An intra-oral infection Halitosis and its Causes, Diagnosis, and Treatment Strategies – A Systematic Review

Noora Abdulrazzaq Naji ^1*, Safa Ali Hamad ², Samar Khalid Al-Adel ², Hamsa Thabet Musa ², Saja Sami Malik ² 

Halitosis, a prevalent issue, often remains untreated, causing social discomfort. Oral causes, especially bacterial buildup, necessitate effective dental management strategies.

Abstract

Halitosis, commonly known as foul breath, affects a substantial portion of the population and often goes unaddressed for an extended period before individuals seek help from specialized clinics. This condition can have significant social and psychological implications. While halitosis can stem from various underlying causes, the oral cavity is responsible for the majority of cases (about 90%). Factors such as bacterial buildup on the tongue and inflammation of the gums or surrounding tissues contribute significantly to oral halitosis. Dentists frequently encounter patients with halitosis in their practice and must possess effective strategies to manage it. Utilizing established methodologies, dentists can achieve considerable therapeutic efficacy. Despite the prevalence of halitosis, many individuals endure its effects for prolonged periods before seeking assistance from dedicated clinics. The literature provides numerous recognized methods for diagnosing and treating halitosis, and this article comprehensively explores these aspects.

Keywords: Halitosis, Oral cavity, Dental practitioner, Therapeutic efficacy, Specialized clinic

References

Al-Ansari JM, Boodai H, Al-Sumait N, Al-Khabbaz AK, Al- Hammari KF, Salako N. Factors associated with self-reported halitosis in Kuwaiti patients. J Dent 2006;34:444–449.

Al-Rassam, Z.T.; Shareef, A.Y. (2006). Urinary tract infections caused by Alcaligenes spp. In diabetic patients. Raf. J. Sci., 17(9),137-146.

Al-Ubaidy, S.I.; Sharif, A.Y. (2008). Microbial contamination of white soft cheese in Ninavah governorate. Raf. J. Sci., 19(2), 115-129.

Armstrong B, Michelle L, Stoltenberg JL. Halitosis: a review of current literature. J Dent Hyg 2010;84:65–75.

Aylikci BU, Colak H. Halitosis: from diagnosis to management. J Nat Sc Biol Med 2013;4:14–21.

Benic GZ, Farella M, Morgan XC, et al. Oral probiotics reduce halitosis in patients wearing orthodontic braces: a randomized triple-blind placebo-controlled trial. J Breath Res 2019;13:036010.

Bicak, D.A. A Current Approach to Halitosis and Oral Malodor—A Mini Review. Open Dent. J. 2018, 12, 322–330.

Bolepalli A, Munireddy C, Peruka S, Polepalle T, Alluri L, Mis- haeel S. Determining the association between oral malodour and periodontal disease: a case control study. J Int Soc Prev Community Dent 2015;5:413–420.

Bollen CM, Beikler T (2012) Halitosis: the multidisciplinary approach. Int J Oral Sci 4: 55-63.

Bornstein, M.M.; Kislig, K.; Hoti, B.B.; Seemann, R.; Lussi, A. 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, 261–267.

Bornstein, M.M.; Stocker, B.L.; Seemann, R.; Bürgin, W.B.; Lussi, A. Prevalence of halitosis in young male adults: A study in swiss army recruits comparing self-reported and clinical data. J. Periodontol. 2009, 80, 24–31.

Bosch M, Nart J, Audivert S, et al. Isolation and characteriza- tion of probiotic strains for improving oral health. Arch Oral Biol 2012;58:558–559.

Burton JP, Chilcott CN, Moore CJ, Speiser G, Tagg JR. A pre- liminary study of the effect of probiotic Streptococcus salivarius K12 on oral malodour parameters. J Appl Microbiol 2006;100:754–764.

Calil C, Liberato FL, Pereira AC, de Castro Meneghim M, Goodson JM, et al. (2009) The relationship between volatile sulphur compounds, tongue coating and periodontal disease. Int J Dent Hyg 7: 251-255.

Casemiro LA, Martins CH, de Carvalho TC, Panzeri H, Lavra- dor MA, Pires de Souza C. Effectiveness of a new toothbrush design versus a conventional tongue scraper in improving breath odour and reducing tongue microbiota. J Appl Oral Sci 2008;16:271–274.

Coil JM, Yaegaki K,Matsuo T, Miyazaki H. Treatment needs (TN) and practical remedies for halitosis. Int Dent J. 2002;52:187–91.

Collins LM, Dawes C (1987) The surface area of the adult human mouth and thickness of the salivary film covering the teeth and oral mucosa. J. Dent Res 66: 1300-1302.

Cortelli, J. R., Barbosa, M. D., & Westphal, M. A. (2008). Halitosis: A review of associated factors and therapeutic approach. Brazilian Oral Research, 1, 44–54.

de Souza RF, de Freitas Oliveira Paranhos H, Lovato da Silva CH, Abu- Naba'a L, Fedorowicz Z, et al. (2009) Interventions for cleaning dentures in adults. Cochrane Database Syst Rev : CD007395.

Faveri M, Feres M, Shibli JA, Hayacibara RF, Hayacibara MM, et al. (2006) Microbiota of the dorsum of the tongue after plaque accumulation: an experimental study in humans. J Periodontol 77: 1539-1546.

Goldberg S, Kozlovsky A, Gordon D, Gelernter I, Sintov A, et al. (1994) Cadaverine as a putative component of oral malodor. J Dent Res 73: 1168-1172.

Haghgoo R, Abbasi F. Evaluation of the use of a peppermint mouth rinse for halitosis by girls studying in Tehran high schools. J Int Soc Prev Community Dent 2013;3:29–35.

Han DG, Lee SM, Lee JG, Kim YJ, Kim JB. Association between viral hepatitis B infection and halitosis. Acta Odontol Scand 2014;72:274–282.

Hoshi K, Yamano Y, Mitsunaga A, Shimizu S, Kagawa J, et al. (2002) Gastrointestinal diseases and halitosis: association of gastric Helicobacter pylori infection. Int Dent J 52 Suppl 3: 207-211.

Hughes, F.J.; McNab, R. Oral malodour—A review. Arch. Oral Biol. 2008, 53 (Suppl. S1), S1–S7.

Hur MH. Reduction of mouth rinse and volatile sulfur com- pound in intensive care patients using an essential oil mouth- wash. Phytother Res 2007;21:641–643.

Kapoor U, Sharma G, Juneja M, Nagpal A. Halitosis: current concepts on etiology, diagnosis and management. European J Dent 2016;10:292–300.

Karban, A., Nakhleh, M. K., Cancilla, J. C., Vishinkin, R., Rainis, T., Koifman, E. … Haick, H. (2016). Programmed nanoparticles for tailoring the detection of inflammatory bowel diseases and irritable bowel syndrome disease via breathprint. Advanced Healthcare Materials, 5, 2339–2344.

Khaira, N.; Palmer, R.M.; Wilson, R.F.; Scott, D.A.; Wade, W.G. Production of volatile sulphur compounds in diseased periodontal pockets is significantly increased in smokers. Oral Dis. 2008, 6, 371–375.

Kim SE, Shim KM, Yoo KH, et al. The effect of Cetylpyridinium chloride on halitosis and periodontal disease-related parameters in dogs. Biotechnol Bioprocess Eng 2008;13:252–255.

Laleman I, Detailleur V, Slot DE, Slomka V, Quirynen M, , Teughels W. Probiotics reduce mutans streptococci counts in humans: a systematic review and meta-analysis. Clinical Oral Invest 2014;18:1539–1552.

Loesche, W.J.; Kazor, C. Microbiology and treatment of halitosis. Periodontol. 2000 2002, 28, 256–279.

Lopes, R.G.; De Godoy, C.H.L.; Deana, A.M.; De Santi,M.E.S.O.; Prates, R.A.; França, C.M.; Fernandes, K.P.S.;Mesquita-Ferrari, R.A.; Bussadori, S.K. Photodynamic therapy as a novel treatment for halitosis in adolescents: Study protocol for a randomized controlled trial. Trials 2014, 15, 443.

McDowell, J.D.; Kassebaum, D.K. Diagnosing and Treating Halitosis. J. Am. Dent. Assoc. 1993, 124, 55–64.

Miyazaki H, Arao M, Okamura K, Kawaguchi Y, Toyofuku A, Hoshi K, et al. Tentative classification of halitosis and its treatment needs. Niigata Dent J. 1999;32:7–11.

Miyazaki H, Sakao S, Katoh Y, Takehara T (1995) Correlation between volatile sulphur compounds and certain oral health measurements in the general population. J Periodontol 66: 679-684.

Moshkowitz M, Horowitz N, Leshno M, Halpern Z (2007) Halitosis and gastroesophageal reflux disease: a possible association. Oral Dis 13:

Nakano Y, Yoshimura M, Koga T. Correlation between oral malodour and periodontal bacteria. Microbes Infect 2002;4:679–683.

Outhouse TL, Fedorowicz Z, Keenan JV, Al-Alawi R. A Cochrane systematic review finds tongue scrapers have short term efficacy in controlling halitosis. Gen Dent 2006;54:352– 359.

Porter, S.R.; Scully, C. Oral malodour (halitosis). BMJ 2006, 333, 632–635.

Quirynen M, Dadamio J, Van den Velde S, De Smit M, Dekeyser C, et al. (2009) Characteristics of 2000 patients who visited a halitosis clinic. J. Clin Periodontol 36: 970-975.

Quirynen M, Dadamio J, Van den Velde S, et al. Characteris- tics of 2000 patients visited a halitosis clinic. J Periodontol 2009;36:970–975.

Quirynen M, Zhao H, Avontroodt P, et al. A salivary incuba- tion test for evaluation of oral malodour: a pilot study. J Peri- odontol 2003;74:937–944.

Quirynen M, Zhao H, van Steenberghe D. Review of the treatment strategies for oral malodour. Clin Oral Investig. 2002;6:1–10.

Rosenberg M, Kulkarni GV, Bosy A, McCulloch CA (1991). Reproducibility and sensitivity of oral malodor measurements with a portable sulphide monitor. J Dent Res 70: 1436-1440.

Rosenberg M, Kulkarni GV, Bosy A, McCulloch CA. Repro- ducibility and sensitivity of oral malodour measurements with a portable sulphide monitor. J Dent Res 1991;70:1436–1440.

Rosenberg, M. Bad breath, diagnosis and treatment. Univ. Tor. Dent. J. 1990, 3, 7–11.

Sandeanu S, Jonkers D, De Bruine A, Hameeteman W, Stockbrugger RW (2001) Non-Helicobacter pylori bacterial flora during acid suppressive therapy: differential findings in gastric juice and gastric mucosa. Aliment Pharmacol Ther 15: 379-388.

Scully C, El-Maaytah M, Porter SR, Greenman J. Breath odor: etiopathogenesis, assessment and management. Eur J Oral Sci. 1997;105:287–93.

Seemann R, Conceicao MD, Filippi A, Greenman J, Lenton P, Nachnani S, et al. Halitosis management by the general dental practitioner–results of an international consensus workshop. J. Breath Res. 2014;8:017101. This article summarizes the results of a consensus workshop of international authorities with the aim of reaching a consensus on general guidelines on how to assess and diagnose patients’ breath odor and on the treatment of halitosis.

Setia S, Pannu P, Gambhir R, Galhotra V, Ahluwalia P, Sofat A. Correlation of oral hygiene practices, smoking and oral health conditions with self-perceived halitosis amongst under- graduate dental students. J Nat Sci Biol Med 2014;5:67–75.

Setia, S.; Pannu, P.; Gambhir, R.S.; Galhotra, V.; Ahluwalia, P.; Sofat, A. Correlation of oral hygiene practices, smoking and oral health conditions with self perceived halitosis amongst undergraduate dental students. J. Nat. Sci. Biol. Med. 2014, 5, 67–72.

Sever, E.; Božac, E.; Saltovic, E.; Simonic-Kocijan, S.; Brumini, M.; Glažar, I. Impact of the Tobacco Heating System and Cigarette Smoking on the Oral Cavity: A Pilot Study. Dent. J. 2023, 11, 251. https://doi.org/10.3390/dj11110251

Sukontapatipark W, El-Agroudi MA, Selliseth NJ, Thunold K, Selvig KA. Bacterial colonization associated with fixed orthodontic appliances. A scanning electron microscopy study. Eur J Orthod 2001;23:475–484.

Suzuki N, Yoneda M, Naito T, Iwamoto T, Masuo Y, et al. (2008) Detection of Helicobacter pylori DNA in the saliva of patients complaining of halitosis. J Med Microbiol 57: 1553-1559.

Suzuki N, Yoneda M, Tanabe K, et al. Lactobacillus salivarius WB21 – containing tablets for the treatment of oral malodour: A double-blind, randomized, placebo-controlled crossover trial. Oral Surg Oral Med Oral Pathol Oral Radiol 2014;117:462– 470.

Tanaka M, Anguri H, Nonaka A, et al. Clinical assessment of oral malodour by the electronic nose system. J Dent Res 2004;83:317–321.

Tessier JF, Kulkarni GV. Bad breath: etiology, diagnosis and treatment. Oral Health. 1991;81:19–22. 24.

Van der Broek A, Feenstra L, de Baat C. A review of the cur- rent literature on aetiology and measurements methods of hali- tosis. J Dent 2007;35:627–635.

Werdmuller BF, van der Putten TB, Balk TG, Lamers CB, Loffeld RJ (2000) Clinical presentation of Helicobacter pylori-positive and –negative functional dyspepsia. J Gastroenterol Hepatol 15: 498-502.

Winkel EG, Roldan S, Van Winkelhoff AJ, Herrera D, Sanz M. Clinical effects of a new mouthrinse containing chlorhexidine, cetylpyridinium chloride and zinc-lactate on oral halitosis. A dual-center, double-blind placebo-controlled study. J Clin Peri- odontol 2003;30:300–306.

Yaegaki K, Coil JM. Examination, classification, and treatment of halitosis; clinical perspectives. J Can Dent Assoc 2000;66:257–61.

Yaegaki K, Coil JM. Examination, classification, and treatment of halitosis; clinical perspectives. J Can Dent Assoc. 2000;66:257–61.

Yaegaki, K., & Sanada, K. (1992). Biochemical and clinical factors influencing oral malodor in periodontal patients. Journal of Periodontology, 63, 783–789.

Yoneda M, Suzuki N, Hirofuji T. Current status of the tech- niques used for halitosis analysis. Austin Chromatography 2015;19:1–3.

Zalewska A, Zatoński M, Jabłonka-Strom A, Paradowska A, Kawala B, et al. (2012) Halitosis--a common medical and social problem. A review on pathology, diagnosis and treatment. Acta Gastroenterol Belg 75: 300-309.

Zürcher A, Filippi A. Findings, diagnoses and results of a halitosis clinic over a seven year period. Schweiz Monatsschr Zahnmed. 2012;122:205–16. This is a retrospective study which analyzed data from 465 patients of the Halitosis Clinic at the University of Basel.