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REVIEW ARTICLE  
Year : 2014  |  Volume : 4  |  Issue : 1  |  Page : 1-3
Measurements of Halitosis: Merits and demerits of various techniques


Department of Periodontics, Tamil Nadu Government Dental College and Hospital, Chennai, Tamil Nadu, India

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Date of Web Publication17-Oct-2014
 

   Abstract 

"Bad breath" (1550BC Ebers Papyrus) has been recorded in the literature for thousands of years and has only come to the force, as it can be a significant social handicap in sophisticated world. Modern literature on bad breath dates back to a monograph published in the 19th century itself. Prevalence is unclear, assessment is difficult and treatment strategies to control oral malodor are primarily directed at reduction of total bacterial counts in the oral cavity. In the present article, we would like to discuss the merits and demerits of different instruments used to measure halitosis.

Keywords: Diagnostic techniques, halitosis, malodor

How to cite this article:
Malathi K, Garg S, Sable D. Measurements of Halitosis: Merits and demerits of various techniques . J Educ Ethics Dent 2014;4:1-3

How to cite this URL:
Malathi K, Garg S, Sable D. Measurements of Halitosis: Merits and demerits of various techniques . J Educ Ethics Dent [serial online] 2014 [cited 2019 Nov 14];4:1-3. Available from: http://www.jeed.in/text.asp?2014/4/1/1/143145



   Introduction Top


Often we come across persons with bad breath in routine life and most of the times they are ignorant of their problem. Bad breath is commonly known as halitosis. It is not a disease but symptoms of various diseases. 80% to 85% of the population after the age of 30 suffers from this malaise. Usually we do not know our malodor because we become adapted to it. [1] Halitophobia: i.e. the fear of being ignored by others due to bad breath. These people avoid talking to others, keep distance and are socially cut off. [2] Prinz suggested that more than 90% of all cases of objectionable breath originate from sources within the oral cavity. Studies by Rosenberg and Tonzetich also support this view.

Oral malodor is caused by the presence of volatile sulphur compounds especially methyl mercaptans and hydrogen sulphide and also by short chain fatty acids. In vitro research indicates that the gram negative anaerobic micro flora is responsible for odor formation. [3] Commonly used approaches to sample and measurements are Halimeter, Spoon Test, High Pressure Liquid Chromatography, Saliva odor test, Gas chromatography, Portable Gas Chromatography, Central Floss Odor Test, Organoleptic Scoring Scale, Saliva Incubation Test, Electronic Nose, Dark field/Phase Contrast Microscope, BANA Test and Diamond Probe etc. This article discusses the merits and demerits of different techniques which are in use now.

Rosenberg and Mcculloh in 1992 have given various methods of measuring malodor, directly or indirectly, however licking and smelling remains the simple method to self-asses the malodor. The first and foremost way is to motivate the patients to practice good oral hygiene. [4]

Self evaluation/examination [5]

Merits

  1. More objective assessment.
  2. Motivate the patients to continue the oral hygiene instructions.


Demerits

  1. Unreliable


Halimeter [5],[6]

It analyses the concentration of Hydrogen Sulphide and Methylmercaptan without discrimination between the two.

Merits

  1. Portability-chair side test.
  2. Non-invasive.
  3. Relatively inexpensive.
  4. No need for skilled personnel.
  5. Low likelihood of cross infections.
  6. Use for intraoral causes of halitosis.
  7. Rapid turnaround time .of one to two minutes between measurements.


Demerits

  1. Inability to distinguish between individual sulphides.
  2. Measurement can't be made in the presence of high levels of ethanol or essential oils.
  3. Cannot be used other than intraoral causes.
  4. It has no specificity.
  5. It is insensitive to dimethyl sulphide.
  6. It detects only sulphur compound.
  7. Instrument shows slight loss of sensitivity with time, necessitating periodic recalibration.


Gas chromatography [5],[6]

It is the method of instrumental analysis of halitosis using gas Chromatography coupled with flame photometric detection.

Merits

  1. Useful for non-oral causes of halitosis.
  2. Very high sensitivity and specificity.
  3. Ability to measure extremely low concentration of gases.
  4. Separation and quantitative measurement of individual gases.
  5. It can detect virtually any compound when using adequate materials and conditions.
  6. Helpful in differential diagnosis.


Demerits

  1. It is expensive.
  2. Requires skilled personnel.
  3. Cumbersome and lack of portability.
  4. More time is required for detection and measurement.


Portable gas chromatography [7]

Merits

  1. Small-available for periodontal clinics.
  2. Useful in quantitative measurements.
  3. Helpful in differential diagnosis.
  4. Has the capacity to measure the concentration of three key sulphur compounds.(hydrogen sulphide, dimethyl sulphide, methyl mercaptan).
  5. Highly sensitive.
  6. Low cost.


Demerits

  1. It cannot detect other than sulphur compounds.
  2. Needs calibration.
  3. The sensor and column need to be replaced every two years.


Organoleptic scoring scale [6],[7],[8]

It is a sensory test scored on the basis of examiner's perception of subject's oral malodor. It is a gold standard in the examination of halitosis.

Merits

  1. Easiest and more often used method.
  2. It gives a reflection of the everyday situation.
  3. No need for special equipment.
  4. Procedure prevents the dilution of odor with room air.


Demerits

  1. Objectivity and reproducibility are poor.
  2. Assessment can be influenced by position of head, hunger and experience of judge.
  3. Has a degree of subjectivity.
  4. Assessment should be performed at several appointments on different days.


Gas chromatography mass spectrometry [5],[7]

Merits

  1. It is useful in the rapid detection of trace levels of mycobacterial secondary alcohols.
  2. Results can be obtained within two days.
  3. High sensitivity and specificity.


Demerits

  1. Expensive.
  2. Skillful personnel are required.


High performance liquid chromatography [7]

Merits

  1. Rapid analysis
  2. Degradation of the sample is quicker.


Demerits

  1. Expensive.
  2. Skilled personnel is required.


Psychophysical staircase method [7]

This is the method used for determination of the threshold level.

Merits

Quantitative assessment is possible

Demerits

Assessment must be repeated because of breath odor can fluctuate from day to day.

Smell identification test-"sensonic" [1]

It is a commercially available test.

Merits

  1. Qualitative assessment is possible.
  2. Partial anosmia can be diagnosed.


Demerits

  1. can't detect odors at low concentration.


Electric nose [1],[3],[8]

A new device that is being developed which has the capacity of the human nose is referred to as the electric nose.

Merits

  1. Can identify the specific components of an odor.
  2. Can analyze the chemical make-up of the compound.
  3. Smaller.
  4. Less expensive.
  5. Easier to use.


Demerits

  1. It cannot determine volatile chemicals precisely.
  2. Can be used only with a specific application(if the metabolites are already known).
  3. It is difficult to distinguish mouth air compounds from others.(The mouth air sample is contaminated with certain amount of respiratory air).


Saliva incubation test [5]

Merits

  1. Non-invasive test for the patient
  2. Helps to identify various compounds that contribute to oral malodor.


Bana test

Merits

  1. Helps to detect bacteria and their enzymes which produce volatile sulphur compounds (T. denticola, P. gingivalis, T. denticola)


Dark field/phase contrast microscopy [5]

Merits

  1. Shifts in the proportions of motile organisms can be noted.
  2. Can monitor therapeutic progress.
  3. Awareness of the patient can be created by showing the bacteria in plaque, tongue coating and saliva.



   Conclusion Top


Selection of the most appropriate method for analysis of halitosis requires careful consideration of available techniques. Offensive odor of the oral cavity may disturb interpersonal communication and social activities. Factors associated for halitosis are usually/commonly due to periodontal disease, poor oral hygiene and oral dryness. To reduce the level of volatile sulphur compounds and other waste products, health educationand preventive intervention are necessary. Inspite of advancement in techniques, treatment for halitosis still presents a therapeutic problem for the clinician.

 
   References Top

1.
Dr Supreet Kaur, Dr Harkiran Kaur, Dr Sukhmandeep Kaur Bhandal Halitosis: Principle Etiopathogenesis, Diagnostic-therapeautic & Preventive aspects of a millennial old problem, Indian Dental Research Review Vol. 8, Issue 2, Dec-2012, Page 34-44.  Back to cited text no. 1
    
2.
Preti G, Clark L, Cowart BJ, Feldman RS, Lowry LD, Weber E, et al. Non oral etiologies of oral malodor and altered chemosensation. J P 1992;63:790-6.  Back to cited text no. 2
    
3.
SUMIT Malhotra, R. K. Yeltiwar, Evaluation of two mouth rinses in reduction of oral malodor using a spectrophotometric technique, Journal of Indian Society of Periodontology - Vol 15, Issue 3, Jul-Sep 2011.  Back to cited text no. 3
    
4.
Tonzetick. J J. Production and origin of malodor. A review of mechanisms and methods of analysis. J Pl 1977;48:13-20.  Back to cited text no. 4
    
5.
Marc quirynen, Sandra van den velde, Betty vandekerckhove, jesica dadamio.oral malador, chapter 29,Carranza's clinical periodontology,11 th ed. Elsivier, 2011, page 463.  Back to cited text no. 5
    
6.
S. Sahitya Reddy. Halitosis chapter 41, essential of periodontlogy paras medical publication, 2013 page no. 430.  Back to cited text no. 6
    
7.
Shalu Bathla. Halitosis, chapter 33, periodontics revisted, Jay Pee brother medical publication, 2011, page 245.  Back to cited text no. 7
    
8.
Dilip et al., Halitosis, chapter 30, Dilip G Nayak, ashita uppoor, Mahesh cp, Textbook of periodontology oral implantology, Elsevier, 2010, page 231.  Back to cited text no. 8
    

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Correspondence Address:
K Malathi
Plot no: 96, 10/ 221, Subamathi Nivas, 4th Street, Vimala Nagar, Medavakkam, Chennai - 600 100, Tamil nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-7761.143145

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