The objective of this study is to evaluate tonsil odor as a contributor to halitosis and to study the reduction of oral malodor by mouth rinsing, without tonsil treatment. In 48 halitosis patients, tonsil odor and oral malodor were assessed through the 0-5 scale. In tonsil odor assessment, a dental burnisher was inserted into the tonsilar crypts and was sniffed by an odor judge. Oral malodor was analyzed through a plastic straw using the same scale by the same judge. The concentrations of H(2)S, CH(3)SH and (CH(3))(2)S were measured by a portable gas chromatograph (GC) (OralChroma) in ppb. After the baseline evaluations the subjects were instructed to scrape the surface of the tongue daily and rinse with a zinc-containing mouthwash twice daily for 1 month. After this period the same evaluations were repeated. Data were analyzed by SPSS software, paired t-test and Pearson correlation. Before mouthwash test: mean values of oral malodor scores and tonsil odor scores were 4.2 and 3.7, respectively. Pearson correlation analysis showed that oral malodor scores and tonsil odor scores had a significant correlation (p = 0.025). Oral malodor scores were correlated with the concentrations of H(2)S (p = 0.0001), CH(3)SH (p = 0.041) but not with (CH(3))(2)S concentration. After mouthwash test: mean values of oral malodor scores and tonsil odor scores were 2.2 and 3.0, respectively. Tonsil odor scores and oral malodor scores were not correlated. Also the paired t-test results showed that the effect of the mouthwash on the reduction of oral malodor and tonsil odor was not the same. Since oral malodor was successfully reduced while tonsil odor remained with a little reduction, it is concluded that tonsilar treatment such as tonsillectomy and laser cryptolysis might be considered only after the failure of mechanochemical therapy.

The primary objectives of the study were to investigate the levels of volatile sulfur compounds (VSCs) in Iranian patients and to find the most prevalent class of halitosis among them. The secondary objective was to study the measures employed by the patients to reduce halitosis. 46.4% of the 222 patients were female (average 32.1 years) and 53.6% were male (average 32.1 years). Contrary to other reports, males were dominant in this study. All the subjects were evaluated through oral examination, gas chromatographic analysis, organoleptic assessment and mouth cleaning and rinsing test (MCART). Finally, each patient was classified according to current classification. The patients were also asked about the measures employed by them to reduce halitosis. The data were statistically analysed using SPSS software. Gas chromatographic analysis revealed that the median values for H(2)S, CH(3)SH and (CH(3))(2)S levels were 214 ppb, 64 ppb and 2 ppb, respectively. Average values of H(2)S, CH(3)SH and (CH(3))(2)S were 358.7 ppb, 143.0 ppb and 19.5 ppb, respectively. A correlation was demonstrated between organoleptic scores and the concentration of only H(2)S, CH(3)SH and the total of three gases. In 62.2% of the subjects, no oral pathologic condition was found, but tongue coating was observed. The patients were in only class I (genuine halitosis) and class II (pseudo-halitosis) halitosis. None of them was diagnosed as halitophobia. The percentages of classes I and II were 98.6% and 1.4%, respectively. The percentages of sub-classes of class I halitosis in total subjects were as follows: 60.8% physiologic halitosis, 37.8% oral pathologic halitosis and 0% extraoral pathologic halitosis. The mean value of organoleptic score for physiologic halitosis was 4.0 and those for oral pathologic halitosis and pseudo-halitosis were 4.3 and 1.6, respectively. MCART was a useful tool to distinguish oral halitosis from extraoral halitosis. Levels of VSCs were not as high as those measured in other countries. Although in most cases VSCs were a contributing factor to halitosis, VSCs levels were not useful diagnostic criteria for the minority of the patients. The most prevalent class and sub-class of halitosis in the patients were genuine halitosis and physiologic halitosis. Measures employed by the patients to reduce halitosis were mostly related to the oral cavity.