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The purpose of this study was to evaluate the effects of known probiotic species Lactiplantibacillus plantarum CCFM1214 and Ligilactobacillus salivarius CCFM1215 on halitosis, the oral status, and the oral microbiome. In a double-blind, randomized controlled trial that lasted for five weeks, 43 participants were divided into an oral probiotics group and a control group and given probiotics or control powder for the first four weeks, with the fifth week being the discontinuation period. 33 participants (probiotics group = 21, control group = 12) completed the entire experiment in the end. Oral samples were taken as part of oral health examinations during the baseline period (day 0) and four weeks after (day 28). The nucleotide sequence of the V3-V4 region of 16S rRNA was determined to examine the impact of intervention and time on the oral microbiome. The effects of L. plantarum CCFM1214 and L. salivarius CCFM1215 on the number of Fusobacterium nucleatum in gingival crevicular fluid (GCF) samples of participants were detected by quantitative PCR. After the intervention, L. plantarum CCFM1214 and L. salivarius CCFM1215 significantly reduced the levels of volatile sulfur compounds (VSCs) and the quantity of F. nucleatum in GCF samples, where the average DNA copy number per ng (log) of F. nucleatum decreased from 7.12 ± 0.04 to 6.01 ± 0.09. The β diversity of the probiotics group, on the whole, tended to be more concentrated and stable after the intervention. In addition, after probiotic intervention, the abundance of Lactobacillus and Bifidobacterium increased, while the abundance of Fusobacterium , Acinetobacter , Porphyromonas , and Aggregatibacter decreased significantly. In general, L. plantarum CCFM1214 and L. salivarius CCFM1215 can alleviate halitosis and considerably lower the value of VSCs and improve the oral microbiota in participants with halitosis.

Objective: This study aimed to evaluate the effect of antimicrobial photodynamic therapy (aPDT) and the use of probiotics on the treatment of halitosis., Methods: Fifty-two participants, aged from 18 to 25 years, exhaling sulfhydride (H2S) ≥ 112 ppb were selected. They were allocated into 4 groups (n = 13): Group 1: tongue scraper; Group 2: treated once with aPDT; Group 3: probiotic capsule containing Lactobacillus salivarius WB21 (6.7 x 108 CFU) and xylitol (280mg), 3 times a day after meals, for 14 days; Group 4: treated once with aPDT and with the probiotic capsule for 14 days. Halimetry with gas chromatography (clinical evaluation) and microbiological samples were collected from the dorsum of the tongue before and after aPDT, as well as after 7, 14, and 30 days. The clinical data failed to follow a normal distribution; therefore, comparisons were made using the Kruskal-Wallis test (independent measures) and Friedman ANOVA (dependent measures) followed by appropriate posthoc tests, when necessary. For the microbiological data, seeing as the data failed to follow a normal distribution, the Kruskal-Wallis rank sum test was performed with Dunn's post-test. The significance level was α = 0.05., Results: Clinical results (halimetry) showed an immediate significant reduction in halitosis with aPDT (p = 0.0008) and/or tongue scraper (p = 0.0006). Probiotics showed no difference in relation to the initial levels (p = 0.7530). No significant differences were found in the control appointments. The amount of Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola were not altered throughout the analysis (p = 0.1616, p = 0.2829 and p = 0.2882, respectively)., Conclusion: There was an immediate clinical reduction of halitosis with aPDT and tongue scraping, but there was no reduction in the number of bacteria throughout the study, or differences in the control times, both in the clinical and microbiological results. New clinical trials are necessary to better assess the tested therapies., Trial Registration: Clinical Trials NCT03996044., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Motta et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Periodontitis is one of the most prevalent infectious diseases in humans and animals. It is a multifactorial disease resulting in attachment loss and tooth loss. Therefore, preventive dentistry, such as daily teeth cleaning or providing dental chews from puppyhood is essential. This study aimed to find an alternative option for preventive dentistry by examining both in vitro and clinically, the antibacterial, antihalitosis, and anti-inflammatory effects of folic acid (FA) in dogs with periodontal disease. The antibacterial and antihalitosis responses of FA were evaluated in vitro using Porphyromonas gulae , a bacterium that plays a significant role in the development of periodontal disease in dogs. Anti-inflammatory responses, such as secretion of IL-1β, IL-6, and IL-8 induced by P. gulae infection in human gingival epithelium have been studied. This study used dogs with P. gulae -associated periodontal diseases and was conducted by providing a dental chew containing 0.13% FA for 28 days. The viability and halitosis production (hydrogen sulfide and methyl mercaptan) of P. gulae was significantly inhibited by FA in a dose and time-dependent manner. IL-1β, IL-6, and IL-8 secretion were also significantly suppressed by FA treatment in a dose-dependent manner. In vitro bactericidal, antihalitosis, and anti-inflammatory effects of FA were confirmed in dogs with P. gulae -associated periodontal disease. One month of oral treatment with 0.13% FA-containing dental chews significantly reduced halitosis as well as P. gulae activity. This study suggests that oral treatment with FA can be a preventive option for periodontal disease in dogs as well as humans., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Oral malodor still constitutes a major challenge worldwide. A strong effort is invested in eliminating volatile sulfur compound-producing oral bacteria through organic natural products such as essential oils. Fusobacterium nucleatum is a known volatile sulfur compound-producing bacteria that inspires oral malodor. The aim of the present study was to test the effect of lavender essential oil on the bacterium's ability to produce volatile sulfide compounds, the principal components of oral malodor. Lavender ( Lavandula angustifolia ) essential oil was extracted by hydrodistillation and analyzed using GC-MS. The minimal inhibitory concentration (MIC) of lavender essential oil on Fusobacterium nucleatum was determined in a previous trial. Fusobacterium nucleatum was incubated anaerobically in the presence of sub-MIC, MIC, and above MIC concentrations of lavender essential oil, as well as saline and chlorhexidine as negative and positive controls, respectively. Following incubation, volatile sulfur compound levels were measured using GC (Oralchroma), and bacterial cell membrane damage was studied using fluorescence microscopy. Chemical analysis of lavender essential oil yielded five main components, with camphor being the most abundant, accounting for nearly one-third of the total lavender essential oil volume. The MIC (4 µL/mL) of lavender essential oil reduced volatile sulfur compound secretion at a statistically significant level compared to the control (saline). Furthermore, the level of volatile sulfur compound production attributed to 1 MIC of lavender essential oil was in the range of the positive control chlorhexidine with no significant difference. When examining bacterial membrane damage, 2 MIC of lavender essential oil (i.e., 8 µL/mL) demonstrated the same, showing antibacterial membrane damage values comparative to chlorhexidine. Since lavender essential oil was found to be highly effective in hindering volatile sulfur compound production by Fusobacterium nucleatum through the induction of bacterial cell membrane damage, the results suggest that lavender essential oil may be a suitable alternative to conventional chemical-based anti-malodor agents.

Objective: To assess the efficacy of Phyllanthus emblica extract in alleviating halitosis and reducing the inflammatory response to halitosis-related bacteria., Methodology: This investigation, using Phyllanthus emblica fruit extract (PE), involved four aspects. First, we evaluated the effect on growth and aggregation of halitosis-related bacteria, including Fusobacterium nucleatum, Porphyromonas gingivalis, and Solobacterium moorei, using a microdilution assay and scanning electron microscopy. Second, volatile sulfur compound (VSC) levels were measured on individuals with halitosis in randomized short-term (26 participants) and double-blind randomized long-term trials (18 participants in each group) after rinsing with PE for 3, 6, and 12 h, and 28 days. Third, we analyzed pro-inflammatory cytokine expression in TR146 cells using quantitative real-time PCR and enzyme-linked immunosorbent assays. Lastly, we assessed pro-inflammatory cytokine secretion and Toll-like receptor (TLR) 2 mRNA expression via the same experimental methods in a three-dimensional oral mucosal epithelial model (3D OMEM)., Results: PE extract dose-dependently inhibited the growth of F. nucleatum (50% inhibition concentration [IC50]=0.079%), P. gingivalis (IC50=0.65%), and S. moorei (IC50=0.07%) and effectively prevented bacterial aggregation. Furthermore, VSC contents decreased significantly at 3, 6, and 12 h after rinsing with 5% PE compared with those in the control. Long-term use of mouthwash containing 5% PE for 28 days led to a significant decrease in VSC contents. PE attenuated the F. nucleatum- or P. gingivalis-stimulated mRNA expression and protein release of interleukin (IL)-6 and IL-8 in TR146 cells. It also suppressed IL-8 and prostaglandin E2 secretion and TLR2 mRNA expression in F. nucleatum-induced OMEMs., Conclusion: Our findings support the use of PE in oral care products to alleviate halitosis and it may reduce inflammation.

Background: Intra-oral halitosis (IOH) is bad breath produced locally by the mouth in addition to systemic diseases and is one of the main causes of interpersonal communication and psychological disorders in modern society. However, current treatment modalities still only alleviate IOH and do not eradicate it. Therefore, based on the differential performance of oral microecology in IOH patients, we propose a microbiota transplantation treatment aimed at restoring oral microecological balance and analyze its feasibility by oral flora colonization test in Wistar rats., Objective: Saliva flora samples were collected from IOH patients and healthy subjects to analyze the feasibility of oral microbiota transplantation (OMT) for the treatment of IOH by the Wistar rat oral flora colonization test., Methods: Seven patients with IOH who visited the First Affiliated Hospital of Xinjiang Medical University from June 2017 to June 2022 with the main complaint of halitosis and three healthy subjects were randomly selected. A Halimeter portable breath detector was used to record breath values and collect saliva flora samples. Sixteen SPF-grade male Wistar rats were housed in the Animal Experiment Center of Xinjiang Medical University and randomly divided into an experimental group (Group E) and a control group (Group C) for the oral flora colonization test. Species composition and associated metabolic analysis of oral flora during the Wistar rat test using 16SrRNA sequencing technology and PICRUSt metabolic analysis. Also, the changes in the breath values of the rats were recorded during the test., Results: The proportion of Porphyromonas, Fusobacterium, Leptotrichia, and Peptostreptococcus was significantly higher in group E compared to group C after colonization of salivary flora of IOH patients (all P < 0.05), and the abundance with Gemella was zero before colonization, while no colonization was seen in group C after colonization compared to baseline. PICRUSt metabolic analysis also showed significantly enhanced IOH-related metabolic pathways after colonization in group E (all P < 0.05), as well as significantly higher breath values compared to baseline and group C (all P < 0.0001). After colonization by salivary flora from healthy subjects, group E rats showed a decrease in the abundance of associated odor-causing bacteria colonization, a reduction in associated metabolism, and a significant decrease in breath values. In contrast, group C also showed differential changes in flora structure and breath values compared to baseline after salivary flora colonization of IOH patients., Conclusions: OMT for IOH is a promising green treatment option, but the influence of environmental factors and individual differences still cannot be ignored., (© 2024. The Author(s).)

Objective: To evaluate the antibacterial effectiveness of a combination of ε-poly-L-lysine (ε-PL), funme peptide (FP) as well as domiphen against oral pathogens, and assess the efficacy of a BOP® mouthwash supplemented with this combination in reducing halitosis and supragingival plaque in a clinical trial., Materials and Methods: The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of the compound against Fusobacterium nucleatum, Porphyromonas gingivalis, Streptococcus mutans, and Aggregatibacter actinomycetemcomitans were determined by the gradient dilution method. Subsequently, the CCK-8 assay was used to detect the toxicity of mouthwash on human gingival fibroblastst, and the effectiveness in reducing halitosis and supragingival plaque of the mouthwash supplemented with the combination was analyzed by a randomized, double-blind, parallel-controlled clinical trial., Results: The combination exhibited significant inhibitory effects on tested oral pathogens with the MIC < 1.56% (v/v) and the MBC < 3.13% (v/v), and the mouthwash containing this combination did not inhibit the viability of human gingival fibroblasts at the test concentrations. The clinical trial showed that the test group displayed notably lower volatile sulfur compounds (VSCs) at 0, 10, 24 h, and 7 d post-mouthwash (P < 0.05), compared with the baseline. After 7 days, the VSC levels of the and control groups were reduced by 50.27% and 32.12%, respectively, and notably cutting severe halitosis by 57.03% in the test group. Additionally, the Plaque Index (PLI) of the test and control group decreased by 54.55% and 8.38%, respectively, and there was a significant difference in PLI between the two groups after 7 days (P < 0.01)., Conclusions: The combination of ε-PL, FP and domiphen demonstrated potent inhibitory and bactericidal effects against the tested oral pathogens, and the newly formulated mouthwash added with the combination exhibited anti-dental plaque and anti-halitosis properties in a clinical trial and was safe., Trial Registration: The randomized controlled clinical trial was registered on Chinese Clinical Trial Registry (No. ChiCTR2300073816, Date: 21/07/2023)., (© 2024. The Author(s).)

Halitosis is a common oral condition, which leads to social embarrassment and affects quality of life. Cumulative evidence has suggested the association of tongue-coating microbiome with the development of intraoral halitosis. The dynamic variations of tongue-coating microbiota and metabolites in halitosis have not been fully elucidated. Therefore, the present study aimed to determine the tongue-coating microbial and metabolic characteristics in halitosis subjects without other oral diseases using metagenomics and metabolomics analysis. The participants underwent oral examination, halitosis assessment, and tongue-coating sample collection for the microbiome and metabolome analysis. It was found that the microbiota richness and diversity were significantly elevated in the halitosis group. Furthermore, species from Actinomyces , Prevotella , Veillonella , and Solobacterium were significantly more abundant in the halitosis group. However, the Rothia and Streptococcus species exhibited opposite tendencies. Eleven Kyoto Encyclopedia of Genes and Genomes pathways were significantly enriched in the halitosis tongue coatings, including cysteine and methionine metabolism. Functional genes related to sulfur, indole, skatole, and cadaverine metabolic processes (such as serA, metH, metK and dsrAB ) were identified to be more abundant in the halitosis samples. The metabolome analysis revealed that indole-3-acetic, ornithine, and L-tryptophan were significantly elevated in the halitosis samples. Furthermore, it was observed that the values of volatile sulfur compounds and indole-3-acetic abundances were positively correlated. The multiomics analysis identified the metagenomic and metabolomic characteristics to differentiate halitosis from healthy individuals using the least absolute shrinkage and selection operator logistic regression and random forest classifier. A total of 19 species and 39 metabolites were identified as features in halitosis patients, which included indole-3-acetic acid, Bacillus altitudinis , Candidatus Saccharibacteria , and Actinomyces species. In conclusion, an evident shift in microbiome and metabolome characteristics was observed in the halitosis tongue coating, which may have a potential etiological significance and provide novel insights into the mechanism for halitosis., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Tongue coating consists of oral bacteria, desquamated epithelium, blood cells, and food residues and is involved in periodontal disease, halitosis, and aspiration pneumonia. Recently, a tongue brush with sonic vibration was developed to clean the tongue. This comparative study examined the extent of tongue coating, its effects on the tongue, bacterial count particularly on the posterior dorsum of the tongue, and the degree of pain using a manual tongue brush and the newly developed sonic tongue brush., Materials and Methods: Patients' extent of tongue coating and the quantity of bacteria were analysed before and after brushing with a sonic or manual nylon tongue brush. Moreover, the impressions of the dorsum linguae were obtained before and after brushing to establish models that were observed under a stereo microscope to evaluate tongue trauma. Pain caused during the use of these brushes was evaluated based on the numerical rating scale (NRS)., Results: The extent of tongue coating and number of bacteria decreased in both the sonic and manual nylon brush groups after tongue cleaning; however, no significant differences were noted. Tongue trauma evaluation revealed that the tongue surface was significantly scratched in the manual brush group compared with the sonic brush group. NRS-based pain evaluation revealed no significant differences., Conclusions: The sonic brush was equally effective in removing tongue coating and bacteria compared with the manual brush. As the sonic brush does not cause tongue trauma, it may be considered a safe and effective cleaning tool of the tongue., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

The major oral odor compound methyl mercaptan (CH 3 SH) is strongly associated with halitosis and periodontitis. CH 3 SH production stems from the metabolism of polymicrobial communities in periodontal pockets and on the tongue dorsum. However, understanding of CH 3 SH-producing oral bacteria and their interactions is limited. This study aimed to investigate CH 3 SH production by major oral bacteria and the impact of interspecies interactions on its generation. Using a newly constructed large-volume anaerobic noncontact coculture system, Fusobacterium nucleatum was found to be a potent producer of CH 3 SH, with that production stimulated by metabolic interactions with Streptococcus gordonii , an early dental plaque colonizer. Furthermore, analysis of extracellular amino acids using an S. gordonii arginine-ornithine antiporter (ArcD) mutant demonstrated that ornithine excreted from S. gordonii is a key contributor to increased CH 3 SH production by F. nucleatum . Further study with 13 C, 15 N-methionine, as well as gene expression analysis, revealed that ornithine secreted by S. gordonii increased the demand for methionine through accelerated polyamine synthesis by F. nucleatum , leading to elevated methionine pathway activity and CH 3 SH production. Collectively, these findings suggest that interaction between S. gordonii and F. nucleatum plays a key role in CH 3 SH production, providing a new insight into the mechanism of CH 3 SH generation in oral microbial communities. A better understanding of the underlying interactions among oral bacteria involved in CH 3 SH generation can lead to the development of more appropriate prophylactic approaches to treat halitosis and periodontitis. An intervention approach like selectively disrupting this interspecies network could also offer a powerful therapeutic strategy.IMPORTANCEHalitosis can have a significant impact on the social life of affected individuals. Among oral odor compounds, CH 3 SH has a low olfactory threshold and halitosis is a result of its production. Recently, there has been a growing interest in the collective properties of oral polymicrobial communities, regarded as important for the development of oral diseases, which are shaped by physical and metabolic interactions among community participants. However, it has yet to be investigated whether interspecies interactions have an impact on the production of volatile compounds, leading to the development of halitosis. The present findings provide mechanistic insights indicating that ornithine, a metabolite excreted by Streptococcus gordonii , promotes polyamine synthesis by Fusobacterium nucleatum , resulting in a compensatory increase in demand for methionine, which results in elevated methionine pathway activity and CH 3 SH production. Elucidation of the mechanisms related to CH 3 SH production is expected to lead to the development of new strategies for managing halitosis., Competing Interests: Although Dr. Hara is employed by Mandom Corp, that company played no role in the study design, data acquisition, or decision to publish.

Objectives: To evaluate the effects of single-dose chlorhexidine oral care on bacterial colonisation and halitosis in patients undergoing elective surgery., Research Methodology: We conducted a two-arm parallel, single-blinded, randomised controlled trial. The intervention group (n = 102) received preoperative oral care with 0.12% chlorhexidine gluconate, and the control group (n = 105) received standard care. The data of the microbiological cultures between the groups were compared at the time of tracheal intubation, at extubation and 30 min after surgery. The presence of halitosis was measured using a survey questionnaire administered to the anaesthesia nurses assigned to the patients., Results: At baseline, no significant differences were found between the intervention and control groups for bacterial colonisation or halitosis. After the intervention, there was no significant difference in microbiological culture, including gram-positive, gram-negative bacilli and cocci results, between the two groups (p > 0.05). The presence of halitosis in the intervention group was significantly lower than in the control group during intubation (p < 0.0001) and at 30 min after surgery (p < 0.02). Regression analysis indicated that receiving oral was protective towards halitosis, while poor oral health was a risk factor., Conclusions: Preoperative oral care using a single dose of chlorhexidine significantly improved the patients' halitosis in the perioperative period, but no significant effect was found on bacterial colonisation. Further studies are needed regarding the safe use of chlorhexidine for oral care., Implication for Clinical Practice: Oral hygiene using chlorhexidine could be beneficial in improving halitosis for anaesthesia personnel who take care of intubated adult patients undergoing elective surgery with general anaesthesia., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Oral microbial dysbiosis is the primary etiologic factor for halitosis and may be the critical preventive target for halitosis. This study included randomized controlled trials (RCTs) assessing the effects of Lactobacillus paracasei ET-22 live and heat-killed bacteria on halitosis and the related oral microbiome. 68 halitosis subjects were divided into placebo, ET-22 live (ET-22.L) and ET-22 heat-killed (ET-22.HK) groups. Subjects took different lozenges three times a day for 4 weeks and underwent saliva collection and assessment of breath volatile sulfur compound (VSC) levels at the beginning and end of the intervention. Salivary volatile organic compounds were measured using HS-SPME-GC/MS, and the microbiome profile was determined by 16S rRNA gene amplicon sequencing. A positive decrease in breath volatile sulfur compound (VSC) levels was observed in the means of both ET-22.L and ET-22.HK groups after 4 weeks of intervention, being more marked in the ET-22.L group ( p = 0.0148). Moreover, ET-22.L and ET-22.HK intervention remarkably changed the composition of total salivary volatile organic compounds (VOCs) and aroma-active VOCs. Key undesirable VOCs, such as indole, pyridine, nonanoic acid, benzothiazole, and valeric acid, were significantly reduced. Meanwhile, ET-22.L or ET-22.HK also altered the taxonomic composition of the salivary microbiome. The halitosis pathogens Rothia and Streptococcus were significantly reduced in the ET-22.HK group and the pathogenic Solobacterium and Peptostreptococcus were significantly inhibited in the ET-22.L group. Collectively, our study suggests that both ET-22.L and ET-22.HK can significantly inhibit the production of undesirable odor compounds in subjects with halitosis, which may be related to the changes of the oral microbiome.

Purpose: To evaluate the effect of a mouthwash containing Lespedeza cuneata extract (LCE) on halitosis as an alternative to chemical mouthwashes. The effect of this natural mouthwash on halitosis-causing bacteria (HCB) was clinically evaluated., Materials and Methods: A total of 84 subjects among 103 participants were recruited from the M Dental Clinic (Busan, South Korea) in this randomised, double-blind, placebo-controlled study. The participants were divided into two groups: 41 in the saline-gargle group (saline group) and 43 in the LCE-gargle group (LCE group). A week before the experiment, scaling and oral health education were conducted to standardise the subjects' oral condition. For clinical evaluation, halitosis and HCB were evaluated pre-gargle (baseline), immediately after gargling (treatment), and 5 days after gargling (5 days post-treatment). Statistical analysis was performed using SPSS for Windows., Results: The level of subjective improvement was statistically significantly greater in the LCE group than the saline group (p < 0.05). Compared with the saline group, the LCE group showed reduced halitosis after 5 days of application. Furthermore, halitosis statistically significantly decreased over time (p < 0.05). Moreover, the LCE group showed a statistically significant decrease in the number of all six HCBs (p < 0.05)., Conclusion: LCE gargle was effective in reducing halitosis both subjectively and objectively, suggesting an antibacterial effect on HCBs in the oral cavity. Thus, LCE, which can be used as a safe mouthwash ingredient, can promote oral health and will be valuable for the oral healthcare product industry. It might also be helpful for people suffering from halitosis.

Background: Hydrogen sulfide (H 2 S) is the most important compound causing oral malodor, and its concentration is thought to be closely correlated with oral microorganism activity. Therefore, clarifying the correlation between oral microbes and metabolites is important., Methods: This study tested with 16S rRNA gene amplicon and shotgun metagenomic sequencing of oral microorganisms and oral malodor tests., Results: There were different of the microbial taxa between the low and high H 2 S groups. And in the high H 2 S group, most of the enriched taxa were genera which abundance was correlated with H 2 S concentration. Fusobacterium periodonticum and Prevotella nanceiensis were significantly different in coverage breadth and depth and in LPS biosynthesis contributions between the two groups. The contribution of F. periodonticum to sulfur metabolism was significantly different between the two groups, and the relative F. periodonticum abundance was higher in the high H 2 S group., Conclusions: The H 2 S content is significantly associated with the oral cavity microorganism composition and abundance. Most microorganisms enriched in people with high H 2 S levels are associated with oral diseases such as caries and periodontal diseases., (© 2022 Wiley Periodicals LLC.)

Objectives: To evaluate the effect of lemon essential oil (LEO) on salivary bacteria and volatile sulfur compound (VSC) production of patients with halitosis., Materials and Methods: Saliva of five patients with halitosis was collected, after adding different concentrations (0.563-9 mg/ml) of LEO, detecting the growth of salivary bacteria, the formation of biofilm, and VSC production, and compare the difference of different concentrations of LEO on bacterial growth and VSC production. 48 volunteers were randomly divided into 4 groups. After gargling with LEO, cetylpyridinium chloride (CPC), chlorhexidine (CHX), and hydrogen peroxide (H 2 O 2 ) separately measure changes of VSC production and pH values at 30, 45, 60, 90, and 120 min and then compare the differences at different time points within group., Results: Compared with the negative control group, under subinhibitory concentrations of LEO (0.563-2.25 mg/ml), the biofilm formation and VSC production of salivary bacteria in LEO group were significantly inhibited (p < 0.05). Compared with the baseline, the VSC production of subjects decreased after rinsing with the LEO in 60 min (p < 0.05). After gargling with LEO, the pH value rose significantly in 30 min and reverted to the baseline level at 120 min (p < 0.05)., Conclusions: Lemon essential oil can inhibit the growth of salivary bacteria and reduce VSC production of patients with halitosis., (© 2022 Wiley Periodicals LLC.)

Intra-oral halitosis usually results from the production of volatile sulfur compounds, such as methyl mercaptan and hydrogen sulfide, by the tongue microbiota. There are currently no reports on the microbial gene-expression profiles of the tongue microbiota in halitosis. In this study, we performed RNAseq of tongue coating samples from individuals with and without halitosis. The activity of Streptococcus (including S. parasanguinis), Veillonella (including V. dispar) and Rothia (including R. mucilaginosa) was associated with halitosis-free individuals while Prevotella (including P. shahi), Fusobacterium (including F. nucleatum) and Leptotrichia were associated with halitosis. Interestingly, the metatranscriptome of patients that only had halitosis levels of methyl mercaptan was similar to that of halitosis-free individuals. Finally, gene expression profiles showed a significant over-expression of genes involved in L-cysteine and L-homocysteine synthesis, as well as nitrate reduction genes, in halitosis-free individuals and an over-expression of genes responsible for cysteine degradation into hydrogen sulfide in halitosis patients., (© 2022. The Author(s).)

Halitosis is a term that refers to an unpleasant or foul odor originating from oral cavity, which is mainly caused by volatile sulfur compounds (VSCs) produced by oral anaerobes such as Porphyromonas gingivalis, Fusobacterium nucleatum, Treponema denticola and Prevotella intermedia . General therapies, such as tooth and tongue brushing or usage of bacteriostat can hardly provide a harmless and continuous therapeutic effect on halitosis. Recent evidence has suggested the potential clinical application value of probiotics in the treatment of halitosis. In this study, Bifidobacterium lactis HN019 and Lactobacillus acidophilus NCFM were identified from four kinds of probiotics and the antimicrobial activities against pathogens related to halitosis and inhibitory effects on VSCs were investigated. The results showed that B. lactis HN019 and L. acidophilus NCFM exhibited superior bacteriostatic action against pathogens related to halitosis and showed remarkable inhibitory effect on the production and emission of VSCs. These findings suggest that B. lactis HN019 and L. acidophilus NCFM may serve as promising parts of a successful halitosis manage plan., (Creative Commons Attribution license.)

Aim: To evaluate the additional effect of a single session of antimicrobial photodynamic therapy (aPDT) on the tongue as an adjunct to scaling and root planing (SRP) on most common volatile sulfur-producing microbes such as Porphyromonas gingivalis (Pg), Treponema denticola (Td) and Fusobacterium nucleatum (Fn) on 3rd, 7th and 14th day postoperatively using RT-PCR analysis., Method and Materials: Twenty-four patients of either sex, presented with moderate to severe malodor, detected by a portable breath checker (Tanita®) were considered for the study and assigned to group A & B. Scaling and root planning was performed in both the groups, followed by photodynamic therapy on the tongue surface in group A. One percent methylene blue photosensitizer was applied on the middle and posterior thirds of the dorsum of the tongue and irradiated in continuous mode at six different points for 90 s at each point., Results: A significant reduction in Halimeter scores throughout the study period was observed. A significant reduction in the tongue coating score on 3rd and 7th day and the total count of Porphyromonas gingivalis (Pg) and Fusobacterium nucleatum (Fn) on 7th and 14th day was seen in group A (p ≤ 0.05). However, the mean reduction in Treponema denticola (Td) was non-significant in both the groups but a greater fall in the total count was seen in group A compared to group B on all the days (p ≥ 0.05)., Conclusion: Within the limitations of the study, it was concluded that photodynamic therapy on the tongue along with scaling and root planing was effective in the reduction of malodour and the total count of bacteria responsible for the same. Long-term clinical trials are required to further substantiate the effectiveness of this technique., Competing Interests: Declaration of Competing Interest The authors declare no conflict of interest., (Copyright © 2022. Published by Elsevier B.V.)

Oral microbiota play a prominent role in canine periodontal disease and wet foods are often blamed for poor oral health, but canine oral microbial communities have been poorly studied. We aimed to determine differences in oral health measures, breath odor, and oral microbiota populations of dogs fed wet or dry food. Twelve adult dogs fed either a commercial dry (extruded) or commercial wet (canned) food for 6 wk were studied. Breath samples were measured for sulfur compounds, teeth were scored for plaque, calculus, and gingivitis by a blinded veterinary dentist, salivary pH was measured, and supragingival (SUP) and subgingival (SUB) plaque samples were collected for microbiota analysis. Plaque DNA was extracted and Illumina sequencing was conducted. Phylogenetic data were analyzed using the CosmosID bioinformatics platform and SAS 9.4, with P <0.05 being significant and P <0.10 being trends. Plaque coverage tended to be higher (P < 0.10) in dogs fed wet vs. dry food, but other oral health scores were not different. Dogs fed dry food had higher (P < 0.05) salivary pH and lower (P < 0.05) breath sulfur concentrations than those consuming wet food. Bacterial alpha diversity was higher in SUP than SUB samples, and a clear separation in beta diversity was observed between sample sites on principal coordinates analysis (PCoA) plots. In SUP samples, dogs fed wet food had a higher alpha diversity than dogs fed dry food, with PCoA plots showing a separation between wet and dry food. Relative abundances of Firmicutes, Synergistetes, and 10 bacterial genera were different (P < 0.05) in SUB samples of dogs fed wet vs. dry food. Relative abundances of Fusobacteria and over 20 bacterial genera were different (P < 0.05) in SUP samples of dogs fed wet vs. dry food. In general, oral health-associated bacterial taxa (Pasteurella, Capnocytophaga, Corynebacterium) were higher, while bacteria associated with poor oral health (Fretibacterium fastidiosum, Filifactor alocis, Treponema medium, Tannerella forsythia, Porphyromonas canoris, Porphyromonas gingivalis) were lower in dogs fed dry food. Such shifts in the oral microbiota may impact periodontal disease risk, but longer dietary intervention studies are required to confirm their role in the disease process. Our results suggest that dogs fed dry extruded foods have lower breath odor and tooth plaque buildup and an oral microbiota population more closely associated with oral health than dogs fed wet canned foods., (© The Author(s) 2022. Published by Oxford University Press on behalf of the American Society of Animal Science. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Halitosis is formed mainly by the volatile compounds produced by periodontal bacteria. Three volatile sulfur compounds (VSCs), hydrogen sulfide, methanethiol, and dimethyl sulfide, have attracted attention as major components of halitosis. However, these compounds cannot account for all odors. In this study, we profiled volatile compounds from the culture supernatants of periodontal bacteria using gas chromatography/mass spectrometry/olfactometry analysis with a monolithic silica gel adsorption device to investigate the potential odorous compounds. Periodontal bacteria have been found to produce volatile compounds belonging to various classes, such as alcohols, ketones, fatty acids, and aromatic compounds, in addition to VSCs. In addition, VSCs different from hydrogen sulfide and methanethiol, which are considered important causative compounds, may also influence to halitosis., (Copyright © 2022 The Society for Biotechnology, Japan. Published by Elsevier B.V. All rights reserved.)

Background: Oral malodour is identified by pet owners as an unpleasant inconvenience, but they may not recognise this likely indicates underlying disease. The primary cause of oral malodour relates to the presence of bacteria in the oral cavity often associated with gingivitis and periodontitis. The purpose of this study was to determine the effect of feeding two oral care chews with different textural properties on oral malodour and the proportion of bacterial species involved in the production of volatile sulphur compounds (VSCs)., Methods: Fourteen dogs (9 Petit Basset Griffon Vendéen (PBGV) and 5 Beagle dogs) participated in the randomised cross-over study for a total of 14 weeks. The cohort was divided into four groups with each exposed to a different intervention per week: chew A, chew B, tooth brushing control or a no intervention control. An induced malodour method was used to assess VSCs in breath samples using a portable gas chromatograph (OralChroma™). Microbiological samples (supragingival plaque and tongue coating scrapes) were analysed for VSC-producing bacteria using Oral Hydrogen Sulfide agar with lead acetate., Results: VSCs were detected in the dogs' breath samples and levels of hydrogen sulphide and methyl mercaptan were found to be reduced following an intervention. Chew B significantly reduced the levels of both hydrogen sulphide (p < 0.001) and methyl mercaptan (p < 0.05) compared to no intervention. Reductions in methyl mercaptan were also observed for chew A and tooth brushing but these were not statistically significant. When compared to no intervention, all interventions significantly reduced the total bacterial load and VSC producing bacterial load in plaque (p < 0.001). For tongue samples, only chew B significantly reduced the total bacterial load and VSC-producing bacterial load (p < 0.001) compared to no intervention., Conclusions: By inducing oral malodour and subsequently applying the one-time interventions, significant reductions in the levels of VSCs were observed. The use of oral care chews texturally designed to deliver a deep, all-round cleaning action can be particularly effective at managing oral malodour in dogs, likely through an enhanced ability to remove bacteria., (© 2022. The Author(s).)

Objectives: The objective is to evaluate the association of Solobacterium moorei (S. moorei) to halitosis and to also check for the effects of two different mouth rinses on levels of S. moorei in saliva and tongue coating and its impact on oral halitosis., Materials and Methods: This was a placebo-controlled parallel study of 160 individuals who were randomized and the study was performed using double-blinded protocol. Enrolled individuals filled a structured questionnaire regarding demographic data, oral hygiene habits, and dietary habits. Full mouth organoleptic odor scores (OLR), volatile sulfur compounds levels, Miyazaki's tongue coating index, and Plaque scores were recorded before intervention (baseline) and after 1-week post treatment. Microbiological samples obtained from the tongue and saliva was investigated for S. moorei levels using real time polymerase chain reaction. Participants were randomly assigned for two test mouth rinses (Melaleuca alternifolia and Chlorhexidine) and placebo groups., Results: All salivary and tongue coating samples were tested positive for S. moorei in the halitosis group. One week post-treatment S. moorei counts in saliva and tongue coating samples of test group showed a significant reduction at P < 0.001. Paired t-test results showed that Melaleuca alternifolia was comparable with chlorhexidine in reduction of OLR, and VSC scores (P < 0.001). Salivary levels of S. moorei in Melaleuca alternifolia group showed a higher reduction (5.67 log 10 copies/mL) than chlorhexidine group (5.1log 10 copies/mL)., Conclusion: S. moorei showed a positive correlation with oral halitosis scores. Both Melaleuca alternifolia and chlorhexidine were equally effective in reducing S. moorei levels and halitosis score., Competing Interests: None

Objective: Face masks help contain the aerosol-mediated transmission of infectious viral particles released from individuals via cough and sneezes. However, the prolonged use of face masks has raised concerns regarding oral hygiene. Here, we present a mouthwash formulation based on α-cyclodextrin and hydroxytyrosol that can maintain healthy oral microbiota., Materials and Methods: We isolated and cultured Candida albicans, Staphylococcus aureus, and a mix of Streptococcus sp., Staphylococcus sp. and Neisseria sp. from oral and throat swabs. The microorganisms were cultured in a standard medium with or without the mouthwash. To evaluate the effect of the mouthwash on the oral microbiota, the DNA from the saliva of 3 volunteers that used the mouthwash was extracted. Then, the DNA was amplified using primer pairs specific for bacterial and fungal DNA. Twelve further volunteers were offered to use the mouthwash and a questionnaire was submitted to them to assess the possible beneficial effects of mouthwash on halitosis and other oral disturbances., Results: The bacteria and fungi cultured in media containing the mouthwash showed a growth reduction ranging from 20 to 80%. The PCR amplification of fungal and bacterial DNA extracted from volunteers that used the mouthwash showed a reduction of both bacteria and fungi. Volunteers that used the mouthwash reported a tendency towards a reduction of halitosis, gingival and mouth inflammation, and dry mouth., Conclusions: The use of a mouthwash containing α-cyclodextrin and hydroxytyrosol is not aggressive against oral mucosa; it is safe and effective to reduce the bacterial and fungal load due to the continuous use of face masks.

While the impact of oral microbiome dysbiosis on autoimmune diseases has been partially investigated, its role on bullous diseases like Pemphigus Vulgaris (PV) is a totally unexplored field. This study aims to present the composition and relative abundance of microbial communities in both healthy individuals and patients with oral PV lesions. Ion Torrent was used to apply deep sequencing of the bacterial 16S rRNA gene to oral smear samples of 15 healthy subjects and 15 patients. The results showed that the most dominant phyla were Firmicutes (55.88% controls-c vs 61.27% patients-p, p value = 0.002), Proteobacteria (9.17%c vs 12.33%p, p value = 0.007) and Fusobacteria (3.39%c vs 4.09%p, p value = 0.03). Alpha diversity showed a significant difference in the number of genera between patients and controls (p value = 0.04). Beta diversity showed statistical differences in the microbial community composition between two groups. Fusobacterium nucleatum, Gemella haemolysans and Parvimonas micra were statistically abundant in patients. We noticed the characteristic fetor coming out of oral PV lesions. Most of anaerobic bacteria responsible for oral halitosis are periopathogenic. Though, only F. nucleatum and P. micra were differentially abundant in our patients. Especially, F. nucleatum has been reported many times as responsible for bad breath. Furthermore, Streptococcus salivarius and Rothia mucilaginosa, species mostly associated with clean breath, were found in relative abundance in the healthy group. Consequently, the distinct malodor observed in PV patients might be attributed either to the abundance of F. nucleatum and P. micra and/or to the lower levels of S. salivarius and R. mucilanginosa in oral lesions.

Halitosis or oral malodor is one of the most common reasons for the patients' visit to the dental clinic, ranking behind only dental caries and periodontitis. In the present times, where social and professional communications are becoming unavoidable, halitosis has become a concern of growing importance. Oral malodor mostly develops due to the putrefaction of substrates by the indigenous bacterial populations. Although culture-based studies have provided adequate information on halitosis, the high throughput omics technologies have amplified the resolution at which oral microbial community can be examined and has led to the detection of a broader range of taxa associated with intra-oral halitosis (IOH). These microorganisms are regulated by the interactions of their ecological processes. Thus to develop effective treatment strategies, it is important to understand the microbial basis of halitosis. In the current review, we provide an update on IOH in context to the role of the oral microbiome, metabolic pathways involved, and novel diagnostic tools, including breathomics. Understanding oral microbiota associated with halitosis from a broader ecological perspective can provide novel insights into one's oral and systemic health. Such information can pave the way for the emergence of diagnostic tools that can revolutionize the early detection of halitosis and various associated medical conditions.

Is there a role for alternative therapies in controlling intra-oral halitosis? Treatments other than tongue cleaning and anti-halitosis products containing zinc, chlorhexidine and cetylpyridinium chloride were considered as alternative therapies. Four databases were searched (PubMed, EMBASE, Web of Science and The Cochrane Library). Inclusion criteria were: examination of alternative halitosis therapies, study population with oral malodour, a (negative or positive) control group and evaluation of breath odour via organoleptic and/or instrumental assessment. Data were extracted for descriptive analysis. The screening of 7656 titles led to the inclusion of 26 articles. Analysis showed heterogeneity concerning the population of interest (from cysteine-induced to genuine halitosis), the examined treatment and the reported outcomes. This made a meta-analysis impossible. Essential oils, fluoride-containing products and herbal substances were the most studied. Results varied enormously and none of the active ingredients had an unambiguously positive effect on the malodour. The risk of bias was assessed as high in all articles. Given the fact that little evidence was found for each of the investigated treatments, it could be concluded that there is currently insufficient evidence that alternative therapies are of added value in the treatment of halitosis. Clinical relevance Scientific rationale: Halitosis is a common problem causing social isolation. Out of embarrassment, patients search the internet, leading to many questions about alternative solutions (e.g. oil pulling, herbs). This is the first systematic review on these alternative therapies. Principal findings : Results varied among studies. Some promising results were found for fluoride-containing toothpastes and probiotics. For other products (such as herbal and antibacterial products and essential oils) results were inconsistent. Long-term follow-up studies on these products are scarce. Moreover, the quality of the studies was poor. Practical implications: No clear evidence was found to support a certain alternative anti-halitosis therapy., (© 2021 IOP Publishing Ltd.)

Study Objective: Malodor is a multifactorial condition with oral pathology representing the main culprit and the tongue being the first to second contributor to the malodor. Bacterial load can represent a quantifiable measure regardless of the original pathology. We hypothesize that reduction in malodor can be represented by tongue changes both in appearance, bacterial and biofilm load reduction (measured by CFU and volatile gases measurement), organoleptic measurement and subjective improvement., Methods: A randomized controlled prospective study under IRB approval. Diagnostic criteria for enrollment and follow up were organoleptic test by 2 judges, Halimeter reading, tongue colors changes HALT questionnaire and direct aerobic and anaerobic tongue cultures measured by CFU. Patients were treated with laser tongue debridement (LTD) with an Er,Cr:YSGG solid state laser has been shown to be effective in biofilm reduction., Results: 54 patients recruited with 35 available for follow up. Improvement was observed on all objective and QOL subjective parameters. Treatment was tolerated well with minimal discomfort., Conclusions: The tongue is proven to be a major contributor to oral malodor and must be addressed in treatment protocol. LTD significantly reduces malodor by subjective and objective criteria. While impossible to determine whether the tongue serves as a bacterial reservoir or is the origin for oral bacteria it is clear that LTD improves oral hygiene and reduces malodor. LTD is safe and easy to perform. We encourage LTD to be a crucial part of any oral malodor treatment protocol., Trial Registration: clinical trials, NCT04120948. Registered 25 September 2019 - Retrospectively registered, https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S00098SX&selectaction=Edit&uid=U0000W0Y&ts=51&cx=-elnx7e., (Copyright © 2020 Elsevier Inc. All rights reserved.)

The aim was to assess the role of probiotics in oral health maintenance among patients undergoing fixed orthodontic therapy (OT). An unrestricted search of indexed databases was performed until April 2020 using the following Mesh-terms: (1) probiotic and (2) orthodontic. Randomized controlled clinical trials (RCTs) evaluating the influence of probiotic therapy (PT) towards oral health maintenance/improvement in patients undergoing fixed OT were included. Data screening, selection, and extraction were performed; and the risk of bias was assessed using the Cochrane Collaboration's tool. All evaluations were performed by 2 independent researchers; and disagreements were resolved via discussion. Nine RCTs were included. Eight studies reported that PT improves oral health in patients undergoing fixed OT. Seven studies showed that PT reduces the counts of oral pathogenic bacteria in the oral biofilm and/or saliva. One study reported that PT reduces halitosis in patients undergoing fixed OT. One study found that PT reduces the scores of plaque index (PI) and gingival index (GI); and one study reported that PT has no significant influence on PI and GI in patients undergoing fixed OT. One study reported that PT does not prevent the formation of white spot lesions during fixed OT. Three and 6 studies had a moderate and low risk of bias, respectively. A power analysis was performed in 4 studies. In conclusion, probiotics exhibit antimicrobial activity against oral pathogenic bacteria; however, due to the limitations of the studies assessed, further well-designed RCTs are needed.

There are many studies on the relationship between the tongue coating and halitosis, but few have evaluated the bacterial community present in the tongue coating. This study identified bacteria in the tongue coating in individuals with and without halitosis using 16S rRNA analysis. Forty subjects (mean age, 46.1 ± 15.8 years) who visited the halitosis clinic at the University Dental Hospital between 2016 and 2017 were divided into halitosis ( n  = 32) and non-halitosis ( n  = 8) groups according to results from an organoleptic test (OT). Additional measurements via gas chromatography (GC) and the Breathtron® instrument confirmed the groupings as the H 2 S, CH 3 SH, (CH 3 ) 2 S, and total volatile sulphur compounds (VSC) levels were significantly higher in the halitosis group than in the non-halitosis group. Bacterial diversity was higher in the halitosis group; the median (quartile) values of the Shannon index were 4.46 (4.21, 4.67) in the halitosis group and 3.80 (3.45, 4.30) in the non-halitosis group. Additionally, the median (quartile) values of the Chao-1 index were 84.0 (77.2, 95.0) in the halitosis group and 71.3 (65.0, 81.5) in the non-halitosis group. These differences in bacterial composition and diversity may further the understanding of causes and treatments for halitosis.

To investigate whether academic stress changes the salivary microbiota and its relationship with salivary parameters, evaluating the effects on the production of volatile sulfur compounds (VSCs) in healthy women. Fifty-five women who were enrolled in a four-year Dentistry course were assessed for academic stress by the questionnaire Maslach Burnout Inventory-Student Survey and were then classified into 'Not Stressed' and 'Stressed' groups. Cortisol and alpha-amylase (AA) were measured as physiological stress biomarkers. Oral Chroma™ gas chromatograph was used to measure concentrations of hydrogen sulfide (H 2 S), methyl mercaptan and dimethyl sulfide. Salivary proteins were evaluated by western blot. Quantitative polymerase chain reaction was used to identify the salivary amounts of halitosis-associated bacteria. The 'Stressed' volunteers showed higher levels of H 2 S, AA, Fusobacterium nucleatum and total bacteria, compared to the 'Not Stressed' individuals (p < 0.05; Mann-Whitney test). Salivary proteins showed no differences between groups (p > 0.05; Mann-Whitney test). Academic stress was positively correlated with H 2 S, total bacteria and F. nucleatum counts, while F. nucleatum was positively correlated with AA. H 2 S showed positive correlations with AA and Solobacterium moorei (p < 0.05; Spearman correlation). Beta-defensin (BD) presented negative correlations with H 2 S and S. moorei (p < 0.05; Spearman correlation). Academic stress increased salivary F. nucleatum and total bacteria, as well as AA activity. The protein BD showed important correlations with bacteria and VSC. These changes appeared to be accountable for increased H 2 S production in the stressed women.

Probiotics and prebiotics are popular among consumers worldwide as natural approaches to prevent gastrointestinal diseases. The effects of their consumption on the gastrointestinal system have been extensively investigated. Recently, the efficacy of probiotics and prebiotics has been evaluated against naturally developing microbiome imbalance in the human body, such as in the oral cavity, skin, female urogenital tract, and respiratory tract. This review examines the scientific data related to the effects of probiotics on the treatment of diseases occurring in the oral cavity. Probiotics can effectively prevent and treat some infectious diseases in the oral cavity, such as halitosis and periodontitis, and can reduce the development of dental caries and the concentration of harmful bacteria, according to clinical studies. The results of this meta-analysis also suggest the use of probiotics to treat halitosis and periodontitis. However, the evidence may be inconclusive due in part to the use of a wide range of probiotics, non-standardized study design, small population size, poor quality reports, and inconsistent data. Therefore, future studies should homogenize terms and definitions for primary and secondary outcomes, increase the number of volunteers/patients in in vitro tests and clinical studies, and include an evaluation of the combined use of pre- and probiotics.

Background: The aim of the study was to observe the antimicrobial activity of Porphyromonas gingivalis and Treponema denticola as well as the effect on reducing volatile sulfur compounds (VSCs)., Materials and Methods: After P. gingivalis and T. denticola were cultured with or without Streptococcus salivarius K12 and M18, VSCs were measured by Oral Chroma. In order to analyze the mechanism for malodor control, the antimicrobial activity of S. salivarius K12 and M18 against P. gingivalis and T. denticola was assessed. SPSS 21.0 was used for data analysis with the Kruskal-Wallis and Jonckheere-Terpstra tests. Mann-Whitney test was applied for post hoc analysis., Results: P. gingivalis and T. denticola VSC levels were reduced by high concentrations of S. salivarius K12 and M18 during coculture. The concentrations were lower than those of single culture (p < .05). An antimicrobial effect was detected on P. gingivalis, and T. denticola by 50% S. salivarius K12 and M18. The spent culture medium and whole bacteria of S. salivarius K12 and M18 reduced the levels of VSCs below the amount in a single culture of P. gingivalis and T. denticola (p < .05)., Conclusion: S. salivarius K12 and M18 decreased the levels of VSCs originating from P. gingivalis and T. denticola., (© 2019 The Authors. Clinical and Experimental Dental Research published by John Wiley & Sons Ltd.)

Objectives: The aim of this study was to investigate the effect of an oral care tablet containing kiwifruit powder on oral bacteria in tongue coating compared with tongue brushing., Material and Methods: Thirty-two healthy, young adults were enrolled, and a crossover clinical trial was conducted. The volatile sulfur compound (VSC) concentration, Winkel tongue-coating index (WTCI), and the number of total bacteria in addition to Fusobacterium nucleatum in tongue coating were measured. We instructed subjects to remove tongue coating by tongue brush for Intervention I, to keep the oral care tablet containing kiwifruit powder on the tongue dorsum and to let it dissolve naturally for Intervention II, and three oral care tablets 1 day before the measurement for Intervention III., Results: There were significant differences in terms of the level of H 2 S, VSC, and WTCI at Intervention I and all evaluation values at Intervention II. There were significant differences in terms of the level of H 2 S, VSC, WTCI, the number of total bacteria, and F. nucleatum at Intervention III. The value of WTCI, the number of bacteria, and F. nucleatum decreased significantly after taking the oral care tablets than after tongue brushing. When compared with Interventions I and III, Intervention III showed the effective results; there were significant differences in the number of total bacteria and F. nucleatum between tongue brushing and taking tablets., Conclusions: These results suggested that the oral care tablet containing kiwifruit powder could be effective in reducing total bacteria and F. nucleatum in tongue coating when compared with tongue brushing., (© 2019 The Authors. Clinical and Experimental Dental Research published by John Wiley & Sons Ltd.)

Background: Oral malodor is a very discomforting condition deriving from the presence of volatile sulfur compounds in the expired air. In halitosis of intraoral etiology, the volatile sulfur compounds are metabolic products of the oral microorganisms within the biofilm coating the tongue dorsum as well as other tissues in the oral cavity. The aim of this study was to characterize and compare the microbial composition of tongue biofilm in volunteers suffering from halitosis and healthy volunteers by means of both the culture method and culture-independent cloning technique., Results: A high bacterial variety (more than 80 different species) was detected using the combination of both methods. A distinct bacterial composition was revealed in the halitosis-associated biofilms compared with the health-associated biofilms. Actinomyces graevenitzii was shown to be significantly associated with the halitosis condition. The culture method identified 47 species, included Veillonella rogosae, never isolated from the tongue biofilm of halitosis patients so far. In the healthy condition, the culture-dependent method showed that the most frequent species were Streptococcus parasanguinis among the aerobes and Veillonella spp. among the anaerobes. The culture-independent cloning method detected more than 50 species. Streptococci, in particular S. mitis/oralis, S. pseudopneumoniae, and S. infantis as well as Prevotella spp., were found most frequently in halitosis patients. Streptococcus salivarius and Rothia mucilaginosa were found more frequently in the healthy condition., Conclusions: The combination of the culture-dependent and culture-independent cloning techniques allowed for a widespread analysis of the tongue biofilm in halitosis patients. The results can support further pharmacological research for new antimicrobial agents and halitosis therapy strategies., (© 2019 The Authors. MicrobiologyOpen published by John Wiley & Sons Ltd.)

Aim: This study aims to assess the microbiome variations related to intraoral halitosis and its relationship with volatile sulfur compounds (VSCs) among periodontally healthy Chinese adults., Material and Methods: Tongue coating samples were collected from 28 periodontally healthy subjects (16 subjects with halitosis and 12 subjects without halitosis) who fulfilled the selection criteria. The organoleptic score (OS) was used to evaluate the halitosis status. The characterization of associated microbial communities was performed using 16S rRNA gene pyrosequencing and metagenomics methods., Results: A wide range of microbial communities, including 13 phyla, 23 classes, 37 orders, 134 genera, 266 species and 349 operational taxonomic units (OTUs), were detected. The Shannon index values were significantly higher in the halitosis group. Genera, such as Prevotella, Alloprevotella, Leptotrichia, Peptostreptococcus and Stomatobaculum, exhibited significantly higher relative percentages in halitosis samples, when compared to healthy samples. Peptostreptococcus, Alloprevotella, Eubacterium nodatum and Stomatobaculum exhibited significantly positive correlations with the total number of VSCs. Prevotella, Peptostreptococcus, Eubacterium nodatum and Alloprevotella were correlated with increased H 2 S and CH 3 SH concentration values. Bergeyella was correlated with decreased total VSC, H 2 S and CH 3 SH concentration values., Conclusion: Microbial diversity was higher in the halitosis group than in the control group, and several bacteria were significantly correlated to halitosis. Furthermore, there were correlations between tongue bacterial composition structure and VSC gases. Tongue coating microbiota can offer important clues in the investigation of the pathogenesis and treatment of halitosis.

Rationale: Halitosis is an unpleasant odor that emanates from the mouth. Studies show halitosis returns in a week, after treatment with PDT. Probably, bacteria living in the periodontal sulcus could recolonize the dorsum of the tongue. Until nowadays, there are no study in adult population that associates halitosis and periodontal treatment with follow-up evaluation. The aim of this randomized, controlled, single-blinded clinical trial is to treat oral halitosis in healthy adults with photodynamic therapy (PDT), associated with periodontal treatment and follow them up for 3 months. PATIENT CONCERNS:: the concerns assessments will be done over the study using anamnesis interviews and specific questionnaire. DIAGNOSES:: halitosis will be evaluated by OralChroma., Interventions: The participants (n = 40) with halitosis will be randomized into 2 groups: G1-treatment with PDT (n = 20) or G2-cleaning of the tongue with a tongue scraper (n = 20)., Outcomes: Halitosis will be evaluated by measuring volatile sulfur compounds using gas chromatography. After the treatments, a second evaluation will be performed, along with a microbiological analysis (RT-PCR) for the identification of the bacteria T. denticola. The assessment of halitosis and the microbiological analysis will be repeated. After that, patients will receive periodontal treatment. The participants will return after 1 week and 3 months for an additional evaluation. Quality of life will be measured by Oral Health Impact Profile questionnaire (OHIP-14)., Lessons: This protocol will determine the effectiveness of phototherapy regarding the reduction of halitosis in adults. clinicaltrials.gov NCT03996915., Ethics and Dissemination: This protocol received approval from the Human Research Ethics Committee of Universidade Nove de Julho (certificate number: 3.257.104). The data will be published in a peer-reviewed periodical.

Background: Solobacterium moorei, the only species in the genus Solobacterium, is a Gram-positive, non-spore-forming, strict anaerobic, short to long bacillus. It has rarely been documented to cause blood stream infections. Here we report the first case of bacteremia caused by S.moorei in China., Case Presentation: A 61-year-old male presented to Peking Union Medical College Hospital (Beijing) with thrombotic thrombocytopenic purpura (TTP) and several other underlying diseases. He also had persistent coma accompanied by intermittent convulsions, halitosis, and intermittent fever. Blood cultures taken when the patient had a high fever were positive, with the anaerobic bottle yielding an organism identified as S.moorei by 16S rRNA gene sequencing, whilst the aerobic bottle grew Streptococcus mitis. After replacement of venous pipeline, and empirical use of vancomycin and meropenem, the patient's body temperature and white blood cell count returned to normal. Unfortunately, the patient died of severe TTP., Conclusion: This is the first case report of S. moorei isolation from blood stream in China. 16S rRNA gene sequencing is the only method that can identify S. moorei. Blood cultures must be taken before administration of antibiotics, and anaerobic culture should be considered for such rare pathogens in patients with oral diseases and immune deficiency.

Intra-oral halitosis (IOH) refers to an unpleasant odor from the oral cavity that is mainly caused by the tongue coating. Although the tongue coating microbiome is thought to play an essential role in IOH, the exact aetiology of IOH remains unclear. Here we investigated and compared the metabolic profiles of the tongue coating microbiomes of patients with IOH versus healthy control. The metabolic profiles were significantly different in IOH patients than in healthy controls. Healthy controls showed higher selenoamino acid and nicotinamide metabolism; these metabolic pathways are mainly involved in maintaining the oxidation-reduction potential and redox state. A total of 39 putative metabolites were associated with IOH. Remarkably, 3 of the metabolites, branched-chain fatty acids (BCFA), 3-fumaryl pyruvate, and acetyl phosphate, are potential key players in IOH. Interestingly, the predominant metabolite in IOH is BCFAs, which might underlie tongue coat formation. In addition, the key metabolite acetyl phosphate has a clear association with the hydrogen sulfide- (H 2 S-) producing metabolic pathway and anaerobic fermentation. These novel metabolomic findings provide insights into the formation of the tongue coating and the production of H 2 S, which causes bad breath.

Volatile sulfur compounds (VSCs) such as hydrogen sulfide (H 2 S) and methyl mercaptan (CH 3 SH) are the main components of oral malodor, and are produced as the end products of the proteolytic processes of oral microorganisms. The main pathway of proteolysis is the metabolism of sulfur-containing amino acids by gram-negative anaerobic bacteria. Gram-positive bacteria may promote VSC production by gram-negative anaerobes by cleaving sugar chains from glycoproteins and thus providing proteins. A large variety of bacteria within the oral microbiota are thought to be involved in the complex phenomenon of halitosis. Oral microbiota associated with a lack of oral malodor, oral microbiota associated with severe and H 2 S-dominant oral malodor, and oral microbiota associated with severe and CH 3 SH-dominant oral malodor have been distinguished through molecular approaches using the 16S rRNA gene. Pathological halitosis may primarily be addressed through treatment of causative diseases. In all cases, plaque control is the basis of oral malodor control, and dentifrices, mouthwashes, and functional foods play a supplementary role in addition to brushing. Recently, the use of natural ingredients in products tends to be favored due to the increase in antibiotic-resistant strains and the side effects of some chemical ingredients. In addition, probiotics and vaccines are expected to offer new strategies for improving the oral conditions through mechanisms other than antibacterial agents., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Weissella (W.) cibaria strain Chonnam Medical University (CMU) has shown oral colonizing ability and inhibitory effects on the formation of volatile sulfur compounds (VSCs) in vitro studies. The present study was conducted to analyze the effects of the W. cibaria CMU on canine oral health. Halitosis, calculus, plaque, gingivitis, and intraoral microbiota were assessed in 3 groups: control (maltodextrin), W. cibaria CMU low concentration (CMU-L, 2 × 10 7 colony forming unit [CFU]), and high-concentration (CMU-H, 2 × 10 9 CFU). Halitosis was analyzed using both organoleptic evaluation and measurement of VSCs. Intraoral microbiota were analyzed by real-time polymerase chain reaction. From week 4, the total VSC level in the CMU-H group (4.0 ± 1.30 ng/10 mL) was significantly lower than in the control group (6.3 ± 2.28 ng/10 mL). Significant reduction in methyl mercaptan in the CMU-treated groups was also observed. In addition, the plaque index in the CMU-treated groups was significantly decreased. The CMU-treated groups showed significant decreases in Fusobacterium nucleatum , Porphyromonas gingivalis , Prevotella intermedia , and Tannerella forsythia and demonstrated the colonizing ability of W. cibaria CMU in the oral cavity. We demonstrated that W. cibaria CMU suppresses halitosis, colonizes the oral cavity, and inhibits the proliferation of malodor-causing oral bacteria in beagles. According to these results, we expect that W. cibaria CMU could be a new oral hygiene solution by reducing VSC production and inhibiting the growth of oral harmful bacteria in companion animals.

Orthodontic braces can impede oral hygiene and promote halitosis. The aim of the study was to investigate the effect of the oral probiotic Streptococcus salivarius M18 on oral hygiene indices and halitosis in patients wearing orthodontic braces. The study was a prospective, randomized, triple-blind, placebo-controlled trial. Patients undergoing fixed orthodontic treatment were randomly allocated to a probiotic group (n = 32) and a placebo group (n = 32). Patients consumed 2 lozenges d -1 for one month. Assessments were taken at baseline, at the end of the intervention, and at a 3 month follow-up. The outcome measures were plaque index (PI), gingival index (GI) and halitosis-causing volatile sulfur compound (VSC) levels. The dental biofilms before and after the intervention were analyzed utilizing next-generation sequencing of bacterial 16S rRNA genes. PI and GI scores were not significantly influenced by the probiotic intervention (intervention × time: p > 0.05). The level of VSCs decreased significantly in both the probiotic group (VSC reduction = -8.5%, 95%CI = -7.4% to -9.1%, p = 0.015) and the placebo group (-6.5%, 95%CI = -6.0% to -7.4%, p = 0.039) after 1 month intervention. However, at the 3 month follow-up, the VSC levels in the placebo group returned to baseline levels whereas those in the probiotic group decreased further (-10.8%, 95%CI = -10.5% to -12.9%, p = 0.005). Time, but not treatment, was associated with the decrease in microbial community alpha diversity and a modest effect on beta diversity. Oral probiotic S. salivarius M18 reduced the level of halitosis in patients with orthodontic braces, but had minimal effects on PI, GI and dental biofilm microflora.

The present study involved a qualitative and quantitative evaluation of tongue dorsum biofilms sampled from halitosis patients and healthy volunteers. The aim of the study was to quantify the distribution of Streptococcus spp. and Fusobacterium nucleatum within the oral halitosis biofilm in order to highlight the role of these bacterial members in halitosis. Tongue plaque samples from four halitosis-diagnosed patients and four healthy volunteers were analyzed and compared. The visualization and quantification of the tongue dorsum biofilm was performed combining fluorescence in situ hybridization (FISH) and confocal laser scanning microscopy (CLSM). Eubacteria, Streptococcus spp. and Fusobacterium nucleatum were stained using specific fluorescent probes. For a comparison of the two tested biofilm groups the Wilcoxon rank-sum test was used. Morphological analysis by CLSM illustrated the distribution of the species which were tracked. Streptococcus spp. appeared to be enclosed within the samples and always associated to F. nucleatum. Furthermore, compared to the control group the biofilm within the halitosis group contained significantly higher proportions of F. nucleatum and Streptococcus spp., as revealed by the FISH and CLSM-analysis. The total microbial load and relative proportions of F. nucleatum and Streptococcus spp. can be considered as causative factors of halitosis and thus, as potential treatment targets.

Pathologic halitosis has been classified into 5 types: oral, airway, gastroesophageal, blood-borne and subjective, respectively. Type 1 (oral) halitosis mostly takes origin from anaerobic bacterial activities on oral surfaces. The role of anaerobic bacterial activities is clearly demonstrated, but despite the large number of anectodal claims, the role of Candida in patients with halitosis has not been adequately investigated. The aim of this study was to confirm the relationship between Candida and halitosis. A total of 136 subjects were enrolled and divided into two groups. The study group comprised of 69 patients with halitosis who had over 0.7 ppm H2S concentration in their oral cavity and the control group comprised of 67 healthly subjects. Self assesment scores for halitosis, Candida colony counts in saliva samples, oral NH3, SO2, H2S, H2 and volatile organic gas concentrations were recorded. H2S producing capacity of subjects was quantified by applying cysteine challenge test. Candida samples were taken from the mouths of the patients with and without halitosis, and Candida albicans isolates were inoculated into broth medium. After 3 days of incubation at 37oC, gas concentrations of the headspace of the flasks were read by a portable multigas detector. The rate of Candida positivity was 44.9% in the study group while it was 46.3% in the control group. There was no statistical significant difference between the groups according to the Candida growth (p= 0.561). The oral gas concentrations were comparable in both groups (p< 0.05). Oral H2S concentration increased 9.65 fold with 20 mM cysteine rinse in patients with halitosis while it was increased 5.8 fold in controls. Self assesment for halitosis were well correlated with clinical signs (p= 0.001, r= 0.8). Concentrations of hidrogen and organic gases were found to be increased in all Candida culture media. In this study, no relationship between the presence of Candida and oral halitosis was detected. As a result, there is no need for diets similar to Candida diet in the treatment of halitosis. On the other hand, cysteine challenge can be a useful diagnostic tool. In addition, portable gas detectors can be used as a convenient and practical halitometer to quantify halitosis.

Fusobacterium nucleatum is a morbific agent in periodontitis and halitosis. Egg yolk antibody (IgY) was obtained from egg yolks from chickens stimulated with F. nucleatum . This study was to assess the effectiveness of IgY on periodontitis and halitosis caused by F. nucleatum in vitro and in vivo. The growth of F. nucleatum was inhibited ( p <0. 05) by different concentrations of IgY in vitro and the results of a Halimeter show volatile sulfur compounds (VSCs) were reduced to 904 ± 57 ppb at a concentration 40 mg/ml of IgY. The changes of fatty acids of F. nucleatum were determined using GC-MS. The scores for odor index of rat saliva were decreased. The major constituent of volatile organic compounds (VOCs) including short-chain acids decreased 46.2% in 10 mg/ml IgY, ammonia decreased 70% in 40 mg/ml IgY, while aldehydes and olefine ketones were almost unchanged. The ELISA assay revealed that IL-6 and TNF-α were decreased after 4 weeks' IgY treatment. Morphometric (X-ray) and histological analyses (HE) showed that IgY reduced alveolar bone loss and collagen fibers became orderly in rat models. As a result, IgY may have the potential to treat periodontitis and halitosis.

Background: Quinoa is a food crop native to the Andes. The process of dehulling quinoa can produce approximately 8-12% husk, which is often discarded because it contains bitter saponin. Saponin derived from quinoa has been reported to exhibit anti-inflammatory and antifungal activity. However, the antibacterial effects of quinoa saponin against halitosis-related bacteria are still unclear., Methods: In this study, quinoa saponin (QS) and alkali-transformed saponin (ATS) were separated by AB-2 resin to obtain QS-30, QS-80, ATS-30 and ATS-80. Halitosis-related bacteria included Porphyromonas gingivalis (P. gingivalis), Clostridium perfringens (C. perfringens) and Fusobacterium nucleatum (F. nucleatum). The MIC and MBC were determined using gradient dilutions in 96-well plates, and the saponins were identified by HPLC and mass spectrometry. The changes in membrane integrity were tested using a microplate reader, the membrane potential was tested by spectrofluorometry, and the morphological characteristics were examined using a transmission electron microscope to explore the antibacterial mechanisms., Results: Antibacterial assays indicated that QS-80 and ATS-80 showed inhibitory activity. In addition, ATS-80 exerted a stronger inhibitory effect than QS-80, especially against Fusobacterium nucleatum, with a lower minimum inhibitory concentration (31.3 μg/mL) and a lower minimum bactericidal concentration (125 μg/mL). ATS-80 destroyed the bacterial membrane structure, leading to bacterial death., Conclusions: Based on the excellent antibacterial activity and economic prospects of quinoa husk, ATS-80 could be used as an antibacterial agent to treat halitosis.

Introduction: Halitosis is a common complaint among people which has various socioeconomic effects. The prevalence of halitosis includes a variety of 22% up to 50% in different societies. According to studies, there have been reports of remarkable improvements in halitosis after Helicobacter pylori eradication treatment. In studies on the relationship between H. Pylori and halitosis, the role of oral factors as the most important cause of halitosis has been neglected. This study was conducted with the aim of investigating the effect of oral factors on halitosis in patients with H. Pylori., Materials and Methods: A total of 100 dyspeptic patients who had H. pylori-positive serologic test were examined by an organoleptic method for the presence of halitosis. DMFT index was used in order to record the dental status. Oral hygiene was evaluated using the simplified oral hygiene index (OHI-S)., Results: The mean DMFT index was 9.09 ± 3.97. The score of simplified oral hygiene index was 1.79 ± 0.949. There was a direct and significant relationship between halitosis with DMFT, OHI-S (P < 0.01). There was no significant relationship between halitosis and coated tongue (P > 0.01)., Conclusions: According to the results of this study, there is a relation between oral factors and halitosis in patients with positive H. pylori test. Due to the lower level of all these indices in patients with halitosis, we cannot attribute halitosis in patients with H. pylori infection to the presence of this microorganism with certainty., (© 2018 John Wiley & Sons Ltd.)

Objective: To evaluate the combined use of Lactobacillus salivarius WB21 and (-)-epigallocatechin gallate (EGCg) for oral health maintenance., Design: The effects of L. salivarius WB21 on growth of Streptococcus mutans, the insoluble glucan produced by S. mutans, and on growth of Porphyromonas gingivalis were evaluated in vitro. In addition, the susceptibility of five oral pathogenic bacteria and L. salivarius WB21 to EGCg, the inhibiting effect of EGCg on methyl mercaptan, and the effects of L. salivarius WB21 and EGCg in combination on growth of P. gingivalis were examined., Results: Lactobacillus salivarius WB21 showed concentration-dependent inhibition of the growth of S. mutans. Addition of L. salivarius WB21 inhibited production of the insoluble glucan by S. mutans (p < 0.001). A filtrate of L. salivarius WB21 culture solution inhibited growth of P. gingivalis (p < 0.001 vs. control), and this effect was enhanced when it was used in combination with EGCg (p < 0.001 vs. the addition of L. salivarius WB21). In addition, EGCg directly inhibited methyl mercaptan in a concentration-dependent manner (p < 0.001). Concerning bacterial susceptibility to EGCg, growth of P. gingivalis, Prevotella intermedia, and Fusobacterium nucleatum was inhibited at 2.5 mg/mL of EGCg, while that of L. salivarius WB21 was inhibited at 25 mg/mL EGCg., Conclusions: Our results imply that L. salivarius WB21 may be useful for controlling dental caries, periodontitis, and oral malodor. In addition, the effects of L. salivarius WB21 on periodontitis and oral malodor may be synergistically enhanced by use in combination with EGCg., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Introduction: Halitosis is the term used to describe any unpleasant odor relative to expired air regardless of its source. The prevalence of halitosis in the population is approximately 30%, of which 80 to 90% of the cases originate in the oral cavity resulting from proteolytic degradation by gram negative anaerobic bacteria. Antimicrobial photodynamic therapy (aPDT) has been widely used with very satisfactory results in the health sciences. It involves the use of a non-toxic dye, called photosensitizer (FS), and a light source of a specific wavelength in the presence of the environmental oxygen. This interaction is capable of creating toxic species that generate cell death. The objective of this controlled clinical study is to verify the effect of aPDT in the treatment of halitosis by evaluating the formation of volatile sulphur compounds with gas chromatography and microbiological analysis before and after treatment., Materials and Methods: Young adults in the age group between 18 and 25 years with diagnosis of halitosis will be included in this research. The selected subjects will be divided into 3 groups: G1: aPDT; G2: scraper, and G3: aPDT and scraper. All subjects will be submitted to microbiological analysis and evaluation with Oral ChromaTM before, immediately after treatment, 7, 14, and 30 days after treatment. For the evaluation of the association of the categorical variables the Chi-square test and Fisher's Exact Test will be used. To compare the means the student t test and analysis of variance (ANOVA) will be used and to analyse the correlation between the continuous variables the correlation test by Pearson will be applied. In the analyses of the experimental differences in each group the Wilcoxon test will be used. For all analyses a level of significance of 95% (P < .05) will be considered., Discussion: Halitosis treatment is a topic that still needs attention. The results of this trial could support decision-making by clinicians regarding aPDT using aPDT for treating halitosis.

Background: Halitosis is an unpleasant breath odour that can interfere with the professional life, social life and quality of life of people who suffer from it. A modality of treatment that has been increasing in dentistry is antimicrobial photodynamic therapy (aPDT). Bixa orellana, popularly known as "urucum" is a plant native to Brazil. The seeds are used to produce a dye that is largely used in the food, textile, paint and cosmetic industries. The aim of this study is to verify whether aPDT with Bixa orellana extract and blue light-emitting diodes (LEDs) is effective in reducing halitosis. This method will also be compared with tongue scraping, the most commonly used conventional method for tongue coating removal, and the association of both methods will be evaluated., Methods/design: A randomized clinical trial will be conducted at the dental clinic of the Universidade Nove de Julho. Thirty-nine patients will be divided by block randomization into three groups (n = 13) according to the treatment to be performed. In Group 1, tongue scraping will be performed by the same operator in all patients for analysis of the immediate results. Patients will also be instructed on how to use the scraper at home. Group 2 will be treated with aPDT with Bixa orellana extract and the LED light curing device: Valo Cordless Ultradent®. Six points in the tongue dorsum with a distance of 1 cm between them will be irradiated. The apparatus will be pre-calibrated at wavelength 395-480 nm for 20 s and 9.6 J per point. In Group 3, patients will be submitted to the tongue scraping procedure, as well as to the previously explained aPDT. Oral air collection with the Oral Chroma™ and microbiological collections of the tongue coating shall be done before, immediately after and 7 days after treatment for comparison., Discussion: Halitosis treatment is a topic that still needs attention. The results of this trial could support decision-making by clinicians regarding aPDT using blue LEDs for treating halitosis on a daily basis, as most dentists already have this light source in their offices., Trial Registration: ClinicalTrials.gov, NCT03346460 . Registered on 17 November 2017.