Professional diagnosis of bad breath

Dr. Mel Rosenberg, Dr. Alon Amit

04.03.09, 15:39

If bad breath is persistent, and all other medical and dental factors have been ruled out, specialized testing and treatment are required.
There are quite a few dental offices and commercial breath clinics that claim to diagnose and treat bad breath. They often use some of several laboratorial methods to diagnose bad breath:
  • Halimeter™: a portable sulfide monitor used to test for levels of sulfur emissions (specifically, hydrogen sulfide) in the mouth air. When used properly this device can be very effective at determining levels of certain VSC-producing bacteria. The Halimeter was developed by Dr. Mel Rosenberg in 1991, and became a baseline instrument for the detection of VSC's throughout the world – in research and in commercial breath clinics. There are several drawbacks in the clinical applications: Other common sulfides (such as mercaptan) are not recorded as easily as the hydrogen sulfide, and can be misrepresented in test results. Certain foods such as garlic and onions produce sulfur in the breath for as long as 48 hours and can result in false readings. The Halimeter is also very sensitive to alcohol, so one should avoid drinking alcohol or using alcohol-containing mouthwashes for at least 12 hours prior to being tested. This analog halimeter requires periodic recalibration to remain accurate, as it loses sensitivity over time.
  • Gas chromatography: portable machines, such as the OralChroma™, are currently being introduced, and gain wider popularity among bad breath specialists. This technology is specifically designed to digitally measure molecular levels of the three major VSCs in a sample of mouth air (hydrogen sulfide, methyl mercaptan, and dimethyl sulfide). It is accurate in measuring the sulfur components of the breath and produces visual results in graph form through computer interface.
  • BANA test: a test directed to find the salivary levels of an enzyme indicating the presence of certain halitosis-related bacteria.
  • ß-galactosidase test: salivary levels of this enzyme were found to be correlated with oral malodor. This test has been developed and patented by Dr. Nir Sterer and Dr. Mel Rosenberg at the Tel-Aviv University School of Dental Medicine.

Although such instrumentation and examinations are widely used in breath clinics, the most important measurement of bad breath, and considered to be the gold standard for diagnosis, is the actual sniffing and scoring of the level and type of the odor carried out by trained experts ("organoleptic measurements"). The level of odor is usually assessed by the odor judges on a six point intensity scale.

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