing appropriate treatment. An organoleptic assessment of halitosis patients may be carried out in specialized institutions but--based on the fact that in most cases the odor originates from oral structures--also by dental professionals including general dental practitioners (GDPs). Thus, this paper describes the scientific background for recommendations on how a GDP or dental hygienist or general practitioner with cases of bad breath should use organoleptic methods as a valid approach to assess malodor in patients, with a view to diagnosis and treatment, and subsequent treatment monitoring.