Halitosis is a prevalent yet often underestimated clinical condition with multifactorial etiology, predominantly arising from intra-oral sources such as periodontal disease, tongue coating and xerostomia. Central to its pathogenesis is the microbial degradation of sulfur-containing substrates, which lead to the production of volatile sulfur compounds and other volatile organic compounds responsible for the characteristic odor. These metabolites are produced by proteolytic anaerobes inhabiting the tongue dorsum, periodontal pockets as well as the dental plaque and predominantly exist as structured biofilms. This review examines halitosis through a systems-based lens, conceptualizing the oral cavity as a dynamic bioreactor governed by microbial consortia and their metabolic pathways, mass transport, enzymatic kinetics, as well as growth conditions attributed to microenvironmental factors. Modeling approaches are required to elucidate the intricate dynamics within oral biofilms, including the heterogeneous structural organization and the fundamental transport and metabolic processes occurring at the biofilm-bulk fluid interface and within the biofilm matrix. These interfacial processes, in turn, regulate the flux of volatile compounds into the oral air. Furthermore, associations between halitosis and dental pathologies, including gingivitis, periodontitis, and periodontal abscesses, are explored through microbial dysbiosis. The review also addresses contemporary management strategies including mechanical debridement, antimicrobial agents and probiotics. Understanding the biochemical, microbial and reactor-like behavior of the oral cavity is critical for the effective diagnosis, monitoring and treatment of halitosis in clinical and research settings.

Purpose Dental hygienists are uniquely positioned to improve oral and overall health outcomes with evidence-based treatment plans. One recommendation that has yet to see its full potential is the use of stannous fluoride (SnF2) toothpaste. Stannous fluoride is more than just an anticaries agent. Its formulation within a toothpaste offers superior performance in reducing plaque, gingivitis, sensitivity, halitosis, and tooth erosion, while maintaining the sulcular barrier integrity. However, most patients are unaware of these easily available benefits for oral health. This short report highlights the universal efficacy of SnF2 toothpaste, including significant reductions in gingival bleeding as compared with regular fluoride; reviews its proposed mechanisms, including antibacterial and antivirulence activity around teeth and implants as well as substructure remineralization; and explores its potential systemic health impact. The specific formulation of the toothpaste product also affects these factors, emphasizing the value of formulation-specific evidence to inform chairside recommendations. Including a well-formulated SnF2 toothpaste as part of daily oral hygiene leverages an existing behavior and reinforces proper habits for better oral health outcomes.

Biofilms are well-organized, surface-attached colonies of microorganisms that can thrive in host cavities. A balanced, diverse mix of protective microbes in these biofilms helps preserve host health. Dysbiosis in biofilms is responsible for consequential diseases in associated tissues. Dietary factors and other xenobiotics can cause ecological dysbiosis in the oral cavity that underpins dental caries, periodontal diseases, halitosis, and periapical infections. Although the gold standard for oral biofilm elimination remains mechanical removal, it is achieved with manual curettage or an ultrasonic scaler. However, the removal of non-pathogenic microorganisms, which contribute to chemical signaling and metabolic complementation of the host, thereby produces deleterious side effects. Therefore, to maintain ecological balance, alternatives are a major area of research. A 'control without killing' approach to modulating biofilms focuses on maintaining biofilm ecology rather than indiscriminately using antimicrobial agents. The extracellular matrix (ECM) of a biofilm protects the embedded microbial communities; measures that disintegrate it can emerge as a promising modality to control the growth of pathogenic microbes in them. Currently, research focuses on limiting virulence traits (acid production, protease activity, or quorum sensing) to degrade the ECM and slow pathogen growth without eliminating commensals. This article highlights current research on approaches to managing oral cavity biofilms and the translational challenges they pose. Understanding these alternative approaches can help formulation researchers, microbiologists, and materials science experts work integratively to manage microbial biofilms. This article opens gateways to implementing oral biofilm-modulating strategies in the management of other biofilm-associated infections.

Wound odor is a common symptom in patients with chronic wounds. Malodorous wounds can result in embarrassment, anxiety, and, therefore, in social isolation of the patient. Current treatment options are limited and focused on masking the odor. Current approaches to wound odor management have notable limitations and fail to adequately address existing therapeutic needs. Wound odor is multifactorial, with a major contribution from volatile organic compounds (VOCs) emitted by microorganisms and necrotic tissue. Several VOCs have been identified as key drivers of malodor, such as short-chain fatty acids, dimethyl-trisulfide, specific alcohols, ketones, and aldehydes. These compounds are detected by the human olfactory system, including olfactory receptors (ORs) expressed on olfactory sensory neurons (OSNs). The human olfactory system comprises more than 400 ORs, which enable the detection of a vast array of odorants, however only a small fraction of these receptors has been deorphanized. This systematic review will evaluate therapeutic clinical strategies addressing malodor and compile current knowledge on VOCs that cause wound odor and the ORs associated with their detection. It summarizes the existing evidence on deorphanized ORs that detect these VOCs in malodorous wounds and outlines experimental mechanisms of deorphanization. Identifying wound-odor-associated VOCs and their corresponding ORs provides a framework for novel therapeutic strategies, such as antagonizing the OR to suppress odor perception. This may directly improve the quality of life of patients with chronic malodorous wounds, particularly in malignant wounds and palliative care.

Halitosis is a multifactorial condition influenced by airway-related factors and breathing patterns. This study aimed to evaluate the relationship between airway dimensions, craniofacial morphology, and breathing type with halitosis in orthodontic patients. In addition, the agreement between the portable breath analyzer and the organoleptic method, as well as the role of self-reported and physiological halitosis, was investigated. This cross-sectional study included 113 systemically and orally healthy orthodontic patients. Lateral cephalometric radiographs were used to assess the sagittal and vertical skeletal patterns and pharyngeal airway dimensions. Halitosis was evaluated using an organoleptic method as the reference standard and a portable breath analysis device for comparison. Oral hygiene habits, breathing type, and perception of halitosis were recorded using a structured questionnaire. Statistical analyses included appropriate parametric and nonparametric tests as well as multivariate logistic regression. Agreement was assessed using Cohen's kappa coefficient. The overall prevalence of halitosis was 8.9% based on organoleptic assessment. Tooth brushing frequency (p= 0.041) and oral dryness (p= 0.004) were significantly associated with halitosis, whereas airway dimensions, skeletal patterns, and breathing types were not (p> 0.05). Physiological halitosis (p= 0.003) and oral dryness (p= 0.047) were significant predictors of self-reported halitosis. The agreement between the self-reported and objective measurements was weak (κ= 0.264;p< 0.001). A statistically significant and substantial level of agreement was observed between the portable device and the organoleptic assessment (κ= 0.698). Airway-related parameters were not identified as significant determinants of halitosis. Within the limitations of this study, halitosis was more closely associated with self-reported oral dryness and tooth-brushing frequency than with airway morphology. Portable breath analyzers may serve as practical adjunctive tools for clinical assessments when used under standardized conditions.

This article reviews the microbiological mechanisms of halitosis, the oral-gut axis, the role of the gut microbiome, related metabolic pathways, and their associations with gastrointestinal diseases, and explores intervention strategies based on microbial regulation. Halitosis is primarily caused by volatile sulfur compounds produced by oral microorganisms, especially gram-negative anaerobic bacteria, and volatile organic compounds in most extraoral etiologies. Studies have found that intestinal microbial dysregulation can affect the composition of oral flora through the oral-gut axis and aggravate bad breath. Gastrointestinal diseases, such as gastroesophageal reflux disease,Helicobacter pyloriinfection, ulcerative colitis and irritable bowel syndrome can directly or indirectly promote the occurrence of bad breath by changing the intestinal microenvironment and microbial metabolic pathways, such as protein spoilage or short-chain fatty acids imbalance, etc. For microbial interventions, traditional Chinese medicine can not only systemically regulate the oral-gut axis balance, but also effectively alleviate bad breath by targeting sterilization and inhibiting the metabolic activity of pathogenic bacteria. This review focuses on elucidating the complex links between halitosis and the gut microbiome, its metabolic pathways, and gastrointestinal diseases, emphasizing the key role of microbial metabolites in pathological mechanisms. It reveals the importance of the oral-gut axis in systemic health and provides a rationale for developing personalized halitosis management strategies based on microbiome regulation.

This research aimed to assess the knowledge, attitudes, and practices of parents with autistic children between the ages of 5 and 15 regarding their children's oral health. A cross-sectional study was conducted among 150 parents of autistic children in Ahvaz, Iran, using a researcher-designed questionnaire comprising four sections: demographic information, knowledge, attitude, and performance. The content validity was established by expert review and reliability tested through a pilot study (KR-20 coefficient for the knowledge domain; Cronbach's alpha for attitude and practice domains) with acceptable internal consistency. Each domain was assessed using a Likert scale. Data were analyzed using one-sample t-test, chi-square test, correlation analysis, and linear regression, with a significance level set at p < 0.05. Among the children, 91 (61.5%) were male; 67 (68.4%) brushed their teeth with maternal assistance; 62 (41.6%) had halitosis; and 58 (38.9%) exhibited bruxism. Moreover, 66 (44.0%) of parents believed that autism did not cause gingival disease in their children; 101 (67.3%) never used mouthwash; and 68 (57.3%) reported biannual dental visits. The mean knowledge, attitude, and performance scores were 5.58, 30.87, and 9.06, respectively. Parents demonstrated above-average knowledge and positive attitudes toward oral health, yet their practical performance remained below the expected level. Higher oral health knowledge and practice scores were significantly correlated with urban areas, higher maternal education and employed mother. Despite good knowledge and attitudes, parents' oral health practices were inadequate. Educational interventions emphasizing practical behavioral change are recommended to bridge the knowledge-practice gap.