JICDRO is a UGC approved journal (Journal no. 63927)

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ORIGINAL RESEARCH
Year : 2014  |  Volume : 6  |  Issue : 2  |  Page : 103-106

The association of periodontal disease with oral malodor before and after antibiotic rinse using FITSCAN® breath checker: A clinical study


Department of Periodontology and Oral Implantology, Dasmesh Institute of Research and Dental Sciences, Faridkot, Punjab, India

Date of Web Publication28-Oct-2014

Correspondence Address:
M P Singh
Department of Periodontology and Oral Implantology, Dasmesh Institute of Research and Dental Sciences, Faridkot - 151203, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2231-0754.143493

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   Abstract 

Context: The term "oral malodor" is used to describe a foul or offensive odor emanating from oral cavity. Dentist is the first professional whom individuals turn up for help. Gram-negative anerobic pathogens implicated in periodontal disease have also been linked to oral malodor. A semi-conductor, hand-held gas sensor with 6 levels of display, brand name FITSCAN® Breath Checker (Tanita Corporation, USA) used to detect oral malodor. Antibiotics are now being tried and used to treat oral malodor and periodontal disease. Aims: To evaluate the association between malodor and periodontal status of patients before and after antibiotic rinse. Materials and Methods: Systemically healthy subjects were divided into three groups - control group, gingivitis group, periodontitis group. Measurement of oral malodor was done by FITSCAN® Breath Checker. Antibiotic rinse preparation containing metronidazole was given to patients. An association between oral malodor and periodontal disease status of patients was determined. Statistical analysis used: For intragroup analysis paired "t" test and for intergroup analysis of halitosis and gingival index "Kruskal-Wallis test" and "Mann-Whitney U test" were applied. Results: Intragroup - Statistical significant decrease in halitosis, Gingival Index (GI) at baseline and 14 days in persons with gingivitis and periodontitis group, no statistical significant decrease in pocket depth before and after antibiotic rinse. Intergroup - Statistical significant decrease in Gingival Index status at baseline and 14 days in both gingivitis andperiodontitisgroups. Conclusion: Strong correlation exists between malodor and periodontal status and antibiotic rinse is effective in reducing oral malodor.

Keywords: Metronidazole, oral malodor, periodontitis


How to cite this article:
Singh M P, Bansal P, Kaur S. The association of periodontal disease with oral malodor before and after antibiotic rinse using FITSCAN® breath checker: A clinical study . J Int Clin Dent Res Organ 2014;6:103-6

How to cite this URL:
Singh M P, Bansal P, Kaur S. The association of periodontal disease with oral malodor before and after antibiotic rinse using FITSCAN® breath checker: A clinical study . J Int Clin Dent Res Organ [serial online] 2014 [cited 2019 Oct 22];6:103-6. Available from: http://www.jicdro.org/text.asp?2014/6/2/103/143493


   Introduction Top


The term "oral malodor" is used to describe a foul or offensive odor emanating from oral cavity. Oral malodor, like periodontal disease, has been linked to the Gram-negative anerobic pathogens that are implicated in periodontal disease, including Porphyromonas gingivalis, Prevotella intermedia, and Fusobacterium nucleatum. These bacteria are capable of producing substantial levels of volatile sulfur compounds (VSCs). [1],[2] These compounds are produced by putrefaction of glycoprotein's and proteins by micro-organisms in the oral cavity, including the gingival sulcus, periodontal pockets, tongue dorsal surfaces, and other mucous surfaces. [3] VSCs are able to alter the permeability of gingival tissues, inducing an inflammatory response. [4] In addition, VSCs can penetrate deeply into other tissues and damage the epithelium, basement membrane, and underlying lamina propria. [5]

Decreasing concentrations of VSCs may be a significant adjunct to periodontal therapy and in the prevention of periodontal disease.

The aim of this study was to demonstrate the association between malodor and periodontal status of patients before and after use of antibiotic rinse.


   Materials and methods Top


The study comprised 30 subjects recruited from Department of Periodontology and Oral Implantology, Dasmesh Institute of Research and Dental Sciences, Faridkot, Punjab. The patients with age 30 years or more, with minimum of 20 teeth present, and patients without any systemic disorder like diabetes, hypertension, blood disorders were included in the study.

While pregnant females, nursing mothers, and smokers were excluded from the study.

Patients were equally divided into three groups of 10 patients each were made where Group 1 Control group, Group 2 Gingivitis group and Group 3 Periodontitis group (Pocket depth 5 mm or more). Subjects were screened for periodontal status by a single examiner on a dental chair and observations were recorded on a printed proforma. Among clinical parameters gingival index (Loe&Sillness, 1963) and periodontal pocket depth using University of North Carolina (UNC)-15 probe were measured at baseline (day 0) and after 14 days.

Oral malodor score was measured at baseline (day 0) using FITSCAN® Breath Checker [Figure 1], which is an innovative palm-size monitor that detects and measures the presence of breath odors (VSCs). On turning it on, start is displayed and patient has to breathe into the sensor until it beeps (breath for about 4 seconds). The opening has to be 1 cm away from mouth keeping the thumb on to the chin so that the sensor is right in front of the mouth and a reading appears on the digital display. It measures odor in seconds and results are displayed in six levels similar to organoleptic method. A 0 reading means no odor, 1 is slight odor, 2 is moderate odor, 3 is heavy odor, 4 is strong odor, 5 is intense odor, and E is error sign which means to try again.

Patients with oral malodor score were given metronidazole antibiotic mouth rinse. No placebo was given. Metronidazole rinse was available under the trade name of Flagyl syrup in market and the rinse was diluted to the concentration of 4% with the help of pharmaceutics and patients were instructed to use the rinse thrice daily for 14 days. Verbal instructions were given to the patients about the use of oral rinse and oral hygiene maintenance. No phase I therapy was done to any subject. Patients were recalled after 14 days.
Figure 1: FITSCAN® Breath Checker

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Data analysis was conducted and "paired t-test" was used to assess the relationship between halitosis and gingival index in both the groups. The Kruskal-Wallis test was applied to compare halitosis at baseline and 14 days in three groups and the Mann-Whitney test was applied to compare gingivitis at baseline and 14 days in three groups.


   Results Top


The clinical results were encouraging, and patients provided positive feedback on the use of this antibiotic rinse for reduction of oral malodor. Patients also reported decrease in gingival bleeding. Differences in baseline and post-treatment measurements of breath odor were compared using a paired t test, and all reductions were significant (P < 0.0001) [Graph 1] [Additional file 1] and [Graph 3] [Additional file 2]). There was significant correlation between halitosis and gingival status of the patients in group B and C [Graph 2] [Additional file 3] and [Graph 4] [Additional file 4] but there was no statistical significance between pocket depth before and after antibiotic rinse in group C (P < 0.0001; Graph 5). [Additional file 5] On intergroup comparison, statistical significant values were found on comparing halitosis and gingival index in all three groups at baseline and 14 days interval showing positive correlation between halitosis and periodontal health of the patients.


   Discussion Top


The treatment with the antibiotic rinse had a positive change in the periodontal status of these patients, and resulted in substantial reduction in bleeding points but without much change in periodontal pocket depth. There was significant decrease in breath odor after use of an antibiotic rinse. Although scaling and root planning are considered the gold standard in the treatment of periodontal disease and have been used to decrease breath odor, recolonization of pathogens - along with the recurrence of the disease and breathodor - is common after scaling. [6] The adjunctive use of antimicrobial therapy along with scaling and root planning proves to be beneficial and should be incorporated as a part of conventional therapy only. Antibiotics can be administered either by systemic route or locally. [7] Since micro-organisms vary considerably in sensitivity to antibiotics, choosing the appropriate antimicrobial chemotherapy is essential for success of the treatment. Most successful treatments address both the bacterial and inflammatory component of the condition. [8] It has been found out that metronidazole is effective in treating periodontal infections. The low minimum inhibitory concentration of metronidazole made it a useful chemotherapeutic agent for treating anaerobic infections. [7] Various other studies have shown improvement in clinical outcomes with the systemic use of metronidazole/ amoxicillin, together with full mouth periodontal debridement. [9],[10] Systemic administration of antimicrobial provides availability of drug to multiple sites of disease activity. However, topical application of antibiotic, will coat all oral tissues, as well as the tonsillar areas, achieving an overall decrease in halitosis and periodontal disease markers without the risk of the systemic effects of an oral antibiotic. [7] Better results are achieved because of venturi effect when vigorous rinsing is done in which particles enter the gingival sulcus and float over a pocket, the crevicular fluid drops, pulling the particle deeper into the pocket. The concentrated antibiotic particles can then act on the biofilm found at the base of these pockets. [7]


   Conclusion Top


This study of cases shows that there is strong correlation between oral malodor and periodontal health status of patients. As there is increase in number of pathogenic microorganisms in periodontal disease, it results in increased oral malodor. Also, with the use of oral metronidazole antibiotic rinse it has been found that there is potential of using antibioticrinses to treat periodontal disease andoral malodor caused by oral pathogens.

Clinical implications

FITSCAN® Breath Checker is an innovative portable device which can be used to detect oral malodor in patients. Also, this study shows that there is strong correlation between oral malodor and periodontal disease status and antibiotic mouth rinses can be effectively used to treat oral malodor and periodontal disease.

 
   References Top

1.
McNamara TF, Alexander JF, Lee M. The role of microorganisms in the production of oral malodor. Oral Surg Oral Med Oral Pathol 1972;34:41-8.  Back to cited text no. 1
[PUBMED]    
2.
Hartley G, McKenzie C, Greenman J, El-Maaytah MA, Scully C, Porter S. Tongue microbiota and malodour: Effects of metronidazole mouthrinse on tongue microbiota and breath ordour. Microb Ecol Health Dis 1999;11:226-33.  Back to cited text no. 2
    
3.
Takeuchi H, Machigashira M, Yamashita D, Kozono S, Nakajima Y, Miyamoto M, et al. The association of periodontal disease with oral malodour in a Japanese population. Oral Dis 2010;16:702-6.  Back to cited text no. 3
    
4.
Offenbacker S. Periodontal disease: Pathogenesis. Ann Periodontol 1996;1:821-78.  Back to cited text no. 4
    
5.
Johnson PW, Ng W, Tonzetich J. Modulation of human gingival fibroblast metabolism by methyl mercaptan. J Periodont Res 1992;27:476-83.  Back to cited text no. 5
    
6.
Hanes PJ, Purvis JP. Local anti-infective therapy: Pharmacological agents. A systematic review. Ann Periodontol 2003;8:79-98.  Back to cited text no. 6
    
7.
Southward K, Bosy A. Treatment of oral malodor and periodontal disease using an antibiotic rinse. Gen Dent 2013;61:41-5.  Back to cited text no. 7
    
8.
Berezow AB, Darveau RP. Microbial shift and periodontitis. Periodontol 2000 2001;55:36-47.  Back to cited text no. 8
    
9.
Cionca N, Giannopoulou C, Ugolotti G, Mombelli A. Amoxicillin and metronidazole as an adjunct to full mouth scaling and root planing of chronic periodontitis. J Periodontol 2009;80:364-71.  Back to cited text no. 9
    
10.
Krayer JW, Leite RS, Kirkwood KL. Non-surgical chemotherapeutictreatment strategies for the management of periodontal disease. Dent Clin North Am 2010;54:13-33.  Back to cited text no. 10
    


    Figures

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