Photodynamic therapy as a novel treatment for halitosis in adolescents: study protocol for a randomized controlled trial

Abstract

BackgroundHalitosis is a common problem that affects a large portion of the population worldwide. The origin of this condition is oral in 90% and systemic in 10% of cases. The unpleasant odor is mainly the result of volatile sulfur compounds produced by Gram-negative bacteria. However, it has recently been found that anaerobic Gram-positive bacteria also produce hydrogen sulfide (H2S) in the presence of amino acids, such as cysteine. Light, both with and without the use of chemical agents, has been used to induce therapeutic and antimicrobial effects. In photodynamic therapy, the antimicrobial effect is confined to areas covered by photosensitizing dye. The aim of the present study is to evaluate the antimicrobial effect of photodynamic therapy on halitosis in adolescents through the analysis of volatile sulfur compounds measured using gas chromatography and microbiological analysis of coated tongue.Methods/DesignA quantitative clinical trial will be carried out involving 60 adolescents randomly divided into the following groups: group 1 will receive treatment with a tongue scraper, group 2 will receive photodynamic therapy applied to the posterior two-thirds of the dorsum of the tongue, and group 3 will receive combined treatment (tongue scraper and photodynamic therapy). Gas chromatography (OralChromaTM) and microbiological analysis will be used for the diagnosis of halitosis at the beginning of the study. Post-treatment evaluations will be conducted at one hour and 24 hours after treatment. The statistical analysis will include the Shapiro-Wilk test for the determination of the distribution of the data. If normal distribution is demonstrated, analysis of variance followed by Tukey’s test will be used to compare groups. The Kruskal-Wallis test followed by the Student-Newman-Keuls test will be used for data with non-normal distribution. Either the paired t-test or the Wilcoxon test will be used to compare data before and after treatment, depending on the distribution of the data.DiscussionThe results of this trial will determine the efficacy of using photodynamic therapy alone or in combination with a tongue scraper to treat bad breath in adolescents.Trial registrationThe protocol for this study was registered with Clinical Trials (registration number NCT02007993) on 10 December 2013.

Translation, Transcultural Adaptation and Validation of the Halitosis Associated Life-Quality Test for Use in Brazilian Adolescents

“…The report of bad breath occurs most commonly after waking up, a transient physiological condition resulting from the reduced salivary flow during sleep [7]. Persistent halitosis can be caused by intraoral factors, such as oral diseases (periodontal disease, gingivitis, caries, biofilm accumulation and tongue coating) [4,7] as well as extraoral factors, such as systemic diseases (upper and lower respiratory tract infection, gastrointestinal disorders, metabolic diseases affecting the kidneys and liver, and endocrine disorders such as diabetes mellitus) [1,4,[7][8][9].…”

“…The malodor originates from volatile sulfur compounds (VSC), i.e., hydrogen sulfate (H2S), methyl mercaptan (CH3SH) and dimethyl sulfate [(CH3)2S] [1,2,7,8,10], which are produced by gram-negative bacteria present in the oral cavity [7,8,10]. In addition, previous in vitro studies have shown that gram-positive bacteria such as Peptostreptococcus spp.…”

Attaching the NorA Efflux Pump Inhibitor INF55 to Methylene Blue Enhances Antimicrobial Photodynamic Inactivation of Methicillin-Resistant Staphylococcus aureus in Vitro and in Vivo

“…The quantitative wound bioluminescence data are presented in Figure 7a. 3,13,21,22,47,48,49,50,51,52,59 …”

Oral mucosal lesions in psoriatic patients based on disease severity and treatment approach

“…13,17 White coated tongue (CT), also known as a hairy tongue, is a consequence of the elongation and retention hyperkeratosis of the filiform papillae. [34][35][36] Causes of papillae hypertrophy may include poor oral hygiene, certain dietary habits, xerostomia due to dehydration, smoking or excessive use of alcohol. It is frequently accompanied by halitosis.…”

“…In some cases, it may indicate an oral yeast infection. [34][35][36] The coated tongue condition is found in up to 28% of the adult population as reported by different studies. 34,36 In our study, CT was present in 31% of the psoriatic patients and we found a significant difference between groups with an extremely large effect of psoriasis on their quality of life compared with the groups with no effect according to DLQI questionnaire.…”