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Treatment of intra-oral halitosis
Kristianstad University, School of Health and Society, Avdelningen för Oral hälsa och folkhälsovetenskap. Kristianstad University, Research environment Oral Health - Public Health - Quality of Life (OHAL).ORCID iD: 0000-0002-5755-3998
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Intra-oral  halitosis  (bad  breath)  is reported  to affect  15-83 % of the adult population. Having intra-oral halitosis is a social and psycho-logical handicap, and may cause people in the  person’s social circle to increase the physical distance or to turn their faces in another direction to avoid the unpleasant smell from the exhaled air. Such behaviours may affect the individual’s self-confidence resulting in insecurity in social and intimate relations. The oral health-related quality of life status has also been reported to be lower in individuals with halitosis. Approximately 90% of what is considered as bad breath is the result of the degradation of organic substrates (proteins) by an- aerobic bacteria of the oral cavity. Intra-oral halitosis can be  assessed using both subjective and objective methods to evaluate the subject’s exhaled air. The most common one and the one often referred to as the ”gold standard”, is the organoleptic scoring system (OLS). OLS is a subjective method  evaluating  the  strength  of halitosis in exhaled air using a scale from 0-5. One objective  method to assess the presence of volatile sulphur compounds in exhaled air is to use a sulphide monitor measuring the total sum of the volatile sulphur  compounds  (T-VSC) in exhaled  air.  The three  gases  (hydrogensulphide (H2S), methyl mercaptan (MM) and dimethyl sulphide (DMS)) in exhaled air related to intra-oral halitosis can be assessed separately using a simplified gas chromatograph. Different treatment models such as periodontal treatment, tongue scraping and rinsing with Zn ion containing products have been used to reduce intra-oralhalitosis. The  present  thesis  has  evaluated  the  efficacy of  different treatment models in the treatment of intra-oral  halitosis.

Place, publisher, year, edition, pages
Malmö university, Faculty of Odontolgy , 2017. , 76 p.
Series
Doctoral dissertation in odontology, 2017
National Category
Dentistry
Identifiers
URN: urn:nbn:se:hkr:diva-16611ISBN: 978-91-7104-718-2 (print)OAI: oai:DiVA.org:hkr-16611DiVA: diva2:1084782
Available from: 2017-03-27 Created: 2017-03-27 Last updated: 2017-05-09Bibliographically approved
List of papers
1. Comparison of different treatment modalities for oral halitosis
Open this publication in new window or tab >>Comparison of different treatment modalities for oral halitosis
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2012 (English)In: Acta Odontologica Scandinavica, ISSN 0001-6357, Vol. 70, no 3, 224-233 p.Article in journal (Refereed) Published
Abstract [en]

Objectives. To assess the effects on intra-oral halitosis by a mouth rinse containing zinc acetate (0.3%) and chlorhexidine diacetate (0.025%) with and without adjunct tongue scraping. Materials and methods. Twenty-one subjects without a diagnosis of periodontitis were randomized in a cross-over clinical trial. Organoleptic scores (OLS) were assessed to define intra-oral halitosis by total volatile sulfur compound (T-VSC) measurements and by gas chromatography. Results. Twenty-one subjects with a mean age of 45.7 years (SD: ±13.3, range: 21–66). The OLS were significantly lower following active rinse combined with tongue scraping (p < 0.001) at all time points. Immediately after, at 30 min, and at day 14, the T-VSC values were lower in the active rinse sequence than in the negative rinse sequence (p < 0.001, p < 0.001 and p < 0.05, respectively). At 30 min and at day 14, the hydrogen sulfide (H2S) and methyl mercaptan (MM) values were lower in the active rinse sequence compared to the inactive rinse sequence (p < 0.001). The inactive rinse sequence with tongue scraping reduced T-VSC at 30 min (p < 0.001) but not at 14 days. Similar reductions in T-VSC, H2S and MM were found in the active rinse sequence with or without tongue scraping. Conclusion. The use of a tongue scraper did not provide additional benefits to the active mouth rinse, but reduced OLS and tongue coating index.

Keyword
halitosis, mouth rinse, tongue scraper
National Category
Dentistry
Identifiers
urn:nbn:se:hkr:diva-9300 (URN)10.3109/00016357.2011.635601 (DOI)000302916000008 ()22149929 (PubMedID)
Available from: 2012-05-18 Created: 2012-05-18 Last updated: 2017-03-27Bibliographically approved
2. The short-term treatment effects on the microbiota at the dorsum of the tongue in intra-oral halitosis patients: a randomized clinical trial
Open this publication in new window or tab >>The short-term treatment effects on the microbiota at the dorsum of the tongue in intra-oral halitosis patients: a randomized clinical trial
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2013 (English)In: Clinical Oral Investigations, ISSN 1432-6981, E-ISSN 1436-3771, Vol. 17, no 2, 463-473 p.Article in journal (Refereed) Published
Abstract [en]

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 10/21with 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 &lt; 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.

Keyword
Bacteria, Halitosis, Mouth rinse, Tongue scraping, VSC
National Category
Dentistry
Identifiers
urn:nbn:se:hkr:diva-9290 (URN)10.1007/s00784-012-0728-y (DOI)000315356700013 ()22573244 (PubMedID)
Available from: 2012-05-16 Created: 2012-05-16 Last updated: 2017-03-27Bibliographically approved
3. The effect of periodontal therapy on intra-oral halitosis: a case series
Open this publication in new window or tab >>The effect of periodontal therapy on intra-oral halitosis: a case series
2016 (English)In: Journal of Clinical Periodontology, ISSN 0303-6979, E-ISSN 1600-051X, Vol. 43, no 5, 445-452 p.Article in journal (Refereed) Published
Abstract [en]

Aim: The aim of this study was to evaluate the effects of non-surgical periodontal therapy on intra-oral halitosis 3months after therapy. Material and methods: Sixty-eight adults with intra-oral halitosis were included in a case series. Intra-oral halitosis was evaluated at baseline, and at 3months after treatment using the organoleptic scores (OLS), Halimeter (R), and a gas chromatograph. Results: Significant reductions for OLS (p<0.01), total sum of volatile sulphur compounds (T-VSC) (p<0.01) and methyl mercaptan (MM) (p<0.05) values were found after treatment. Hydrogen sulphide (H2S) levels were not significantly reduced. The numbers of probing pockets 4mm, 5mm and 6mm were significantly reduced as a result of therapy (p<0.001). Bleeding on probing (BOP) and plaque indices were also significantly reduced (p<0.001). For the 34 individuals with successful periodontal treatment (BOP<20% and a 50% reduction of total pocket depth) reductions in OLS (p<0.01) and T-VSC scores (p<0.01) were found. Eleven individuals were considered effectively treated for intra-oral halitosis presenting with a T-VSC value <160ppb, a H2S value <112ppb and a MM value <26ppb. Conclusion: Non-surgical periodontal therapy resulted in reduction of OLS, MM and T-VSC values 3months after therapy. Few individuals were considered as effectively treated for intra-oral halitosis.

Keyword
Bad breath, hydrogen sulphide, oral halitosis, oral malodour, periodontitis, volatile sulphur compounds
National Category
Dentistry
Identifiers
urn:nbn:se:hkr:diva-15484 (URN)10.1111/jcpe.12525 (DOI)000374990100007 ()26847598 (PubMedID)
Available from: 2016-12-12 Created: 2016-06-07 Last updated: 2017-03-27Bibliographically approved
4. The long-term effect of a zinc acetate and chlorhexidine diacetate containing mouth rinse on intra-oral halitosis: a randomized clinical trial
Open this publication in new window or tab >>The long-term effect of a zinc acetate and chlorhexidine diacetate containing mouth rinse on intra-oral halitosis: a randomized clinical trial
2016 (English)In: Article in journal (Refereed) Submitted
National Category
Dentistry
Identifiers
urn:nbn:se:hkr:diva-16610 (URN)28727160 (PubMedID)
Available from: 2017-03-27 Created: 2017-03-27 Last updated: 2017-08-14Bibliographically approved

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