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Table of Contents   
ORIGINAL RESEARCH  
Year : 2012  |  Volume : 23  |  Issue : 3  |  Page : 326-330
Using a portable sulfide monitor as a motivational tool: A clinical study


1 Department of Periodontology & Oral Implantology, Genesis Institute of Dental Sciences & Research, Ferozepur, Punjab, India
2 Department of Periodontology & Oral Implantology, National Dental College & Hospital, Derabassi, Punjab, India

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Date of Submission06-Jul-2011
Date of Decision06-Sep-2011
Date of Acceptance13-Nov-2011
Date of Web Publication11-Oct-2012
 

   Abstract 

Aims and Objectives: Bad breath has a significant impact on daily life of those who suffer from it. Oral malodor may rank only behind dental caries and periodontal disease as the cause of patient's visit to dentist. An aim of this study was to use a portable sulfide monitor as a motivational tool for encouraging the patients towards the better oral hygiene by correlating the plaque scores with sulfide monitor scores, and comparing the sulfide monitor scores before and after complete prophylaxis and 3 months after patient motivation.
Materials and Methods : 30 patients with chronic periodontitis, having chief complaint of oral malodor participated in this study. At first visit, the plaque scores (P1) and sulfide monitor scores before (BCR1) and after complete oral prophylaxis (BCR2) were taken. Then the patients were motivated towards the better oral hygiene. After 3 months, plaque scores (P2) and sulfide monitor scores (BCR3) were recorded again.
Statistical Analysis: It was done using SPSS (student package software for statistical analysis). Paired sample test was performed.
Results: Statistically significant reduction in sulfide monitor scores was reported after the complete oral prophylaxis and 3 months after patient motivation. Plaque scores were significantly reduced after a period of 3 months. Plaque scores and breathchecker scores were positively correlated.
Conclusion
: An intensity of the oral malodor was positively correlated with the plaque scores. The portable sulfide monitor was efficacious in motivating the patients towards the better oral hygiene.

Keywords: Chronic periodontitis, malodor, portable sulfide monitor

How to cite this article:
Uppal RS, Malhotra R, Grover V, Grover D. Using a portable sulfide monitor as a motivational tool: A clinical study. Indian J Dent Res 2012;23:326-30

How to cite this URL:
Uppal RS, Malhotra R, Grover V, Grover D. Using a portable sulfide monitor as a motivational tool: A clinical study. Indian J Dent Res [serial online] 2012 [cited 2018 Dec 19];23:326-30. Available from: http://www.ijdr.in/text.asp?2012/23/3/326/102216
Halitosis, often called oral malodor or bad breath, is a commonly experienced condition with a variety of etiologic factors. [1] This is the third most common cause of the patient's visit to the dentist. Although numerous non-oral sites and many different causes have been suggested. [2] an estimated 80% to 90% of all bad breath odors originates from the mouth itself. [3]

Oral malodor can be attributed to a variety of products arising from bacterial metabolism of amino acids. These metabolites include many volatile sulfur compounds (VSCs) such as hydrogen peroxide, methyl mercaptan, dimethyl sulfide and compounds like skatole and indole. [4] These gases mainly originate from the breakdown of sulfur containing amino acids such as cysteine ,cystine, methionine or peptides by microbial putrefaction within the oral cavity, [5],[6] mainly on the dorsum of the tongue. [7],[8] These compounds are produced primarily by anaerobic gram negative periodontal pathogens. [9] Studies have also demonstrated that these compounds are toxic at low concentrations. [10] VSCs may, therefore, not only be associated with the oral malodor but also probably contribute to the etiology of both gingivitis and periodontitis. [11] Amongst the gram negative bacteria, P.gingivali, P.intermedi, F .nucletu, and T. denticola, the so called periopathogens are major contributors of the volatile sulfur compounds. [3],[12],[13]

Tonzetich et al provided evidence that the pathological malodor may accelerate periodontal disease. [14] VSCs increase the permeability of the oral mucosa, collagen solubility [15],[16] and decrease the protein or collagen synthesis. [17],[18] Non-oral etiology may include upper and lower respiratory infections, neurological conditions, gastrointestinal tract disorders, various systemic diseases and use of certain drugs. [19]

Organoleptic rating is considered as a reference standard of oral malodor detection. A rating from 0-5 had been proposed by Rosenberg and McCulloh. [20] Gas chromatography and saliva incubation test have disadvantages of high cost, cumbersome and lack of portability, the time required for detection and measurement and of not being used on chair side. [21]

Recently, a small, very handy and portable sulfide monitor has been introduced in the market under the name Tanita's breathchecker which is capable of detecting the volatile sulfur compounds in the breath. In Indian population, due to lack of an education and knowledge about an importance of oral hygiene, sometimes the oral hygiene is neglected. In this study, we tried to motivate the patients towards the better oral hygiene. This study has been conducted using Tanita's breathchecker as a motivational tool for encouraging the patients towards the better oral hygiene, by co-relating the oral hygiene status of the patients with breathchecker scores and comparing the breathchecker scores before and after the complete oral prophylaxis, thus motivating the patient towards the better oral hygiene.

Aims and Objectives

  • To correlate plaque scores (P1) and breathchecker scores (BCR1) at baseline.
  • To compare the breathchecker scores before complete oral prophylaxis (BCR1) and after complete oral prophylaxis (BCR2).
  • To compare breathchecker scores at baseline (BCR1) and 3 months after oral prophylaxis and patient motivation (BCR3).
  • To motivate the patient towards the better oral hygiene.

   Materials and Methods Top


30 patients were selected under the following inclusion criteria:

  • The patients having a chief complaint of bad breath and poor oral hygiene status.
  • Patients having generalized chronic periodontitis.
  • Patients not suffering from any systemic disease that can be a cause of oral malodor.
  • Not on medication or antibiotic therapy that can be associated with oral malodor.
  • Patients who have not undergone clinical oral prophylaxis procedure for at least one year.
  • Patients not under any other clinical trial.
Following instruments were used for the study purpose:

  • Complete set of scalers (Hu-friedy)
  • A periodontal probe, mirror and tweezers.
  • Tanita's breathchecker instrument (made in China) [Figure 1].
    Figure 1: Showing breathchecker instrument.

    Click here to view
Breathchecker is capable of detecting volatile sulfur compounds. As the monitor of breathchecker is turned on, it emits a beep, when the second beep is heard, the patient is asked to blow air into the sensor. After the third beep, odor levels are displayed on the screen of the monitor [Figure 2].
Figure 2: Patient using breathchecker instrument.

Click here to view


Breathchecker scores and its interpretation:

0-No odor, 1 -Slight odor, 2 - Moderate odor, 3- Strong odor, 4-Very strong odor, 5-Intolerable odor. If no reading is displayed on the monitor, then it is considered as an error and the procedure is repeated again.

To ensure that the odor is from the oral cavity, the patient was asked to pinch nose with the finger, stop his or her breathing for a moment with the lips sealed and then exhale gently by opening the mouth. The odor detected thus was from the local factors of the oropharyngeal cavity. [22]

Method

At the first visit of the patient, complete case history of the patient was taken to include the patient in to study following the above mentioned criteria. Plaque scores (Silness and Loe, plaque index 1964) and breathchecker scores (BCR1) were also recorded using Tanita's breathchecker before oral prophylaxis as baseline data. After recording both, P1 (plaque score at baseline) and BCR1 (breathchecker score at base line), complete prophylaxis of the patient was done at the same visit. Complete oral prophylaxis included scaling and root planing and tongue cleaning.

30 minutes after the completion of the scaling procedure, the breathchecker scores were recorded again (BCR2). A slight reduction was observed in the BCR scores after the complete oral prophylaxis. Then we showed the pre and post prophylaxis readings to the patients, and motivated the patients towards the oral hygiene. Bass technique of tooth brushing was demonstrated to the patients. The patients were also given a demonstration of tongue cleaning. Patients were instructed to use Tanita's breathcheckers to monitor their breath odor on routine basis and maintain oral hygiene. Patients were evaluated after 1 month for oral hygiene status.

After 3 months, plaques scores (P2) and breathchecker scores (BCR3) were taken again. All the data thus collected was put to statistical analysis.

Statistical analysis: It was done using SPSS (student package software for statistical analysis). Paired sample test was performed to find paired difference of plaque scores and breathchecker scores at baseline and 3 months after. Correlation between plaque scores and breathchecker scores was evaluated using Pearson's correlation coefficient.


   Results Top


Mean plaque score at baseline was 2.4+0.67, which was decreased to 0.51+0.25 after 3 months [Table 1]. An overall decrease of 1.88+0.72 was reported in plaque score in a period of 3 months, which was statistically significant [Table 2].
Table 1: Showing the mean, median and standard deviation (S.D.) measures of plaque scores at baseline (P1), breathchecker scores at baseline (BCR1) i.e before the complete oral prophylaxis, breathchecker scores after the complete oral prophylaxis (BCR2) and breathchecker scores 3 months after the patient motivation (BCR3)

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Table 2: Showing the paired difference of plaque scores and breathchecker scores at baseline, after the complete prophylaxis and 3 months after the patient motivation

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Mean breathchecker scores at baseline was 4.46+0.74, which was reduced to 3.2+0.56 after the complete oral prophylaxis [Table 1]. This change was statistically significant (P=0.001). Mean breathchecker score after 3 months was reported to be 1.2+0.41. An overall decrease of 3.2+0.79 was recorded from baseline to 3 months, which was statistically significant [Table 2]. Plaque scores and breathchecker scores were found to be positively correlated [Table 3].
Table 3: Showing the correlation between the plaque score (P1) and the breathchecker score (BCR1) at baseline

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   Discussion Top


Previous studies revealed sufficient information to conclude that, the major cause of bad breath is oral microflora that produces volatile odoriferous molecules. In this study, we have used a small portable sulfide monitor as a motivational tool, so that the patients can be encouraged towards the better oral hygiene and thus prevent periodontal disease and bad breath. The sulfidemonitor provided an objective reading that indicate the intensity of the volatile sulfur compounds.

It was found that after the oral prophylaxis, there was reduction in the breathchecker scores. The mean value of the breathchecker scores at baseline (BCR1) was 4.4667, which was reduced to 3.2 after the complete oral prophylaxis (BCR2), and it was further reduced to 1.2 3 months after the patient motivation (BCR3) . This can be attributed to the reduction in the microbial load of the oral cavity and removal of the local factors that can perpetuate the oral malodor.

After 3 months, the breathchecker scores were further significantly reduced, that can be considered as the effect of the patient's oral hygiene procedure that was instructed to the patients after the complete oral prophylaxis. It was interesting to notice that the reduction in the levels of breathchecker scores after patient motivation was far more significant than the reduction that occurred as a result of the complete oral prophylaxis. As when complete oral prophylaxis was performed, the breathchecker scores were taken just 30 minutes after the procedure, therefore, there was very little time interval for an alteration of the microflora of the oral cavity. However, when the patient maintained proper oral hygiene for next 3 months, significant alterations might have occurred in the oral microflora such as decrease in the periodontopathogens or may be an increase in the beneficial species which further resulted in the reduction in intensity of the oral malodor. But, to validate this assumption, further microbiological studies are indicated.

In this study, mean plaque score was found to be positively correlated to the breathchecker scores i.e the intensity of the oral malodor, similar to the observation of Bosy et al, [23] who showed that the plaque scores were positively correlated with the intensity of the oral malodor and is in contrast to Yageki et al, [24] who showed that there is no correlation between the plaque scores and an intensity of the oral malodor. Pearson's correlation coefficient was used to determine the correlation between the plaque scores and the breathchecker scores. The P-value was .001, which indicated highly significant positive correlation. It was found that after the complete oral prophylaxis, the plaque scores and breathchecker scores (an intensity of the oral malodor) reduced to significant extent, similar to the observation of Tonzetich et al, [25] and Schimdt et al. [26]


   Conclusion Top


Oral malodor is a subject of considerable public interest. Although many advances have occurred in the field of diagnosis of oral malodor, these scientific advances had not been stymied by lack of simplified instrumentation. But now, an introduction of Tanita's breathchecker has made the chair side assessment of oral malodor possible in no time; multiple patients can be examined at the same time and the variations in the oral malodor intensity before and after the complete oral prophylaxis can be shown to the patients in the clinic itself. Thus, the patients can be easily motivated towards the better oral hygiene by putting an emphasis on the role of poor oral hygiene in halitosis and periodontiits.

 
   References Top

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Correspondence Address:
Ranjit Singh Uppal
Department of Periodontology & Oral Implantology, Genesis Institute of Dental Sciences & Research, Ferozepur, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.102216

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