bluuebunny/crossref_metadata_2025 huggingface dataset:
O2  Oral malodor research sponsored by industry
Authors: Bowman J , Borden L , Lieght R , Mason S
Published: March 2005

Hill Top Research has been performing oral malodor research for over 30 years, for commercial companies who use these independent clinical studies to support advertising messages. Much of the clinical data generated by Hill Top Research, Inc. does not reach the public domain of peer reviewed scientific journals because client sponsors often consider this research to contain proprietary information. Alternatively academic journals do not consider this type of clinical research to meet sufficiently high basic research standards for publication. This dichotomy results in a knowledge gap between industry and academia as to how malodor research is carried out by industry. The purpose of this presentation is to review the regulatory environments which govern Oral Malodor marketing claims in Europe and North America and thus the clinical research standards which are desirable to substantiate the data to a standard which will withstand competitive legal challenges and regulatory review. The impact of subject data protection laws, good clinical practice guidelines, IRB/IEC review, statistical sample sizes, dental association requirements, and the principles behind sensory research will be discussed in relation to Oral Malodor clinical research. Explanations will be given as to how some requirements may be relaxed depending up whether the purpose of the investigation is ‘early stage proof of concept’ research evaluating the feasibility of introducing new formulations or ingredients as compared to ‘Safety and Efficacy’ clinical research carried out on final formulations necessary to meet the requirements of a regulatory submission or challenge in the market place.
O20  Psychophysical aspects of odour
Authors: van Toller S
Published: March 2005

The history of psychology during the last century should certainly include a statement about the neglect of the crucial topic of human emotion and also ignorance concerning the role of the olfactory sensory system in human behaviour. During my research career, together with my research students, these are topics I addressed. The sense of smell is not a vestigial system but a sensory input of vital importance in human behaviour. Our experiments involved behaviour and psychophysiological and brain activity studies. Some of these studies involved collaboration with members of Quest working in sensory evaluation. Currently it is slowly being recognized that all human sensory input is integrative and each of the sensory systems is important.
O22  Eating behaviour of institutionalized elderly people in relation to tongue cleaning
Authors: Neander KD , Seemann R , Rathke S , Hesse F
Published: March 2005

Introduction  Backing the oral hygiene of elderly people in need of care is an important task for geriatric nursing personal. Tongue cleaning has been generally recommended to improve the oral hygiene status, to prevent the development of oral malodour, and to improve the sense of taste. In Germany, no official recommendations for oral hygiene procedures in hospitals or nursing homes are available and if tongue cleaning is performed a regular toothbrush or a wooden spatula are mainly used. So far, only limited data have been published regarding the influence of tongue cleaning on taste sensation.

Aim  Therefore, the aim of this study was to investigate, whether a regime of daily tongue cleaning with a specially designed tongue cleaner could improve the eating behaviour of institutionalised elderly patients.

Methods  The study population consisted of 150 edentulous occupants (mean age 74 ± 4 s.d.) of a nursing home in Goettingen. Each subject served as its own control. During the test phase of 2 weeks each participant received five times daily a tongue cleaning procedure using the One Drop Only tongue cleaner (One Drop Only, Berlin; Germany; a combination of a tongue brush and a tongue scraper). During the control run the tongue cleaning was carried out also five times daily over a 2‐week period using a regular toothbrush. All procedures were performed by a carefully instructed geriatric nurse. As a measure for the eating behaviour the amount of spurned and returned drinks and food was determined by weighing. The individual impression of taste was also determined by using a questionnaire. All subjects were able to eat and drink without assistance.

Results  During the test period the subjects reported an increased appetite and only 18.3% of the served food and 17.1% of the served drinks were spurned and returned. In contrast, during the control phase the subjects returned 52% of the food and 53.2% of the drinks. These differences were statistically significant (P < 0.05, t‐test n. FERGUSON: α = 1%; f = 8; t = 3.37).

Conclusion  From our data we can conclude that the daily use of a specially designed tongue cleaner (One Drop Only) was capable of improving the appetite of institutionalised elderly patients. (This study was carried out without knowledge and support of the One Drop Only Company).
P1  Bad breath among young Israeli recruits
Authors: Levin L , Rosenberg M
Published: March 2005

The purpose of the present study was to evaluate the extent of self‐reported bad breath in an Israeli population of young army recruits and to assess its relationship with other self‐reported parameters, as well as general dental status. Self‐reported parameters included smoking status, bad taste, gingival bleeding and the presence of tonsilloliths. The study comprised 426 young adults recruits (ages 18–19), almost all males (95%), all of whom agreed to answer a questionnaire. All participants underwent a dental screening and were divided into three groups regarding to their dental status (do not need treatment, need moderate treatment, need extensive treatment). Statistical analysis included Pearson's chi square test of association using BMDP statistical software. Among the recruits, 142 (33 %) were active smokers. Thirty‐five participants (8.2%) reported bad breath as well as bad taste. Twenty‐seven (6.3%) reported being told that they had bad breath. Tonsilloliths were reported by 31 participants (7.3%) and gingival bleeding by 80 (18.8%). Self‐reported bad breath was positively associated with bad taste, gingival bleeding, the presence of tonsilloliths and general dental status (P < 0.05). The study indicates that self reports of bad breath are associated by objective factors (e.g. dental status, tonsilloliths) as well as subjective parameters (bad taste). To our knowledge this is the first report indicating that one young adult in thirteen may suffer from tonsilloliths.
P2  Association between oral malodor and other body odors
Authors: Bar‐Ness R , Greenstein  , Zigdon H , Rosenberg M
Published: March 2005

The purpose of the present study was to determine to what extent bad breath is associated with other body odors (axillary odor and pedal odor) in a group of 38 healthy adults. Two odor judges scored malodor from the mouth, tongue dorsum (spoon test), both axillae and shoes of the participants. Volatile sulfides were checked intraorally, as well as by sampling the subjects’ shoes. In addition, microbial counts of tongue dorsum (spoon), axillae and shoe insole were assessed using DiaSlides™. In general, significant correlations (P < 0.05; Pearson) were found comparing underarm and shoe odor parameters. For example, a correlation of r = 0.360 (P = 0.026) was obtained comparing left axilla odor score and left shoe odor score of judge 2. Similarly, a correlation of r = 0.534 (P = 0.027) was found between volatile sulfide levels measured in left shoe, and left axilla odor score of judge 1. In contrast, comparisons of oral malodor parameters did not correlate significantly with the other odors tested. The results do not support the hypothesis that subjects suffering from bad breath have elevated levels of other body odors, as the result of poor personal hygiene habits. Rather, the correlations observed comparing axillary and pedal parameters suggest that these two areas share factors which are not exhibited in the oral cavity, such as similar skin microbiota and perspiration levels, which are not relevant in the case of oral malodor.
P3  The analysis of characteristics of the elderly people with high VSC level
Authors: Aizawa F , Kishi M , Moriya T , Takahashi M , Inaba D , Yonemitsu M
Published: March 2005

Objective  The purpose of this study is to examine characteristics of the elderly people who had objectionable level of VSC.

Methods  In 2002, a total of 115 people (mean age = 85 years) in Japan were surveyed. In the survey, we carried out oral examination, collecting tongue coat, measurement of the volatile sulphur compounds (VSC) levels in mouth air by VSC monitor (Oral ChromaTM, Takasago, Japan), and assessment of the QOL using SF‐36.

Results and discussion  Average number of present teeth among subjects was 4.30 ± 7.11, and edentulous subjects were 66 persons and dentulous subjects were 49 persons. We divided subjects into two groups by VSC levels: the bad breath group (H2S >112 ppb and CH3SH >26 ppb) had seven persons, and the group without bad breath had 108 persons. It was shown that the amount of tongue coat was significantly higher in bad breath group (P = 0.020), while there was no significant difference in the amount of tongue coat between edentulous subjects and dentulous subjects. And, it was shown that the proportion of dentulous subjects in bad breath group was significantly higher (χ2 = 5.664; P = 0.041). Further, the analysis was performed for the result of SF‐36 scores. It was shown that the scores of vitality (VT), social function (SF) and mental health (MH) were significantly higher in bad breath group. Although the levels of QOL had a tendency to be higher in dentulous subjects, there was no significant difference.

Conclusion  These results showed that the elderly people with bad breath had tendency to be dentulous and had high deposit of tongue coat. And in this elderly group, people with bad breath tended to have mentally and physically improved.
P4  Parameters related to oral malodor in a population of 71 Israelis
Authors: Stamou E , Rosenberg M
Published: March 2005

Bad breath is a common problem which is associated with a variety of factors. The contribution of dental factors related to periodontal health with bad breath remains controversial. Further, because of the problems inherent in odor judge scoring of oral malodor, other adjunct techniques have been proposed. We have recently developed one such colorimetric technique (the ‘OK2KISS’ test), based on the level of beta‐galactosidase in saliva.

Aims  The aim of the present study were (i) to determine the factors associated with oral malodour in a group of 71 Israeli subjects, and (ii) to compare existing testing methodologies with a new technique, recently developed in this laboratory (the ‘OK2KISS’ test).

Methods  The study population consisted of a convenience sample 71 Israeli subjects (mean age 36.2 ± 38.4; ages ranging from 15 to 65) who were either undergoing a standard medical (n = 14), checkup, were about to commence orthodontic treatment (n = 12 ), or were siblings, or parents of orthodontic patients at Tel Aviv University (n = 55). Parameters measured included whole mouth odor judge scoring, halimeter, OK2KISS, gingival index, plaque index and probing depth.

Results  Odor judge scores were significantly associated with halimeter (r = 0.55; P < 0.001), as well as the OK2Kiss test (r = 0.52; P < 0.001). However, neither gingival index, plaque index, nor probing depth was significantly associated with odor judge scores or halimeter scores. Logistic regression analysis showed that both halimeter and OK2Kiss scores factored significantly (P = 0.005 and 0.018, respectively, odds ratios 14.9 and 2.7, respectively) in predicting the severity of oral malodour.

Conclusion  The study suggests that (i) in this population, periodontal health and oral malodour were not related; and (ii) that the OK2Kiss, together with halimeter scores, can serve to predict the severity of oral malodour levels.
P5  Halitosis and related factors in a Chinese general population
Authors: Liu X , Abe S , Shinada K , Chen X , Zhang B , Yaegaki K , Kawaguchi Y
Published: March 2005

The purpose of this study was to estimate the distribution of halitosis in a general Chinese population and assess the relationship between halitosis and oral health status and other social or behavioral factors. The subjects were 1000 males and 1000 females aged from 15 to 64 years in urban and rural area of Beijing, China. Questionnaire survey and oral examination was conducted. Questionnaire items included socio‐economic status (income and education), oral habits (brushing), knowledge for oral health, dental attendance, life habits (smoking), medical history and self‐assessment of halitosis. Oral examination comprised of DMFT, plaque index (PI), calculus index (CI), pocket depth (PD), modified sulcus bleeding index (mSBI) and tongue coating score (TCS). Volatile sulfur compounds (VSC) concentrations in mouth air were assessed by Halimeter. If VSC was 75 ppb and above, the subject was diagnosed halitosis. As a result, the prevalence of halitosis was 35.4% for the total population. Age and area of residence did not related to the VSC value. The levels of VSC were different among the period of assessment time. In the 15–24, 25–34 and 55–64‐year‐old groups, VSC values were significantly higher in the late afternoon. DMFT was not related with VSC. General health, social and behavioral factors did not relate to VSC. According to the logistic regression analysis, TCS, gender, CI and mSBI was significantly correlated with VSC. TCS had the highest OR value among them. The prevalence of halitosis was high in this population. Tongue coating played the most important role in determining VSC level, followed by periodontal status. However DMFT, smoking, social economic status, oral habits, general health and other social factors did not contribute to the level of VSC. The effective oral health promotion programs would be necessary to improve the poor oral health status and decrease the level of VSC for this study population.
P7  Complaints of halitosis related to the extraoral cavity. A preliminary report of 700 consecutive patients
Authors: Van Den Broek AMWT , Feenstra L , De Baat C
Published: March 2005

Patients with complaints of halitosis do seek treatment from physicians and dental practitioners, because of the fear that their halitosis may interfere with their social activities. Although the prevalence of halitosis has been reported to be as high as 50%, most physicians and dental practitioners are poorly informed about the causes and treatments of halitosis. In order to care for patients with complaints of halitosis a multidisciplinary team was established at the Erasmus Medical Centre, Rotterdam, The Netherlands. The team included a dental hygienist, an otorhinolaryngologist, and a dentist, who developed a special halitosis programme. One short press release regarding the establishment of the team, was provided to the national press‐centre. In the out‐patient clinic more than 700 patients were seen by the team. Using a structured questionnaire fed to a PC, patients answered questions regarding complaints about the oral cavity, the upper respiratory tract, the throat, their general health, their cleansing habits of the oral cavity, and prior experiences with general physicians, dental practitioners, and medical specialists. They underwent examinations of the extent of their halitosis, of the perioral and neck region, the oral cavity, the upper respiratory tract, and the upper digestive tract. Finally, the members of the team came to a joint diagnosis and a joint treatment plan for every individual patient. Of the first 700 consecutive patients 57% were women. More than 80% were between 20 and 59 years old. One‐third reported that they were never having breakfast or ate only soft food in the morning. Only 2% were diagnosed as having chronic sinusitis, 11% as having pharyngitis, 3% as having laryngitis, and 3% as having tonsillitis.
P9  Screening for severe periodontal disease in an elderly population using methyl mercaptan concentration ratio
Authors: Yamaga T , Rahardjo A , Shirone K , Miyazaki H
Published: March 2005

Objective  The purpose of this study was to examine the usefulness of methyl mercaptan concentration ratio on mass screening for periodontal disease in an elderly population.

Methods  One hundred and twenty‐two individuals (73 males and 49 females) aged 75 years who had at least 20 teeth in 2003 were chosen from participants of the Niigata Elderly Study (longitudinal study since 1998). Volatile sulfur compounds (VSC) in their mouth such as hydrogen sulfide (H2S), methyl mercaptan (CH3SH) and dimethyl sulfide ((CH3)2S) were measured, using portable gas chromatography (Oral Chroma®, Abilit Co Ltd, Osaka, Japan). The subjects were divided into periodontitis/no periodontitis groups based on having at least one site of pocket depth with more than 6 mm (PD 6+ mm). A CH3SH concentration ratio was defined as CH3SH/(CH3SH + H2S). The receiver operating characteristic curve was plotted to decide the best cut off point of the CH3SH concentration ratio for screening of subjects with PD 6+ mm.

Results and discussion  The best cut‐off point of the CH3SH concentration ratio was 0.35, and the sensitivity and specificity of this cut‐off point were 58.7 and 68.4%, respectively. The percentage of subjects with PD 6+ mm in the group of CH3SH concentration ratio ≥0.35 was 52.9 % (27 of 51) and that in the <0.35 group was 26.8 % (19/71), and, the groups were significantly different (P = 0.0059, χ2 test). It had been reported that VSC, in particular CH3SH concentration, was significantly higher in persons with periodontal disease than in periodontally healthy persons. Furthermore, in this study, the use of a portable gas chromatography enabled the VSC measurements for periodontal disease screening outside of the clinic.

Conclusion  These findings suggest that CH3SH concentration ratio may be useful on mass screening for periodontal disease in an elderly population.
P11  Correlation of headache and problems of vision with halitosis
Authors: Iwanicka‐Grzegorek E , Lipkowska E , Kepa J , Michalik J , Aleksinski M
Published: March 2005

Objective  Headaches are a common problem and may occur in response to several factors, e.g. high blood pressure, emotions, changes of atmospheric pressure. It is believed, that amines appearing due to halitosis may take part in this process. Different factors may cause problem of vision among humans. It is presumed that amines detected in halitosis chemically act on the neurological system. This process is sustained and the central nervous system is chemically intoxicated.

Methods  Eighty‐four patients suffering from halitosis and 40 healthy subjects aged 20–62 (avg. 39.7) participated in this study. Each subject completed a questionnaire and was then examined for organoleptic score, VSC by halimeter and evaluation of low molecular weight amines by ninhydrine colourimetric reaction. Halitosis was diagnosed if the average level of VSC as measured by the halimeter was >125 ppb and the organoleptic measurement using a 5‐point scale was >2. Statistical analysis was performed using Wilcoxon's and Chi square test.

Results  About 68% of respondents suffering from halitosis had problems with vision (P = 0.035). Headaches occurring among halitosis males were rare (20.0%), but were more common in females (43.0%). Differences in the incidence of headaches according to gender and diagnosis of halitosis were not statistically significant (P = 0.8).

Conclusion  Problems with vision are more common in patients with halitosis. Such problems may be caused by metabolites of low molecular weight amine compounds produced during halitosis, which chemically act on the central nervous system.
P14  Characteristics of a cohort of patients suffering from halitosis and effect of a short‐term treatment
Authors: Abati S , Cargnel M , Ottolina P , Scala A , Luzi G , Strohmenger L
Published: March 2005

Objectives  The aim of this study was to describe the clinical features of a cohort of patients suffering from bad breath observed at the Halitosis Unit of the Department of Stomatology – University of Milano. Moreover, the diagnostic and the short‐term therapeutic approach to these patients has been evaluated.

Methods  The clinical chart of patients have been reviewed and relevant data collected to be analyzed with an Apple Powerbook G4 PC. Patients complaining of bad breath were admitted to the halitosis unit. At first visit they were submitted to (i) clinical interview (ii) oral and periodontal examination (iii) tongue coating index recording (iv) hedonic breath testing (count‐to‐twenty test, wrist‐lick test, spoon test, floss test) (v) measurement of oral VSC concentration with Interscan Halimeter®. By 1 week patients were submitted to professional prophylaxis and oral hygiene instructions with specific attention to tongue brushing. Patients were then prescribed with no‐alcohol chlorexidine 0.2% for 30 s mouthrinse plus 30 s gargle twice a day after brushing. At the control appointment after 2 weeks the tongue coating index, the hedonic tests and the oral VSC measurements were recorded again.

Results  One hundred and nine patients (F = 52; M = 59) were observed and treated at the halitosis unit in the period 2000–2002. Thirteen patients were halitophobic without any objective evidence of bad breath whereas 14 had causal ENT diseases. Of the remaining 82 patients with halitosis from oral causes, 60 showed no evidence of active periodontitis. In this latter group a significant reduction of the hedonic test scores and of the oral VSC concentration was found in 85% of patients. Eighty percent also declared a subjective improvement.

Conclusions  The clinical protocol described was effective for the diagnosis and treatment of oral halitosis; the treatment with chlorexidine 0.2% was successful in the short‐term control of the condition.

Acknowledgement  This work was supported by the scientific fund FIRST 2000 – UNIMI.
O4  An inventory study on a randomized group of 1000 patients visiting a multidisciplinary breath odor clinic at a university hospital
Authors: Vandekerckhove B , Quirynen M , Van Steenberghe D
Published: March 2005

In 1994 the first European multidisciplinary (periodontology, ENT, psychiatry and occasionally gastro‐enterology) outpatient clinic was initiated at the University Hospital in Leuven, Belgium. The first 1000 patient files on the alphabetical list were analysed. It surprisingly consisted of 499 men and 501 women (2–90 years old, mean 38). The majority consulted spontaneously (69%), others were referred by their house doctor (14%), general dentist (6%) or medical/oral specialists (11%). One‐third had complaints since more than 5 years. Two‐thirds were informed by confidents or colleagues about their breath odor while they were unaware of it, 15% of the patients noticed it themselves and 18% were informed by others besides noticing it themselves. Not a single patient was alcoholic but 14% were tobacco addicts. In 83.4% of the patients there was an oral problem. Mostly tongue coating or/and periodontitis, was evident. In 3.6% it was a combination of ENT/intra‐oral causes. An ENT or gastro‐enterologic cause was detected in 3.1 and 1.3% respectively. ENT causes involved postnasal drip, tonsillitis, sinusitis, rhinitis. Only 1% had a metabolic or hormonal problem. The latter regularly also had tongue coating or periodontitis, but the elimination of these causes did not solve the entire problem. On the other hand in 7.6% of the patients no physical cause could be detected, while psychological/psychiatric problems were clearly identified. After the first multidisciplinary examination and treatment initiation/instructions, a control visit was proposed 2–6 months later. All patients were meanwhile referred for follow‐up to their general dentist or periodontologist or house doctor/medical specialist. Nearly 60% of the patients did not show up at the second appointment. When a sample was contacted by telephone (n = 40) all declared they were cured. 10% of the patients needed 3 appointments or more. From the 31% of the patients who came back for their control visit, 68.5% had experienced a (clear‐cut) improvement, and 22.7% noticed a slight to strong improvement. The patients who did not report any improvement (8.8%) were nearly all identified as having psychological or psychiatric traits.
P18  Clinical effectiveness of a triclosan/copolymer/ sodium fluoride dentifrice in controlling oral malodor: a three‐week clinical trial
Authors: Deyu HU , Zhang YP , Margaret Petrone JD , Volpe AR , Devizio W , Proskin HM
Published: March 2005

Objective  The purpose of the study was to compare the effectiveness of a dentifrice containing 0.3% triclosan/2% polyvinylmethylether/maleic acid (PVM/MA) copolymer/0.243% sodium fluoride (TCF) to a commercially‐available dentifrice containing 0.243% sodium fluoride (control) for the management of oral malodor in a 3‐week, randomized double‐blind, longitudinal clinical trial.

Methods  A panel of four expert judges used a nine‐point hedonic scale to evaluate breath odor using a protocol designed in accordance with the ADA Draft Acceptance Program Guideline for Products Used in the Management of Oral Malodor. Following a baseline evaluation, prospective subjects with hedonic scores above the threshold value for unpleasant breath were stratified by score and randomized into two treatment groups. Subjects brushed their teeth for 1 min with their assigned dentifrice, twice a day, for 3 weeks. Before oral malodor evaluations, the subjects refrained from eating odorigenic foods, from using mouthrinses and breath mints and from performing dental hygiene procedures.

Results  Eighty‐one adult male and female subjects completed the study. The baseline hedonic scores for the TCF and control dentifrices were 7.80 and 7.84, respectively, corresponding to unpleasant breath. The final mean oral malodor scores for the TCF dentifrice differed significantly from the baseline and control values (P < 0.05) for every time point examined (1.5‐, 4.0‐, 12.0‐h and 1‐, 2‐ and 3‐week intervals). The mean final breath scores for the TCF dentifrice group were 3.06, 3.48, 3.42, 3.66, 3.42 and 3.36, respectively, for each time point. These scores correspond to pleasant breath. Conversely, the control dentifrice group scored at levels either above 5.0 (before 12 h) or above 7.0 (after 12 h) which corresponded to neutral or unpleasant breath.

Conclusion  In conclusion, the results of this double‐blind clinical study clearly indicate that a dentifrice containing triclosan/copolymer/NaF provides effective control of oral malodor for up to 12 h.
P20  Effect of protease tablet on reduction of tongue coating
Authors: Yoshimatsu D , Sugimura S , Ioka T , Kometani T , Yamaga T , Miyazaki H
Published: March 2005

Objective  Practical treatment of halitosis requires tongue cleaning since volatile sulphur compounds (VSC) seems mainly to be from the tongue coating. From this point of view, mechanical tools such as tongue brushes or scrapers have been developed. However, approaches by chemical tongue cleaning have not been reported. Thus we developed tablets containing protease from kiwifruits, which could resolve tongue coating, and assessed the effects of the protease tablet to control tongue coating.

Methods  Crossover studies and double blind experiments were designed using volunteers with informed consent. The trial was done twice per volunteer, that is, they had a tablet with or without the addition of protease from kiwifruits (test and placebo) with intervening washout periods of at least 2 weeks. The degree of change in tongue coating was evaluated visually using a tongue coating score which consisted of an area component (0–3) and a thickness component (0–3). An image analyzer was also used to measure the changing in actual area of coating.

Results  The average value of the tongue coating scores after taking a test tablet (11.4 ± 5.2) was significantly smaller (P < 0.01) than before taking the tablet (18.8 ± 7.0). Image analyzer measurements also showed significant reduction (P < 0.01) of tongue coating by taking test tablet. On the other hand, a placebo tablet showed no significant effects in both analyses.

Conclusions  This study indicated that taking protease tablets could reduce tongue coating. We are planning further clinical trials that can show reduced VSC concentrations in mouth air with decreasing tongue coating.
P21  Design and operation of a human breath freshness panel
Authors: Saint E , Richards J , McNulty D , Bradshaw DJ , Munroe MJ
Published: March 2005

Breath freshening products are the fastest growing sector in the oral care marketplace. There is a clear need for robust testing protocols to evaluate the relative effectiveness of these products. The objective of this study was to design and set‐up an organoleptically‐assessed human breath freshening panel to allow reliable and robust comparative assessment of a range of oral care products. Initially, 10 prospective breath‐odour judges were assessed in a Quest standard test for skills in recognition, differentiation, ranking and descriptive assessment of chemical odorants. The four highest scoring judges were further trained in assessment of chemical malodours relevant to breath freshening, using odorants including methyl mercaptan, indole, skatole, cadaverine, putrescine, butyric and isovaleric acids. An extensive programme of sniffing the breath odour of volunteers was undertaken, scoring breath using both the ‘Rosenberg’ (0–5) intensity scale, as well as a residual flavour (hedonic/pleasantness) scale. Comparative scores were analysed to ensure reasonably low inter‐judge variability. A panel of members of the public were recruited as the Quest Breath Freshness panel. Panellists were assessed by a qualified dentist, and those with severe tooth decay, extensive dentures or severe periodontal disease were excluded, as were diabetics, pregnant women or those with any pre‐disposition to respiratory illness. The panel has been used to conduct breath assessments prior to product use, and at a range of set time‐points thereafter, up to 4 h. Results are routinely analysed by ANOVA. Trials were further optimized to use a 4‐ or 5‐week, crossover, double‐blind experimental design. Data from the panel has been used to support product claims, and to assess the efficacy of combinations of flavours, antimicrobial agents and oral product formats in delivering breath freshening benefits. The panel now runs routinely, and is used for research and commercial assessment of product benefits. The Quest breath freshness panel provides robust experimental data on the effectiveness of oral care products for breath freshening.
P23  Discrimination of oral‐halitosis substance under humidity‐rich environment by using QCM sensor array and a preconcentrator
Authors: Ito J , Nakamoto T , Uematsu H
Published: March 2005

Objectives  A halitosis test for objective evaluation is required. Halitosis is due to Volatile Sulfur Compounds (VSCs) produced by bacterial metabolism. In this study, we proposed a method for discriminating among sulfur compounds using a Quartz Crystal Microbalance (QCM) sensor array combined with a preconcentrator. The adjustment of the temperature profile, the optimization of the flow path sequence and the use of a dehumidification filter enabled VSC measurement under a high‐humidity condition. Moreover, the result of principal component analysis indicated that three types of VSCs were separated using the sensor‐array output pattern.

Methods  Multiple QCMs with different coating films were used as a sensor array and the pattern recognition of eight different sensor responses enabled the odor identification. The preconcentrator was used not only for improving limit of detection but for eliminating the influence of humidity by adjusting the desorption temperature. The headspace over the liquid (water or ODO) where VSC was dissolved with the concentration of 0.1% (w/w) was used as the samples.

Results and conclusion  An experiment on the discrimination among VSCs was performed. The headspace vapor of each sample was supplied to the preconcentrator for 30 s, followed by an exposure of the vapor thermally desorbed at 170°C to the QCM sensor array. The sensing films suitable for VSCs were selected among the various candidates and the peaks of the sensor responses to VSCs were analyzed using principal component analysis. Each sample was measured 10 times at the intervals of 30 min. As a result, it was found that three kinds of VSCs were successfully discriminated. Furthermore, it was found that the sensor responses increased in case of longer accumulation time. Thus, it is possible to detect the sample with lower concentration. This measurement method will be effective to diagnose halitosis objectively.
P26  Breath odor evaluation by detection of volatile sulfur compounds – correlation with organoleptic odor ratings
Authors: Hunter CM , Niles HP , Lenton PA , Majerus GJ , Vazquez J , Kloos C , Subramanyam R , Williams MI , Cummins D
Published: March 2005

Detection of oral volatile sulfur compounds (VSCs) by gas chromatography (GC) is a widely used method for evaluating breath odor. Air aspirated from the mouth is injected into the GC column for analysis. To eliminate discrepancies caused by variations in operator sampling or injection techniques, a new GC system designed to aspirate breath samples directly into the GC was developed.

Objective  A clinical study was performed to compare this new automated breath‐sampling GC system to organoleptic evaluation by two‐trained odor judges.

Methods  A randomized, two‐cell, double‐blind, parallel design was used in which subjects were tested before and 3 h after using either a mouthrinse containing zinc or a matching placebo rinse. Thirteen subjects used the zinc mouthrinse, and twelve used the placebo. Subjects with a wide range of VSC levels were studied. The average organoleptic ratings for each subject at each time point were compared to the average VSC measurements made with the GC, and Pearson product–moment correlation coefficients between the corresponding GC and organoleptic measurements were determined.

Results  The correlation between the GC and organoleptic assessment methods were highly significant (P ≤ 0.001) for: total VSCs, 0.65; H2S, 0.63; CH3SH, 0.61; and (CH3)2S, 0.46. The correlation between the two judges was also highly significant (0.823, P < 0.001).

Conclusion  These results demonstrate the utility of the automated gas chromatography method for evaluating breath odor.
O5  Clinical association of volatile sulfur compounds, Halimeter values, organoleptic score and tongue coating in oral malodor
Authors: Winkel EG , Tangerman A
Published: March 2005

Objective  Oral malodor is now generally accepted to be the main cause (about 90%) of bad breath. The objective of this study is to evaluate the potential power of volatile sulfur compounds (VSC), Halimeter values, organoleptic score (OLS) and tongue coating in assessing oral malodor.

Methods  We investigated the mouth‐ and nose‐breath of 42 subjects with oral malodor, visiting our bad breath clinic. The methods used were gas chromatography, Halimeter measurements, organoleptic scoring (OLS) and tongue coating measurements.

Results  The concentrations of hydrogen sulfide (H2S), methylmercaptan (MM, CH3SH) and dimethylsulfide (DMS, CH3SCH3) in the mouth‐breath of the 42 patients with oral malodor amounted to 0.74 ± 0.95 (s.d.), 0.42 ± 0.30, and 0.29 ± 0.19 nmol l−1, respectively. H2S and MM were absent in nose‐breath of all patients, indicating that the origin of these VSC is the mouth. DMS in nose‐breath (0.21 ± 0.12 nmol l−1) was similar to that in mouth breath, indicating that the origin of DMS lies outside the mouth. The recognition threshold value of MM is four to 30 times lower than that of H2S and about three times lower than that of DMS, indicating that MM is the major source of oral malodor. A significant correlation (r = 0.726, P < 0.001) was found between mouth‐H2S and mouth‐MM. No significant correlations were found between these two VSC and DMS. The correlations of H2S and MM with the Halimeter measurements, with OLS and with tongue coating are all highly significant.

Conclusions  Oral malodor is mainly caused by MM. The Halimeter is most sensitive for H2S. Nevertheless, thanks to the good correlation between H2S and MM, the Halimeter remains a useful apparatus in predicting oral malodor. OLS and tongue‐coating assessments are also useful methods in detecting oral malodor.
P27  Comparison of ninhydrine methods of detecting amine compounds with other methods of detection in halitosis
Authors: Iwanicka‐Grzegorek E , Lipkowska E , Kepa J , Michalik J , Wierzbicka M
Published: March 2005

Objectives  Availability of required substrate – amino acids is a factor determining the appearance of halitosis. The aim of the study was to determine whether a chemical test for low molecular weight amines in the saliva may be a new method of diagnosing halitosis.

Methods  Eighty‐four patients suffering from halitosis and 40 healthy volunteers aged 20–62 (avg. 39.7) participated in the study. Halitosis was diagnosed if the average level of VSC measured by a halimeter was >125 ppb and the organoleptic measurement using a 5‐point scale was >2. In all subjects low molecular weight amines were evaluated by the ninhydrine method. Patients with halitosis were randomized into a treatment groups. Zinc tablets, tablets and mouthwash containing chlorhexidine or lyophilized lactic acid‐forming bacteria were used. Test subjects were examined at day 0, 7, 14, 21 and after 3 months and controls on day 0, 21 and after 3 months. Statistical analysis was performed using Wilcoxon's test.

Results  Analysis showed, that the level of amines was highest in subjects with halitosis (0.39, s.d. 0.06) and correlated significantly with results of VSC measurement and organoleptic scores (P < 0.001). Reduction of amine levels after treatment was statistically significant (0.36, s.d. 0.06, P < 0.001). The amine levels in healthy controls was lower (0.29, s.d. 0.07) and remained at a similar, stable level.

Conclusions  The ninhydrin method of detecting salivary amines may be one of the methods of diagnosing halitosis, because salivary amine levels significantly correlated with VSC levels measured by halimeter and organoleptic scores. This method may also be used to evaluate treatment efficacy.
P29  The effects of essential oils on periodontopathic bacteria and oral halitosis
Authors: Takarada K
Published: March 2005

Oral halitosis has been associated with periodontal disease. Hydrogen sulphide, methyl mercaptan and dimethyl sulphide are the major components of halitosis originating in the oral cavity. These compounds are mainly produced by periodontopathic bacteria in the oral cavity. In the absence of the bacteria, the odoriferous compounds are not generated. We have demonstrated the antibacterial effects of essential oils on the periodontopathic bacteria such as Porphyromonas gingivalis, Actinobacillus actinomycetemcomitans and Fusobacterium nucleatum. As essential oils, manuka oil, tea tree oil, eucalyptus oil, lavandula oil, and romarinus oil were used, and their minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) were determined. The essential oils inhibited the growth of the bacteria tested, and manuka oil did so most effectively. MBC values showed that lavandula oil acted bacteriostatically, and the remaining oils bactericidally. Bacterial strains tested were killed completely by exposure for 30 s to 0.2% manuka oil, tea tree oil or eucalyptus oil. This study showed that among the essential oils tested, tea tree oil and manuka oil, particularly the latter, had strong antibacterial activity against periodontal disease associated bacteria. In the present study, we investigated the clinical effects of essential oils in the treatment of oral halitosis. When the degree of halitosis before and after the treatment was evaluated, the essential oils demonstrated efficacy in reducing the level of the three major components of halitosis. From the data of the present study, we consider that essential oils can be used in oral health management. This study was supported by grant from Kanpou Science Foundation.
P30  Relationship of oral malodor with tongue microbiota analyzed with real‐time PCR
Authors: Yamamoto Y , Tanaka M , Ehara M , Nonaka A , Anguri H , Kuboniwa M , Shizukuishi S
Published: March 2005

Oral malodor is thought to mainly originate from the bacterial population present on the surfaces of tongue. However, the relationship between oral malodor and tongue microbiota has been little studied. In the present study, we analyzed tongue microbiota with real‐time PCR and examined an association of oral malodor with tongue microbiota. The subject population consisted of 37 patients who complained of oral malodor. Oral malodor was assessed by an organoleptic test (OLT) and volatile sulfur compound (VSC) levels by gas chromatography. Real‐time PCR was carried out in tongue biofilm samples using a LightCyclerTM system as previously described (Kuboniwa et al. 2002) and the bacterial proportion in clinical sample was used as a quantitative parameter. The correlation coefficient between the proportion of total five Gram‐negative anaerobes (P. gingivalis, T. forsythensis, P. intermedia, P. nigrescens,and T. denticola) and total VSC level (r = 0.84) was higher than that between the bacterial proportion and OLT score (r = 0.24). In these five Gram‐negative anaerobes, the proportions of P. intermedia, P. nigrescens and T. denticola were correlated with the concentration of hydrogen sulfide (r = 0.79, 0.73 and 0.50, respectively). The proportions of P. gingivalis, P. intermedia and P. nigrescens were also correlated with the concentration of methyl mercaptan (r = 0.91, 0.40 and 0.71, respectively). When a linear regression analysis was conducted using the proportion of each of five Gram‐negative anaerobes as independent variable, the explanatory power of these independent variables showed 77% for total VSC level and 10% for OLT score. These results suggest that Gram‐negative anaerobes in tongue microbiota may contribute VSC production and may be also related to oral malodor.
P31  The relationship between the relative amount of Porphyromonas gingivalis in saliva and halitosis
Authors: Kato H , Awano S , Yoshida A , Ansai T , Takehara T
Published: March 2005

Objectives  Porphyromonas gingivalis is one of the microorganisms that most actively produce CH3SH and we have reported that subjects with P. gingivalis have higher CH3SH levels than subjects without P. gingivalis. However, little is known about the relationship between P. gingivalis levels in saliva and the condition of oral malodor. In this study, we evaluatedthe association between the relative amount of P. gingivalis in saliva and halitosis in mouth air.

Methods  All of the subjects were patients at the Preventive Dentistry and Breath Odor Clinic of Kyushu Dental College, where they received a periodontal examination. Volatile sulfur compounds (VSC: hydrogen sulfide and methyl mercaptan) were measured using gas chromatography. Saliva samples were collected in a sterile plastic tube over a period of 5 min while the subject chewed on paraffin wax, and were then immediately stored at –80°C until use. Template DNA was obtained from the stored saliva using an Easy‐DNA Kit (Invitrogen, CA, USA) according to the manufacturer's instructions. Conventional PCR assays were used to confirm the presence of P. gingivalis. A 5’ nuclease TaqMan PCR was used to quantify P. gingivalis in saliva. The relative numbers of bacteria were measured using the comparative threshold cycle method.

Results  We found a quantitative relationship between the P. gingivalis levels in saliva and the condition of halitosis in mouth air.

Conclusion  We analyzed the relationship between the relative amount of P. gingivalis in saliva and oral malodor.
P36  Use of n‐butanol as an odourant to standardize the organoleptic scale of breath odour judges
Authors: Saad S , Greenman J , Duffield J
Published: March 2005

The alcohol n‐butanol has been recommended for use as a standard odorant by various groups for the training or standardization of breath odor judges and sensory evaluation panels.

Objective  To assess the use of n‐butanol as a suitable odorant for use in organoleptic training of breath judges.

Methods  One judge with full smell acuity was trained in the method of organoleptic assessment using odorant solutions of all chemical classes (acids, amines, indole, sulphides) with the exception of alcohols. The subject was proficient in scoring odorant solutions, standard gas mixtures and human breath using the Rosenberg 0–5 organoleptic scale. The judge had gained over 5 years experience of assessment and for the purposes of this work was considered to be the gold standard. A wide range of n‐butanol solutions were prepared from 0 up to 90 000 ppm and dispensed as replicate 12 ml volumes in Universal bottles (24 ml) leaving a headspace of 12 ml. Sets of odorants were prepared, labelled by code, randomised and presented to the judge in a completely blind fashion. The judge scored each concentration. This process was repeated on 32 occasions over a period of 12 weeks. Means of data for each determination for each concentration series were plotted against the log concentrations of odorant. Linear regression slope analysis was used to measure slope, the 95% CI of slope and the scatter of points (R2 value). Head space concentrations of odorant were determined using GC analysis.

Results  The n‐butanol regression slope gave a high R2 value (0.971) and low scatter. However, the data did not correspond to that of other workers using an ASTM method where the range of recommended butanol concentrations was insufficient at the high end to determine the top of the organoleptic scale and insufficient at the low end to determine threshold. Moreover, headspace analysis using GC confirmed the published gas concentrations to be in error by a factor of 10. It was also observed that high concentrations of odourants were irritant causing desensitization if used for prolonged periods.

Conclusion  A previously described method had erroneous headspace calculations listed and n‐butanol could not be recommended as a training odorant because of its irritancy.