A review of the current literature on aetiology and measurement methods of halitosis

doi:10.1016/j.jdent.2007.04.009

Journal of Dentistry

Volume 35, Issue 8, August 2007, Pages 627-635

https://doi.org/10.1016/j.jdent.2007.04.009 Get rights and content

Abstract

Objectives

This work reviews the current knowledge of aetiology and measurement methods of halitosis.

Data

Halitosis is an unpleasant or offensive odour emanating from the breath. The condition is multifactorial and may involve both oral and non-oral conditions.

Sources

A private, monthly with keywords halitosis, malodo(u)r, (a)etiology, measurement, and management from Medline and Pubmed updated database of literature was reviewed.

Conclusions

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.

Section snippets

Aetiology of halitosis

Genuine halitosis is multifactorial and may involve both oral and non-oral conditions. However, in approximately 80–90% of all cases it is caused by oral conditions, defined as oral malodour.8, 11

Measurement methods of halitosis

The three primary measurement methods of genuine halitosis are organoleptic measurement, gas chromatography, and sulphide monitoring. Additional or alternative measurement methods are BANA test, chemical sensors, salivary incubation test, quantifying β-galactosidase activity, ammonia monitoring, ninhydrin method, and polymerase chain reaction.

Discussion

Halitosis seems an important negative factor in social communication. Just a few studies are reporting the prevalence of halitosis in the general population. Because of the important health and social implications of halitosis, epidemiologic, aetiologic and measurement studies are needed to assess the prevalence of halitosis in the general population world-wide, to identify factors associated with this condition, such as age, gender, socioeconomic factors, oral health status, and (oral) health

Concluding remarks

Most adults suffer from genuine halitosis occasionally, while an estimated 10–30% of the population suffers from this problem regularly. In approximately 80–90% of all cases halitosis is caused by oral conditions, defined as oral malodour. Oral malodour arises from microbial degradation of organic substrates. Non-oral aetiologies of genuine halitosis may include disturbances of the upper and lower respiratory tract, disorders of the gastrointestinal tract, some systemic diseases, metabolic

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Citation Excerpt :
People who have halitosis often feel embarrassed about it and are adversely affected in terms of the social aspects of their life [1]. These social effects of halitosis usually urge compel patients to seek professional care [2]. Halitosis is considered the third most common reason for dentist visits in the United States, after caries and periodontal disease [3].
Halitosis is the general term used to describe any disagreeable odor in exhaled air, regardless of whether the odorous substances originate from oral or non-oral sources. Previous research has strongly associated tobacco smoking in the development of halitosis, as it increases the synthesis of toxic volatile sulfur compounds in diseased periodontal pockets. In this review, we summarize the etiopathology and epidemiology of halitosis as well as the current evidence on the impact of smoking by means of a meta-analysis.
PubMed and Embase were searched to identify publications that reported halitosis in smokers and nonsmokers. Meta-analyses were performed if a sufficient number (n ≥ 3) of articles were available that evaluated the same outcome.
The meta-analyses showed that there was an increased risk of halitosis in current smokers versus nonsmokers (odds ratios). These results were consistent both in fixed and random effects models. Even though the interstudy heterogeneity was high (I² = 91%), sensitivity analysis by limiting the number of studies yielded similar results, with no-to-moderate heterogeneity (I² = 0–65%). The analysis comparing ever smokers with never smokers showed no significant difference in the risk of halitosis in ever smokers. The same effect was observed when upon stratifying the analyses on the basis of ascertainment of halitosis (self-reported or measured by a Halimeter).
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ReviewA review of the current literature on aetiology and measurement methods of halitosis

Abstract

Objectives

Data

Sources

Conclusions

Section snippets

Aetiology of halitosis

Measurement methods of halitosis

Discussion

Concluding remarks

Oral Surgery, Oral Medicine, and Oral Pathology

Clinical Therapeutics

International Dental Journal

International Dental Journal

Oral Surgery, Oral Medicine, and Oral Pathology

International Dental Journal

Oral Surgery, Oral Medicine, and Oral Pathology

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

Biochemical and Biophysical Research Community

International Dental Journal

International Dental Journal

International Dental Journal

Otolaryngology-Head and Neck Surgery

The Journal of Pediatrics

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

International Dental Journal

International Dental Journal

Life Sciences

International Journal of Pediatric Otorhinolaryngology

International Journal of Pediatric Otorhinolaryngology

Surgery

Journal of the American Dental Association

Auris Nasus Larynx

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

Journal of the American Dental Association

Archives of Oral Biology

International Dental Journal

Production and origin of oral malodor: a review of mechanisms and methods of analysis

Journal of Periodontology

Effects of new fish oil derivative on fatty acid phospholipid-membrane pattern in a group of Crohn's disease patients

Digestive Diseases Sciences

Breath malodor in an asthmatic patient caused by side-effects of medication: a case report and review of the literature

Oral Diseases

Examination classification and treatment of halitosis; clinical perspectives

Journal of the Canadian Dental Association

A breath of fresh air

Journal of the American Dental Association

Correlation between volatile sulphur compounds and certain oral health measurements in the general population

Journal of Periodontology

Oral malodor-related parameters in the Chinese general population

Journal of Clinical Periodontology

Experiences of a Belgian multidisciplinary breath odour clinic

Acta Otorhinolaryngology Belgica

Volatile sulfur compounds in mouth air from clinically healthy subjects and patients with periodontal disease

Journal of Periodontal Research

Biochemical and clinical factors influencing oral malodor in periodontal patients

Journal of Periodontology

Relationship of sulcular sulfide level to severity of periodontal disease and BANA test

Journal of Periodontology

Relationship between sulcular sulfide level and oral malodor subjects with periodontal disease

Journal of Periodontology

Assessment of newly developed tongue sulfide probe for detecting oral malodor

Journal of Clinical Periodontology

Relationship between tongue coating and secretory-immunoglobulin A level in saliva obtained from patients complaining of oral malodour

Journal of Clinical Periodontology

Breath malodour: a step by step approach

The capacity of subgingival microbiotas to produce volatile sulfur compounds in human serum

Oral Microbiology and Immunology

The formation of hydrogen sulfide and methyl mercaptan by oral bacteria

Oral Microbiology and Immunology

Salivary and metabolic factors involved in oral malodor formation

Journal of Periodontology

On the transformation of sulfur-containing amino acids and peptides to volatile sulfur compounds (VSC) in the human mouth

European Journal of Oral Sciences

Modeling of the oral malodor system and methods of analysis

Quintessence International

β-Galactosidase activity in saliva is associated with oral malodor

Journal of Dental Research

Gas chromatographic method for trapping and detection of volatile gas compounds from human mouth air

Review
A review of the current literature on aetiology and measurement methods of halitosis