Bad breath (halitosis) is an important social complaint. In most cases (≥90%), the cause of halitosis can be found within the oral cavity. Under this circumstance, the term oral malodor applies. It affects both healthy and periodontally diseased individuals. Oral malodor is mainly caused by a microbial degradation of both sulfur-containing and nonsulfur-containing amino acids into volatile, bad-smelling gases. Anaerobic gram-negative bacteria, the same species that have been linked to periodontal diseases, are especially involved in this process, explaining why clinicians often associate oral malodor with periodontitis. Some volatile organic compounds render patients more susceptible to periodontitis and this supports the malodor-periodontitis link. This review investigates the interaction between oral malodor and periodontal diseases. Pro and con arguments regarding the mechanisms of halitosis and clinical implications will be presented. In general, however, the impact of tongue coatings has been found to be the dominant factor, besides gingivitis and periodontitis. The last part of this review discusses the treatment of bad breath, with different options.

Focused question: What is the effect of a dentifrice (DF), a mouthwash (MW), tongue cleaning (TC), or any combination of these as adjunct to toothbrushing on intra-oral malodour and tongue coating as compared to toothbrushing alone in systemically healthy patients, when used for a minimum follow-up period of 2 weeks? Material and Methods: The MEDLINE-PubMed, Cochrane-CENTRAL and EMBASE databases were searched up to August 2014. Measurements of Volatile Sulphur Compounds and organoleptic scores of oral malodour were selected as outcome variables. Data were extracted and a descriptive analysis was performed. Results: Independent screening of 1054 unique papers resulted in 12 eligible clinical trials with a medium-term (≥2 weeks) duration. The majority of studies provided a significant reduction in oral malodour when evaluating products with an active ingredient (incorporated into a DF or a MW) used adjunctively to toothbrushing. The added value of tongue cleaning over a MW was evaluated in one study. Conclusion: Due to very limited evidence, the potential effect of a specifically formulated dentifrice, a mouthwash or a tongue scraper for treating oral malodour is, in general, unclear. For mouthwashes containing the active ingredients chlorhexidine + cetylpyridinium chloride + zinc (CHX + CPC + Zn) and zinc chloride + cetylpyridinium chloride (ZnCl + CPC) most evidence was available. The strength of a recommendation to use these products was graded to be 'weak'.

At the moment there are no clear protocols for the assessment of bad breath. An organoleptic evaluation is still the reference. To date there are several tools available to detect and quantify specific compounds related to halitosis. This paper reviews the available information on three sulphur monitors (OralChroma™ (CHM-1), Halimeter® and Breathtron®), in order to suggest guidance for the general dental practitioner. All three devices showed an acceptable correlation with organoleptic scores. The Halimeter® and Breathtron® seem the most appropriate devices for a general dental practitioner, because they are easy to handle. Because of its capacity of distinguishing between different sulphur compounds and due to its time-consuming and complicated use, the OralChroma™ (CHM-1) seems more suitable in a research environment.

A new device (BB Checker) able to detect malodour compounds has recently been made available. This retrospective analysis aimed at evaluating the usefulness of this device as adjunct tool for the diagnosis of oral malodour. Data from 100 consecutive volunteers with bad breath complaints attending their first consultation at a halitosis clinic were analysed. In addition to the standard protocol (organoleptic ratings from mouth and nose air, and from tongue coating when present; OralChroma and Halimeter measurements from mouth air; and intra-oral examinations), oral, exhaled and nasal air samples were examined with the BB Checker. We could not establish a correlation between the BB Checker values and the organoleptic scores, or the sulfur-compound levels determined by the OralChroma or the Halimeter (R < 0.3, p > 0.05). The overall sensitivity and specificity of the new device did not exceed the 50%. The correlations between the organoleptic scores and the OralChroma and the Halimeter measurements were good and in line with previous reports (R between 0.56 and 0.73). Our results do not favour the use of the BB Checker as adjunct tool in the diagnosis of oral malodour.

OBJECTIVETo assess how much adults with congenital heart disease understand about their heart defect, its treatment, and the preventive measures necessary to avoid complications.DESIGNDescriptive, cross sectional study.SETTINGAdult congenital heart disease programme in one tertiary care centre in Belgium.PATIENTS62 adults with congenital heart disease (47 men; 15 women), median age 23 years.MAIN OUTCOME MEASURESPatients' knowledge was assessed during an outpatient visit using the Leuven knowledge questionnaire for congenital heart diseases, a 33 item instrument developed for this study.RESULTSPatients had adequate knowledge (> 80% correct answers) about their treatment, frequency of follow up, dental practices, occupational choices, appropriateness of oral contraceptives, and the risks of pregnancy. Knowledge about the name and anatomy of the heart defect, the possibility of recurrent episodes of endocarditis during their lifetime, and the appropriateness of different physical activities was moderate (50–80% correct answers). There was poor understanding (< 50% correct answers) about the reasons for follow up, the symptoms of deterioration of the heart disease, the definition, characteristics, and risk factors of endocarditis, the impact of smoking and alcohol on the heart disease, the hereditary nature of the condition, and the suitability of intrauterine devices as contraceptives.CONCLUSIONSAdults with congenital heart disease have important gaps in their knowledge about their condition. The results of this study can be used as a basis for developing or optimising structured educational interventions to enhance patients' health behaviour.