Treatment of intra-oral halitosis

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 di- rection to avoid the unpleasant smell from the exhaled air. Such be- haviours may affect the individual’s self -confidence resulting in ins e- curity in social and inti mate 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 as- sessed using both subjective and objective methods to evaluate the subject’s exhaled air. The most common one and the one often r e- ferred to as the ” gold standard”, is the organoleptic scoring system (OLS). OLS is a subjective method evaluating the strength of halit o- sis 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 sul- phur compounds (T -VSC) in exhaled air. The three gases (hydrogen sulphide (H 2 S), 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 -oral halitosis. The present thesis has evaluated the efficacy of different treatment models in t he treatment of intra -oral halitosis

Comparison of different treatment modalities for oral halitosis

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

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

<p>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.</p><p>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.</p><p>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 <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.</p><p>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.</p><p>Periodontally healthy subjects with intra-oral halitosis benefit from daily rinsing with zinc- and chlorhexidine-containing mouth rinse.</p>