This system allows for multiple diagnoses in the same patient, reflecting the multifactorial nature of the complaint. It represents the most accurate model to understand halitosis and forms an efficient and logical basis for clinical management of the complaint.

Lack of evidence currently prevents firm conclusions, but the following is recommended: (1) Use reliable methods for halitosis diagnosis and confirmation of tonsillar etiology. Initial treatment such as tongue scraping is useful to rule out oral halitosis. (2) Tonsillar procedures are contraindicated in: subjective halitosis, non-tonsillar etiology, or if medical management resolves halitosis. (3) Where indicated and where facilities permit, less invasive techniques such as laser cryptolysis may be preferable to tonsillectomy in adults, potentially avoiding general anesthetic and the higher risk associated with tonsillectomy in this group.

The results demonstrated that artificially generated oral H2S nasal VOC and alveolar H2 can be individually quantified. This gas measurement protocol can be used diagnostically or to gauge response to therapy in any medical or dental setting.

Background The cysteine challenge test is often used to check the H2S production capacity of the mouth. Patients with oral halitosis group (n = 305) or non‐oral halitosis group (n = 191) and healthy individuals (control group, n = 102) were compared with each other to identify any possible relationship between initial and cysteine‐induced oral H2S concentrations. Subjects and Method The medical records of 598 participants were reviewed retrospectively. Oral H2S concentrations before (pre‐CR) and after cysteine rinse (post‐CR) with 5 mL of 20 mmol L‐cysteine solution for 30 s were compared. Results Pre‐CR H2S concentrations were >0.8 ppm in 75.1% of oral group patients but less than <0.8 ppm in 87.3% of the non‐oral group and 86.9% of controls. After cysteine rinse, oral H2S concentrations exceeded 12 ppm in 72% of the oral halitosis patients but were lower in 88% of non‐oral group and 99% of controls. Whilst post‐CR/pre‐CR ratio was >12 in 74.5% of the oral group, it was <12 in 81.7% of the non‐oral group and 83.4% of controls. Conclusion Cysteine challenge test can be used as a diagnostic tool to identify an individual's tendency to produce oral malodor, not only to quantify momentary halitosis level.

Hydrogen sulfide (HS) and other volatile sulfur compounds (VSCs) appear mainly in the oral air of patients with halitosis. It seems that VSCs are directly involved in the pathogenesis of gingival diseases. In previous studies, short-term (7 hours-4 days), high concentrations (5-400 ppm) of HS applications on periodontal tissues have been evaluated in a culture medium. The aim of the present study was to investigate the potential effects of lower (equivalent to halitosis) concentrations of HS on rat gingival tissue for longer-term inhalation. The threshold level of pathologic halitosis perceived by humans at 250 ppb of HS was converted to rat equivalent concentration (4.15 ppm). Rats in the experimental (HS) group (n=8) were exposed to HS continuously but not the control rats (n=8). After 50 days, the gingival sulcular tissue samples of each rat were taken and examined using transmission electron microscope. Ultrastructural changes in the sulcular epithelia of the rat gingiva showed deformation of celullar shape, vacuolization, and disintegrity of intercelullar connection by loss of desmosomes and collagen fibrils. No basal membrane damage was observed. Inhalation of low levels of HS (equivalent of halitosis) in the oral environment causes ultrastructural celullar damages in rat sulcular mucosa. These results suggest that halitosis may be the potential reason for periodontal destruction in humans.