A timely focus on halitosis

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CB12’s Arifa Sultana takes a closer look at the causes and cures for Halitosis

Unpleasant smelling breath can be extremely debilitating and impact considerably on a patient’s overall quality of life. Therefore, dental professionals need to educate patients and offer sound advice to successfully manage this extremely sensitive issue.

In 90 per cent of cases, halitosis emanates from the oral cavity. The source is commonly due to poor oral hygiene, periodontal disease, tongue coating, food impaction, unclean dentures or faulty restorations [1]. However, healthy individuals with good oral hygiene can also experience halitosis [2].

As dental professionals know, there are plenty of crevices in the mouth that can retain food debris and enable anaerobic bacteria, which can survive and grow with little or no oxygen, to survive and grow prolifically. In fact, it is the perfect environment for producing volatile sulphur compounds (VSCs) or sulphurous gases, which cause an unpleasant odour when exhaled.

VSCs are formed as by-products during the interaction and microbial putrefaction of food debris, cells, saliva and blood, and primarily, these gases contain hydrogen sulphide, which has the odour of rotting eggs, methyl mercaptan that produces a barnyard smell, and dimethyl sulphide, which smells of rotting cabbage or garlic.

The oral microbes that are most likely to cause unpleasant smelling breath are Gram negative bacteria and until fairly recently, were listed as: Prevotella (Bacteroides) melaninogenica, Treponema denticola, Porphyromonas gingivalis, Porphyromonas endodontalis, Prevotella intermedia, Bacteroides loescheii, Enterobacteriaceae, Tannerella forsythensis (Bacteroides forsythus), Centipeda periodontii, Eikenella corrodens, Fusobacterium nucleatum vincentii, Fusobacterium nucleatum nucleatum, Fusobacterium nucleatum polymorphum, and Fusobacterium periodonticum [3]. Nevertheless, in the last decade or so
Solobacterium moorei has also been identified in patients with halitosis.

Solobacterium moorei can produce 2-3 times more hydrogen sulphide (H2S) than Porphyromonas gingivalis [4]. A recent study of microbiological samples from the saliva and tongue coatings of 193 patients, detected the presence of Solobacterium moorei, and suggested a strong association between this bacterial species and halitosis [5].

Furthermore, when the microbial profiles of the tongue dorsum in healthy individuals were investigated, one of the most predominant microbes identified was Solobacterium moorei [6]. Consequently, patients with no previous history of halitosis and no periodontal disease can present with halitosis because the surface of the tongue can retain a complex range of bacteria1 and is a major site for VSC production [7].

Patients try all kinds of remedies such as sucking mints, drinking green tea and chewing parsley to address the undesirable effects of halitosis. Yet, for the most part, these can only disguise oral malodour and have temporary effects. After any dental disease and decay has been effectively treated, and oral health instruction has been reiterated, patients with halitosis need a solution that can control and neutralise VSCs to effectively address the actual cause of unpleasant smelling breath.

It has long been recognised that zinc and chlorhexidine have the ability to inhibit the formation of VSCs [8]. Tests have also confirmed that this combination is the most efficient way of converting the offensive sulphur content of VSCs into odourless, insoluble sulphides and most importantly, it provides a long-lasting effect [9]. Therefore, and to offer a solution to manage halitosis successfully, dental professionals can recommend CB12 mouthwash.

With a patented formula that includes zinc acetate and chlorhexidine diacetate, CB12 mouthwash has been clinically proven to target and neutralise VSCs and prevent unpleasant smelling breath for up to 12 hours.

By providing patients with a reliable recommendation to tackle the real cause of halitosis, dental professionals can help to improve patients’ oral health as well as improve their confidence and well-being.

For more information about CB12 White and how it could benefit your patients, visit www.cb12.co.uk 

References:
1] Uğur Aylıkcı B. et al. Halitosis: From diagnosis to management. J Nat Sci Biol Med. 2013 Jan-Jun; 4(1): 14–23. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3633265/ [Accessed 4th December 2017]
2] van den Velde S. et al. Halitosis associated volatiles in breath of healthy subjects. J Chromatogr B Analyt Technol Biomed Life Sci. 2007 Jun 15; 853(1-2):54 61. https://www.ncbi.nlm.nih.gov/pubmed/17416556/ [Accessed 4th December 2017]
3] Porter SR and Scully C. Oral malodour (halitosis). BMJ. 2006 Sep 23; 333(7569): 632–635. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1570844/ [Accessed 4th December 2017]
4] Stephen A.S. et al. In vitro growth characteristics and volatile sulphur compound production of Solobacterium moorei. Anaerobe 2014 Apr. 26 53-57. http://www.sciencedirect.com/science/article/pii/S1075996414000080 [Accessed 4th December 2017]
5] Vancauwenberghe F. et al. The role of Solobacterium moorei in oral malodour. Journal of Breath Research 7 (4). http://iopscience.iop.org/article/10.1088/1752-7155/7/4/046006/pdf [Accessed 4th December 2017]
6] Kazor C.E. et al. Diversity of bacterial populations on the tongue dorsa of patients with halitosis and healthy patients. J Clin Microbiol. 2003 Feb; 41(2): 558–563. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC149706/ [Accessed 4th December 2017]
7] Wåler SM. On the transformation of sulfur-containing amino acids and peptides to volatile sulfur compounds (VSC) in the human mouth. Eur J Oral Sci. 1997 Oct; 105(5 Pt 2):534-7. https://www.ncbi.nlm.nih.gov/pubmed/9395120  [Accessed 4th December 2017]
8] Yaegaki K, Suetaka T. The effect of mouthwash on oral malodour production. Shigaku. 1989 Apr; 76(7):1492-500. https://www.ncbi.nlm.nih.gov/pubmed/2761963 [Accessed 4th December 2017]
9] Erovic Ademovski S et al. The effect of different mouth rinse products on intra-oral halitosis. Int J Dent Hyg. 2016 May; 14(2):117-23. https://www.ncbi.nlm.nih.gov/pubmed/26031397 [Accessed 4th December 2017]

Photo by Lasaye Hommes on Unsplash