Relationship between tonsil odor and oral malodor: a clinical study on 48 Iranian patients

The objective of this study is to evaluate tonsil odor as a contributor to halitosis and to study the reduction of oral malodor by mouth rinsing, without tonsil treatment. In 48 halitosis patients, tonsil odor and oral malodor were assessed through the 0-5 scale. In tonsil odor assessment, a dental burnisher was inserted into the tonsilar crypts and was sniffed by an odor judge. Oral malodor was analyzed through a plastic straw using the same scale by the same judge. The concentrations of H(2)S, CH(3)SH and (CH(3))(2)S were measured by a portable gas chromatograph (GC) (OralChroma) in ppb. After the baseline evaluations the subjects were instructed to scrape the surface of the tongue daily and rinse with a zinc-containing mouthwash twice daily for 1 month. After this period the same evaluations were repeated. Data were analyzed by SPSS software, paired t-test and Pearson correlation. Before mouthwash test: mean values of oral malodor scores and tonsil odor scores were 4.2 and 3.7, respectively. Pearson correlation analysis showed that oral malodor scores and tonsil odor scores had a significant correlation (p = 0.025). Oral malodor scores were correlated with the concentrations of H(2)S (p = 0.0001), CH(3)SH (p = 0.041) but not with (CH(3))(2)S concentration. After mouthwash test: mean values of oral malodor scores and tonsil odor scores were 2.2 and 3.0, respectively. Tonsil odor scores and oral malodor scores were not correlated. Also the paired t-test results showed that the effect of the mouthwash on the reduction of oral malodor and tonsil odor was not the same. Since oral malodor was successfully reduced while tonsil odor remained with a little reduction, it is concluded that tonsilar treatment such as tonsillectomy and laser cryptolysis might be considered only after the failure of mechanochemical therapy.