Examination, classification, and treatment of halitosis; clinical perspectives.
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Patients with halitosis may seek treatment from dental clinicians for their perceived oral malodour. In this article, an examination protocol, classification system and treatment needs for such patients are outlined. Physiologic halitosis, oral pathologic halitosis and pseudo-halitosis would be in the treatment realm of dental practitioners. Management may include periodontal or restorative treatment or both, as well as simple treatment measures such as instruction in oral hygiene, tongue cleaning and mouth rinsing. Psychosomatic halitosis is more difficult to diagnose and manage, and patients with this condition are often mismanaged in that they receive only treatments for genuine halitosis, even though they do not have oral malodour. A classification system can be used to identify patients with halitophobia. Additionally, a questionnaire can be used to assess the psychological condition of patients claiming to have halitosis, which enables the clinician to identify patients with psychosomatic halitosis. In understanding the different types of halitosis and the corresponding treatment needs, the dental clinician can better manage patients with this condition. (+info)
Pharyngeal foreign body in a child persisting for three years.
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Foreign body ingestions are common in children. They can pose a diagnostic problem if the foreign body is embedded in the soft tissues of pharynx. A 4 year old girl presented with halitosis for two years. A pharyngeal foreign body, a metallic ring, was seen on lateral radiographs of the neck. The foreign body was removed under general anaesthesia. A completely embedded pharyngeal foreign body should be considered in cases presenting with halitosis. (+info)
Diversity of bacterial populations on the tongue dorsa of patients with halitosis and healthy patients.
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The primary purpose of the present study was to compare the microbial profiles of the tongue dorsa of healthy subjects and subjects with halitosis by using culture-independent molecular methods. Our overall goal was to determine the bacterial diversity on the surface of the tongue dorsum as part of our ongoing efforts to identify all cultivable and not-yet-cultivated species of the oral cavity. Tongue dorsum scrapings were analyzed from healthy subjects with no complaints of halitosis and subjects with halitosis, defined as an organoleptic score of 2 or more and volatile sulfur compound levels greater than 200 ppb. 16S rRNA genes from DNA isolated from tongue dorsum scrapings were amplified by PCR with universally conserved bacterial primers and cloned into Escherichia coli. Typically, 50 to 100 clones were analyzed from each subject. Fifty-one strains isolated from the tongue dorsa of healthy subjects were also analyzed. Partial sequences of approximately 500 bases of cloned inserts from the 16S rRNA genes of isolates were compared with sequences of known species or phylotypes to determine species identity or closest relatives. Nearly complete sequences of about 1,500 bases were obtained for potentially novel species or phylotypes. In an analysis of approximately 750 clones, 92 different bacterial species were identified. About half of the clones were identified as phylotypes, of which 29 were novel to the tongue microbiota. Fifty-one of the 92 species or phylotypes were detected in more than one subject. Those species most associated with healthy subjects were Streptococcus salivarius, Rothia mucilaginosa, and an uncharacterized species of Eubacterium (strain FTB41). Streptococcus salivarius was the predominant species in healthy subjects, as it represented 12 to 40% of the total clones analyzed from each healthy subject. Overall, the predominant microbiota on the tongue dorsa of healthy subjects was different from that on the tongue dorsa of subjects with halitosis. Those species most associated with halitosis were Atopobium parvulum, a phylotype (clone BS095) of Dialister, Eubacterium sulci, a phylotype (clone DR034) of the uncultivated phylum TM7, Solobacterium moorei, and a phylotype (clone BW009) of STREPTOCOCCUS: On the basis of our ongoing efforts to obtain full 16S rRNA sequences for all cultivable and not-yet-cultivated species that colonize the oral cavity, there are now over 600 species. (+info)
Olfactory reference syndrome: diagnostic criteria and differential diagnosis.
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Olfactory reference syndrome (ORS) has been defined as a psychiatric condition characterized by persistent preoccupation about body odour accompanied by shame, embarrassment, significant distress, avoidance behaviour and social isolation. ORS has however not been included in the Diagnostic and Statistical Manual of Mental Disorders (4th edition) (DSM-IV) and, given that its primary symptoms may be found in various other disorders, differential diagnosis can be problematic. Using an illustrative case of ORS, we propose diagnostic criteria for ORS. We also argue that ORS represents a unique cluster of symptoms that can be delineated as a separate diagnostic entity, and that ORS falls on a spectrum of social anxiety disorders that includes social anxiety disorder, taijin kyofusho, and body dysmorphic disorder. (+info)
The aetiology and treatment of oral halitosis: an update.
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Halitosis refers to the condition of offensive mouth odour. More than 90% of cases of halitosis originate from the oral cavity. The implicated bacteria (Fusobacterium nucleatum, Prevotella intermedia, and Tannerella forsythensis) are located in stagnant areas in the oral cavity, such as the dorsal surface of tongue, periodontal pockets, and interproximal areas. These bacteria proteolyse the amino acids releasing volatile sulphur compounds. The management of halitosis involves determining and eliminating the causes, which includes identifying any contributory factors, because certain medical conditions are also associated with characteristic smells. Professional advice should be given on oral hygiene and diet, and treatments should include dental scaling, and root planing of the associated periodontal pockets to reduce the bacterial loading. In addition to the normal oral hygiene practice, tongue cleaning and use of mouthwash are advocated. This paper discusses the common aetiological factors, classification of oral halitosis, and its treatment. (+info)
The effects of a chlorhexidine mouthrinse on culturable microorganisms of the tongue and saliva.
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A randomized and cross-over design clinical study with normal adult volunteers examined the effects of a 0.12% chlorhexidine (CHX) mouthrinse and a control rinse on a range of microflora including those implicated in halitosis on the tongue and saliva. Saliva and tongue scrapings were collected from 13 subjects prior to treatments with additional samples collected at 3 h post-treatment cultured on media to enumerate anaerobic, Gram-positive and Gram-negative bacteria, odorigenic bacteria producing hydrogen sulphide (H2S) and oral bacteria with proteolytic activity. In comparison to the control, rinsing with CHX demonstrated statistically significant reductions that ranged from 81-90% for tongue microflora with a 89-95% decrease noted on salivary flora (p<0.05). The effects of CHX on anaerobic, Gram-positive and Gram-negative bacteria are in accord with those noted on odorigenic bacteria producing H2S or proteolytic activity. These results help to explain previous clinical results on the malodor efficacy of CHX and highlight microbiological approaches for bacteria implicated in malodor. (+info)
Hydrogen sulfide-producing bacteria in tongue biofilm and their relationship with oral malodour.
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The aims of this study were to identify hydrogen sulfide (H2S)-producing bacteria among tongue biofilm microflora and to investigate the relationship between bacterial flora and H2S levels in mouth air. Oral malodour levels in 10 subjects (age 21-56 years) were assessed by gas chromatography, and Breathtron and organoleptic scores. Based on these assessments, subjects were divided into two groups: an odour group and a no/low odour group. Tongue coatings were sampled and spread onto Fastidious Anaerobe Agar plates containing 0.05% cysteine, 0.12% glutathione and 0.02% lead acetate, and were then incubated anaerobically at 37 degrees C for 2 weeks. Bacteria forming black or grey colonies were selected as H2S-producing phenotypes. The numbers of total bacteria (P<0.005) and H2S-producing bacteria (P<0.05) in the odour group were significantly larger than those in the no/low odour group. Bacteria forming black or grey colonies (126 isolates from the odour group; 242 isolates from the no/low odour group) were subcultured, confirmed as producing H2S and identified according to 16S rRNA gene sequencing. Species of Veillonella (38.1% in odour group; 46.3% in no/low odour group), Actinomyces (25.4%; 17.7%) and Prevotella (10.3%; 7.8%) were the predominant H2S-producing bacteria in both the odour and no/low odour groups. These results suggest that an increase in the number of H2S-producing bacteria in the tongue biofilm is responsible for oral malodour, although the bacterial composition of tongue biofilm was similar between the two groups. (+info)
Effect of visible light on malodour production by mixed oral microflora.
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Oral malodour is considered to be caused by the proteolytic activity of anaerobic Gram-negative oral bacteria. In a previous study, it was shown that these bacteria were susceptible to blue light (wavelengths of 400-500 nm). In this study, the effect of blue light on malodour production by mixed oral microflora was tested in a salivary incubation assay. Whole saliva samples were exposed to a xenon light source for 30, 60, 120 and 240 s, equivalent to fluences of 34, 68, 137 and 274 J cm(-2), respectively. Malodour was scored by two judges. The levels of volatile sulfide compounds (VSC) were measured using a sulfide monitor (Halimeter), the microbial population was assessed using viable counts and microscopy, salivary protein degradation was followed by SDS-PAGE densitometry and VSC-producing bacteria were demonstrated using a differential agar. The results showed that the exposure of mixed salivary microflora to blue light caused a reduction in malodour production concomitant with a selective inhibitory effect on the population of Gram-negative oral bacteria. These results suggest that light exposure might have clinical applications for the treatment of oral malodour. (+info)