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Background: Pathologic subjective halitosis is known as a halitosis complaint without objective confirmation of halitosis by others or by halitometer measurements; it has been reported to be associated with social anxiety disorder. Olfactory reference syndrome is a preoccupation with the false belief that one emits a foul and offensive body odor. Generally, patients with olfactory reference syndrome are concerned with multiple body parts. However, the mouth is known to be the most common source of body odor for those with olfactory reference syndrome, which could imply that the two conditions share similar features. Therefore, we investigated potential causal relationships among pathologic subjective halitosis, olfactory reference syndrome, social anxiety, and preoccupations with body part odors., Methods: A total of 1360 female students (mean age 19.6 ± 1.1 years) answered a self-administered questionnaire regarding pathologic subjective halitosis, olfactory reference syndrome, social anxiety, and preoccupation with odors of body parts such as mouth, body, armpits, and feet. The scale for pathologic subjective halitosis followed that developed by Tsunoda et al.; participants were divided into three groups based on their scores (i.e., levels of pathologic subjective halitosis). A Bayesian network was used to analyze causal relationships between pathologic subjective halitosis, olfactory reference syndrome, social anxiety, and preoccupations with body part odors., Results: We found statistically significant differences in the results for olfactory reference syndrome and social anxiety among the various levels of pathologic subjective halitosis (P < 0.001). Residual analyses indicated that students with severe levels of pathologic subjective halitosis showed greater preoccupations with mouth and body odors (P < 0.05). Bayesian network analysis showed that social anxiety directly influenced pathologic subjective halitosis and olfactory reference syndrome. Preoccupations with mouth and body odors also influenced pathologic subjective halitosis., Conclusions: Social anxiety may be a causal factor of pathologic subjective halitosis and olfactory reference syndrome.

Dimethyl sulfide (DMS), a volatile sulfur compound (VSC) found in mouth air, is thought to be associated with systemic diseases; this in contrast to the two other VSCs found in mouth air: hydrogen sulfide and methyl mercaptan (MM). This study aimed to validate the relationship between DMS in mouth air and oral and systemic factors. The subjects were 393 elderly Japanese volunteers participating in an oral and systemic health survey. They were surveyed for the concentration of VSC components in their mouth air and for their oral and systemic health status. Using logistic regression models, the prevalence of DMS in mouth air above the organoleptic threshold level (OTL) was found to be significantly associated with high-density lipoprotein (HDL) cholesterol level, medical history of colon polyps and asthma, being female, and the presence of MM in mouth air above the OTL. Our data suggest that systemic factors, such as a high serum HDL cholesterol level and a medical history of asthma and colon polyps, might be more prominent in subjects with elevated DMS. The differences, although statistically significant, are quite small. They also indicate that an oral factor, such as a high MM mouth-air level also influences the DMS mouth-air level in addition to systemic factors.

Objective: It is well-known that some periodontopathic bacteria, especially Porphyromonas gingivalis, Fusobacterium nucleatum, Tannerella forsythia (formerly Bacteroides forsythus or Tan. forsythensis), and Treponema denticola, actively produce volatile sulfur compounds (VSCs), such as H2S and CH3SH. We previously reported a qualitative relationship between periodontopathic bacteria and VSCs; however, a quantitative analysis of periodontopathic bacteria in oral specimens is required for further characterization of the relationship between oral bacteria and VSCs. In this study, we report a real-time polymerase chain reaction (PCR) method for the quantitative analysis of VSC-producing bacteria in oral specimens., Subjects and Methods: Specimens were collected from 22 patients who visited the Preventive Dentistry and Breath Odor Clinic of Kyushu Dental College. A real-time PCR assay using the TaqMan system, based on the 5'-3' exonuclease activity of Taq polymerase, was employed for the quantitative analysis of periodontopathic bacteria that produce VSCs., Results: Using real-time PCR, we performed a quantitative analysis of P. gingivalis, F. nucleatum, Tan. forsythia, and T. denticola in the saliva, on the tongue coat, and in the subgingival plaque of patients with oral malodor., Conclusion: Real-time PCR using the TaqMan system can be used for the quantitative analysis of VSC-producing oral bacteria.

Objective: This study aimed to determine the clinical assessment of volatile sulfur compound (VSCs) for the evaluation of noticeable oral malodor using gas chromatography (GC)., Methods: The oral malodor of 127 adult patients was investigated using the organoleptic test and GC, and the relation between the organoleptic evaluation and VSCs were analyzed., Results: The optimum cut-off values of CH3SH, H2S and total VSC (CH3SH + H2S) to discriminate between the patients with and without noticeable oral malodor were obtained from ROC curves, and determined to be 0.44, 1.10 and 2.20 ng/10 ml, respectively. The logistic regression was analyzed for estimation of the association between an organoleptic evaluation greater than a slight level and the groups with CH3SH, H2S or total VSC with concentrations above the optimum cut-off value. Only CH3SH showed an independent association with noticeable oral malodor., Conclusions: It was evident that CH3SH was a more useful marker for the evaluation of oral malodor than H2S. Moreover, it appears CH3SH is the predominant causative factor of noticeable oral malodor.

Objective: The purpose of this study was to determine whether a reduction of salivary flow would influence the production of methylmercaptan (CH(3)SH) and hydrogen sulfide (H(2)S), which are volatile sulfur compounds (VSCs) known to cause oral malodor., Study Design: The VSCs in mouth air were measured by means of gas chromatography. Spitting and masticatory (stimulated) methods were used to determine the salivary flow rates of 174 patients., Results: There was no significant correlation between the level of VSCs and salivary flow rate. However, subjects with extremely low resting salivary flow rates had significantly higher CH(3)SH and H(2)S concentrations and tongue-coating scores than those with higher resting salivary flow rates. Moreover, logistic analyses revealed that extremely low resting salivary flow, the increase in tongue coating, and a probing pocket depth greater than 4 mm were strong explanatory factors for the generation of VSCs, which could have caused oral malodor., Conclusions: These findings suggested that an extreme reduction in resting saliva influenced the generation of CH(3)SH and H(2)S in mouth air.

Objective: To evaluate the association between the presence of periodontal pathogenic bacteria in saliva and halitosis in mouth air., Design: Cross-sectional microbiological and clinical oral examination of adult patients., Subjects: 101 adult patients (25 males, 76 females) who attended the Preventive Dentistry and Breath Odour Clinic of Kyushu Dental College. Their average age was 50.0+/-13.5 years old (mean +/- SD)., Setting: The subjects were classified into three groups: halitosis subjects with a probing depth (PD) > or = 4mm (P group), halitosis subjects without PD > or = 4mm (H group), and non-halitosis subjects without PD > or = 4mm (C group)., Methods: All subjects received a periodontal examination. Volatile sulphur compounds (VSC: hydrogen sulphide and methyl mercaptan) were measured using gas chromatography. The presence of Bacteroides forsythus, Porphyromonas gingivalis, Actinobacillus actinomycetemcomitans and Prevotella intermedia in the saliva was detected by polymerase chain reaction., Results and Conclusion: The presence of B. forsythus, P. gingivalis and P. intermedia influenced the production of VSC. Specifically, the presence of B. forsythus in subjects with periodontitis was strongly correlated to the concentration of VSC in mouth air.