Tomoyuki Iwamoto

Effects of probiotic Lactobacillus salivarius WB21 on halitosis and oral health: an open-label pilot trial.

OBJECTIVE The objective of this study was to evaluate whether oral administration of lactobacilli alters the degree of halitosis and clinical conditions associated with halitosis. STUDY DESIGN Twenty patients with genuine halitosis were given 2.0 x 10(9)Lactobacillus salivarius WB21 and xylitol in tablet form daily. Oral malodor and clinical parameters were evaluated at the same time of day for each patient after 2 and 4 weeks. RESULTS All 20 patients were positive for L. salivarius DNA in their saliva at 2 weeks, although 12 patients were negative for this organism at baseline. Oral malodor parameters significantly decreased at 2 weeks in the subjects with physiologic halitosis. The scores of an organoleptic test and bleeding on probing significantly decreased at 4 weeks in the subjects with oral pathologic halitosis. CONCLUSIONS Oral administration of probiotic lactobacilli primarily improved physiologic halitosis and also showed beneficial effects on bleeding on probing from the periodontal pocket.

Detection of Helicobacter pylori DNA in the saliva of patients complaining of halitosis

Helicobacter pylori infection, which causes peptic ulcers and gastric cancer, is considered a possible cause of halitosis. Recently, the oral cavity was identified as a possible H. pylori reservoir, particularly in the presence of periodontal disease, which is a cause of halitosis. The purpose of this study was to evaluate by PCR the prevalence of oral H. pylori in the saliva of subjects complaining of halitosis. Samples were obtained from 326 non-dyspeptic subjects, comprising 251 subjects with actual malodour and 75 subjects without halitosis. DNA was extracted from the samples, and the presence of H. pylori and periodontopathic bacteria including Porphyromonas gingivalis, Treponema denticola and Prevotella intermedia was examined by PCR. H. pylori was detected in 21 (6.4 %) of 326 samples. The methyl mercaptan concentration and periodontal parameters including tooth mobility, periodontal pocket depth (PPD) and occult blood in the saliva were significantly greater in the H. pylori-positive subjects. Each of the periodontopathic bacteria was also detected at a significantly higher frequency in the H. pylori-positive subjects. Among those patients with a PPD of > or =5 mm and a tongue coating score of < or =2, no difference was observed in oral malodour levels between the H. pylori-positive and -negative subjects. However, the presence of occult blood in the saliva and the prevalence of Prevotella intermedia were significantly greater in the H. pylori-positive subjects. H. pylori was detected in 16 (15.7 %) of 102 subjects with periodontitis, suggesting that progression of periodontal pocket and inflammation may favour colonization by this species and that H. pylori infection may be indirectly associated with oral pathological halitosis following periodontitis.

Relationship between halitosis and psychologic status

OBJECTIVE To examine the psychosomatic aspects of patients complaining of halitosis. STUDY DESIGN Breath malodor in 165 patients was measured using an organoleptic test (OLT), sulfide monitoring, and gas chromatography. Clinical evaluation included oral examination, OLT, and volatile sulfur compound measurement. The psychologic condition of patients was assessed using the Cornell Medical Index (CMI). RESULTS Every item in the CMI questionnaire was negatively correlated with the OLT scores. Nine of 21 subjects (42.9%) diagnosed with pseudohalitosis and approximately 20% of subjects diagnosed with genuine halitosis were considered to be provisionally neurotic. Subjects with pseudohalitosis reported significantly higher physical scores, but not mental scores, than those with genuine halitosis. Subjects with physiologic halitosis showed significantly higher symptoms of depression than those with oral pathologic halitosis. CONCLUSION The psychologic condition of patients complaining of halitosis was associated with the actual degree of malodor and the clinical characteristics.

Effect of S-PRG Eluate on Biofilm Formation and Enzyme Activity of Oral Bacteria.

Recently, the antibacterial activity of a composite resin containing prereacted glass ionomer (S-PRG) filler was revealed. We examined the effect of an S-PRG eluate on various biologic activities of Streptococcus mutans and Porphyromonas gingivalis. Adherence ability of S. mutans was evaluated by microtiter plate assay; protease and gelatinase activities of P. gingivalis were examined by synthetic substrate hydrolysis and gelatin film spot assay, respectively. Coaggregation of P. gingivalis with Fusobacterium nucleatum was also examined. S-PRG eluate was found to suppress streptococcal adherence. S-PRG eluate inhibited the protease and gelatinase activities of P. gingivalis and the coaggregation between P. gingivalis and F. nucleatum. These results indicate that S-PRG eluate suppresses streptococcal adherence and inhibits the protease and coaggregation activities of P. gingivalis. These findings may prompt research into novel strategies for preventing caries and periodontitis.

Lactobacillus salivarius WB21–containing tablets for the treatment of oral malodor: a double-blind, randomized, placebo-controlled crossover trial

OBJECTIVE This study evaluated the effect of probiotic intervention using lactobacilli on oral malodor. STUDY DESIGN We conducted a 14-day, double-blind, placebo-controlled, randomized crossover trial of tablets containing Lactobacillus salivarius WB21 (2.0 × 10(9) colony-forming units per day) or placebo taken orally by patients with oral malodor. RESULTS Organoleptic test scores significantly decreased in both the probiotic and placebo periods compared with the respective baseline scores (P < .001 and P = .002), and no difference was detected between periods. In contrast, the concentration of volatile sulfur compounds (VSCs) (P = .019) and the average probing pocket depth (P = .001) decreased significantly in the probiotic period compared with the placebo period. Bacterial quantitative analysis found significantly lower levels of ubiquitous bacteria (P = .003) and Fusobacterium nucleatum (P = .020) in the probiotic period. CONCLUSIONS These results indicated that daily oral consumption of tablets containing probiotic lactobacilli could help to control oral malodor and malodor-related factors.

Relationship between the β-galactosidase activity in saliva and parameters associated with oral malodor.

Volatile sulfur compounds (VSCs) are produced by enzymes capable of transforming S-amino acids to corresponding sulfides. Protein degradation by periodontopathogens plays an important role in this process, and the proteolysis of glycoproteins depends on the initial removal of the carbohydrate side chains. In the present report, we tested the relationship between the β-galactosidase activity in saliva and parameters that influence oral malodor, including daily habits and oral conditions. The prevalence of periodontopathic bacteria was also examined. Forty-nine saliva samples were collected from halitosis patients. Patients were examined for breath odor and other associated parameters. Their breath odor was assessed using an organoleptic test, a portable sulfide monitor and gas chromatography. The presence of periodontopathic bacteria in the saliva was also examined. β-galactosidase activity was measured with the chromogenic substrates 5-bromo-4-chloro-3-indoyl-β-d-galactopyranoside and isopropyl-β-d-thiogalactopyranoside. β-galactosidase activity was positively correlated with malodor strength (organoleptic score, portable sulfide monitor score and VSC concentrations). Enzyme activity was also correlated with the degree of observable tongue coating. However, it showed no relationship with periodontal condition, saliva flow, tooth decay, unfitted restorations or the color of any tongue coating. While there was no relationship with Porphyromonas gingivalis and Treponema denticola, there was a negative correlation with Prevotella intermedia. These results indicate that β-galactosidase activity plays an important role in malodor production. Interestingly, the activity of this enzyme was not related to the presence of periodontopathic bacteria, which are the main malodor-producing organisms. The results obtained here may have been associated with physiologic halitosis, which is not necessarily associated with oral problems or with periodontopathic bacteria.

Enterococcus faecium WB2000 Inhibits Biofilm Formation by Oral Cariogenic Streptococci

This study investigated the inhibitory effect of probiotic Enterococcus faecium WB2000 on biofilm formation by cariogenic streptococci. The ability of E. faecium WB2000 and JCM5804 and Enterococcus faecalis JCM5803 to inhibit biofilm formation by seven laboratory oral streptococcal strains and 13 clinical mutans streptococcal strains was assayed. The Enterococcal strains inhibited biofilm formation in dual cultures with the mutans streptococcal strains Streptococcus mutans Xc and Streptococcus sobrinus JCM5176 (P < 0.05), but not with the noncariogenic streptococcal strains. Enterococcus faecium WB2000 inhibited biofilm formation by 90.0% (9/10) of the clinical S. mutans strains and 100% (3/3) of the clinical S. sobrinus strains. After culturing, the pH did not differ between single and dual cultures. The viable counts of floating mutans streptococci were lower in dual cultures with E. faecium WB2000 than in single cultures. Enterococcus faecium WB2000 acted as a probiotic bacterial inhibitor of cariogenic streptococcal biofilm formation.

Effects of oil drops containing Lactobacillus salivarius WB21 on periodontal health and oral microbiota producing volatile sulfur compounds

The objective of this paper is to evaluate the effects of oil drops containing Lactobacillus salivarius WB21 on periodontal health and oral microbiota producing volatile sulfur compounds (VSCs). For this study, 42 subjects were randomly assigned to receive oil samples containing L. salivarius WB21 or a placebo for two weeks. Oral assessment and saliva collection were performed on days 1 and 15. Bacterial analysis was performed using the real-time polymerase chain reaction and terminal restriction fragment length polymorphism (T-RFLP). In both the experimental and placebo groups, the average probing depth, number of periodontal pockets, and the percentage of bleeding on probing (BOP) decreased while stimulated salivary flow increased on day 15. BOP was reduced in the experimental group compared with the placebo group (P = 0.010). In the experimental group, total bacterial numbers decreased, and the number of L. salivarius increased. The number of Prevotella intermedia, which is correlated with hydrogen sulfide concentration in mouth air, increased in the placebo group and did not change in the experimental group. T-RFLP analysis found that the peak area proportions representing Porphyromonas gingivalis, P. intermedia, Tannerella forsythensis, and Fusobacterium nucleatum decreased in the experimental group, although there was no significant change in the bacterial composition. Thus we observed oil drops containing L. salivarius WB21 improved BOP and inhibited the reproduction of total and VSC-producing periodontopathic bacteria compared with the placebo group, but also showed the limit of its efficacy in controlling VSCs producing and periodontal pathogens.

A Case Report of Tooth Wear Associated with a Patient's Inappropriate Efforts to Reduce Oral Malodor Caused by Endodontic Lesion

Here, we report a case of severe tooth wear associated with a patients inappropriate efforts to reduce oral malodor. A 72-year-old male patient visited our breath clinic complaining of strong breath odor. Former dentists had performed periodontal treatments including scaling and root planing, but his oral malodor did not decrease. His own subsequent breath odor-reducing efforts included daily use of lemons and vinegar to reduce or mask the odor, eating and chewing hard foods to clean his teeth, and extensive tooth brushing with a hard-bristled toothbrush. Oral malodor was detected in our breath clinic by several tests, including an organoleptic test, portable sulphide monitor, and gas chromatography. Although patients oral hygiene and periodontal condition were not poor on presentation, his teeth showed heavy wear and hypersensitiving with an unfitted restoration on tooth 16. Radiographic examination of the tooth did not reveal endodontic lesion, but when the metal crown was removed, severe pus discharge and strong malodor were observed. When this was treated, his breath odor was improved. After dental treatment and oral hygiene instruction, no further tooth wear was observed; he was not concerned about breath odor thereafter.

A Case of Oral Malodor: Improving the Motivation of Patients by Use ofBacterial Examination

Here, we report a case of oral malodor that was diagnosed by bacterial examination. The patient (a 32-year-old female) visited our breath clinic because a family member advised her to do so. Strong oral malodor was detected by several tests including an organoleptic test, a portable sulfide monitor, and gas chromatography. She noticed her oral malodor, but her motivation toward treatment was low. Even after explaining the cause of halitosis and the importance of oral hygiene, her motivation did not improve. So we applied a bacterial examination, and explained the results in detail. She understood how oral bacteria had caused the oral malodor, and she tried to do tooth brushing better. After a basic periodontal treatment, her oral condition improved and the number of periodontopathic bacteria reduced. She continued with careful tooth brushing even after the periodontal treatment, and her breath odor remarkably decreased. This case report indicates the usefulness of bacterial examination for motivating patients to improve their oral hygiene.