Self-perceived and self-reported breath odour and the wearing of face masks during the COVID-19 pandemic

Preliminary investigation of a combined herbal extract of Aruncus dioicus, Cirsium nipponicum, and Ocimum basilicum for halitosis

BACKGROUND

Halitosis, the unpleasant odor in the oral cavity, has garnered increased attention and concern due to the growing significance of social interaction. SGE-107, a blend of 3 botanical drugs-Korean goat's beard, Cirsium tanakae, and Basil-with caffeic acid as its indicator component. This study aims to investigate the efficacy of SGE-107 in treating halitosis in patients with mild gastrointestinal symptoms.

METHODS

We enrolled 25 participants with oral malodor and dyspeptic symptoms. We assessed the severity of halitosis using the visual analog scale. Throughout a 4-week period of administering SGE-107, we evaluated both objective and subjective parameters, including the halitosis-associated life-quality test, the Korean gastrointestinal symptom rating scale, levels of volatile sulfur compounds, salivary flow rate, oral moisture, tongue index, Winkel tongue coating index, and tongue temperature.

RESULTS

After the intervention period, both the visual analog scale (5.88 ± 1.03 vs 2.38 ± 0.93, P < .001) and the scores of the halitosis-associated life-quality test (31.21 ± 11.78 vs 13.83 ± 6.38, P < .001) showed significant reductions. The proportion of participants with abnormal levels of methyl mercaptan (a volatile sulfur compound) also significantly decreased (17, 70.8% vs 9, 37.5%, P = .039). Furthermore, there were significant improvements in reflux, constipation, diarrhea, and the total scores on the Korean gastrointestinal symptom rating scale. Throughout the study period, only 2 participants experienced mild adverse events.

CONCLUSION

SGE-107 appears to be a safe and effective treatment for halitosis-associated with gastrointestinal symptoms; nevertheless, the limited sample size necessitates further large-scale randomized, controlled studies to confirm our findings.

Oral microbiome as a co-mediator of halitosis and periodontitis: a narrative review

Objective

Halitosis or oral malodor is an unpleasant odor from the oral cavity. However, although patients with periodontitis often complain of halitosis, their relationship has not been fully elucidated. We reviewed previous literature based on the hypothesis that the relationship between halitosis and periodontitis is mediated by the oral microbiome.

Materials and methods

This narrative review sought to provide insight into the causative role of the oral microbiome in influencing halitosis and periodontitis. In addition, we tried to deepen knowledge related to the relationship between halitosis and periodontitis generated by the oral microbiome accumulated over the past 40 years.

Results

From 1984 to 2023, a total of 106 papers that carefully and scientifically dealt with halitosis and periodontitis were included in this narrative review. Based on previous results, halitosis and periodontitis were closely related. For decades, researchers have taken an intriguing approach to the question of whether there is a relationship between halitosis and periodontitis. Central factors in the relationship between halitosis and periodontitis include volatile sulfur compounds (VSCs), the oral microbiota that produce VSCs, and the inflammatory response.

Conclusions

Taken together, the more severe periodontitis, the higher the level of VSC in halitosis, which may be mediated by oral microbiome. However, the relationship between the occurrence, maintenance, and exacerbation of periodontitis and halitosis is not a necessary and sufficient condition for each other because they are complex interplay even in one individual.

A Comparison of the Effect of Facemasks on Perceived Breathability and Air Quality during Daily Activities and Indoor Exercises

Transmission of COVID-19 occurs predominantly through respired droplets and aerosols containing the SARS-CoV-2 virus. As a solution, face masks have been used to protect against infection. Wearing face masks during indoor exercises is essential to prevent the spread of virus-containing respiratory droplets and aerosols. However, previous studies have not investigated all elements, including the users' perceived breathability (PB) and perceived air quality (PAQ) when wearing a face mask during indoor exercises. The current study aimed to assess users' perceived comfort (PC) of face masks based on assessment criteria of PB and PAQ during moderate to vigorous exercises, and compare them with those during normal daily activities. Data on PC, PB, and PAQ were collected from an online questionnaire survey from 104 participants doing regular moderate to vigorous exercises. Within-subjects comparison with self-controlled case series design was performed to compare PC, PB, and PAQ between wearing face masks during exercises and daily activities. Results showed that the degree of dissatisfaction with PC, PB, and PAQ while wearing face masks and performing indoor exercises is higher than when performing daily activities (p < 0.05). The significance of the study implies that masks comfortable for daily activities may not remain the same during moderate to vigorous exercises, especially during indoor exercises.

Volatile sulfide compounds and oral microorganisms on the inner surface of masks in individuals with halitosis during COVID-19 pandemic

Mask-wearing is still recommended owing to the continuing impact of the COVID-19 pandemic. Within the closed chamber created by the mask, people are increasingly self-aware of their oral malodor. In this prospective and cross-sectional study, we aimed to measure volatile sulfide compound (VSC) levels in patients with halitosis and investigate the oral microbiome profile on the inner surface of their KF94 masks. We also investigated which oral microbiota increases VSC levels and whether the oral microbiomes of oral saliva and mask are correlated. A total of 50 subjects (41 women, average age 38.12 ± 12.58 years old) were included in the study, 25 healthy subjects and 25 patients with halitosis who wore masks for more than 3 h. The dominant bacterial species, bacterial profile, and Shannon diversity index of whole unstimulated saliva and the inner surface of the mask were investigated. The bacterial 16S ribosomal RNA genes of the major oral bacterial species were analyzed using real-time PCR. Gas chromatography was used to measure hydrogen sulfide (H₂S) and methyl mercaptan (CH₃SH), which are representative VSCs. The total bacterial DNA copy number was significantly higher in the saliva sample than in the mask sample (p < 0.001), and the average value was 276 times greater. Shannon diversity index was also significantly higher in saliva than in the inner surface of the mask (2.62 ± 0.81 vs. 1.15 ± 1.52, p < 0.001). The most common Gram-negative and Gram-positive species in the masks were Porphyromonas gingivalis (Pg) and Lactobacillus casei (Lc), respectively. The bacterial species with significant positive correlations between saliva and mask samples were Prevotella intermedia (Pi) (r = 0.324, p = 0.022), Eikenella corrodens (r = 0.309, p = 0.029), Lc (r = 0.293, p = 0.039), and Parvimonas micra (Pm) (r = 0.366, p = 0.009). The mean value of CH₃SH was significantly higher in the halitosis group than in the non-halitosis group (17.84 ± 29.00 vs. 3.84 ± 10.57 ppb, p = 0.031). In the halitosis group, the DNA copy numbers and VSC levels showed highly positive correlation coefficients in the order Pg, Treponema denticola (Td), Tannerella forsythia (Tf), Pi, and Prevotella nigrescens (Pn) (all p < 0.05). Regarding bacterial profiles of the mask, Td was strongly correlated with CH₃SH (r = 0.414, p = 0.040) and total VSCs (r = 0.374, p = 0.033) only in halitosis group. Mask-wearing time was strongly correlated with total VSCs, H₂S, and CH₃SH (all r > 0.8, p < 0.001). Oral bacteria, whose association with halitosis has been identified, increased VSC levels in mask-wearing subjects during the COVID-19 pandemic, particularly the number of Gram-negative anaerobes such as Pg and Td. Mask-wearing time was a major factor in increasing VSC levels. The study results suggest that people with halitosis could control these Gram-negative bacteria by improving oral hygiene and regularly changing masks.

Effect of face masks on salivary parameters and halitosis: Randomized controlled crossover trial

BACKGROUND

Face masking is associated with self-perceived dry mouth and halitosis. Aim of the study was to measure the effect of different face masks on salivary parameters and halitosis.

METHODS

The randomized controlled crossover clinical trial with four periods included 40 oral healthy participants using different face masks (cloth mask, surgical mask, filtering facepiece 2 [FFP2] mask) or no mask (control) for 4 h in random order. Unstimulated salivary flow rate (primary outcome) and stimulated salivary flow rate, salivary pH and buffer capacity of stimulated and unstimulated saliva (secondary outcomes, blinded), and volatile sulfur compounds (secondary outcome) were measured before and after the 4-h periods. Statistical analysis was performed by repeated measures ANOVA (p < 0.05).

RESULTS

Of 40 randomized participants, 39 completed the study. Unstimulated salivary flow rate prior to face masking amounted to 0.6 ± 0.3 ml/min. Face masking had no significant effect on unstimulated salivary flow (p = 0.550). Face masking had also no significant effect on the other salivary parameters (p ≥ 0.518). The concentration of volatile sulfur compounds (VSC) prior to face masking amounted to 157.3 ± 59.7 ppb. After face masking, the concentration of VSC increased slightly, but not significantly (p = 0.055): 168.1 ± 76.3 ppb (control), 199.3 ± 132.7 ppb (cloth masks), 188.5 ± 101.1 ppb (surgical masks), and 189.7 ± 90.1 ppb (FFP2 masks).

CONCLUSION

Four hours of face masking did not change the salivary flow rate, pH, and buffer capacity, and had no significant effect on VSC's levels. Wearing face masks does not seem to result in measurable side-effects on salivary parameters such as a reduced salivary flow rate or VSC's levels.

CLINICAL TRIAL REGISTRATION

The protocol was prospectively registered at ClinicalTrials.gov (NCT04914208) on June 4, 2021.

Self-Perceived Halitosis and Related Factors Among the Mask-Wearing Population During the COVID-19 Pandemic in Delhi, India: A Cross-Sectional Study

Introduction Halitosis (oral malodor) is a common health condition throughout the world. In India, data on self-reported halitosis and related factors is limited. Mouth mask usage has been made compulsory after the coronavirus disease 2019 (COVID-19) pandemic. This could possibly alter oral microflora and environment and contribute to halitosis. The aim of the study was to determine the prevalence of self-perceived halitosis (SPH) among mask-wearing patients visiting a tertiary care dental hospital in Delhi, India. Methods A cross‑sectional study was conducted among a convenience sample of 300 patients visiting a tertiary care dental hospital in the capital of India. SPH status was measured using a self-designed and structured questionnaire containing socio-demographic factors, mask-related habits, and self-perceived oral health status. Statistical analysis was done using Jamovi software (The jamovi project, Sydney, Australia) version 1.8. Descriptive analysis followed by a chi-square test and a multivariate logistic regression test was applied. Results Bad breath was perceived by 86 study subjects. Of the participants, 16.7% felt that they had bad breath before the pandemic, and 38% of the participants had an increased perception or feeling of bad breath since regular mask usage. Of the participants, 42.7% felt that they had an increased feeling of dryness in the mouth post-pandemic. SPH status was associated with mask usage frequency (p<0.001), change (p<0.001) and type of mask (p=0.004), increased feeling of dryness (p<0.001), frequency of toothbrushing (p<0.001), self-reported oral disease (p=0.007), and dental treatment in the past 12 months (p=0.005). Conclusion The SPH status of the study population was associated with mask-related habits and self-reported oral health status. The findings highlight the importance of possible amendments in preventive and curative care for patients with halitosis post-COVID-19 pandemic.

Pandemic COVID-19 Influence on Adult's Oral Hygiene, Dietary Habits and Caries Disease-Literature Review

Coronavirus disease (COVID-19) is an infectious disease caused by the SARS-CoV-2. The pandemic over the past two years has completely changed people's daily habits with an impact on oral hygiene, eating habits, and oral health.

MATERIALS AND METHODS

The available literature was reviewed on the PubMed platform and from other sources MEDLINE and Cochrane Reviews. The analysis included comparative and clinical trials as well as pragmatic clinical/randomized controlled trials, and observational studies which focused on the effects of COVID-19 on the dietary habits of the population, oral hygiene, and caries incidence.

RESULTS

The analysis shows that the COVID-19 pandemic had a significant negative impact on dietary habits and an ambiguous impact on oral health habits of the population. The researchers showed that patients' visits were limited only to those necessary, because of fear of infecting with the SARS-CoV-2.

CONCLUSIONS

The literature review shows that the COVID-19 pandemic, by affecting many aspects of everyday life, including eating habits, caring for oral hygiene, and avoiding regular visits to the dentist, may generate an increase in oral diseases. Due to the differences in knowledge results, further research observations in this field are necessary.

COVID-19 Pandemic: Effect of Different Face Masks on Self-Perceived Dry Mouth and Halitosis

Due to the COVID-19 pandemic, the use of face masks has increased, resulting in potential health-related side-effects. Therefore, the study aimed to analyse the effect of wearing face masks on self-perceived dry mouth and halitosis. A questionnaire addressing the daily wearing time of different face masks (community masks, surgical/medical masks and KN95-/N95-/FFP2-masks) and self-perceived dry mouth and halitosis was given to adults attending or working at a university hospital. Statistical analysis was performed using Wilcoxon signed-rank test and multiple linear regression analysis (p < 0.05). 3750 participants (age: 50.4 ± 15.5 years; 60.0% female) were included. During the pandemic, face masks were used for 4.7 ± 3.8 h per day: community masks: 0.9 ± 2.0 h, medical/surgical masks: 1.9 ± 2.8 h and KN95-/N95-/FFP2-masks: 1.9 ± 2.5 h per day. The use of face masks significantly increased self-perceived dry mouth and halitosis (both p < 0.001). Self-perceived dry mouth and halitosis increased with increasing wearing time (community masks: dry mouth: p < 0.001, halitosis: p = 0.014; medical/surgical masks: both: p < 0.001; KN95-/N95-/FFP2-masks: dry mouth: p < 0.001, halitosis: p = 0.011). The perception of dry mouth and halitosis was increased in females compared to males (both: p < 0.001). Participants used to wearing face masks prior to the pandemic perceived dry mouth to a higher extent (p = 0.043). Self-perceived halitosis was lower in older than in younger participants (p < 0.001). Due to the increased perception of dry mouth and halitosis, people might abstain from wearing face masks. Further studies need to analyse measurable changes in dry mouth or halitosis.