Hematological biomarkers of systemic inflammation in genuine (physiologic and pathologic) halitosis

Halitosis is an unpleasant odor discharged through the oral cavity with a prevalence as high as 30%-50% of the general population. Conventional diagnostic methods have been focused on mouth air analysis measuring the amount of sulfur compounds which does not directly reflect the cause of halitosis. Also, the possible role of halitosis as an indicator of general health status has been steadily suggested and inflammation has been constantly associated with aversive body odor. Therefore, this study aimed to search for inter-relationships between hematologic indicators, clinical characteristics, and halitosis measurement that can predict the presence of pathologic halitosis and its intensity. Furthermore, the tentative relationship between halitosis and the presence of systemic inflammation was investigated. A total of 125 patients were divided into 103 patients in the genuine halitosis group (value ⩾80 ppb) and 22 patients in the pseudo halitosis group (value <80 ppb) based on portable sulfide monitor measurements. Clinical examination and hematological indices including inflammatory prognostic factors and halitosis measurements including organoleptic testing, portable sulfide monitor, and gas chromatography were evaluated. The genuine halitosis group showed a significantly higher white blood cell (WBC) count (p< 0.01) compared to the pseudo halitosis group. Erythrocyte sedimentation rate (ESR,β= 0.341,p< 0.05) values and duration of halitosis (β= 0.353,p< 0.05) showed a significant association with halitosis intensity and neutrophil to lymphocyte ratio (NLR) values (β= 3.859,p< 0.05) were significantly related to genuine halitosis diagnosis. A new WBC cut-off value of 5575μl^-1showed near to fair discriminative power in predicting genuine halitosis (area under the curve 0.661,p< 0.05). The results of this study showing an increased WBC count in genuine halitosis and its strong association with hematologic indices of subclinical inflammation including ESR and NLR suggest inflammatory hematologic markers as potential diagnostic tools in the diagnosis of genuine halitosis.