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Published in: Head & Face Medicine 1/2024

Open Access 01-12-2024 | Halitosis | Research

Halitosis in young patients with chronic kidney disease: findings from a randomized controlled trial

Authors: Karolin Charlotte Hoefer, Anna Greta Barbe, Anne Adams, Christoph Schoppmeier, Michael Jochen Wicht, Lutz T Weber, Michael J Noack, Isabelle Graf

Published in: Head & Face Medicine | Issue 1/2024

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Abstract

Background

Chronic kidney disease (CKD) directly affects oral health. Yet data about halitosis in young CKD patients and the impact of dental prophylaxis is limited. Therefore, as part of this randomized clinical trial, halitosis in young CKD patients undergoing intensive or standard oral preventive procedures was to be explored.

Methods

Three volatile sulfur compounds (hydrogen sulfide, methyl mercaptan and dimethyl sulfide) were measured in 30 young patients with CKD (mean age 14.2 years; 16 males, 14 females). Breath samples were taken after 3 and 6 months and analyzed with selective gas chromatography (OralChroma). Tongue coating (Winkel Index) and clinical indices to determine local inflammation or oral hygiene (Papillary Bleeding Index and Quigley-Hein Index) were assessed. Within an extended anamnesis, patients and their mothers and nurses were questioned about the perceived halitosis. Corresponding quotes were noted verbatim. Patients were randomized to either intensive need-related oral health care measures (oral preventative program, OPP) or a one-stage standard prevention (treatment as usual, TAU).

Results

While there were no differences in volatile sulfur compound levels between TAU and OPP at the three time points of measurements (p > 0.05), there was a tendency towards a reduction in dimethyl sulfide and hydrogen sulfide of affected patients within the OPP group over time. Looking at potential differences between both groups with regard to tongue coating, significant differences were observed between baseline and 3 months after study start in the OPP group, and between baseline and 6 months after study start in the TAU group (p < 0.05). The burden of halitosis was frequently reported by patients’ mothers and nurses.

Conclusions

Young CKD patients regularly suffered from halitosis and dimethyl sulfide was its main source. Preventive measures mainly resulted in a reduction of tongue coating. Trial registration: The German Clinical Trial Register (# DRKS00010580).
Literature
1.
go back to reference Silva MF, Leite FRM, Ferreira LB, Pola NM, Scannapieco FA, Demarco FF, et al. Estimated prevalence of halitosis: a systematic review and meta-regression analysis. Clin Oral Investig. 2018;22(1):47–55.CrossRefPubMed Silva MF, Leite FRM, Ferreira LB, Pola NM, Scannapieco FA, Demarco FF, et al. Estimated prevalence of halitosis: a systematic review and meta-regression analysis. Clin Oral Investig. 2018;22(1):47–55.CrossRefPubMed
2.
go back to reference Memon MA, Memon HA, Muhammad FE, Fahad S, Siddiqui A, Lee KY et al. Aetiology and associations of halitosis: a systematic review. Oral Dis. 2022. Memon MA, Memon HA, Muhammad FE, Fahad S, Siddiqui A, Lee KY et al. Aetiology and associations of halitosis: a systematic review. Oral Dis. 2022.
3.
go back to reference Guedes CC, Bussadori SK, Weber R, Motta LJ, Costa da Mota AC, Amancio OMS. Halitosis: prevalence and association with oral etiological factors in children and adolescents. J Breath Res. 2019;13(2):026002.CrossRefPubMed Guedes CC, Bussadori SK, Weber R, Motta LJ, Costa da Mota AC, Amancio OMS. Halitosis: prevalence and association with oral etiological factors in children and adolescents. J Breath Res. 2019;13(2):026002.CrossRefPubMed
4.
go back to reference AlMadhi NA, Sulimany AM, Alzoman HA, Bawazir OA. Halitosis in Children Undergoing Full Mouth Rehabilitation under General Anesthesia. Child (Basel). 2021;8(2). AlMadhi NA, Sulimany AM, Alzoman HA, Bawazir OA. Halitosis in Children Undergoing Full Mouth Rehabilitation under General Anesthesia. Child (Basel). 2021;8(2).
5.
go back to reference Santaella NG, Simpione G, Maciel AP, Lauris JR, da Silva Santos PS. Volatile sulphur compounds in people with chronic kidney disease and the impact on quality of life. Odontology. 2021;109(3):561–7.CrossRefPubMed Santaella NG, Simpione G, Maciel AP, Lauris JR, da Silva Santos PS. Volatile sulphur compounds in people with chronic kidney disease and the impact on quality of life. Odontology. 2021;109(3):561–7.CrossRefPubMed
7.
go back to reference Tangerman A. Halitosis in medicine: a review. Int Dent J. 2002;52 Suppl 3:201 – 16. Tangerman A. Halitosis in medicine: a review. Int Dent J. 2002;52 Suppl 3:201 – 16.
8.
go back to reference Harvey-Woodworth CN. Dimethylsulphidemia: the significance of dimethyl sulphide in extra-oral, blood borne halitosis. Br Dent J. 2013;214(7):E20.CrossRefPubMed Harvey-Woodworth CN. Dimethylsulphidemia: the significance of dimethyl sulphide in extra-oral, blood borne halitosis. Br Dent J. 2013;214(7):E20.CrossRefPubMed
9.
go back to reference Richter JL. Diagnosis and treatment of halitosis. Compendium Continuing Educ Dentistry (Jamesburg NJ: 1995). 1996;17(4):370–24. quiz 88. Richter JL. Diagnosis and treatment of halitosis. Compendium Continuing Educ Dentistry (Jamesburg NJ: 1995). 1996;17(4):370–24. quiz 88.
10.
go back to reference Conceicao MDD, Giudice FS, Carvalho LF. The Halitosis consequences Inventory: psychometric properties and relationship with social anxiety disorder. BDJ Open. 2018;4:18002.CrossRefPubMedPubMedCentral Conceicao MDD, Giudice FS, Carvalho LF. The Halitosis consequences Inventory: psychometric properties and relationship with social anxiety disorder. BDJ Open. 2018;4:18002.CrossRefPubMedPubMedCentral
11.
go back to reference Briceag R, Caraiane A, Raftu G, Horhat RM, Bogdan I, Fericean RM et al. Emotional and Social Impact of Halitosis on adolescents and young adults: a systematic review. Med (Kaunas). 2023;59(3). Briceag R, Caraiane A, Raftu G, Horhat RM, Bogdan I, Fericean RM et al. Emotional and Social Impact of Halitosis on adolescents and young adults: a systematic review. Med (Kaunas). 2023;59(3).
12.
13.
go back to reference Deutscher H, Derman S, Barbe AG, Seemann R, Noack MJ. The effect of professional tooth cleaning or non-surgical periodontal therapy on oral halitosis in patients with periodontal diseases. A systematic review. Int J Dent Hyg. 2018;16(1):36–47.CrossRefPubMed Deutscher H, Derman S, Barbe AG, Seemann R, Noack MJ. The effect of professional tooth cleaning or non-surgical periodontal therapy on oral halitosis in patients with periodontal diseases. A systematic review. Int J Dent Hyg. 2018;16(1):36–47.CrossRefPubMed
14.
go back to reference AlMadhi NA, Sulimany AM, Alzoman HA, Bawazir OA. Halitosis and Associated Risk factors in children: a cross-sectional study. J Contemp Dent Pract. 2021;22(1):51–5.CrossRefPubMed AlMadhi NA, Sulimany AM, Alzoman HA, Bawazir OA. Halitosis and Associated Risk factors in children: a cross-sectional study. J Contemp Dent Pract. 2021;22(1):51–5.CrossRefPubMed
15.
go back to reference Winkel EG, Roldan S, Van Winkelhoff AJ, Herrera D, Sanz M. Clinical effects of a new mouthrinse containing chlorhexidine, cetylpyridinium chloride and zinc-lactate on oral halitosis. A dual-center, double-blind placebo-controlled study. J Clin Periodontol. 2003;30(4):300–6.CrossRefPubMed Winkel EG, Roldan S, Van Winkelhoff AJ, Herrera D, Sanz M. Clinical effects of a new mouthrinse containing chlorhexidine, cetylpyridinium chloride and zinc-lactate on oral halitosis. A dual-center, double-blind placebo-controlled study. J Clin Periodontol. 2003;30(4):300–6.CrossRefPubMed
16.
go back to reference Mann JFE, Chang TI, Cushman WC, Furth SL, Ix JH, Hou FF, et al. Commentary on the KDIGO 2021 Clinical Practice Guideline for the management of blood pressure in CKD. Curr Cardiol Rep. 2021;23(9):132.CrossRefPubMedPubMedCentral Mann JFE, Chang TI, Cushman WC, Furth SL, Ix JH, Hou FF, et al. Commentary on the KDIGO 2021 Clinical Practice Guideline for the management of blood pressure in CKD. Curr Cardiol Rep. 2021;23(9):132.CrossRefPubMedPubMedCentral
17.
go back to reference Tangerman A, Winkel EG. The portable gas chromatograph OralChroma™: a method of choice to detect oral and extra-oral halitosis. J Breath Res. 2008;2(1):017010.CrossRefPubMed Tangerman A, Winkel EG. The portable gas chromatograph OralChroma™: a method of choice to detect oral and extra-oral halitosis. J Breath Res. 2008;2(1):017010.CrossRefPubMed
18.
19.
go back to reference Mayring P. Qualitative Inhaltsanalyse. Grundlagen und Techniken 2010. Mayring P. Qualitative Inhaltsanalyse. Grundlagen und Techniken 2010.
20.
go back to reference Axelsson P, Lindhe J. The effect of a preventive programme on dental plaque, gingivitis and caries in schoolchildren. Results after one and two years. J Clin Periodontol. 1974;1(2):126–38.CrossRefPubMed Axelsson P, Lindhe J. The effect of a preventive programme on dental plaque, gingivitis and caries in schoolchildren. Results after one and two years. J Clin Periodontol. 1974;1(2):126–38.CrossRefPubMed
21.
go back to reference Szalai E, Tajti P, Szabó B, Hegyi P, Czumbel LM, Shojazadeh S, et al. Daily use of chlorine dioxide effectively treats halitosis: a meta-analysis of randomised controlled trials. PLoS ONE. 2023;18(1):e0280377.CrossRefPubMedPubMedCentral Szalai E, Tajti P, Szabó B, Hegyi P, Czumbel LM, Shojazadeh S, et al. Daily use of chlorine dioxide effectively treats halitosis: a meta-analysis of randomised controlled trials. PLoS ONE. 2023;18(1):e0280377.CrossRefPubMedPubMedCentral
22.
go back to reference Choi HN, Cho YS, Koo JW. The Effect of Mechanical Tongue cleaning on oral Malodor and Tongue Coating. Int J Environ Res Public Health. 2021;19(1). Choi HN, Cho YS, Koo JW. The Effect of Mechanical Tongue cleaning on oral Malodor and Tongue Coating. Int J Environ Res Public Health. 2021;19(1).
23.
go back to reference Seemann R, Conceicao MD, Filippi A, Greenman J, Lenton P, Nachnani S, et al. Halitosis management by the general dental practitioner–results of an international consensus workshop. J Breath Res. 2014;8(1):017101.CrossRefPubMed Seemann R, Conceicao MD, Filippi A, Greenman J, Lenton P, Nachnani S, et al. Halitosis management by the general dental practitioner–results of an international consensus workshop. J Breath Res. 2014;8(1):017101.CrossRefPubMed
24.
go back to reference Simenhoff ML, Burke JF, Saukkonen JJ, Ordinario AT, Doty R. Biochemical profile or uremic breath. N Engl J Med. 1977;297(3):132–5.CrossRefPubMed Simenhoff ML, Burke JF, Saukkonen JJ, Ordinario AT, Doty R. Biochemical profile or uremic breath. N Engl J Med. 1977;297(3):132–5.CrossRefPubMed
25.
go back to reference Schönermarck U, Dengler C, Gmeinwieser A, Praun S, Schelling G, Fischereder M, et al. Exhaled breath volatile organic and inorganic compound composition in end-stage renal disease. Clin Nephrol. 2016;86(9):132–40.CrossRefPubMed Schönermarck U, Dengler C, Gmeinwieser A, Praun S, Schelling G, Fischereder M, et al. Exhaled breath volatile organic and inorganic compound composition in end-stage renal disease. Clin Nephrol. 2016;86(9):132–40.CrossRefPubMed
26.
go back to reference Neri G, Lacquaniti A, Rizzo G, Donato N, Latino M, Buemi M. Real-time monitoring of breath ammonia during haemodialysis: use of ion mobility spectrometry (IMS) and cavity ring-down spectroscopy (CRDS) techniques. Nephrology, dialysis, transplantation: official publication of the European Dialysis and Transplant Association -. Eur Ren Association. 2012;27(7):2945–52. Neri G, Lacquaniti A, Rizzo G, Donato N, Latino M, Buemi M. Real-time monitoring of breath ammonia during haemodialysis: use of ion mobility spectrometry (IMS) and cavity ring-down spectroscopy (CRDS) techniques. Nephrology, dialysis, transplantation: official publication of the European Dialysis and Transplant Association -. Eur Ren Association. 2012;27(7):2945–52.
27.
go back to reference Obermeier J, Trefz P, Happ J, Schubert JK, Staude H, Fischer DC, et al. Exhaled volatile substances mirror clinical conditions in pediatric chronic kidney disease. PLoS ONE. 2017;12(6):e0178745.CrossRefPubMedPubMedCentral Obermeier J, Trefz P, Happ J, Schubert JK, Staude H, Fischer DC, et al. Exhaled volatile substances mirror clinical conditions in pediatric chronic kidney disease. PLoS ONE. 2017;12(6):e0178745.CrossRefPubMedPubMedCentral
28.
go back to reference Schalkers I, Parsons CS, Bunders JF, Dedding C. Health professionals’ perspectives on children’s and young people’s participation in health care: a qualitative multihospital study. J Clin Nurs. 2016;25(7–8):1035–44.CrossRefPubMed Schalkers I, Parsons CS, Bunders JF, Dedding C. Health professionals’ perspectives on children’s and young people’s participation in health care: a qualitative multihospital study. J Clin Nurs. 2016;25(7–8):1035–44.CrossRefPubMed
29.
go back to reference Bailey PK, Hamilton AJ, Clissold RL, Inward CD, Caskey FJ, Ben-Shlomo Y, et al. Young adults’ perspectives on living with kidney failure: a systematic review and thematic synthesis of qualitative studies. BMJ Open. 2018;8(1):e019926.CrossRefPubMedPubMedCentral Bailey PK, Hamilton AJ, Clissold RL, Inward CD, Caskey FJ, Ben-Shlomo Y, et al. Young adults’ perspectives on living with kidney failure: a systematic review and thematic synthesis of qualitative studies. BMJ Open. 2018;8(1):e019926.CrossRefPubMedPubMedCentral
30.
go back to reference Kiliś-Pstrusińska K, Medyńska A, Chmielewska IB, Grenda R, Kluska-Jóźwiak A, Leszczyńska B, et al. Perception of health-related quality of life in children with chronic kidney disease by the patients and their caregivers: multicentre national study results. Qual Life Res. 2013;22(10):2889–97.CrossRefPubMedPubMedCentral Kiliś-Pstrusińska K, Medyńska A, Chmielewska IB, Grenda R, Kluska-Jóźwiak A, Leszczyńska B, et al. Perception of health-related quality of life in children with chronic kidney disease by the patients and their caregivers: multicentre national study results. Qual Life Res. 2013;22(10):2889–97.CrossRefPubMedPubMedCentral
31.
go back to reference Wijngaarde RO, Hein I, Daams J, Van Goudoever JB, Ubbink DT. Chronically ill children’s participation and health outcomes in shared decision-making: a scoping review. Eur J Pediatr. 2021;180(8):2345–57.CrossRefPubMedPubMedCentral Wijngaarde RO, Hein I, Daams J, Van Goudoever JB, Ubbink DT. Chronically ill children’s participation and health outcomes in shared decision-making: a scoping review. Eur J Pediatr. 2021;180(8):2345–57.CrossRefPubMedPubMedCentral
32.
go back to reference Gutman T, Hanson CS, Bernays S, Craig JC, Sinha A, Dart A, et al. Child and parental perspectives on communication and decision making in Pediatric CKD: a Focus Group Study. Am J Kidney Dis. 2018;72(4):547–59.CrossRefPubMed Gutman T, Hanson CS, Bernays S, Craig JC, Sinha A, Dart A, et al. Child and parental perspectives on communication and decision making in Pediatric CKD: a Focus Group Study. Am J Kidney Dis. 2018;72(4):547–59.CrossRefPubMed
33.
go back to reference Lambert V, Glacken M, McCarron M. Meeting the information needs of children in hospital. J Child Health Care. 2013;17(4):338–53.CrossRefPubMed Lambert V, Glacken M, McCarron M. Meeting the information needs of children in hospital. J Child Health Care. 2013;17(4):338–53.CrossRefPubMed
34.
go back to reference Szalai E, Tajti P, Szabó B, Kói T, Hegyi P, Czumbel LM, et al. Organoleptic and halitometric assessments do not correlate well in intra-oral halitosis: a systematic review and meta-analysis. J Evid Based Dent Pract. 2023;23(3):101862.CrossRefPubMed Szalai E, Tajti P, Szabó B, Kói T, Hegyi P, Czumbel LM, et al. Organoleptic and halitometric assessments do not correlate well in intra-oral halitosis: a systematic review and meta-analysis. J Evid Based Dent Pract. 2023;23(3):101862.CrossRefPubMed
Metadata
Title
Halitosis in young patients with chronic kidney disease: findings from a randomized controlled trial
Authors
Karolin Charlotte Hoefer
Anna Greta Barbe
Anne Adams
Christoph Schoppmeier
Michael Jochen Wicht
Lutz T Weber
Michael J Noack
Isabelle Graf
Publication date
01-12-2024
Publisher
BioMed Central
Published in
Head & Face Medicine / Issue 1/2024
Electronic ISSN: 1746-160X
DOI
https://doi.org/10.1186/s13005-024-00428-y

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