MASLD can cause halitosis by small intestinal bacterial overgrowth

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Xiao Xian Qian1,2

  • 1Department of Gastroenterology and Halitosis Clinic, Minhang Hospital, Fudan University, Shanghai, China.

Oral Diseases
|May 20, 2024
PubMed
Abstract

Insights

Metabolic dysfunction-associated steatotic liver disease (MASLD) can cause bad breath through small intestinal bacterial overgrowth (SIBO). This study found SIBO significantly increases halitosis severity and exhaled dimethyl sulfide in MASLD patients.

Area of Science:

  • Gastroenterology
  • Hepatology
  • Metabolic Disorders

Background:

  • Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly prevalent.
  • Patients with MASLD often experience halitosis, suggesting an extra-oral cause.
  • Small intestinal bacterial overgrowth (SIBO) is a potential contributor to MASLD and halitosis.

Purpose of the Study:

  • To investigate the hypothesis that SIBO contributes to MASLD and subsequent extra-oral halitosis.
  • To assess the prevalence of SIBO in patients with MASLD and halitosis.
  • To quantify the impact of SIBO on halitosis severity and specific biomarkers.

Main Methods:

  • Retrospective cross-sectional study of 885 patients with extra-oral halitosis.
  • Diagnosis of MASLD using Fibroscan and cardiometabolic criteria.
  • Diagnosis of SIBO via hydrogen breath test.
  • Measurement of halitosis using organoleptic score (OLS) and exhaled dimethyl sulfide (DMS) via OralChroma.

Main Results:

  • 15.05% of halitosis patients had MASLD; 65.41% of these MASLD patients were SIBO-positive.
  • SIBO-positive patients exhibited significantly higher OLS (4 vs 2) and exhaled DMS levels (56 vs 43 ppb) compared to SIBO-negative patients (p < 0.001).
  • Exhaled hydrogen levels strongly correlated with OLS and DMS levels (r=0.774, r=0.740; p < 0.001).

Conclusions:

  • Small intestinal bacterial overgrowth (SIBO) is a significant factor in halitosis development among patients with MASLD.
  • SIBO exacerbates halitosis severity and elevates exhaled dimethyl sulfide levels in MASLD patients.
  • Targeting SIBO may be a therapeutic strategy for managing halitosis in MASLD.
Keywords:
dimethyl sulfideextra‐oral halitosishydrogen breath testmetabolic dysfunction‐associated steatotic liver diseasesmall intestinal bacterial overgrowth

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