Bad breath : prevalence, periodontal disease, microflora and inflammatory markers

Abstract

Bad breath usually originates within the oral cavity and is believed to be associated with periodontal disease. The over all aim of the present thesis was to study periodontal conditions in subjects with bad breath as well as the prevalence of bad breath in subjects with periodontal disease.

Paper I was designed to study the relationships between foetor ex ore, halitophobia, oral hygiene and periodontal disease. The aim of Paper II was to study periodontal conditions the presence of certain microorganisms, and inflammatory mediators, in subjects with bad breath. Our hypothesis was that the periodontal condition of patients with bad breath was worse than in subjects without this symptom.

In Paper I, of 840 men [mean age = 35.7 years (±2.8 SD)] and 841 woman [mean age = 35.7 years (±2.9 SD)] who participated in an epidemiological study of periodontal health that was started in 1985, 2.4 % were found to exhibit foetor ex ore and 1 % were diagnosed as having halitophobia. Subjects with both periodontal disease and bad breath demonstrated a higher percentage of teeth with pockets =5 mm than did individuals without bad breath (p<0.001). Moreover subjects with foetor ex ore showed significantly higher levels of plaque and calculus values than did those without this symptom (p< 0.01and p<0.001 respectively).

Of the 28 participants described in Paper II, [mean age = 54.4 (±3.5 SD) years] selected from the same group of patients described in Paper I, 8 still had bad breath, 10 suffered from periodontal disease without bad breath and 10 were periodontally healthy nonsmokers. Subjects with bad breath had more teeth with pocket depths =5 mm or =8-mm, than did subjects with periodontal disease but without bad breath. In the subjects with bad breath, all of the micro-organisms analysed by the PCR method, were detected and a significantly larger number of subjects with than without bad breath were colonized by P.g. (p< 0.01).

Conclusions: Paper I: Foetor ex ore is caused by poor oral hygiene, reflected by the amount of calculus and plaque present and visits to the dentist. In subjects with periodontitis, foetor ex ore may be a useful indicator of the severity of the disease. Halitophobia correlated with the presence of a relatively large amount of calculus on the teeth and occurs independently of foetor ex ore. Paper II: Subjects with both bad breath and periodontal disease exhibited higher levels of plaque, more gingival inflammation, more severe periodontal disease, and higher levels of PGE2 and elastase in their gingival crevicular fluid than did periodontal patients without bad breath. More subjects with bad breath harboured A.a. and P.g. than those without this symptom. In particular P.g was significantly more often detected in the group with bad breath.

General conclusions: The subjects with bad breath and periodontal disease exhibited the same levels of plaque throughout the 18-year study period. Bad breath, which could be a sign of active periodontal disease, does not seem to be influenced by smoking