Halitosis: the multidisciplinary approach

Curd M L Bollen, Thomas Beikler, Curd M L Bollen, Thomas Beikler

Abstract

Halitosis, bad breath or oral malodour are all synonyms for the same pathology. Halitosis has a large social and economic impact. For the majority of patients suffering from bad breath, it causes embarrassment and affects their social communication and life. Moreover,halitosis can be indicative of underlying diseases. Only a limited number of scientific publications were presented in this field until 1995. Ever since, a large amount of research is published, often with lack of evidence. In general, intraoral conditions, like insufficient dental hygiene, periodontitis or tongue coating are considered to be the most important cause (85%) for halitosis. Therefore, dentists and periodontologists are the first-line professionals to be confronted with this problem. They should be well aware of the origin, the detection and especially of the treatment of this pathology. In addition, ear-nose-throat-associated (10%) or gastrointestinal/endocrinological (5%) disorders may contribute to the problem. In the case of halitophobia, psychiatrical or psychological problems may be present. Bad breath needs a multidisciplinary team approach: dentists, periodontologists, specialists in family medicine, ear-nose-throat surgeons, internal medicine and psychiatry need to be updated in this field, which still is surrounded by a large taboo.Multidisciplinary bad breath clinics offer the best environment to examine and treat this pathology that affects around 25% of the whole population. This article describes the origin, detection and treatment of halitosis, regarded from the different etiological origins.

References

    1. Rayman S, Almas K. Halitosis among racially diverse populations: an update. Int J Dent Hyg. 2008;6 1:2–7.
    1. Nadanovsky P, Carvalho LB, Ponce de Leon A. Oral malodour and its association with age and sex in a general population in Brazil. Oral Dis. 2007;13 1:105–109.
    1. Saito H, Kawaguchi Y. Halitosis prevention campaign: a report of oral health promotion activities in Japan. Int Dent J. 2002;52 Suppl 3:197–200.
    1. Liu XN, Shinada K, Chen XC, et al. Oral malodour-related parameters in the Chinese general population. J Clin Periodontol. 2006;33 1:27–31.
    1. Al-Ansari JM, Boodai H, Al-Sumait N, et al. Factors associated with the self-reported halitosis in Kuwaiti patients. J Dent. 2006;34 7:444–449.
    1. Rosenberg M, Kulkarni GV, Bosy A, et al. Reproducibility and sensitivity of oral malodour measurements with a portable sulphide monitor. J Dent Res. 1991;70 11:436–440.
    1. Miyazaki H, Sakao S, Katoh Y, et al. Correlation between volatile sulphur compounds and certain oral health measurements in the general population. J Periodontol. 1995;66 8:679–684.
    1. Loesche WJ, Grossman N, Dominguez L, et al. Oral malodour in the elderlyIn: van Steenberghe D, Rosenberg M, editors. Bad breath: A multi-disciplinary approach Leuven; Leuven University Press; 1996181–194.
    1. Avcu N, Ozbek M, Kutoglu D, et al. Oral findings and health status among hospitalized patients with physical disabilities, aged 60 or above. Arch Gerontol Geriatr. 2005;41 1:69–79.
    1. Bornstein MM, Kislig K, Hoti BB, et al. Prevalence of halitosis in the population of the city of Bern, Switzerland: a study comparing self-reported and clinical data. Eur J Oral Sci. 2009;117 3:261–267.
    1. Vandekerckhove B, Bollen C.Epidemiology in the general population, specific populations and in a multidisciplinary halitosis consultationIn: van Steenberghe D, editor. Ademgeur. Houten; Prelum Uitgevers; 20093–10.
    1. Krespi YP, Shrime MG, Kacker A. The relationship between oral malodour and volatile sulphur compound producing bacteria. Otolaryngol Head Neck Surg. 2006;135 5:671–676.
    1. Goldberg S, Kozlovsky A, Gordon D, et al. Cadaverine as a putative component of oral malodour. J Dent Res. 1994;73 6:1168–1172.
    1. Calil C, Liberato FL, Pereira AC, et al. The relationship between volatile sulphur compounds, tongue coating and periodontal disease. Int J Dent Hyg. 2009;7 4:251–255.
    1. Yaegaki K, Sanada K. Volatile sulphur-compounds in mouth air from clinically healthy subjects and patients with periodontal disease. J Periodont Res. 1992;27 4 Pt 1:233–238.
    1. Tanaka M, Yamamoto Y, Kuboniwa M, et al. Contribution of periodontal pathogens on tongue dorsa analysed with real-time PCR to oral malodour. Microbes Infect. 2004;6 12:1078–1083.
    1. Greenman J, Duffield J, Spencer P, et al. Study on the organoleptic intensity scale for measuring oral malodour. J Dent Res. 2004;83 1:81–85.
    1. Quirynen M, Dadamio J, van den Velde S, et al. Characteristics of 2000 patients who visited a halitosis clinic. J Clin Periodontol. 2009;36 11:970–975.
    1. Roldán S, Herrera D, Sanz M. Biofilms and the tongue: therapeutical approaches for the control of halitosis. Clin Oral Investig. 2003;7 4:189–197.
    1. Collins LM, Dawes C. The surface area of the adult human mouth and thickness of the salivary film covering the teeth and oral mucosa. J Dent Res. 1987;66 8:1300–1302.
    1. Faveri M, Feres M, Shibli JA, et al. Microbiota of the dorsum of the tongue after plaque accumulation: an experimental study in humans. J Periodontol. 2006;77 9:1539–1546.
    1. Quirynen M, Avontroodt P, Soers C, et al. Impact of tongue cleansers on microbial load and taste. J Clin Periodontol. 2004;31 7:506–510.
    1. Snel J, Burgering M, Smit B, et al. Volatile sulphur compounds in morning breath of human volunteers. Arch Oral Biol. 2011;56 1:29–34.
    1. de Suza RF, de Freitas Oliveira Paranhos H, Lovato da Silva CH, et al. Interventions for cleaning dentures in adults. Cochrane Database Syst Re. 2009. p. CD007395.
    1. Morita M, Wang HL. Association between oral malodour and adult periodontitis: a review. J Clin Periodontol. 2001;28 9:813–819.
    1. Horning GM. Necrotizing gingivostomatitis: NUG to noma. Compend Contin Educ Dent. 1996;17 10:951–958.
    1. Albuquerque DF, de Souza Tolentino E, Amado FM, et al. Evaluation of halitosis and sialometry in patients submitted to head and neck radiotherapy. Med Oral Pathol Oral Cir Bucal. 2010;15 6:e850–e854.
    1. Almståhl A, Wikström M. Oral microflora in subjects with reduced salivary secretion. J Dent Res. 1999;78 8:1410–1416.
    1. Pajukoski H, Meurman JH, Halonen P, et al. Prevalence of subjective dry mouth and burning mouth in hospitalized elderly patients and outpatients in relation to saliva, medication, and systemic diseases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001;92 6:641–649.
    1. Kleinberg I, Wolff MS, Codipilly DM. Role of saliva in oral dryness, oral feel and oral malodour. Int Dent J. 2002;52 Suppl 3:236–240.
    1. Koshimune S, Awano S, Gohara K, et al. Low salivary flow and volatile sulphur compounds in mouth air. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;9 1:38–41.
    1. Iwanicka-Grzegorek K, Lipkowska E, Kepa J, et al. Comparison of ninhydrin method of detecting amine compounds with other methods of halitosis detection. Oral Dis. 2005;11 Suppl 1:37–39.
    1. Traudt M, Kleinberg I. Stoichiometry of oxygen consumption and sugar, organic acid and amino acid utilization in salivary sediment and pure cultures of oral bacteria. Arch Oral Biol. 1996;41 10:965–978.
    1. Nalcaci R, Baran I. Oral malodor and removable complete dentures in the elderly. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;105 6:e5–e9.
    1. Astor FC, Hanft KL, Ciocon JO. Xerostomia: a prevalent condition in the elderly. Ear Nose Throat J. 1999;78 7:476–479.
    1. Prahabita PK, Bhat KM, Bhat GS. Oral malodor: a review of the literature. J Dent Hyg. 2006;80 3:8.
    1. Delanghe G, Ghyselen J, van Steenberghe D, et al. Multidisciplinary breath-odour clinic. Lancet. 1997;350 9072:187.
    1. van den Broek AM, Feenstra L, de Baat C. A review of the current literature on aetiology and measurement methods of halitosis. J Dent. 2007;35 8:627–635.
    1. Ansai T, Takehara T. Tonsilloliths as a halitosis-inducing factor. Br Dent J. 2005;198 5:263–264.
    1. Mulwafu W, Fagan JJ, Isaacs S. Adult tonsillectomy—are long waiting lists putting patients at risk. S Afr J Surg. 2006;44 2:66–68.
    1. Attia EL, Marshall KG. Halitosis. Can Med Assoc J. 1982;126 11:1281–1285.
    1. Fletcher SM, Blair PA. Chronic halitosis from tonsilloliths: a common aetiology. J La State Med Soc. 1988;140 6:7–9.
    1. Tsuneishi M, Yamamoto T, Kokegucji S, et al. Composition of the bacterial flora in tonsilloliths. Microbes Infect. 2006;8 9/10:2384–2389.
    1. Amir E, Shimonov R, Rosenberg M. Halitosis in children. J Pediatr. 1999;134 4:338–343.
    1. Monteiro-Amado F, Chinellato LE, de Rezende ML. Evaluation of oral and nasal halitosis parameters in patients with repaired cleft lip and/or palate. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;100 6:682–687.
    1. Lanza DC. Diagnosis of chronic rhinosinusitis. Ann Otol Rhinol Laryngol. 2004;193 Suppl 1:10–14.
    1. Mazzone PJ. Analysis of volatile organic compounds in the exhaled breath for the diagnosis of lung cancer. J Thorac Oncol. 2008;3 7:774–780.
    1. Stoeckli SJ, Schmid S. Endoscopic stapler-assisted diverticuloesophagostomy for Zenker's diverticulum: patient satisfaction and subjective relief of symptoms. Surgery. 2002;131 2:158–162.
    1. Struch F, Schwahn C, Wallaschofski H, et al. Self-reported halitosis and gastro-oesophageal reflux disease in the general population. J Gen Intern Med. 2008;23 3:260–266.
    1. Werdmuller BF, van der Putten TB, Balk TG, et al. Clinical presentation of Helicobacter pylori-positive and -negative functional dyspepsia. J Gastroenterol Hepatol. 2000;15 5:498–502.
    1. Moshkowitz M, Horowitz N, Leshno M, et al. Halitosis and gastroesophageal reflux disease: a possible association. Oral Dis. 2007;13 6:581–585.
    1. Hoshi K, Yamano Y, Mitsunaga A, et al. Gastrointestinal diseases and halitosis: association of gastric Helicobacter pylori infection. Int Dent J. 2002;52 Suppl 3:207–211.
    1. Lee H, Kho HS, Chung JW, et al. Volatile sulphur compounds produced by Helicobacter pylori. . J Clin Gastroenterol. 2006;40 5:421–426.
    1. Suzuki N, Yoneda M, Naito T, et al. Detection of Helicobacter pylori DNA in the saliva of patients complaining of halitosis. J Med Microbiol. 2008;57 Pt 12:1553–1559.
    1. Kinberg S, Stein M, Zion N, et al. The gastrointestinal aspects of halitosis. Can J Gastroenterol. 2010;24 9:552–556.
    1. Yilmaz AE, Bilici M, Tonbul A, et al. Paediatric halitosis and Helicobacter pylori infection. J Coll Physicians Surg Pak. 2012;22 1:27–30.
    1. Stephenson BM, Rees BI. Extrinsic duodenal obstruction and halitosis. Postgrad Med J. 1990;66 777:568–570.
    1. Preti G, Clark L, Cowart BJ, et al. Non-oral aetiologies of oral malodour and altered chemosensation. J Periodontol. 1992;63 9:790–796.
    1. Keles M, Tozoglu U, Uyanik A, et al. Does peritoneal dialysis affect halitosis in patients with end-stage renal disease. Perit Dial Int. 2011;31 2:168–172.
    1. Feller L, Blignaut E. Halitosis: a review. J South African Den Assoc. 2005;60 1:17–19.
    1. Bollen CM, Rompen EH, Demanez JP.Halitosis: a multidisciplinary problem Rev Med Liege 199954132–36.French.
    1. van Steenberge D.Endocrinological aspectsIn: van Steenberghe D, editor. Ademgeur. Houten; Prelum Uitgevers; 2009107–115.
    1. van den Velde S, Quirynen M, van Hee P, et al. Halitosis associated volatiles in breath of healthy subjects. J Chromatogr B Analyt Technol Biomed Life Sci. 2007;853 1/2:54–61.
    1. Whittle CL, Fakharzadeh S, Eades J, et al. Human breath doors and their use in diagnosis. Ann N Y Acad Sci. 2007;1098:252–266.
    1. Mackay RJ, McEntyre CJ, Henderson C, et al. Trimethylaminuria: causes and diagnosis of a socially distressing condition. Clin Biochem Rev. 2011;32 1:33–43.
    1. Scully C, Greenman J. Halitology (breath odour: aetiopathogenesis and management) Oral Dis. 2012;18 4:333–345.
    1. Tangerman A, Meuwese-Arends MT, Jansen JB. Foetor hepaticus. Lancet. 1994;343 8912:1569.
    1. van den Velde S, Nevens F, van Hee P, et al. GC-MS analysis of breath odor compounds in liver patients. J Chromatogr B Analyt Technol Biomed Life Sci. 2008;875 2:344–348.
    1. Kawamoto A, Sugano N, Motohashi M, et al. Relationship between oral malodour and the menstrual cycle. J Periodontal Res. 2010;45 5:681–687.
    1. Calil CM, Lima PO, Bernardes CF, et al. Influence of gender and menstrual cycle on volatile sulphur compounds production. Arch Oral Biol. 2008;53 12:1107–1112.
    1. Marx RE. Pamidronate (Aridea) and zoledronateinduced avascular necrosis of the jaws: a growing epidemic. J Oral Maxillofac Surg. 2003;61 9:1115–1118.
    1. Stockmann P, Vairaktaris E, Wehrhan F, et al. Osteotomy and primary wound closure in bisphosphonate-associated osteonecrosis of the jaw: a prospective clinical study with 12 months follow-up. Support Care Cancer. 2010;18 4:449–460.
    1. Seemann R.Organoleptische BeurteilungIn: Seemann R, editor. Halitosismanagement in der Zahnärztlichen praxis Balingen; Spitta; 2006
    1. Tonzetich J. Production and origin of oral malodour: a review of mechanisms and methods of analysis. J Periodontol. 1977;48 1:13–20.
    1. Rosenberg M, McCulloch CA. Measurement of oral malodour: current methods and future prospects. J Periodontol. 1992;63 9:776–782.
    1. Salako NO, Philip L. Comparison of the use of the Halimeter and the OralChroma™ in the assessment of the ability of common cultivable oral anaerobic bacteria to produce malodorous volatile sulphur compounds from cysteine and methionine. Med Princ Pract. 2011;20 1:75–79.
    1. Tonzetich J. Direct gas chromatographic analysis of sulphur compounds in mouth air in man. Arch Oral Biol. 1971;16 6:587–597.
    1. Larsson BT, Widmark G. A gas chromatographic method for analysis of volatiles in saliva samples. Acta Pharm Sued. 1969;6 4:479–488.
    1. Tonzetich J, Coil JM, Ng W. Gas chromatographic method for trapping and detection of volatile organic compounds from human mouth air. J Clin Dent. 1991;2 3:79–82.
    1. Bradshaw DJ, Perring KD, Cawkill PM, et al. Creation of oral care flavours to deliver breath-freshening benefits. Oral Dis. 2005;11 Suppl 1:75–79.
    1. Menon MV, Coykendall AL. Effect of tongue scraping. J Dent Res. 1994;73 9:1492.
    1. Outhouse TL. A platinum standard of effectiveness in oral health care interventions: the Cochrane systemic review. Gen Dent. 2006;54 4:228–229.
    1. van der Sleen MI, Slot DE, van Trijffel E, et al. Effectiveness of mechanical tongue cleaning on breath odour and tongue coating: a systematic review. Int J Dent Hyg. 2010;8 4:258–268.
    1. Quirynen M, Zhao H, van Steenberghe D. Review of the treatment strategies for oral malodour. Clin Oral Investig. 2002;6 1:1–10.
    1. Outhouse TL, Al-Alawi R, Fedorowicz Z, et al. Tongue scraping for treating halitosis. Cochrane Database Syst Rev. 2006. p. CD005519.
    1. Bollen CM, Vandekerckhove BN, Papaioannou W, et al. Full- versus partial-mouth disinfection in the treatment of periodontal infections. A pilot study: long-term microbiological observations. J Clin Periodontol. 1996;23 10:960–970.
    1. Quirynen M, Zhao H, Soers C, et al. The impact of periodontal therapy and the adjunctive effect of antiseptics on breath odour-related outcome variables: a double-blind randomized study. J Periodontol. 2005;76 5:705–712.
    1. Delanghe G, Ghyselen J, Bollen C, et al. An inventory of patients' response to treatment at a multidisciplinary breath odor clinic. Quint Int. 1999;70 3:307–310.
    1. Rosenberg M, Gelernter I, Barki M, et al. Day-long reduction of oral malodour by a two-phase oil: water mouthrinse as compared to chlorhexidine and placebo rinses. J Periodontol. 1992;63 1:39–43.
    1. Pitts G, Brogdon C, Hu L, et al. Mechanism of action of an antiseptic, antiodor mouthwash. J Dent Res. 1983;62 6:738–742.
    1. Frascella J, Gilbert R, Fernandez P. Door reduction potential of a chlorine dioxide mouthrinse. J Clin Dent. 1998;9 1:39–42.
    1. Raven S, Matheson J, Huntington E, et al. The efficacy of a combined zinc and triclosan system in the prevention of oral malodourIn: van Steenberghe D, Rosenberg M, editors. Bad breath: a multidisciplinary approach Leuven; Leuven University Press; 1996241–254.
    1. Suarez FL, Furne JK, Springfield J, et al. Morning breath odour: influence of treatments on sulphur-gases. J Dent Res. 2000;79 10:1773–1777.
    1. Navada R, Kumari H, Le S, et al. Oral malodour reduction from a zinc-containing toothpaste. J Clin Dent. 2008;19 2:69–73.
    1. Feng X, Chen X, Cheng R, et al. Breath malodour reduction with use of a stannous containing sodium fluoride dentifrice: a meta-analysis of four randomized and controlled clinical trials. Am J Dent. 2010;23 Spec No B:27B–31B.
    1. Sharma NC, Galustians HJ, Qaqish J, et al. Clinical effectiveness of a dentifrice containing triclosan and a copolymer for controlling breath odour. Am J Dent. 2007;20 2:79–82.
    1. Fedorowicz Z, Aljufairi H, Nasser M, et al. Mouthrinses for the treatment of halitosis. Cochrane Database Syst Rev. 2008. p. CD006701.
    1. Young A, Jonski G, Rölla G, et al. Effects of metal salts on the oral production of volatile sulphur containing compounds (VSC) J Clin Periodontol. 2001;28 8:776–781.
    1. Young A, Jonski G, Rölla G. Inhibition of orally produced volatile sulphur compounds by zinc, chlorhexidine or cetylpyridinium chloride—effect of concentration. Eur J Oral Sci. 2003;111 5:400–404.
    1. Sterer N, Rubinstein Y. Effect of various natural medicinals on salivary protein putrefaction and malodour production. Quint Int. 2006;37 8:653–658.
    1. Grandis JR, Johnson JT, Vickers RM, et al. The efficacy of perioperative antibiotic therapy on recovery following tonsillectomy in adults: randomized double-blind placebo-controlled trial. Otolaryngol Head Neck Surg. 1992;106 2:137–142.
    1. Bunzen DL, Campos A, Leão FS, et al. Efficacy of functional endoscopic sinus surgery for symptoms in chronic rhinosinusitis with or without polyposis. Braz J Otorhinolaryngol. 2006;72 2:242–246.
    1. Dal Rio AC, Passos CA, Nicola JH, et al. CO2 laser cryptolysis by coagulation for the treatment of halitosis. Photomed Laser Surg. 2006;24 5:630–636.
    1. Shortt P, Wilson R, Erskine I. Tendinitis: the Achilles heel of quinolones! Emerg Med J. 2006;23 12:e63.
    1. Labenz J, Morgner-Miehlke A. An update on the available treatments for non-erosive reflux disease. Expert Opin Pharmacother. 2006;7 1:47–56.
    1. Bytzer P, Dahlerup JF, Eriksen JR, et al. Diagnosis and treatment of Helicobacter pylori infection. Dan Med Bull. 2011;58 4:C4271.
    1. Malaguarnera M, Restuccia S, Motta M, et al. Interferon, cortisone, and antivirals in the treatment of chronic viral hepatitis: a review of 30 years of therapy. Pharmacotherapy. 1997;17 5:998–1005.
    1. Burton JP, Chilcott CN, Moore CJ, et al. A preliminary study of the effect of probiotic Streptococcus salivarius K12 on oral malodour parameters. J Appl Microbiol. 2006;100 4:754–764.
    1. Iwamoto T, Suzuki N, Tanabe K, et al. Effects of probiotic Lactobacillus salivarius WB21 on halitosis and oral health: an open-label pilot trial. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;110 2:201–208.
    1. Kang MS, Kim BG, Chung J, et al. Inhibitory effect of Weissella cibaria isolates on the production of volatile sulphur compounds. J Clin Periodontol. 2006;33 3:226–232.
    1. Henker J, Schuster F, Nissler K. Successful treatment of gut-caused halitosis with a suspension of living non-pathogenic Escherichia coli bacteria—a case report. Eur J Pediatr. 2001;160 10:592–594.
    1. Nagel D, Lutz C, Filippi A. Halitophobia—an under-recognized clinical picture. Schweiz Monatsschr Zahnmed. 2006;116 1:57–64.
    1. Malasi TH, El-Hilu SM, Mirza IA, et al. Olfactory delusional syndrome with various aetiologies. Br J Psychiatry. 1990;156:256–260.
    1. Bohn P. Imagined halitosis: a social phobia symptom. J Calif Dent Assoc. 1997;25 2:161–164.
    1. Eli I, Koriat H, Baht R, et al. Self-perception of breath odor: role of body image and psychopathologic traits. Percept Mot Skills. 2000;91 3 Pt 2:1993–2001.
    1. Lochner C, Stein DJ. Olfactory reference syndrome: diagnostic criteria and differential diagnosis. J Postgrad Med. 2003;49 4:328–331.
    1. Suzuki N, Yoneda M, Naito T, et al. Relationship between halitosis and psychologic status. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008 Oct;106 4:542–547.
    1. Adams KH, Hansen ES, Pinborg LH, et al. Patients with obsessive/compulsive disorder have increased 5-HT2A receptor binding in caudate nuclei. Int J Neuropsychopharmacol. 2005;8 3:391–401.
    1. Uher R, Farmer A, Henigsberg N, et al. Adverse reactions to antidepressants. Br J Psychiatry. 2009;195 3:202–210.
    1. Persson S, Edlund MB, Claesson R, et al. The formation of hydrogen sulphide and methylmercaptan by oral bacteria. Oral Microbiol Immunol. 1990;5 4:195–201.
    1. Claus D, Geypens B, Rutgeerts P, et al. Where gastroenterology and periodontology meet: determination of oral volatile organic compounds using closed-loop trapping and high-resolution gas chromatography-ion trap detectionIn: van Steenberghe D, Rosenberg M, editors. Bad breath: a multidisciplinary approach Leuven; Leuven University Press; 199615–28.

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