The relationship between patient's self assessment of oral maloudour, salivary β-galactosidases and halitosis

According to the American Dental Association, approximately 50% of the adult population have had at least an occasional complaint of oral malodor, while 25% appear to have a severe chronic problem. In some cases the patient may complain bad breath that does not really exist (pseudo-halitosis) and in other cases, however, despite he has a severe halitosis, he is not aware of it. Self-assessment of breath is not considered reliable, then the dentist must rely on other objective measurements of halitosis. OBJECTIVES: The aim of this study was to compare patients’ self-rating of oral malodour with spectrophotometrical evaluation of salivary β-galactosidases and organoleptic scores of halitosis. METHODS AND MATERIALS: Analysis were performed on 30 healthy volunteers (11 females, 19 males) selected from academic staff, students, clerks, and patients of the Department of Stomatology and Oral Sciences of University G. d’Annunzio of Chieti. All volunteers signed informed consent and answered to questions about their anamnesis. After patients completed a dichotomous questionnaire regarding a self evaluation of breath. They were asked to follow a protocol which included abstaining from certain food and drugs at least 72 h before testing and procedures of oral hygiene during the 3 h earlier. For judge scoring of whole-mouth malodor, patients were instructed to exhale briefly through the mouth, at a distance of approximately 10 cm from the nose of the judge. Organolepctic scores were recorded as a dichotomous variable (yes= appreciable odor; no= no appreciable odor). The amount of salivary β- galactosidases was measured spectrophotometrically and posive patients were recorded with “yes” and negative ones with “no”. RESULTS: The correspondence between self assessment of oral malodor and β-galactosidase evaluation of halitosis is of 73%. Organoleptic analysis and self-assessment are in agreement in 80% of cases. Only 20% of patients resulted positive to all three analysis. 40% of volunteers analized complained oral malodour but 20% of them resulted negative both in organoleptic evaluations and on β-galactosidases analysis (pseudo-halitosis). One of patients who did not complain halitosis resulted positive. DISCUSSION: Pre-visit questionnaire sought to exclude cases of extraoral halitosis. Analyzing medical records of patients without corrispondence between organoleptic evaluation and salivary β-galactosidases activity, resulted the presence of endodontic abscess. Treating these conditions halitosis disappeared. CONCLUSIONS: Salivary β-galactosidases evaluation combined with organoleptic measurements is an additional method to detect cases of pseudo-halitosis and for the management of them.