Clinical evaluation of 222 Iranian patients with halitosis

The primary objectives of the study were to investigate the levels of volatile sulfur compounds (VSCs) in Iranian patients and to find the most prevalent class of halitosis among them. The secondary objective was to study the measures employed by the patients to reduce halitosis. 46.4% of the 222 patients were female (average 32.1 years) and 53.6% were male (average 32.1 years). Contrary to other reports, males were dominant in this study. All the subjects were evaluated through oral examination, gas chromatographic analysis, organoleptic assessment and mouth cleaning and rinsing test (MCART). Finally, each patient was classified according to current classification. The patients were also asked about the measures employed by them to reduce halitosis. The data were statistically analysed using SPSS software. Gas chromatographic analysis revealed that the median values for H(2)S, CH(3)SH and (CH(3))(2)S levels were 214 ppb, 64 ppb and 2 ppb, respectively. Average values of H(2)S, CH(3)SH and (CH(3))(2)S were 358.7 ppb, 143.0 ppb and 19.5 ppb, respectively. A correlation was demonstrated between organoleptic scores and the concentration of only H(2)S, CH(3)SH and the total of three gases. In 62.2% of the subjects, no oral pathologic condition was found, but tongue coating was observed. The patients were in only class I (genuine halitosis) and class II (pseudo-halitosis) halitosis. None of them was diagnosed as halitophobia. The percentages of classes I and II were 98.6% and 1.4%, respectively. The percentages of sub-classes of class I halitosis in total subjects were as follows: 60.8% physiologic halitosis, 37.8% oral pathologic halitosis and 0% extraoral pathologic halitosis. The mean value of organoleptic score for physiologic halitosis was 4.0 and those for oral pathologic halitosis and pseudo-halitosis were 4.3 and 1.6, respectively. MCART was a useful tool to distinguish oral halitosis from extraoral halitosis. Levels of VSCs were not as high as those measured in other countries. Although in most cases VSCs were a contributing factor to halitosis, VSCs levels were not useful diagnostic criteria for the minority of the patients. The most prevalent class and sub-class of halitosis in the patients were genuine halitosis and physiologic halitosis. Measures employed by the patients to reduce halitosis were mostly related to the oral cavity.