Association between oral malodor and measurements obtained using a new sulfide monitor

doi:10.1016/j.jdent.2006.02.004

Journal of Dentistry

Volume 34, Issue 10, November 2006, Pages 770-774

https://doi.org/10.1016/j.jdent.2006.02.004 Get rights and content

Abstract

Objective

The purpose of this study was to evaluate the ability of a new volatile sulfur compounds (VSCs) monitor to assess oral malodor in subjects and compare its performance with those of organoleptic testing and gas chromatography.

Methods

The mouth air of 260 patients was measured by three methods: VSCs monitor (Breathtron™), organoleptic test by two judges and gas chromatography (GC). Mcnemar test and Pearson correlation were used to analyze the data among these methods.

Results

The log values of VSCs measured by a sulfide monitor were significantly correlated with the organoleptic ratings, and also with log values of H₂S, CH₃SH, and (CH₃)₂S determined by GC (P < 0.01). Using the results of organoleptic and GC to classify subjects into normal and malodor groups, the sulfide monitor's sensitivity was shown to be more than 79% and the specificity was 61–73%.

Conclusions

This sulfide monitor could be used for oral malodor measurement, moreover, according to its portability, it could be conveniently used for clinical setting and field surveys.

Introduction

Oral malodor may be caused by several intra- and extra-oral factors.1, 2 Volatile sulfur compounds (VSCs), especially hydrogen sulfide (H₂S), methyl mercaptan (CH₃SH), and dimethyl sulfide ((CH₃)₂S) are the gases that have demonstrated correlations with oral malodor.3, 4, 5 The assessment of VSCs is an important criteria for classification of halitosis,² and the measurement of VSCs is useful for diagnosing and monitoring the benefits of therapy for halitosis patients.

There are three main methods of oral malodor assessment, organoleptic measurement, gas chromatography (GC) and sulfide monitoring.⁶ The simplest approach is the organoleptic ratings by human judges.⁷ It is considered the gold standard for measuring bad breath, both for the industry and academia.⁸ This method closely simulates the everyday situations in which bad breath is detected, but it is subjective and requires trained odor judges whose reliability has been questioned.4, 9 However, standardization and calibration of odor judges will be developed in the coming years.⁸ Quantitative analysis of VSC gases by GC is considered to be a reliable measurement for the diagnosis of halitosis,² since it can measure the levels of specific VSCs. Moreover, GC results are highly objective and reproducible.² However, GC is not appropriate for chair-side clinical use because it requires a costly large-scale system, a long run time and an experienced operator.

Between these extremes portable sulfide monitors (e.g., the Halimeter™ (Interscan Corp., Chatsworth, CA, USA)9, 10, 11 and VSCs monitors⁷) have been reported to be inexpensive, easily used devices for measurement of VSCs concentration. In the present study, we evaluated the ability of a new VSCs monitor (Breathtron™, New Cosmos Electric Company, Osaka, Japan) to assess oral malodor in patients and compared its results with those of organoleptic testing and gas chromatography.

Section snippets

Materials and methods

Subjects were 260 patients who visited the Fresh Breath Clinic, Dental Hospital, Tokyo Medical and Dental University. Patients enrolled in the study signed an informed consent form and completed a questionnaire about their chief complaint. Their malodors, dental and medical history relating to malodor were also recorded.

Results

The subject population comprised of 68 males and 192 females with mean age 45.4 years. The subjects in this study considered themselves to have suffered from bad breath for several months or years. Ninety percent of the subjects answered that their daily life was disturbed by malodor. In all subjects, there was no medical diseases history which was considered to be non-oral causes of malodor.¹⁸ Malodor levels of these subjects are shown in Table 1.

Table 2 indicates the number of patients

Discussion

In this study, most of the patients who came to our clinic were females. Previous studies also found a predominance of female patients at their breath odor clinics.19, 20, 21 One of the probable reasons is that females tend to be more anxious about their bad breath in comparison with males.²⁰ According to the questionnaire, approximately 90% of the patients reported that their daily life was disturbed by malodor. For example, patients were afraid of talking with other people or they hesitated

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Cited by (24)

ORGANOLEPTIC AND HALITOMETRIC ASSESSMENTS DO NOT CORRELATE WELL IN INTRA-ORAL HALITOSIS: A SYSTEMATIC REVIEW AND META-ANALYSIS
2023, Journal of Evidence-Based Dental Practice
The gold standard method for diagnosing oral halitosis is the subjective organoleptic measurement. Device-supported methods are also widespread worldwide. The challenges and safety concerns around performing organoleptic measurements during pandemics and the diversity of measuring device alternatives raised our clinical question: which halitometer is the most suitable for diagnosing halitosis?
This systematic review was registered in PROSPERO (ID CRD42022320024). The search was performed on March 23, 2022 in the following electronic databases: MEDLINE, Embase, Scopus, Web of Science, and CENTRAL. Adult populations with or without halitosis were included, and patients with systemic diseases were excluded. Organoleptic (subjective) measurement and the device-supported (objective) methods were compared; the primary outcome was the correlation coefficient, and the secondary was the specificity and sensitivity of the devices. QUADAS-2 and QUADAS-C were used to evaluate the risk of bias in the studies. Random–effects meta analyses were performed on the outcomes, and the secondary outcomes were plotted on a common ROC plot.
A total of 1231 records were found in the 5 databases. After the selection process, 76 articles were eligible for the systematic review, and 14,635 patients were involved in the qualitative analysis. The pooled Spearman's correlation coefficient (c.c.) for sulfide monitors was 0.65; 95% CIs: [0.53-0.74]; I² = 95%, P < .01. The pooled Spearman's c.c. for portable gas chromatographs was 0.69; 95% CIs: [0.63-0.74]; I² = 12%, P < .01. The pooled Spearman's c.c. for gas chromatographs was 0.76; 95% CIs: [0.67-0.83]; I² = 0%, P < .01.
None of the most commonly used halitometers proved to be significantly superior to the others. Halimeter and OralChroma measurements did not correlate well with the organoleptic level of oral halitosis in adults. Therefore, better halitometers need to be developed as an alternative to organoleptic measurements.
Halitosis in obese patients and those undergoing bariatric surgery
2013, Surgery for Obesity and Related Diseases
Citation Excerpt :
Thus, the combination of these 2 methods reduced the possibility of errors and increased the reliability of the results. In the present study, just as in previous work [8,9,15,17–19], we found a positive correlation between the measures taken using the organoleptic method and those obtained using the portable sulfide monitor. In addition to confirming the ability of the examiner to perform the organoleptic evaluation, this result supports the hypothesis that the halitosis found in the present study was strongly associated with the VSC.
Patients undergoing bariatric surgery often complain of bad breath. However, the relationship between bariatric surgery and halitosis is relatively unknown. The purpose of the present study was to evaluate and compare the occurrence of halitosis among patients before and after a specific type of bariatric surgery, Roux-en-Y gastric bypass, and its relationship with the tongue coating index, plaque index, and salivary flow rate.
A total of 62 patients with good oral health and in treatment for obesity at the walk-in clinic of Santa Casa Hospital, Belo Horizonte, Brazil, were selected. Of this sample, 31 were bariatric surgery candidates (control group) and 31 had already undergone Roux-en-Y gastric bypass surgery (case group). After completing a questionnaire, all patients underwent an oral clinical examination. Halitosis was measured using an organoleptic scale and a portable sulfide monitor.
The Spearman correlation demonstrated a strong positive relation between the organoleptic rates and the concentration of volatile sulfur compounds determined using the sulfide monitor (r_s = .58; P = .0001). No difference was found in the prevalence of halitosis between the 2 groups (P = .48). Only the salivary flow rate was significantly reduced in the control group compared with the case group (P = .02). In the case group, the concentration of volatile sulfur compounds correlated negatively with the salivary flow rate (P = .04) and positively with the tongue coating index (P = .005). The tongue coating index was significantly increased in those patients who did not brush the tongue (P < .04) and who had had episodes of vomiting (P = .02).
These data suggest that no significant association exists between halitosis and Roux-en-Y gastric bypass. However, they do highlight the possible effect of this surgery on the oral cavity.
Evaluation of oral malodor in children
2008, Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology
Citation Excerpt :
Measurements were conducted between 9:00 and 11:00 in the morning.12,18 Patients were instructed to close their mouth for 3 min in an upright position before each sample collection and breathe through their nose during the measurements.12 Organoleptic measurements were carried out throughout the study by a single examiner.14,16,19
The aim of this study was to assess oral malodor in highly caries-active children aged 7-15 years, analyze its association with oral malodor parameters, and investigate whether oral hygiene practices and orodental treatments can decrease the effect of oral malodor.
The study included a total of 30 subjects with high caries activity (11 boys and 19 girls), mean age 10.5 ± 2.4 years, who were living in Kirikkale, Middle Anatolia, Turkey. Oral malodor assessment was carried out by portable sulfide monitor and organoleptic method. A self-administered structured questionnaire was given to the participants. The baseline and final measurements were taken for both malodor-related parameters (volatile sulfur compounds [VSCs] and organoleptic ratings) and dental parameters (tongue coating scores [TCS], plaque index [PI], dental index [DFS+DMFS], community periodontal index of treatment needs [CPITN]). Analysis included frequency, cross-tabulations, analysis of variance, independent-samples t test,and paired t test. Odds ratios of VSC-related factors were also calculated. Significance was set at the 5% level.
Gender, DFS+DMFS, and frequency of toothbrushing were not found to be significantly correlated with either VSC levels in mouth air or organoleptic ratings (P > .05). However, tongue coating (P = .003), CPITN (P = .014), PI (P = .017), and age (P = .053) were significantly correlated with VSC levels in mouth air. Regarding the final recordings, significant correlation (P < .001) was found between VSC levels and TCS. Also, significant differences were found between baseline and final measurements in both oral malodor parameters and dental parameters (TCS, CPITN, and PI; P < .001).
These results revealed that oral malodor in children is related to periodontal parameters and especially tongue coating. Moreover, malodor parameters were improved by increased awareness of the importance of oral hygiene.
Oral malodor and removable complete dentures in the elderly
2008, Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology
The objectives of this study were to assess oral malodor in patients with removable complete dentures and analyze its association with age, sex, subjective oral dryness, burning mouth, tongue coating, and overnight denture wear in elderly subjects.
The study comprised 105 complete denture wearers (56 male, 49 female) between the ages of 50 and 78 from the province of Kirikkale in the Central Anatolia Region of Turkey. Oral malodor was assessed using a portable sulfide monitor. Participants were given a self-administered, structured questionnaire. Baseline and final volatile sulfur compound (VSC) levels and tongue-coating scores (TCS) were measured. Analysis included frequency, cross-tabulations, ANOVA, and independent sample and paired t tests. Odds ratios of VSC-related factors were also calculated. A P value less than .05 was considered statistically significant.
There was no significant correlation found between age, gender, smoking, existence of a medical condition, or regular use of medication and VSC levels in mouth air (P > .05). However, educational level (P < .05), oral dryness (P < .05), burning mouth (P < .05), overnight denture wear (P < .01), and TCS (P < .001) were found to be significantly correlated with VSC levels. Significant differences were also found between baseline and final measurements of both VSC levels and TCS (P < .01).
This study found the accumulation of bacterial plaque on the tongue, oral dryness, burning mouth, overnight denture wear, and lower educational levels to be significantly related to oral malodor. Following tongue care maintenance and overnight removal of dentures, patients' oral malodor levels decreased significantly.
A review of the current literature on aetiology and measurement methods of halitosis
2007, Journal of Dentistry
This work reviews the current knowledge of aetiology and measurement methods of halitosis.
Halitosis is an unpleasant or offensive odour emanating from the breath. The condition is multifactorial and may involve both oral and non-oral conditions.
A private, monthly with keywords halitosis, malodo(u)r, (a)etiology, measurement, and management from Medline and Pubmed updated database of literature was reviewed.
In approximately 80–90% of all cases, halitosis is caused by oral conditions, defined as oral malodour. Oral malodour results from tongue coating, periodontal disease, peri-implant disease, deep carious lesions, exposed necrotic tooth pulps, pericoronitis, mucosal ulcerations, healing (mucosal) wounds, impacted food or debris, imperfect dental restorations, unclean dentures, and factors causing decreased salivary flow rate. The basic process is microbial degradation of organic substrates. Non-oral aetiologies of halitosis include disturbances of the upper and lower respiratory tract, disorders of the gastrointestinal tract, some systemic diseases, metabolic disorders, medications, and carcinomas. Stressful situations are predisposing factors. There are three primary measurement methods of halitosis. Organoleptic measurement and gas chromatography are very reliable, but not very easily clinically implemented methods. The use of organoleptic measurement is suggested as the ‘gold standard’. Gas chromatography is the preferable method if precise measurements of specific gases are required. Sulphide monitoring is an easily used method, but has the limitation that important odours are not detected. The scientific and practical value of additional or alternative measurement methods, such as BANA test, chemical sensors, salivary incubation test, quantifying β-galactosidase activity, ammonia monitoring, ninhydrin method, and polymerase chain reaction, has to be established.
A new portable sulfide monitor with a zinc-oxide semiconductor sensor for daily use and field study
2007, Journal of Dentistry
For measuring oral malodor in daily clinical practice and in field study, we developed and evaluated a highly sensitive portable monitor system.
We examined sensitivity and specificity of the sensor for volatile sulfur compounds (VSC) and obstructive gases, such as ethanol, acetone, and acetaldehyde. Each mouth air provided by 46 people was measured by this monitor, gas chromatography (GC), and olfactory panel and compared with each other. Based on the result, we used the monitor for mass health examination of a rural town with standardized measuring.
The sensor detected hydrogen sulfide, methyl mercaptan, and dimethyl sulfide with 10–1000 times higher sensitivity than the other gases. The monitor's specificity was significantly improved by a VSC-selective filter. There were significant correlations between VSC concentration by the sulfide monitor and by GC, and by organoleptic score. Thirty-six percent of 969 examinees had oral malodor in a rural town. Seventy-eight percent of 969 examinees were motivated to take care of their oral condition by oral malodor measuring with the monitor.
The portable sulfide monitor was useful to promote oral health care not only in clinics, but also in field study. The simple and quick operation system and the standardized measuring make it one of parameters of oral condition.

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Association between oral malodor and measurements obtained using a new sulfide monitor

Abstract

Objective

Methods

Results

Conclusions

Introduction

Section snippets

Materials and methods

Results

Discussion

International Dental Journal

International Dental Journal

Archives of Oral Biology

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology

Journal of the American Dental Association

Archives of Oral Biology

Oral odors in early experimental gingivitis

Journal of Periodontal Research

Examination, classification, and treatment of halitosis; clinical perspectives

Journal of the Canadian Dental Association

A new monitor with a zinc-oxide thin film semiconductor sensor for the measurement of volatile sulfur compounds in mouth air

Journal of Periodontology

Proceedings of the sixth international conference on breath odor

Oral Disease

Halitosis measurement by an industrial sulphide monitor

Journal of Periodontology