Gastrointestinal diseases and halitosis: association of gastric Helicobacter pylori infection

Characteristics of extra-oral halitosis induced by functional constipation: a prospective cohort study

Characteristics of extra-oral halitosis induced by functional constipation (FC) have never been revealed. To address this, this prospective cohort was conducted with 100 FC patients, who were divided into a halitosis group and a negative group. Organoleptic score (OLS) ⩾ 2 in nose breath was diagnosed as extra-oral halitosis. Concentration of overall volatile sulfur compounds (VSCs) measured by Halimeter, concentration of hydrogen sulfide (HS), methanethiol (MT), dimethyl sulfide (DMS) and their total amount measured by OralChroma in nose breath was recorded asC-VSC,C-HS,C-MT,C-DMS andC-sum respectively. We found that 82% (82/100) of the FC patients had extra-oral halitosis. However, only 12.5% (3/82) and 1.22% (1/82) of halitosis group were correctly diagnosed with the current diagnostic threshold ofC-VSC ⩾ 110 parts per billion (ppb) and ⩾150 ppb.C-VSC,C-DMS andC-sum were significantly higher in the halitosis group compared to the negative group (allP< 0.001), with ratios of about 2.2 times, 3.1 times and 2.1 times respectively.C-HS andC-MT were low and not significantly different between the groups. Positive correlations were observed among OLS,C-VSC,C-DMS andC-sum. The area under curve of receiver operating characteristics ofC-VSC, C-DMS andC-sum for predicting FC-induced halitosis was 0.909, 0.9073 and 0.962 respectively, with the threshold values of ⩾36 ppb, ⩾52 ppb and ⩾75 ppb respectively. Therefore, we conclude that: (1) DMS is the primary contributor to FC-induced extra-oral halitosis. (2) OLS, Halimeter and OralChroma are consistent in detecting FC-induced extra-oral halitosis. (3) The diagnostic threshold for Halimeter should be adjusted toC-VSC ⩾ 36 ppb and the diagnostic threshold for OralChroma should be set asC-DMS ⩾ 52 ppb for diagnosing FC-induced extra-oral halitosis.

Physiological roles of hydrogen sulfide in mammalian cells, tissues and organs

H2S belongs to the class of molecules known as gasotransmitters, which also includes nitric oxide (NO) and carbon monoxide (CO). Three enzymes are recognized as endogenous sources of H2S in various cells and tissues: cystathionine g-lyase (CSE), cystathionine β-synthase (CBS) and 3-mercaptopyruvate sulfurtransferase (3-MST). The current article reviews the regulation of these enzymes as well as the pathways of their enzymatic and non-enzymatic degradation and elimination. The multiple interactions of H2S with other labile endogenous molecules (e.g. NO) and reactive oxygen species are also outlined. The various biological targets and signaling pathways are discussed, with special reference to H2S and oxidative posttranscriptional modification of proteins, the effect of H2S on channels and intracellular second messenger pathways, the regulation of gene transcription and translation and the regulation of cellular bioenergetics and metabolism. The pharmacological and molecular tools currently available to study H2S physiology are also reviewed, including their utility and limitations. In subsequent sections, the role of H2S in the regulation of various physiological and cellular functions is reviewed. The physiological role of H2S in various cell types and organ systems are overviewed. Finally, the role of H2S in the regulation of various organ functions is discussed as well as the characteristic bell-shaped biphasic effects of H2S. In addition, key pathophysiological aspects, debated areas, and future research and translational areas are identified A wide array of significant roles of H2S in the physiological regulation of all organ functions emerges from this review.

An Investigation of Stability and Species and Strain-Level Specificity in Bacterial Volatilomes

Microbial volatilomics is a rapidly growing field of study and has shown great potential for applications in food, farming, and clinical sectors in the future. Due to the varying experimental methods and growth conditions employed in microbial volatilomic studies as well as strain-dependent volatilomic differences, there is limited knowledge regarding the stability of microbial volatilomes. Consequently, cross-study comparisons and validation of results and data can be challenging. In this study, we investigated the stability of the volatilomes of multiple strains of Staphylococcus aureus, Pseudomonas aeruginosa and Escherichia coli across three frequently used nutrient-rich growth media. Volatilomic stability was assessed based on media-, time- and strain-dependent variation across the examined bacterial volatilomes. Strain-level specificity of the observed volatilomes of E. coli and P. aeruginosa strains was further investigated by comparing the emission of selected compounds at varying stages of cell growth. Headspace solid phase microextraction (HS-SPME) sampling coupled with gas chromatography mass spectrometry (GC-MS) was used to analyze the volatilome of each strain. The whole volatilomes of the examined strains demonstrate a high degree of stability across the three examined growth media. At the compound-level, media dependent differences were observed particularly when comparing the volatilomes obtained in glucose-containing brain heart infusion (BHI) and tryptone soy broth (TSB) growth media with the volatilomes obtained in glucose-free Lysogeny broth (LB) media. These glucose-dependent volatilomic differences were primarily seen in the emission of primary metabolites such as alcohols, ketones, and acids. Strain-level differences in the emission of specific compounds in E. coli and P. aeruginosa samples were also observed across the media. These strain-level volatilomic differences were also observed across varying phases of growth of each strain, therefore confirming that these strains had varying core and accessory volatilomes. Our results demonstrate that, at the species-level, the examined bacteria have a core volatilome that exhibits a high-degree of stability across frequently-used growth media. Media-dependent differences in microbial volatilomes offer valuable insights into identifying the cellular origin of individual metabolites. The observed differences in the core and accessory volatilomes of the examined strains illustrate the complexity of microbial volatilomics as a study while also highlighting the need for more strain-level investigations to ultimately elucidate the whole volatilomic capabilities of microbial species in the future.

Effects of eradication of Helicobacter pylori on oral malodor and the oral environment: a single-center observational study

Objective

Although a relationship between Helicobacter pylori and oral malodor has been suggested, it remains to be confirmed. One reason for this is that many studies assess oral malodor subjectively. Another reason for the uncertainty is that the reduction in oral malodor may be due to the effect of antibiotics on the oral microbiota. In this study, changes in oral malodor along with the eradication treatment of H. pylori were investigated by organoleptic test and gas chromatography. In addition, the salivary bacterial composition and clinical parameters were analyzed.

Results

The organoleptic test score, hydrogen sulfide and dimethyl sulfide concentrations, and all clinical parameters except for tongue-coating score were significantly decreased at 1 week compared with baseline. Although antibiotic treatment also altered the overall composition of the salivary bacterial population, it had recovered at 7 weeks. On the date that H. pylori was determined to have been eradicated from all of the subjects (7 weeks after treatment), only the organoleptic test score was significantly lower compared with baseline. The hydrogen sulfide and dimethyl sulfide concentrations were non-significantly lower than those at baseline.

Microbiota and Malodor-Etiology and Management

Accumulating evidence indicates that microbiota plays a critical role in physiological processes in humans. However, it might also contribute to body malodor by producing numerous odorous molecules such as ammonia, volatile sulfur compounds or trimethylamine. Although malodor is commonly overlooked by physicians, it constitutes a major problem for many otherwise healthy people. Thus, this review aims to investigate most common causes of malodor and describe potential therapeutic options. We searched PUBMED and Google Scholar databases to identify the clinical and pre-clinical studies on bad body smell, malodor, halitosis and microbiota. Unpleasant smell might originate from the mouth, skin, urine or reproductive fluids and is usually caused by odorants that are produced by resident bacterial flora. The accumulation of odorous compounds might result from diet, specific composition of microbiota, as well as compromised function of the liver, intestines and kidneys. Evidence-based guidelines for management of body malodor are lacking and no universal treatment exists. However, the alleviation of the symptoms may be achieved by controlling the diet and physical elimination of bacteria and/or accumulated odorants.

Halitosis and helicobacter pylori infection: A meta-analysis

BACKGROUND

Halitosis is used to describe any disagreeable odor of expired air regardless of its origin. Numerous trials published have investigated the relation between Helicobacter pylori (H pylori) infection and halitosis, and even some regimes of H pylori eradication have been prescribed to those patients with halitosis in the clinic. We conducted a meta-analysis to define the correlation between H pylori infection and halitosis.

OBJECTIVES

To evaluate whether there is a real correlation between H pylori infection and halitosis, and whether H pylori eradication therapy will help relieve halitosis.

METHODS

We searched several electronic databases (The Cochrane Library, MEDLINE, EMBASE, PubMed, Web of Science, and Wanfangdata) up to December 2015. Studies published in English and Chinese were considered in this review. After a final set of studies was identified, the list of references reported in the included reports was reviewed to identify additional studies. Screening of titles and abstracts, data extraction and quality assessment was undertaken independently and in duplicate. All analyses were done using Review Manager 5.2 software.

RESULTS

A total of 115 articles were identified, 21 of which met the inclusion criteria and presented data that could be used in the analysis. The results showed that the OR of H pylori infection in the stomach between halitosis-positive patients and halitosis-negative patients was 4.03 (95% CI: 1.41-11.50; P = 0.009). The OR of halitosis between H pylori-positive patients and H pylori-negative patients was 2.85 (95% CI: 1.40-5.83; P = 0.004); The RR of halitosis after successful H pylori eradication in those H pylori-infected halitosis-positive patients was 0.17 (95% CI: 0.08-0.39; P <0.0001), compared with those patients without successful H pylori eradication. And the RR of halitosis before successful H pylori eradication therapy was 4.78 (95% CI: 1.45-15.80; P = 0.01), compared with after successful H pylori eradication therapy.

CONCLUSIONS

There is clear evidence that H pylori infection correlates with halitosis. H pylori infection might be important in the pathophysiological mechanism of halitosis, and H pylori eradication therapy may be helpful in those patients with refractory halitosis.

Factors Associated with Halitosis in White-Collar Employees in Shanghai, China

Objective

To investigate the factors associated with halitosis in Chinese white-collar employees.

Materials and Methods

Subjects in three randomly selected office buildings in Shanghai, China, were enrolled in this cross-sectional study using cluster random sampling. Oral malodor was assessed by measuring volatile sulfur compounds (VSCs) with a portable sulfide monitor. Subjects’ oral health, including dental caries, periodontal status, and tongue coating, was evaluated clinically. A questionnaire was used to obtain information about participants’ demographic characteristics, oral hygiene habits, and health behaviors.

Results

Of the 805 subjects invited to participate in this study, 720 were enrolled (89.4% response rate). Data from these subjects were used for statistical analyses. The prevalence of halitosis was 33.2%. In the final regression model, halitosis was significantly related to tongue coating thickness, periodontal pocket depth, no food consumption within 2 hours prior to oral examination, and less intake frequency of sweet foods.

Conclusions

In this Chinese white-collar population, tongue coating and periodontal disease were associated with halitosis. Oral hygiene education should be provided at the population level to encourage the maintenance of oral health and fresh breath. Consumption of sweet foods may reduce VSC production, although this finding requires further investigation.

On the importance of developing a new generation of breath tests for Helicobacter pylori detection

State-of-the-art methods for non-invasive detection of the Helicobacter pylori (H. pylori) infection have been considered. A reported global tendency towards a non-decreasing prevalence of H. pylori worldwide could be co-influenced by the functional limitations of urea breath tests (UBTs), currently preferred for the non-invasive recognition of H. pylori in a clinical setting. Namely, the UBTs can demonstrate false-positive or false-negative results. Within this context, limitations of conventional clinically exploited H. pylori tests have been discussed to justify the existing need for the development of a new generation of breath tests for the detection of H. pylori and the differentiation of pathogenic and non-pathogenic strains of the bacterium. This paper presents the results of a pilot clinical study aimed at evaluating the development and diagnostic potential of a new method based on the detection of the non-urease products of H. pylori vital activity in exhaled gas. The characteristics of breath of adolescents with H. pylori-positive and H. pylori-negative functional dyspepsia, together with a consideration of the cytotoxin-associated gene A (CagA) status of H. pylori-positive subjects, have been determined for the first time using innovative point-contact nanosensor devices based on salts of the organic conductor tetracyanoquinodimethane (TCNQ). The clinical and diagnostic relevance of the response curves of the point-contact sensors was assessed. It was found that the recovery time of the point-contact sensors has a diagnostic value for differentiation of the H. pylori-associated peptic ulcer disease. The diagnostically significant elongation of the recovery time was even more pronounced in patients infected with CagA-positive H. pylori strains compared to the CagA-negative patients. Taking into account the operation of the point-contact sensors in the real-time mode, the obtained results are essential prerequisites for the development of a fast and portable breath test for non-invasive detection of cytotoxic CagA strains of H. pylori infection. The relaxation time of the point-contact nanosensors could be selected as a diagnostic criterion for non-invasive determination of H. pylori-associated destructive lesions of the gastroduodenal area in adolescents, using the point-contact spectroscopic concept of breath analysis. This can subsequently be implemented into a 'test-and-treat' approach for the management of uninvestigated dyspepsia in populations with a high prevalence of H. pylori (according to the Maastricht III and IV Consensus recommendations).

Eradication of gastric Helicobacter pylori ameliorates halitosis and tongue coating

BACKGROUND

The influence of gastric Helicobacter pylori infection on the development of oral pathoses remains unclear. The aim of this study is to examine the influence of gastric H. pylori infection on occurrence of halitosis and coated tongue.

MATERIALS AND METHODS

Ninety-eight patients with dyspepsia were included in the study and their salivary samples and gastric biopsies were analyzed for the presence of H. pylori by Nested-PCR. Halitosis and coated tongue were assessed at the initial examination and 3 months after systemic eradication therapy against H. pylori.

RESULTS

Gastric biopsies of 66 patients were positive for H. pylori. Only one saliva sample was H. pylori positive. At initial examination, halitosis was observed in 20 patients (30.3%) out of 66 who had gastric H. pylori infection and in only 3 patients (9.4%) out of 32 without H. pylori infection (p = 0.0236). Coated tongue was diagnosed in 18 (27.2%) patients with the infection compared to only 2 (6.25%) patients negative for gastric H. pylori (p = 0.0164). Patients with gastric infection were treated with the triple eradication therapy (Amoxicillin, Clarythromycin, Pantoprazol) and their gastric biopsies and oral status were examined 3 months later. Halitosis was significantly more prevalent in the group of patients with persistent H. pylori infection (42.1%) compared to only 6.4% of patients in the group where infection was successfully eradicated (p = 0.0012). Coated tongue was diagnosed in 47.4% of patients where H. pylori was still present after eradication therapy and in only 6.4% where eradication succeeded (p = 0.0003).

CONCLUSION

Our findings suggest that eradication of gastric H. pylori significantly alleviates halitosis and coated tongue, the two oral conditions that may be considered as extragastric manifestations of this common chronic bacterial infection.

Effect of Metronidazole on Halitosis of 2 to 10 Years Old Children

Background:

Regarding the fact that halitosis has social and personal aspects which can lead to social embarrassment and consequently low self-esteem and self-confidence in subjects suffering from the problem, especially children, its proper treatment is an important issue.

Objectives:

The aim of this study was to evaluate the effect of metronidazole as a nonspecific antimicrobial agent in the treatment of halitosis in children.

Materials and Methods:

In this study, 2-10 years old children with oral halitosis were enrolled. Children without H. pylori infection and parasitic infection were randomized in two interventional and control groups. Metronidazole was given 5mg/kg/day for one week. Information regarding the demographic characteristics of studied population and halitosis (duration and time of day with more halitosis and its severity) before and after intervention was recorded using a questionnaire

Results:

77 children with halitosis were studied in two interventional (40 children) and control (37 children) groups. There was no significant difference between two groups before intervention. After intervention, halitosis improvement rate - according to the reports of mothers of studied children - was higher significantly in intervention group (P < 0.05).

Conclusions:

The results support the effectiveness of metronidazole in the treatment of halitosis. Moreover, it supports recent findings regarding the participation of specific bacteria specially unculturable ones in the pathogenesis of the disease.

Hydrogen sulfide signaling in the gastrointestinal tract

SIGNIFICANCE

The current literature regarding the effects of the gaseous signal molecule hydrogen sulfide (H2S) in the gastrointestinal system is reviewed. Bacterial, host and pharmaceutical-derived H2S are all considered and presented according to the physiological or pathophysiological effects of the gaseous signal molecule. These subjects include the toxicology of intestinal H2S with emphasis on bacterial-derived H2S, especially from sulfate-reducing bacteria, the role of endogenous and exogenous H2S in intestinal inflammation, and the roles of H2S in gastrointestinal motility, secretion and nociception.

RECENT ADVANCES

While its pro- and anti-inflammatory, smooth muscle relaxant, prosecretory, and pro- and antinociceptive actions continue to remain the major effects of H2S in this system; recent findings have expanded the potential molecular targets for H2S in the gastrointestinal tract.

CRITICAL ISSUES

Numerous discrepancies remain in the literature, and definitive molecular targets in this system have not been supported by the use of competitive antagonism.

FUTURE DIRECTIONS

Future work will hopefully resolve discrepancies in the literature and identify molecular targets and mechanisms of action for H2S. It is clear from the current literature that the long-appreciated relationship between H2S and the gastrointestinal tract continues to be strong as we endeavor to unravel its mysteries.

Canine olfactory detection of cancer versus laboratory testing: myth or opportunity?

According to the most recent global cancer statistics, the burden of malignancies continues to increase worldwide, so that there is a compelling need to reinforce the screening strategies and implement novel diagnostic approaches for early detection. Canines are widely used by police forces and civilian services for detecting explosives and drugs due to their superior olfactive apparatus, which is characterized by a detection threshold as low as parts per trillion. There is mounting evidence that dogs might be effectively trained to detect patients with various form of cancers due to the presence of a characteristic "odor signature". In particular, preliminary studies reported that appropriately trained dogs exhibit an extraordinary ability to detect melanoma as well as prostate, breast, ovary and lung cancers by recognizing a characteristic "odor signature" in body, urines, sweat, breath and even blood. The most problematic issue that has emerged so far is the large heterogeneity of performance across the different studies as well as within the same study, which might be dependent upon genetic characteristics or training methodology. This article is aimed to provide an overview of the available data on cancer sniffer dogs, highlighting the appealing perspectives and the potential drawbacks.

Halitosis: the multidisciplinary approach

Halitosis, bad breath or oral malodour are all synonyms for the same pathology. Halitosis has a large social and economic impact. For the majority of patients suffering from bad breath, it causes embarrassment and affects their social communication and life. Moreover,halitosis can be indicative of underlying diseases. Only a limited number of scientific publications were presented in this field until 1995. Ever since, a large amount of research is published, often with lack of evidence. In general, intraoral conditions, like insufficient dental hygiene, periodontitis or tongue coating are considered to be the most important cause (85%) for halitosis. Therefore, dentists and periodontologists are the first-line professionals to be confronted with this problem. They should be well aware of the origin, the detection and especially of the treatment of this pathology. In addition, ear-nose-throat-associated (10%) or gastrointestinal/endocrinological (5%) disorders may contribute to the problem. In the case of halitophobia, psychiatrical or psychological problems may be present. Bad breath needs a multidisciplinary team approach: dentists, periodontologists, specialists in family medicine, ear-nose-throat surgeons, internal medicine and psychiatry need to be updated in this field, which still is surrounded by a large taboo.Multidisciplinary bad breath clinics offer the best environment to examine and treat this pathology that affects around 25% of the whole population. This article describes the origin, detection and treatment of halitosis, regarded from the different etiological origins.

Halitosis and Helicobacter pylori infection

There is disagreement about a possible relationship between Helicobacter pylori (H. pylori) infection and objective halitosis, as established by volatile sulfur compounds (VSCs) in the breath. Many studies related to H. pylori used self-reported halitosis, a subjective and unreliable method to detect halitosis. In this study a possible relation between H. pylori and halitosis was evaluated, using an objective method (gas chromatography, GC) to detect the VSCs, responsible for the halitosis. The levels of the VSCs hydrogen sulfide (H(2)S), methyl mercaptan (MM) and dimethyl sulfide (DMS) were measured in mouth breath and in stomach air of 11 H. pylori positive patients and of 38 H. pylori negative patients, all with gastric pathology. Halitosis was also established by organoleptic scoring (OLS) of mouth-breath. The levels of H(2)S, MM and DMS in the mouth-breath and stomach air of the H. pylori positive patients did not differ significantly from those of the H. pylori negative patients. OLS of the mouth-breath resulted in 9 patients with halitosis, 1 out of the H. pylori positive group and 8 out of the H. pylori negative group, which is not statistically different. The concentrations of the VSCs in stomach air were in nearly all cases below the thresholds of objectionability of the various VSCs, indicating that halitosis does not originate in the stomach. The patients with gastric pathology were also compared with control patients without gastric pathology and with normal volunteers. No significant differences in VSCs in mouth breath were observed between these groups. Thus, in this study no association between halitosis and H. pylori infection was found. Halitosis, as established by GC and OLS, nearly always originates within the oral cavity and seldom or never within the stomach.

The gastrointestinal aspects of halitosis

BACKGROUND

Halitosis is a common human condition for which the exact pathophysiological mechanism is unclear. It has been attributed mainly to oral pathologies. Halitosis resulting from gastrointestinal disorders is considered to be extremely rare. However, halitosis has often been reported among the symptoms related to Helicobacter pylori infection and gastroesophageal reflux disease.

OBJECTIVE

To retrospectively review the experience with children and young adults presenting with halitosis to a pediatric gastroenterology clinic.

METHODS

A retrospective chart review of patients diagnosed with halitosis as a primary or secondary symptom was conducted. All endoscopies were performed by the same endoscopist.

RESULTS

A total of 94 patients had halitosis, and of the 56 patients (59.6%) who were recently examined by a dental surgeon, pathology (eg, cavities) was found in only one (1.8%). Pathology was found in only six of 27 patients (28.7%) who were assessed by an otolaryngology surgeon. Gastrointestinal pathology was found to be very common, with halitosis present in 54 of the 94 (57.4%) patients. The pathology was noted regardless of dental or otolaryngological findings. Most pathologies, both macroscopically and microscopically, were noted in the stomach (60% non-H pylori related), followed by the duodenum and the esophagus. Fifty-two of 90 patients (57.8%) were offered a treatment based on their endoscopic findings. Of the 74 patients for whom halitosis improvement data were available, some improvement was noted in 24 patients (32.4%) and complete improvement was noted in 41 patients (55.4%).

CONCLUSIONS

Gastrointestinal pathology was very common in patients with halitosis regardless of dental or otolaryngological findings, and most patients improved with treatment.

Detection of exhaled hydrogen sulphide gas in healthy human volunteers during intravenous administration of sodium sulphide

INTRODUCTION

Hydrogen sulphide (H(2)S) is an endogenous gaseous signaling molecule and potential therapeutic agent. Emerging studies indicate its therapeutic potential in a variety of cardiovascular diseases and in critical illness. Augmentation of endogenous sulphide concentrations by intravenous administration of sodium sulphide can be used for the delivery of H(2)S to the tissues. In the current study, we have measured H(2)S concentrations in the exhaled breath of healthy human volunteers subjected to increasing doses sodium sulphide in a human phase I safety and tolerability study.

METHODS

We have measured reactive sulphide in the blood via ex vivo derivatization of sulphide with monobromobimane to form sulphide-dibimane and blood concentrations of thiosulfate (major oxidative metabolite of sulphide) via ion chromatography. We have measured exhaled H(2)S concentrations using a custom-made device based on a sulphide gas detector (Interscan).

RESULTS

Administration of IK-1001, a parenteral formulation of Na(2)S (0.005-0.20 mg kg(-1), i.v., infused over 1 min) induced an elevation of blood sulphide and thiosulfate concentrations over baseline, which was observed within the first 1-5 min following administration of IK-1001 at 0.10 mg kg(-1) dose and higher. In all subjects, basal exhaled H(2)S was observed to be higher than the ambient concentration of H(2)S gas in room air, indicative of on-going endogenous H(2)S production in human subjects. Upon intravenous administration of Na(2)S, a rapid elevation of exhaled H(2)S concentrations was observed. The amount of exhaled H(2)S rapidly decreased after discontinuation of the infusion of Na(2)S.

CONCLUSION

Exhaled H(2)S represents a detectable route of elimination after parenteral administration of Na(2)S.

Halimeter ppb Levels as the Predictor of Erosive Gastroesophageal Reflux Disease

BACKGROUND/AIMS

In a previous issue published in Gut and Liver, we found that erosive changes in the esophagogastroduodenal mucosa were strongly correlated with increased levels of volatile sulfur-containing compounds (VSC), suggesting that halitosis could be a symptom reflecting the erosive status of the upper gut mucosa. Together with other studies showing a possible association between halitosis and gastroesophageal reflux disease (GERD), under the premise that halitosis could be one of extraesophageal manifestations of erosive GERD (ERD), we investigated the significance of Halimeter ppb levels on ERD compared to non-erosive gastroesophageal reflux disease (NERD).

METHODS

Subjects were assigned to the NERD group if there was no evidence of esophageal erosive changes on endoscopy, despite reflux symptoms, and to the ERD group if they had GERD A, B, C, or D (according to the Los Angeles classification). The VSC levels were measured in all patients with either a Halimeter (before endoscopy) or by gas chromatography of the gastric juices aspirated during endoscopy.

RESULTS

The VSC level differed significantly between the NERD and ERD groups (p<0.0001), suggesting that this can be used to discriminate between NERD and ERD. However, the VSC level did not differ significantly with the severity of GERD. Even though hiatal hernia and a body mass index of >24 kg/m(2) was significantly associated with ERD, there was no correlation with Halimeter ppb levels. Minimal-change lesions exhibited the highest VSC levels, signifying that minimal change lesions can be classified as ERD based on our finding that halimeter ppb levels were descrimitive of erosive change.

CONCLUSIONS

Erosive changes in the esophageal mucosa were strongly associated with VSC levels, supporting the hypothesis that halitosis can be a potential biomarker for the discrimination between ERD and NERD, reflecting the presence of erosive change in the lower esophagogastric junction.

Kissing as an evolutionary adaptation to protect against Human Cytomegalovirus-like teratogenesis

Mouth to mouth sexual kissing is seen in more than 90% of human cultures. Various theories have been put forward to account for this but none offer a full explanation within an evolutionary framework. As mouth to mouth sexual kissing exposes each participant to the diseases of the other, it must confer significant benefit. Human Cytomegalovirus (HCMV) is a ubiquitous infection that carries a severe teratogenic risk if primary infection is acquired during certain critical periods. As HCMV is present in salivary gland epithelial cells and sheds from periodontitis induced lesions, female inoculation with a specific male's HCMV is most efficiently achieved through mouth to mouth contact and saliva exchange, particularly where the flow of saliva is from the male to the typically shorter female. The current hypothesis proposes that mouth to mouth sexual kissing enables females to control when they become infected with a particular male's HCMV and so protect their offspring from the threat of teratogenesis from primary infection during vulnerable times in their development. Females only gain this benefit if they also avoid becoming infected by other males. Hence HCMV induced teratogenesis is a strong viral pressure towards the development of monogamy as well as kissing as a behavioural strategy to protect against it.

Associations among hair loss, oral sulfur-containing gases, and gastrointestinal and metabolic linked diseases in Japanese elderly men: pilot study

BACKGROUND

Male pattern baldness (MPB), an observable trait, has been reported to be associated with various diseases, such as prostate cancer and cardiovascular disease. Oral sulfur-containing gases have also been suggested to be useful as markers of systemic health condition. However, there are no known reports regarding the associations among MPB, and oral sulfur-containing gases, and systemic health conditions in males.

METHODS

We studied 170 male subjects aged either 60 or 65 years old. The degree of MPB was assessed using the Norwood-Hamilton Baldness scale. Oral sulfur-containing gases were measured using a compact-designed device. All subjects completed physical and laboratory blood examinations, a face-to-face medical questionnaire, and an oral examination.

RESULTS

There were significant differences between the levels of CH3SCH3 and baldness patterns, independent of age. When we analyzed whether the association was linked to systemic health condition, a strong significant association was observed between the level of CH3SCH3 and severe MPB in subjects with gastrointestinal diseases, hypertension, and hypercholesterolemia.

CONCLUSION

These results suggest that MPB is associated with the level of CH3SCH3, a sulfur-containing gas that causes oral malodor, in elderly Japanese males. Further, the association was intensified by the existence of gastrointestinal tract and metabolic disorders.

The Prevalence of Self-Reported Halitosis and Oral Hygiene Practices among Libyan Students and Office Workers

AIMS

The aims of this study were to assess the prevalence of self-reported halitosis, oral hygiene practices and related diseases among Libyan students and employees.

METHODS

Six hundred self-administered structured questionnaires were used to investigate self-perception of halitosis and oral hygiene practices among a group of Libyan volunteers. Chi square test was used to detect significant differences between frequencies and to test correlation between self-perception of halitosis and measures of oral hygiene.

RESULTS

Forty three percent of the subjects were males and 57% were females. Forty four percent of the males and 54% of the females revealed self-perception malodour. Malodour was reported with the highest frequency (68%) during wake up time. Malodour was perceived by 31.7% of the females and 23.4% of the males during the hand-on-mouth test (p=0.04). Significantly more females (89.9%) than males (75.7%) practiced brushing (p<0.001). Fifty one percent of the males and 49.6% of females had dental caries. Smoking was significantly (p<0.001) more prevalent among males (17%) than among females (1%). Brushing was practiced by 85% of non-smokers and 68% of smokers (p=0.004). About 71% of the subjects who practiced brushing reported malodour during wake up time in comparison to subjects who did not practice brushing (p=0.041).

CONCLUSIONS

The prevalence of self-perceived malodour among the Libyan volunteers in this study is within the range of other studies. There is a great demand to reduce the incidence of dental caries and periodontal diseases.

Volatile sulfur compounds as a predictor for esophagogastroduodenal mucosal injury

BACKGROUND/AIMS

Halitosis is a symptom that bothers patients more socially than medically and its pathogenic mechanisms are unclear and treatment armamenterium is limited. Clinicians generally ignored active interventions. Since halitosis is closely associated with volatile sulfur compounds (VSCs), we used a Halimeter and gas chromatography to measure VSCs in patients with Helicobacter-pylori (H. pylori)-associated gastric diseases.

METHODS

We categorized 72 patients with H. pylori infection into two groups based on their endoscopic findings: a non-erosive mucosal group (NE, n=24) and an erosive mucosal group (E, n=48). Halitosis was objectively assessed by applying either a Halimeter to breath air or gas chromatography to gastric juice. Simultaneously, the expression of VSC-generating enzyme was measured with reverse-transcriptase PCR using mRNA isolated from biopsy tissues.

RESULTS

The levels of VSCs in exhaled breaths or aspirated gastric juices differed significantly between the NE and E groups (p<0.00001), suggesting that VSCs might reflect eroded epithelial damage induced by H. pylori infection. The expressions of cystathionine beta-synthase (CBS) and cystathionine gamma-lyase (CSE) were broadly consistent with the degree of mucosal injury.

CONCLUSIONS

Erosive changes in esophagogastroduodenal mucosa were strongly correlated with increased VSC levels, suggesting that halitosis might result from H. pylori-associated erosive lesions.

Halitosis--an assessment protocol proposal

Halitosis is an embarrassing symptom with a significant social impact. Halitosis affects millions of people worldwide and many resources are spent annually in products to improve halitus, unsuccessfully. The study of halitosis in a scientific basis is justified once halitosis causes social restriction, decreases life quality and may be an indication of serious diseases.

AIM

To elaborate a protocol for halitosis assessment in order to minimize costs, avoid unnecessary tests and provide a guideline for diagnosis.

METHODS

The protocol was created based on the literature and on the authors personal experiences, adopting an evidence-based anamnesis.

RESULTS

There are many causes of halitosis and most of them are related to the oral cavity; others are related to otolaryngologic and respiratory diseases. Gastrointestinal diseases, liver/renal impairment and other metabolic syndromes are less frequent, but also important causes of halitosis.

CONCLUSION

There are important costs involved in halitosis assessment and treatment, including medical appointments, specialist assessment, and complementary tests. Such costs would be minimized by adopting a protocol of evidence-based anamnesis and a flowchart for a rational clinical investigation.

A review of the current literature on management of halitosis

Halitosis is an unpleasant or offensive odour, emanating from the oral cavity. In approximately 80% of all cases, halitosis is caused by microbial degradation of oral organic substrates. Major degradation products are volatile sulphur-containing compounds. In this review, the available management methods of halitosis and their effectiveness and significance are presented and discussed. Undoubtedly, the basic management is mechanically reducing the amount of micro-organisms and substrates in the oral cavity. Masking products are not, and antimicrobial ingredients in oral healthcare products are only temporary effective in reducing micro-organisms or their substrates. Good short-term results were reported with chlorhexidine. Triclosan seems less effective, essential oils and cetylpyridinium chloride are only effective up to 2 or 3 h. Metal ions and oxidizing agents, such as hydrogen peroxide, chlorine dioxide and iminium are active in neutralizing volatile sulphur-containing compounds. Zinc seems to be an effective safe metal at concentrations of at least 1%. The effectiveness of active ingredients in oral healthcare products is dependent on their concentration and above a certain concentration the ingredients can have unpleasant side effects. Tonsillectomy might be indicated if (i) all other causes of halitosis are managed properly; (ii) halitosis still persists and (iii) crypts in tonsils are found to contain malodorous substrates.

Halitosis and gastroesophageal reflux disease: a possible association

OBJECTIVE

Previous reports have suggested that gastrointestinal (GI) diseases may cause halitosis. The aim of this study was to evaluate the relationship between upper GI conditions, especially gastroesophageal reflux disease (GERD), and halitosis.

PATIENTS AND METHODS

One hundred and thirty two consecutive patients complaining of upper GI symptoms were included in the study. All the patients completed a validated questionnaire that was designed to characterize and measure the severity of their symptoms. The questionnaire also contained questions about awareness and severity of oral bad breath. Following the filling of the questionnaire, the patients were physically examined and subjected to an upper GI endoscopy.

RESULTS

The final diagnosis among the 132 patients (M/F = 70/62, mean age 45.2 years, range 20-87 years) was GERD in 72 patients (55%), Functional dyspepsia in 52 (39%), Peptic ulcer in seven patients (5%) and gastric cancer in one patient (1%). Halitosis was significantly associated with the occurrence and severity of heartburn (P = 0.027), regurgitation (P = 0.002) sour taste (P < 0.001), belching (P = 0.001) and burburigmus (P = 0.006). Halitosis was not associated with upper abdominal pain, bloating, early satiety and chest pain. In relation to the final diagnosis, halitosis was significantly associated only with GERD (P = 0.002) but not with functional dyspepsia (P = 0.855) and peptic ulcer disease (0.765). No correlation was found between Helicobacter pylori infection status and halitosis occurrence and severity (analysis of variance F = 0.001, P = 0.977).

CONCLUSIONS

Halitosis is a frequent symptom of GERD and may be considered as an extra-esophageal manifestation of GERD. On the other hand, we did not find an association between functional dyspepsia, peptic ulcer disease and H. pylori infection with halitosis occurrence or severity.

Halitose: proposta de um protocolo de avaliação

A Halitose é um sintoma constrangedor com significativo impacto social. Ela afeta milhões de pessoas ao redor do mundo e muitos recursos são investidos em produtos para a melhora do hálito, sem sucesso. O estudo da halitose com uma abordagem científica se justifica, uma vez que a halitose é causa de restrição social, diminui a qualidade de vida e pode ser indicativo da presença de doenças mais graves. OBJETIVO: Elaborar um protocolo de avaliação da halitose com o objetivo de minimizar custos, evitar exames desnecessários e orientar o diagnóstico causal. MÉTODO: O protocolo foi elaborado baseado na literatura e na experiência pessoal dos autores, adotando uma anamnese baseada em evidências. RESULTADO: Existem muitas causas da halitose e a maioria delas está relacionada com a cavidade oral, outras estão relacionadas com doenças otorrinolaringológicas e respiratórias. Doenças gastrointestinais, alterações das funções renais e hepáticas e outras síndromes metabólicas são causas menos freqüentes, porém importantes de halitose. CONCLUSÃO: Existem custos importantes envolvidos no diagnóstico e tratamento da halitose, incluindo consultas ambulatoriais, avaliação de especialistas e exames complementares. Estes custos poderiam ser minimizados adotando uma anamnese baseada em evidências e um organograma para uma investigação clínica racional.

Sex Differences in Romantic Kissing among College Students: An Evolutionary Perspective

This study provides a descriptive account of kissing behavior in a large sample of undergraduate college students and considers kissing in the context of both short-term and long-term mating relationships. Kissing was examined as a mate assessment device, a means of promoting pair bonds, and a means of inducing sexual arousal and receptivity. A total 1,041 college students completed one of three questionnaires measuring kissing preferences, attitudes, styles, and behaviors. Results showed that females place more importance on kissing as a mate assessment device and as a means of initiating, maintaining, and monitoring the current status of their relationship with a long-term partner. In contrast, males place less importance on kissing, especially with short-term partners, and appear to use kissing to increase the likelihood of having sex. The results suggest that kissing may play an important role as an adaptive courtship/mating ritual.

Eradication therapy in Helicobacter pylori-positive patients with halitosis: long-term outcome

OBJECTIVE

The aim of this study was to investigate the incidence and long-term outcome of halitosis before and after eradication therapy in patients with functional dyspepsia and Helicobacter pylori infection.

SUBJECTS AND METHODS

Halitosis and dyspepsia-related symptoms were investigated by way of a questionnaire. Only patients with functional dyspepsia, H. pylori infection and no histological evidence of atrophy were included in the study. A total of 18 patients fulfilled these criteria and completed the study. Four to six weeks after the end of eradication treatment, endoscopy or [(13)C] breath test was performed to check for H. pylori in the gastric mucosa. Halitosis and dyspeptic symptoms were re-evaluated during and at the end of follow-up.

RESULTS

H. pylori infection was eradicated in all patients, in the 14/18 patients (77.8%) with triple drug therapy, and the 4/18 patients (22.2%) with quadruple drug therapy. During the follow-up period (mean 55.8 +/- 21.3 months (range 6-108 months)) resolution of halitosis was observed in 16/18 patients (88.9%), while 2 patients (11.1%) (p < 0.001) continued to present with halitosis. Also, eradication therapy resulted in statistically significant relief of all dyspeptic symptoms, except bloating.

CONCLUSION

Eradication of H. pylori in patients with functional dyspepsia and halitosis results in sustained resolution of halitosis during long-term follow-up in the majority of cases. This finding supports the existence of a link between H. pylori infection and halitosis and suggests that H. pylori eradication might be considered in patients with halitosis.

Factors associated with self-reported halitosis in Kuwaiti patients

OBJECTIVES

Oral malodor is a common complaint of dental patients, yet limited data is available on the actual prevalence of this condition. The aim of this study was to assess the prevalence and factors associated with self-reported halitosis in Kuwaiti patients.

METHODS

This was a cross-sectional study of Kuwaiti adults using a 19-point self-administered structured questionnaire on self-perception of halitosis. Significant associations between self-reported oral malodor and sociodemographic, medical history, and oral hygiene variables were examined with multiple logistic regression analysis.

RESULTS

A total of 1551 subjects participated (response rate=86.2%). The prevalence of self-reported halitosis was 23.3%. Use of the toothbrush less than once daily was the factor most strongly associated with self-perceived halitosis (OR=2.68; 95% CI=1.83-3.92; p<0.001). Other factors significantly associated with self-perceived halitosis included current or past smoking (OR=2.51), female gender (OR=1.54), being 30 years of age or older (OR=1.35), having high school education or less (OR=1.41), history of chronic sinusitis (OR=1.58) or gastrointestinal disorders (OR=1.73), never using miswak (OR=1.56), and never using dental floss (OR=1.33).

CONCLUSION

Inadequate oral hygiene practices were the factors most strongly associated with self-reported oral malodor in this sample of Kuwaiti patients. Other factors with significant associations included history of gastrointestinal tract disorders, chronic sinusitis, older age, female gender, and lower education levels.

Volatile sulfur compounds produced by Helicobacter pylori

GOALS

To assess the volatile sulfur compounds produced by three strains of Helicobacter pylori in broth cultures mixed with sulfur-containing amino acids.

BACKGROUND

Halitosis has been reported in H. pylori-positive patients, and volatile sulfur compounds such as hydrogen sulfide and methyl mercaptan are known to be responsible for inducing oral malodor. Whether H. pylori produces these volatile sulfur compounds has yet to be established.

STUDY

Three strains of H. pylori (ATCC 43504, SS 1, DSM 4867) were cultured with 5 mM cysteine and methionine. After 72 hours of incubation, the headspace air was aspirated and injected directly into a gas chromatograph. The concentrations of hydrogen sulfide and methyl mercaptan were analyzed and compared between experimental and control cultures

RESULTS

In broth containing 5 mM cysteine, hydrogen sulfide was increased by ATCC 43504 (P < 0.01) and SS 1 (P < 0.05), while methyl mercaptan was elevated only by SS 1 (P < 0.05). In broth containing 5 mM methionine, methyl mercaptan increases were significant for SS 1 (P < 0.05) and DSM 4867 (P < 0.05). In broth containing 5 mM cysteine and 5 mM methionine, the concentration of hydrogen sulfide was higher than in controls for all three strains (P < 0.01); that of methyl mercaptan was higher only for SS 1 (P < 0.01). Cysteine addition to cultures containing methionine increased hydrogen sulfide and methyl mercaptan for ATCC 43504 (P < 0.05) and SS 1 (P < 0.05). Conversely, addition of methionine to cultures containing cysteine increased methyl mercaptan only for DSM 4867 (P < 0.01).

CONCLUSIONS

The production of volatile sulfur compounds by H. pylori is not only very complicated but also strain-specific. Nevertheless, H. pylori was shown to produce hydrogen sulfide and methyl mercaptan, which suggests that this microorganism can contribute to the development of halitosis.

Helicobacter pylori and extragastric diseases -- other helicobacters

The role of Helicobacter pylori infection is explored in more and more extragastric diseases without definite proof in most of the studies, except possibly some hematologic diseases. In cardiovascular diseases, including stroke, the presence of CagA positive strains may be involved. The possible role of helicobacters in hepatobiliary diseases goes beyond that of H. pylori to involve enterohepatic helicobacters. New Helicobacter species are regularly described and molecular methods are developed to improve their detection. Helicobacter felis remains the major species to be used in animal models of Helicobacter infection.