Reproducibility and Sensitivity of Oral Malodor Measurements with a Portable Sulphide Monitor

Abstract

Forty-one subjects with bad breath were assessed for oral malodor and periodontal status on three occasions, at intervals of approximately one week. Oral malodor was assessed by measurement of peak and steady-state volatile sulphide levels with a portable sulphide monitor and by organoleptic measurement of whole-mouth, tongue dorsum, and interproximal dental odors by two independent judges. Reproducibility of measurements, assessed by paired t tests and Kappa testing, demonstrated no significant differences between any ofthe test results from the first and second appointments. Steady-state sulphide levels were the most reproducible of all tests. The ability of the tests to detect an expected reduction of malodor following a 0.2% chlorhexidine mouthrinse regimen was investigated by comparison of test values between the second and third appointments. Following the mouthrinsing treatment, 43% reductions of peak, 47% reductions of steady-state volatile sulphide levels, and 15-58% reductions in all other measurement categories were observed. The majority of the participants (22/41) had no pockets greater than 5 mm and exhibited both moderate gingival inflammation (Mean Gingival Index = 1.17) and moderate plaque accumulation (Mean Plaque Index = 1.84). Plaque Index and presence of pockets greater than 7 mm were weakly related to sulphide measurements. Whereas assessment of steady-state sulphide levels by the sulphide monitor does not constitute a direct measure of oral malodor, its relation to organoleptic measurement, superior reproducibility, objectivity, and sensitivity support the use of the sulphide monitor in clinical studies.

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References

Brening, R.H. ; Sulser, G.F. ; and Fosdick, L.S. (1939): The Determination of Halitosis by Use of the Osmoscope and the Cryoscopic Method, J Dent Res 18:127-132.

Cain, W.S. (1989): Testing Olfaction in a Clinical Setting, Ear Nose and Throat J 68:322-328.

Cohen, J.A. (1960): A Coefficient of Agreement for Nominal Scales , Educ Psychol Measurement 20:37-46.

Doty, R.L. ; Green, P.A. ; Ram, C. ; and Yankell, S.L. (1982): Communication of Gender from Human Breath Odors: Relationship to Perceived Intensity and Pleasantness, Hormones and Behavior 16:13-22.

Ishikawa, M. ; Shibuya, K. ; Tokita, F. ; and Koshimizu, M. (1984): A Study of Bad Breath (2): The Evaluation of Bad Breath from by Methylmercaptan Production in Mouthrinse, J Dent Health 34:54-60.

Kleinberg, I. and Westbay, G. (1990): Oral Malodor , Crit Rev Oral Biol Med 1:247-260.

Kostelc, J.G. ; Preti, G. ; Zelson, P.R. ; Brauner, L. ; and Baehni, P. (1984): Oral Odors in Early Experimental Gingivitis, J Periodont Res 19:303-312.

Kostelc, J.G. ; Preti, G. ; Zelson, P.R. ; Stoller, N.H. ; and Tonzetich, J. (1980): Salivary Volatiles as Indicators of Periodontitis , J Periodont Res 15:185-192.

Kostelc, J.G. ; Zelson, P.R. ; Preti, G. ; and Tonzetich, J. (1981): Quantitative Differences in Volatiles from Healthy Mouths and Mouths with Periodontitis, Clin Chem 27:842-845.

10.

Landis, J.R. and Koch, G.G. (1977): The Measurement of Observer Agreement for Categorical Data, Biometrics 33:154-174.

11.

Loe, H. and Silness, J. (1963): Periodontal Disease in Pregnancy. I. Prevalence and Severity, Acta Odontol Scand 21:533-551.

12.

Nara, F. (1977): The Relationship Between the Halitosis and Oral Conditions of the Periodontal Patients, J Jpn Assoc Periodont 19:100-108.

13.

Persson, S. ; Claesson, R. ; and Carlsson, J. (1989): The Capacity of Subgingival Microbiotas to Produce Volatile Sulfur Compounds in Human Serum, Oral Microbiol Immunol 4:169-172.

14.

Rosenberg, M. ; Septon, I. ; Eli, I. ; Bar-Ness, R. ; Gelernter, I. ; Brenner, S. ; and Gabbay, J. (1991): Halitosis Measurement by an Industrial Sulphide Monitor, J Periodontol 62:487-489.

15.

Sackett, D.L. ; Haynes, R.B. ; and Tugwell, P. (1985): The Selection of Diagnostic Tests. In: Clinical Epidemiology: A Basic Science for Clinical Medicine. Toronto: Little, Brown, p. 51.

16.

Schmidt, N.F. ; Missan, S.R. ; Tarbet, W.J. ; and Cooper, A.D. (1978): The Correlation Between Organoleptic Mouth-Odor Ratings and Levels of Volatile Sulfur Compounds, Oral Surg Oral Med Oral Pathol 45 :560-567.

17.

Schmidt, N.F. and Tarbet, W.J. (1978): The Effect of Oral Rinses on Organoleptic Mouth Odor Ratings and Levels of Volatile Sulfur Compounds, Oral Surg Oral Med Oral Pathol 45:876-883.

18.

Shapiro, S.S. and Wilk, M.B. (1965): An Analysis of Variance Test for Normality (Complete Samples), Biometrika 52:591-611.

19.

Silness, J. and Loe, H. (1964): Periodontal Disease in Pregnancy. II. Correlation Between Oral Hygiene and Periodontal Condition, Acta Odontol Scand 22:121-135.

20.

Solis-Gaffar,M.C. ; Niles, H.P. ; Rainieri, W.C. ; and Kestenbaum, R.C. (1975): Instrumental Evaluation of Mouth Odor in a Human Clinical Study, J Dent Res 54:351-357.

21.

Spouge, J.D. (1964): Halitosis. A Review of Its Causes and Treatment , Dent Pract Dent Rec 14:307-317.

22.

Sulser, G.F. ; Brening, R.H. ; and Fosdick, L.S. (1939): Some Conditions that Affect the Odor Concentrations of Breath, J Dent Res 18 :355-359.

23.

Tachibana, Y. (1957): The Relation Between Pyorrhea Alveolaris and H2S Producing Bacteria in Human Mouth, J Stomatol Soc Jpn 24 :219-229.

24.

Tonzetich, J. (1977): Production and Origin of Oral Malodour: A Review of Mechanisms and Methods of Analysis, J Periodont 48:13-20.

25.

Tonzetich, J. (1978): Oral Malodour: An Indicator of Health Status and Oral Cleanliness, Int Dent J 28:309-319.

26.

Tonzetich, J. and Ng, S.K. (1976): Reduction of Malodor by Oral Cleansing Procedures , Oral Surg Oral Med Oral Pathol 42:172-181.

27.

Tsunoda, M. ; Sato, H. ; and Ohkushi, T. (1981): The Experimental Study for the Effect of Sodium Copper Chlorophyllin in Halitosis, J Jpn Assoc Periodont 23:490-498.