Clinical Characteristics of Patients with Halitosis
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1 28 2 ( ) J Korean Oriental Med 2007;28(2):13-21 원저 김진성 류봉하 Clinical Characteristics of Patients with Halitosis Jin-sung Kim Bong-ha Ryu 3rd Department of Internal Medicine Hospital of Oriental Medicine College of Oriental Medicine Kyunghee University Objective : Halitosis or bad breath is a common concern for many people The aim of this study was to investigate clinical characteristics of halitosis patients and correlation with their various associated elements Methods : We surveyed 169 halitosis patients by reviewing questionnaires from the Halitosis Clinic in the Hospital of Oriental Medicine Kyunghee University from January 2004 to March 2006 The questionnaires contained various items including sex age history of smoking and alcohol intake duration of symptoms in a week time and condition of severe halitosis suggestive origin of halitosis taste abnormality oral hygiene self-assessed halitosis severity dry mouth postnasal drip tonsillolith globus pharyngeus reflux sensation too much gas and Winkel tongue coating index Volatile sulfur compounds were measured with a Results : The halitosis patients actively carried out management methods such as non-smoking moderation in drink teeth brushing and tongue scraping in order to decrease their oral malodor Tongue coating significantly affected the reading score and tongue coating and dry mouth significantly affected self-assessed halitosis severity Conclusions : Our results suggest that tongue coating and dry mouth should be treated to improve satisfaction in halitosis patients Key Words : halitosis tongue coating dry mouth 서론 ) ( 1) : 3 (Tel : Fax : oridoc@cholcom) 5-7) 2-4) 8-9) 13
2 (274) 28 2 ( ) 4) WTC INDEX = A+B+C+D+E+F o=no coating (Volatile 1=light coating 2=heavy coating sulfur compounds; VSCs) 10) Fig (Winkel tongue coating Index ) 대상및방법 ( ) Winkel tongue coating index(wtci) 12) (Figure 1) 1 연구대상 Visual analogue scale(vas) 2 연구방법 1) 11) 169 2) (Model No RH-17 Interscan Co USA) (Instruction Manual for ) (bias) 3 ±10 ppb 14
3 1 : (275) 1 3) % 1 3 WTCI p 005 SPSS 120 for Windows 결과 1 인구사회적특성 1) (432%) (213%) (200%) (Table 1) 2) (18%) 61 (82%) 95 1 (1%) 94 (99%) (Table 1) 3) (91%) (97%) Table 1 Variables Male (n=74) Female (n=95) Total (n=169) Age (years) Mean 18 (24) 29 (39) 16 (22) 7 (10) 3 (4) (7) 18 (20) 44 (46) 17 (18) 5 (5) 4 (4) (5) 36 (21) 73 (43) 33 (20) 12 (7) 7 (4) 357 Smoking yes no 13 (18) 61 (82) 94 (99) 14 (8) 155 (92) Alcohol (No of drinking in a week) 5 times 2-4 times 1 time never 6 (8) 45 (61) 22 (30) 27 (29) 65 (68) 4 (2) 6 (4) 72 (43) 87 (51) 15
4 (276) 28 2 ( ) (Table 1) 2 구취환자의생활특성 1) (92%) 2) (6%) 4 (2%) (Table 2) 31 (42%) 52 (55%) Table 2 Duration of Symptom in a week 1 day 2-3 days 4-7 days Time of severe halitosis after rising before noon after noon before sleep always unknown Condition of severe halitosis fasting postprandial with oral dryness with stress always unknown Suggestive origin of halitosis tongue gum teeth saliva throat in nose G-I tract exhaled breath unknown Taste abnormality yes no No of brushing teeth in a day 1 time 2 times 3 times irregular No of brushing tongue in a day everytime when brushing teeth once a day sometimes never Variables Male (n=74) Female (n=95) Total (n=169) 2 (3) 3 (4) 69 (93) 31 (42) 11 (15) 2 (3) 11 (15) 19 (25) 14 (19) 5 (7) 17 (23) 11 (15) 8 (11) 19 (25) 13 (18) 4 (5) 13 (18) 5 (7) 3 (4) 6 (8) 30 (40) 24 (32) 50 (68) 20 (27) 54 (73) 59 (80) 8 (11) 4 (5) 3 (4) 2 (2) 6 (6) 87 (92) 52 (55) 10 (11) 8 (8) 22 (23) 25 (26) 14 (15) 13 (14) 15 (16) 9 (9) 19 (20) 17 (18) 6 (6) 16 (17) 7 (7) 15 (16) 27 (29) 44 (46) 51 (54) 17 (18) 75 (79) 73 (77) 9 (9) 13 (14) 4 (2) 9 (6) 156 (92) 83 (49) 3 (2) 21 (13) 2 (1) 19 (11) 41 (24) 39 (23) 19 (11) 30 (18) 26 (15) 17 (10) 38 (23) 30 (18) 3 (2) 10 (6) 29 (17) 8 (5) 10 (6) 21 (12) 57 (33) 68 (40) 101 (60) 3 (2) 37 (22) 129 (76) 132 (78) 17 (10) 17 (10) 3 (2) 16
5 1 : (277) 83 (49%) 21 (13%) 19 (11%) 41 (24%) (Table 2) 3) 39 (23%) 38 (23%) 30 (18%) 26 (15%) (Table 2) 4) 57 (33%) 30 (18%) 29 (17%) 21 (12%) (Table 2) 5) 24 (32%) 50 (68%) 44 (46%) 51 (54%) 68 (40%) (Table 2) (76%) 2 37 (22%) (Table 2) 7) 132 (78%) 1 17 (10%) 17 (10%) 3 (2%) (Table 2) 3 구취에영향을미치는인자 WTCI(p=0000) (Table 3) (p=0006) WTCI(P=0002) (Table 4) 고찰 6) Table 3 Variables Unstandardized coefficient(β) Standard error P value SAHS* Dry mouth Postnasal drip Tonsillolith Globus pharyngeus Reflux Too much gas WTCI** (Constant) * Self-assessed halitosis severity ** Winkel tongue coating index 17
6 (278) 28 2 ( ) Table 4 Variables Unstandardized coefficient(β) Standard error P value Dry mouth Postnasal drip Tonsillolith Globus pharyngeus Reflux Too much gas WTCI* (Constant) * Winkel tongue coating index (pseudohalitosis) (halitophobia) (Genuine halitosis) (physilolgical halitosis) (pathological halitosis) 13) (432%) (213%) (200%) 4) VSCs VSCs peptide methyl mercaptan dimethyl sulfide 16) 14-15) 85% 29) 13 (18%) 61 (82%) 1 (1%) 94 (99%) 8% ) 94% 19-20) Helicobacter 1 pylori 21-24) 25-26) 4 7 Trimethylaminuria 27-28) 156 (92%)
7 1 : (279) 83 (49%) 21 (13%) 19 (11%) 41 (24%) 39 (23%) 38 (23%) 30 (18%) 26 (15%) 57 (33%) 30 (18%) 29 (17%) 21 (12%) 40% 30) 31) VSCs( hydrogen sulfide methyl mercaptan) Gas chromatography(gc) GC 32) WTCI WTCI(p=0000) Rosenberg 33) (76%) 132 (78%) (p=0006) WTCI(P=0002)
8 (280) 28 2 ( ) Helicobacter pylori Trimethylaminuria 참고문헌 1 Tonzetich J Production and Origin of Oral Malodor: a review of mechanisms and methods of analysis J Periodont 1997;48: ;36(1): ; 29(2): ;25(4): ;10(1): ;3 (1): ;4(1): ;7(1): : :? 2006;27(2): ;25(1): Winkel EG Roldan S Van Winkelhoff AJ Herrera D Sanz M Clinical effects of a new mouthrinse containing chlorhexidine cetylpyridunium chloride and zinc-lactate on oral halitosis A dual-center double-blind placebo-controlled study J Clin Periodontol 2003;30(4): Yaegaki K Coil JM Examination classification and treatment of halitosis; clinical perspectives J Can Dent Assoc 2000;66: Stedman RL The chemical composition of tobacco and tobacco smoke Chem Rev 1968; 68: Waler SM On the transformation of sulfurcontaining amino acids and peptides to volatile sulfur compounds (VSC) in the human mouth Eur J Oral Sci 1997;105: Delanghe G Ghyselen J van Steenberghe D Feenstra L Multidisciplinary breath-odour clinic Lancet 1997;350(9072):187 20
9 1 : (281) 17 Ansai T Takehara T Tonsillolith as a halitosisinducing factor Br Dent J 2005;198 (5): Tsuneishi M Yamamoto T Kokeguchi S Tamaki N Fukui K Watanabe T Composition of the bacterial flora in tonsilloliths Microbes Infect 2006; In: - : 1998: Amir E Shimonov R Rosenberg M Halitosis in children J Pediatr 1999;134(3): Tiomny E Arber N Moshkowitz M Peled Y Gilat T Halitosis and Helicobacter pylori A Possible link? J Clin Gastroenterol 1992; 15(3): Ierardi E Amoruso A Notte TL Francavilla R Castellaneta S Marrazza E et al Halitosis and Helicobacter pylori-a Possible Relationship Dig Dis Sci 1998;43(12): Hoshi K Yamano Y Mitsunaga A Shimizu S Kagawa J Ogiuchi H Gastrointestinal diseases and halitosis: association of gastric Helicobacter pylori infection Int Dent J 2002;52: Lee H Kho HS Chung JW Chung SC Kim YK Volatile sulfur compounds produced by Helicobacter pylori J Clin Gastroenterol 2006;40(5): Suarez F Springfield J Furne J Levitt M Differentiation of Mouth versus Gut as Site of Origin of Odiferous breath gases after Garlic ingestion Am J Physiol 1999;276:G425-G Henker J Schuster F Nissler K Successful treatment of gut-caused halitosis with a suspension of living non-pathogenic Escherichia coli bacteria-a case report Eur J Pediatr 2001;160(10): Mitchell SC Smith RL Trimethylaminuria: the fish malodor syndrome Drug Metab Dispos 2001;29(4 pt2): Mitchell S Trimethylaminuria (fish-odour syndrome) and oral malodour Oral Dis 2005; 11 Suppl 1: Khaira N Palmer RM Wilson RF Scott DA Wade WG Production of volatile sulphur compounds in diseased periodontal pockets is significantly increased in smokers Oral Dis 2000;6(6): Schiffman SS Taste and smell losses in normal aging and disease JAMA 1997;278(16): DeBoever EH Loesche WJ Assessing the Contribution of Anaerobic Microflora of the Tongue to Oral Malodor JADA 1995;126: Rosenberg M McCulloch CAG Measurement of Oral Malodor: Current Methods and Future Prospects J Periodontol 1992;63: In: - : 1998:
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