Sachiko Takehara

Clinical trial of oral malodor treatment in patients with periodontal diseases

BACKGROUND AND OBJECTIVE Only a few clinical research studies have assessed different therapeutic approaches to oral malodor in subjects affected by periodontal diseases. The aim of this study was to evaluate the effects of periodontal treatment and tongue cleaning on oral malodor parameters in periodontitis and gingivitis patients. MATERIAL AND METHODS The subjects were 102 periodontitis and 116 gingivitis patients with oral malodor. Oral malodor was measured by organoleptic test and Oral Chroma™. Oral health status, including tooth conditions, periodontal health, tongue coating and proteolytic activity of the BANA test in tongue coating were assessed. Subjects in each periodontal disease group were randomly assigned into two subgroups depending on the sequence of treatment: periodontal treatment and tongue cleaning. Oral malodor and oral health parameters were compared by groups and sequence of treatment. RESULTS For subjects in the periodontitis group, there were statistically significant reductions in oral malodor after periodontitis treatment or tongue cleaning; however, major reductions were found after periodontitis treatment. For those in the gingivitis group, there were also statistically significant reductions in oral malodor after gingivitis treatment or tongue cleaning, but the most marked reductions were observed after tongue cleaning. At the completion of treatment, all oral malodor parameters fell below the threshold levels in all subgroups. CONCLUSION The present study indicated that periodontal treatment played an important role and tongue cleaning contributed to a lesser extent to reduction in oral malodor in periodontitis patients. In contrast, tongue cleaning alone can be the primary approach to reduce oral malodor in gingivitis patients.

Effects of a mouthwash with chlorine dioxide on oral malodor and salivary bacteria: a randomized placebo-controlled 7-day trial

BackgroundPrevious research has shown the oxidizing properties and microbiological efficacies of chlorine dioxide (ClO2). Its clinical efficacies on oral malodor have been evaluated and reported only in short duration trials, moreover, no clinical studies have investigated its microbiological efficacies on periodontal and malodorous bacteria. Thus, the aim of this study was to assess the inhibitory effects of a mouthwash containing ClO2 used for 7 days on morning oral malodor and on salivary periodontal and malodorous bacteria.Methods/DesignA randomized, double blind, crossover, placebo-controlled trial was conducted among 15 healthy male volunteers, who were divided into 2 groups. Subjects were instructed to rinse with the experimental mouthwash containing ClO2 or the placebo mouthwash, without ClO2, twice per day for 7 days. After a one week washout period, each group then used the opposite mouthwash for 7 days. At baseline and after 7 days, oral malodor was evaluated with Organoleptic measurement (OM), and analyzed the concentrations of hydrogen sulfide (H2S), methyl mercaptan (CH3SH) and dimethyl sulfide ((CH3)2S), the main VSCs of human oral malodor, were assessed by gas chromatography (GC). Clinical outcome variables included plaque and gingival indices, and tongue coating index. The samples of saliva were microbiologically investigated. Quantitative and qualitative analyses were performed using the polymerase chain reaction-Invader method.Results and DiscussionThe baseline oral condition in healthy subjects in the 2 groups did not differ significantly. After rinsing with the mouthwash containing ClO2 for 7 days, morning bad breath decreased as measured by the OM and reduced the concentrations of H2S, CH3SH and (CH3)2S measured by GC, were found. Moreover ClO2 mouthwash used over a 7-day period appeared effective in reducing plaque, tongue coating accumulation and the counts of Fusobacterium nucleatum in saliva. Future research is needed to examine long-term effects, as well as effects on periodontal diseases and plaque accumulation in a well-defined sample of halitosis patients and broader population samples.Trial registrationClinicalTrials.gov NCT00748943

A randomized double blind crossover placebo-controlled clinical trial to assess the effects of a mouthwash containing chlorine dioxide on oral malodor

BackgroundPrevious research has shown the oxidizing properties and microbiological efficacies of chlorine dioxide (ClO2), however, its clinical efficacies on oral malodor have been evaluated only with organoleptic measurements (OM) or sulphide monitors. No clinical studies have investigated the inhibitory effects of ClO2 on volatile sulfur compounds (VSCs) using gas chromatography (GC). The aim of this study was to assess the inhibitory effects of a mouthwash containing ClO2 on morning oral malodor using OM and GC.MethodsA randomized, double blind, crossover, placebo-controlled clinical trial was conducted among 15 healthy male volunteers, who were divided into 2 groups. In the first test phase, the group 1 subjects (N = 8) were instructed to rinse with the experimental mouthwash containing ClO2, and those in group 2 (N = 7) to rinse with the placebo mouthwash without ClO2. In the second test, phase after a one week washout period, each group used the opposite mouthwash.Oral malodor was evaluated before rinsing, right after rinsing and every 30 minutes up to 4 hours with OM, and concentrations of hydrogen sulfide (H2S), methyl mercaptan (CH3SH) and dimethyl sulfide ((CH3)2S), the main VSCs of human oral malodor, were evaluated with GC.ResultsThe baseline oral condition in the subjects in the 2 groups did not differ significantly. The mouthwash containing ClO2 improved morning bad breath according to OM and reduced concentrations of H2S, CH3SH and (CH3)2S according to GC up to 4 hours after rinsing. OM scores with ClO2 were significantly lower than those without ClO2 at all examination times. Significant reductions in the concentrations of the three kinds of VSCs measured by GC were also evident at all examination times. The concentrations of the three gases with ClO2 were significantly lower than those without ClO2 at most examination times.ConclusionIn this explorative study, ClO2 mouthwash was effective at reducing morning malodor for 4 hours when used by healthy subjects.Trial registrationClinicalTrials.gov NCT00655772

Clinical oral malodor measurement with a portable sulfide monitor

OBJECTIVE The aim of this study was to evaluate the clinical ability of Breathtron by comparing it with other malodor measurement procedures: the organoleptic test (OT) and gas chromatography (GC). SUBJECTS AND METHODS Patients were 475 patients who visited a fresh breath clinic. Oral malodor was measured with the OT, GC, and Breathtron. Correlation analysis and two linear regression analyses were conducted to examine the relationship of the Breathtron values with OT scores and volatile sulfide compound (VSC) concentrations by GC: i.e. the regression of Breathtron on OT and the regression of Breathtron on total VSCs by GC. Receiver operating characteristics (ROC) analysis was conducted to investigate the sensitivity and specificity of Breathtron. RESULTS The Breathtron values were significantly correlated with OT and VSCs by GC. In the regression analysis, predicted Breathtron values were 199.3 and 520.1 ppb for OT scores 1 and 2, and reasonably close to total VSCs by GC between 550 and 750 ppb. The ROC analysis demonstrated that Breathtron is a useful and valuable adjunct measurement tool. CONCLUSIONS Breathtron is a simple, rapid and reliable appliance for screening oral malodor if an appropriate malodor threshold level is chosen.

Degradation of MUC7 and MUC5B in human saliva.

Background Two types of mucins, MUC7 and MUC5B constitute the major salivary glycoproteins, however their metabolic turnover has not been elucidated in detail to date. This study was conducted to examine turnover of MUC7 and MUC5B in saliva, by focusing on the relationship between their deglycosylation and proteolysis. Methodology/Principal Findings Whole saliva samples were collected from healthy individuals and incubated at 37°C in the presence of various protease inhibitors, sialidase, or a sialidase inhibitor. General degradation patterns of salivary proteins and glycoproteins were examined by SDS-polyacrylamide-gel-electrophoresis. Furthermore, changes of molecular sizes of MUC7 and MUC5B were examined by Western blot analysis. A protein band was identified as MUC7 by Western blot analysis using an antibody recognizing an N-terminal epitope. The MUC7 signal disappeared rapidly after 20-minutes of incubation. In contrast, the band of MUC7 stained for its carbohydrate components remained visible near its original position for a longer time indicating that the rapid loss of Western blot signal was due to the specific removal of the N-termimal epitope. Pretreatment of saliva with sialidase facilitated MUC7 protein degradation when compared with samples without treatment. Furthermore, addition of sialidase inhibitor to saliva prevented proteolysis of N-terminus of MUC7, suggesting that the desialylation is a prerequisite for the degradation of the N-terminal region of MUC7. The protein band corresponding to MUC5B detected in both Western blotting and glycoprotein staining showed little sign of significant degradation upon incubation in saliva up to 9 hours. Conclusions/Significance MUC7 was highly susceptible to specific proteolysis in saliva, though major part of MUC5B was more resistant to degradation. The N-terminal region of MUC7, particularly sensitive to proteolytic degradation, has also been proposed to have distinct biological function such as antibacterial activities. Quick removal of this region may have biologically important implication.

Saliva viscosity as a potential risk factor for oral malodor

Abstract Objectives. The objective of this study was to assess whether saliva viscosity, measured by a viscometer, was a predictor of oral malodor. Materials and methods. The subjects were 617 patients who visited an oral malodor clinic. The organoleptic test (OT) was used for diagnosis of oral malodor. An oral examination assessed the numbers of teeth present and decayed teeth as well as the presence or absence of dentures. Further, periodontal pocket depths (PD), gingival bleeding, dental plaque and tongue coating were investigated. Unstimulated saliva were collected for 5 min. Saliva viscosity was measured with a viscometer. Logistic regression analysis with oral malodor status by OT as a dependent variable was performed. Possible confounders including age, gender, number of teeth present, number of decayed teeth, number of teeth with PD ≥ 4 mm, number of teeth with bleeding on probing, presence or absence of dentures, plaque index, area of tongue coating, saliva flow rate, saliva pH and saliva viscosity were used as independent variables. Results. Saliva viscosity (p = 0.047) along with the number of teeth with PD ≥4 mm (p = 0.001), plaque index (p = 0.037) and area of tongue coating (p < 0.001) were significant variables for oral malodor. Subjects with a higher number of teeth with PD ≥ 4 mm (OR = 1.32), plaque index (OR = 2.13), area of tongue coating (OR = 3.17) and saliva viscosity (OR = 1.10) were more likely to have oral malodor compared to those with lower values. Conclusions. The results suggested that high saliva viscosity could be a potential risk factor for oral malodor.

Factors affecting the motivation for dental check-ups and anxiety in the elderly in Tokyo

OBJECTIVES The purpose of this study was to identify factors influencing the motivation for regular dental check-ups and anxiety about future dental problems in the elderly. BACKGROUND Regular dental check-ups are important to maintain oral health. Anxiety affects the quality of life of the elderly. However, few studies have investigated the factors influencing the motivation for regular dental check-ups and anxiety in the elderly. MATERIALS AND METHODS Among 452 elderly persons, 215 participants provided useful answers to our questionnaire. The questionnaire consisted of items concerning oral and living conditions of the subjects. Logistic regression analysis was conducted. RESULTS The mean age of the study sample was 75.7 +/- 5.8 years. The percentage of edentulous subjects was 12.1%. The motivation for regular dental check-ups was significantly positively correlated with the number of teeth present (p < 0.01), using inter-dental brushes (p < 0.01), being on regular prescribed medication (p < 0.05), and having experience of providing oral care for the bedridden (p < 0.05). Anxiety about future oral problems was significantly associated with self-rated health status (p < 0.01) and the presence of dentists who could be counted on to provide domiciliary visits (p < 0.05). CONCLUSION The participants of this study had a high motivation for regular dental check-ups, but were concerned about the future, particularly if they became bedridden.

The relationship between turbidity of mouth-rinsed water and oral health status

OBJECTIVES The purpose of this study was to examine the relationship between turbidity of mouth rinsed water and oral health status such as dental and periodontal conditions, oral hygiene status, flow rate of saliva and oral bacteria. MATERIALS AND METHODS Subjects were 165 patients who visited the Dental Hospital, Tokyo Medical and Dental University. Oral health status, including dental and periodontal conditions, oral hygiene status and flow rate of saliva, was clinically examined. The turbidity was measured with a turbidimeter. Quantification of Fusobacterium spp, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola and total bacteria levels was performed using real-time PCR. The Pearson correlation and multiple regression analysis were used to explore the associations between the turbidity and oral health parameters. RESULTS The turbidity showed significant correlations with the number of decayed teeth and deep pockets, the plaque index, extent of tongue coating and Fusobacterium spp, P. gingivalis, T. forsythia, T. denticola and total bacteria levels. In a multiple regression model, the turbidity was negatively associated with the flow rate of saliva and positively associated with the total number of bacteria (p < 0.001). CONCLUSION Current findings suggested that turbidity of mouth rinsed water could be used as an indicator to evaluate oral health condition and the amount of bacteria in the oral cavity. In addition, the turbiditimeter appeared as a simple and objective device for screening abnormality of oral health condition at chair side as well as community-based research.

Prevalence and risk factors of halitosis in Japanese school children

Little data are available regarding halitosis in Japanese children. The aim of the current study was to investigate the prevalence and risk factors associated with halitosis in Japanese elementary and junior high school children.

Relationships between occupational and behavioral parameters and oral health status.

The aim of the present study was to assess the influence of various workplace parameters and oral health behaviors on tooth decay, periodontal disease, and the number of teeth present in industrial workers. The study participants were 1,078 workers (808 males, 270 females, mean age 42.8 ± 11.4 yr) employed at 11 different workplaces. Oral examinations and a self-administered questionnaire were conducted for participants. A logistic regression analysis was conducted to identify factors related to their oral health status. Factors significantly associated with decayed teeth were smoking (OR=2.02), not having received tooth brushing instruction (OR=1.73), not having annual dental examinations (OR=1.64) and not brushing before sleeping (OR=0.55). The factors significantly associated with severe periodontal disease were employment with a company with fewer than 50 employees (OR=15.56) and not brushing teeth before bedtime (OR=2.41). The factors significantly associated with having 23 teeth or fewer were subjects in the education and learning support industry compared with manufacturing industry (OR=5.83) and transport industry (OR=12.01). The results of the present study showed that various occupational parameters and health behaviors are associated with oral health status including tooth decay, periodontal disease, and tooth loss.