Chronic rhinosinusitis (CRS) is a heterogeneous and often debilitating disease characterized by persistent sinonasal symptoms and inflammation and is phenotypically classified as CRS with nasal polyps (CRSwNP) or without nasal polyps (CRSsNP). Although CRSsNP is the more prevalent phenotype (approximately 80%), it remains disproportionately understudied, leading to critical gaps in understanding and management. This systematic literature review synthesized current global evidence on the epidemiological, clinical, humanistic, and economic burden of CRSsNP, highlighting areas of unmet need and raising awareness of the impact of this disease. PRISMA-compliant searches were conducted for CRSsNP records published 2004-2024 (epidemiological studies 2014-2024) across six electronic databases. Targeted hand searches were performed for abstracts (2022-2024), health technology assessments, guidelines, and clinical trial registries. Of 2215 records identified, 157 met inclusion criteria. CRSsNP prevalence was 4.3-10.4% in the USA, South Korea, and Spain. Patients experienced a range of symptoms including nasal/sinus (obstruction, discharge, crusting), pain, sensory (anosmia, cacosmia), respiratory (cough, asthma), oral (dry throat, halitosis), and sleep impairment. There was considerable variability in the availability and use of tools to assess severity; this impeded cross-study comparisons, consistent disease staging, and treatment escalation criteria. Associated comorbidities included asthma, chronic obstructive pulmonary disease, gastroesophageal reflux disease, and primary antibody deficiencies. Humanistic burden was assessed using a variety of outcome measures and was higher for patients with CRSsNP than for controls. Limited data were available on economic burden. Currently available therapies were associated with high rates of treatment failure, inadequately controlled symptoms, and the need for multiple lines of therapy. CRSsNP is associated with considerable burden across clinical, humanistic, and economic domains, exacerbated by diagnostic variability, treatment limitations, and a lack of standardized research methodologies. This highlights the need for coordinated efforts among stakeholders to better address this chronic condition and support future improvements in patient outcomes.

Oronasal fistula (ONF) is an epithelialized tract between the oral and nasal cavities, for which various flaps are used in surgical closure. ONF may lead to regurgitation of food into the nasal cavity, nasal obstruction, halitosis, and other symptoms that contribute to patient discomfort and impaired quality of life. Surgical closure is challenging, occasionally requiring multiple procedures and carrying a risk of recurrence. The nasolabial flap (NLF) is a well-established local flap for soft tissue reconstruction in the orofacial region; superiorly based flaps are typically used for defects of the nasal dorsum, tip, and ala, while inferiorly based flaps are applied to defects of the nasal floor, lips, and buccal mucosa. The NLF provides dependable vascularity and favorable donor-site esthetic outcomes. Although superiorly based NLFs are not commonly used for intraoral reconstruction, this case report suggests that they can serve as a feasible option for ONF closure in carefully selected patients when the flap lies within an appropriate distance from the maxilla.

Halitosis in companion animals lacks safe, effective long-term solutions. This study evaluated sugar cane polyphenols (SP) as an oral deodorizer for dogs using acute and 30 day intervention trials. Efficacy was evaluated by sensory scoring, volatile profiling, microbiome analysis, and mechanistic assays. Oral malodor was significantly reduced in both the acute (0-120 min) spray test and the 30 day SP intervention, accompanied by decreases in volatile sulfur compounds and indole. Mechanistic evidence indicated that SP interacts with odorants through noncovalent interactions and reduces protein surface hydrophobicity. Molecular simulations further supported competitive occupation of hydrophobic and aromatic protein binding regions by SP. Meanwhile, salivary β-glucosidase activity was inhibited in a concentration-dependent manner. SP exposure was also associated with reduced abundances of odor-associated oral taxa, such as Porphyromonas and Fusobacterium. These findings support SP as a food-grade strategy for controlling canine halitosis, with translational relevance to oral care applications.

Background and Objectives: Halitosis can impair psychosocial well-being, and orthodontic appliances may modify plaque retention and oral ecology. We compared patient-perceived halitosis burden, clinician-rated malodor, and oral health-related quality of life (OHRQoL) among clear aligner users, fixed-brace patients, and untreated controls, and explored oral and salivary correlates of worse malodor severity. Methods: This cross-sectional study (March 2024-November 2025) enrolled 184 participants aged 15-35 years (aligners n = 62; fixed braces n = 64; controls n = 58). Outcomes were HALT (0-100), organoleptic score (0-5), and OHIP-14 (0-56). Plaque index, gingival inflammation, tongue coating, and unstimulated salivary flow were recorded; low flow was defined as <0.25 mL/min. Organoleptic score ≥ 2 was used descriptively for clinically relevant malodor prevalence, whereas organoleptic score ≥3 defined a moderate-to-severe malodor phenotype for secondary exploratory internal modeling. Multivariable robust linear models (HALT) and proportional-odds ordinal logistic regression (organoleptic severity) were used. Results: Fixed braces showed higher HALT (53.7 ± 6.2) than controls (46.3 ± 6.4) and aligners (41.7 ± 7.4) (p < 0.001), higher organoleptic scores (2.9 ± 0.4 vs. 2.4 ± 0.6 vs. 2.2 ± 0.6; p < 0.001), and worse OHIP-14 (18.6 ± 4.7 vs. 15.9 ± 4.3 vs. 13.8 ± 4.8; p < 0.001). Clinically relevant malodor prevalence (organoleptic ≥ 2) was 96.9% in fixed braces, 79.3% in controls, and 66.1% in aligners (p < 0.001); because ≥2 was used as a broad descriptive threshold, these values should be interpreted as descriptive rather than diagnostic prevalence estimates. In adjusted models, greater tongue coating, higher plaque, and low salivary flow were associated with worse organoleptic severity, whereas appliance category did not remain independently associated with HALT once concurrent clinical correlates were included. Conclusions: Fixed braces showed higher unadjusted malodor burden and worse OHRQoL than aligners and untreated controls, but appliance category should be interpreted as a contextual exposure linked to plaque-retentive conditions rather than as a standalone causal determinant. Plaque accumulation, tongue coating, and lower salivary flow showed the strongest associations with worse malodor severity. These findings should be interpreted in light of the cross-sectional design, possible observer and selection bias, and residual confounding.

The oral microbiome is an important aspect of overall oral health in dogs. To investigate the ability of a postbiotic, canine oral health postbiotic (COHP), to support oral health, a double-blind, placebo-controlled study was conducted with a dirty tooth model to assess its ability to reduce volatile sulfur compound (VSC) producing microbes that cause halitosis and modulate canine oral microbiome composition. Ten client-owned dogs were randomly split into 2 groups. The groups received either the COHP or a placebo as a powder topper on food for 7 days. Oral microbiome samples were collected on day 0 and day 7 along with the buccal gingival margin. Hydrogen sulfide (H2S)-producing colonies were quantified by plating the oral microbiome samples and counting pigment-producing colonies. Additionally, oral microbiome samples were sequenced, and taxa abundance was quantified. A trend toward a reduction in H2S-producing colonies was observed in the COHP group (P = .06), but not in the placebo group (P = .9). Canine oral health postbiotic reduced the abundance of 9 times as many taxa as the placebo, including taxa that form biofilms and produce VSCs. The placebo reduced the abundance of only one taxon, which is not associated with biofilms or VSCs. The findings provide evidence for COHP's ability to promote a positive shift in the canine oral microbiome, and, together with previous results, provides evidence that it may broadly help to maintain canine oral health.

Zenker's diverticulum (ZD) is an acquired outpouching of the mucosa and the submucosa through a point of weakness between the inferior pharyngeal constrictor and the cricopharyngeus muscles. It commonly presents with dysphagia, regurgitation, and halitosis. We retrospectively reviewed seven patients treated with open cervical surgery between 2010 and 2025. Six underwent diverticulectomy and cricopharyngeal myotomy, and one underwent diverticulopexy. The mean age was 59.4 years, and 85.7% were male. All patients experienced dysphagia, and regurgitation and halitosis were present in 42.8% each. Diagnosis was established through a barium swallow study, with complementary imaging performed in selected cases. No postoperative complications or mortality occurred. The mean hospital stay was 2.4 days, and after a mean follow-up of 7 months, no recurrences or reinterventions were observed. Open cervical surgery remains a safe and effective option in properly selected patients, although the small sample size and short follow-up warrant cautious interpretation of these findings.

Semaglutide, a glucagon-like peptide-1 receptor agonist, has demonstrated clinically meaningful weight loss effects in patients with Type 2 diabetes and high BMI, and dental practitioners and physicians are often encountering patients who take these medications. Semaglutide is known to be associated with several systemic side effects, including delayed gastric emptying, belching, reflux and nausea, nutritional changes, and gastrointestinal discomfort. Systemic effects secondarily manifest in the oral cavity, and as a result, patients taking semaglutide may present with xerostomia (dry mouth), halitosis (bad breath), enamel erosion tied to vomiting, altered taste, among other oral signs and symptoms. It is important for dental professionals and physicians to become informed of possible symptoms and corresponding management strategies, given the multiple potential indirect effects on the oral cavity and relevance to dental treatment planning. This article reviews the pharmacodynamics of semaglutide and dives into the current evidence on oral manifestations of the drug family and implications for dental and oral health. It outlines practical management recommendations for dentists and the broader interdisciplinary healthcare team.

Xylitol, a naturally occurring sugar alcohol, exhibits multifaceted benefits in dentistry, including inhibition of cariogenic bacteria, suppression of biofilm formation and stimulation of salivary flow. Therefore, it is of interest to review synthesizes current evidence on its role in caries prevention, periodontal therapy and management of xerostomia, candidiasis and halitosis. Clinical and public health implications have been discussed, with emphasis on optimal dosage, delivery methods and integration into preventive strategies. Emerging evidence highlights its relevance as a safe and adjunctive modality within evidence-based preventive and therapeutic protocols. Future studies should include rigorously designed randomized controlled trials and translational studies to establish standardized guidelines for integrating it into clinical practice and community-based oral health programs.

Misclassification of halitosis frequently results in ineffective treatment. A clinical classification system is presented that organizes halitosis into eight types based on etiology and clinical presentation. Intraoral causes include tongue biofilm, periodontal disease, peri-implant disease, and xerostomia-associated halitosis, while extraoral causes comprise airway related conditions and metabolic/systemic disorders with pulmonary elimination of bloodborne compounds. Perceptual conditions are categorized as pseudohalitosis and halitophobia. A diagnostic workflow is proposed to guide clinicians in distinguishing etiologies.

A diverse microbial community exists within the human oral cavity that plays an essential role in maintaining health or inducing diseases such as dental caries, periodontal disease, and halitosis. Probiotics, live microorganisms that provide health benefits when consumed in adequate amounts, have been found to be promising as a means of modulating the oral microbiome and combating these diseases. This review incorporates present knowledge about the mechanism of probiotic action, including competitive exclusion of pathogens, antimicrobial metabolite production, biofilm disruption, and immune modulation. Efficacy against pathogenic bacteria like Streptococcus mutans and Porphyromonas gingivalis has been proven by prominent probiotic groups Lactobacillus, Bifidobacterium, and Streptococcus, resulting in oral microbial homeostasis. Clinical applications of probiotics include prevention of caries, plaque reduction, and management of gingivitis and periodontitis, with research focusing on strain-specific effects. Emerging trends include precision probiotics tailored to each oral condition, postbiotics as strong alternatives (formerly "strong contenders"), and innovative delivery systems to enhance viability and colonization. The hurdles of strain specificity, regulatory gaps, and inconsistencies of clinical outcome continue. Safety concerns, while rare, represent possible risks of horizontal gene transfer and opportunistic infections in immunocompromised hosts. Future directions lie in genetic modification, new delivery methods, and standard clinical protocols to enhance probiotic function. This review emphasizes the clinical potential of probiotics as adjunctive treatments in oral medicine, with the caveat that further work is needed to overcome current challenges and enhance their therapeutic efficacy.

Fasting during Ramadan can influence oral hygiene behaviors and oral health outcomes. This study aimed to assess dental hygiene practices, attitudes and perceived oral health issues among adult Muslims observing fasting in Bangladesh. A hospital-based cross-sectional survey was conducted at the Dental Unit of Mymensingh Medical College, Bangladesh, among 278 fasting Muslim adults (≥18 years) during Ramadan (1st March 2025 to 31st March 2025). The study aimed to assess dental hygiene practices and oral health concerns related to fasting. Data were collected through face-to-face interviews using a pretested questionnaire. The mean age of participants was 32.6±14.2 years, with 54.7% aged 20-39 years. Females comprised 54.7% of the sample. Most participants brushed once daily (56.8%), primarily after Suhoor and Iftar (38.1%) and 67.6% used fluoride toothpaste. Advanced oral hygiene practices were less common: only 2.9% flossed daily, 10.4% cleaned their tongue daily and 37.4% used Miswak. Mouthwash use after Iftar/ Suhoor was high (85.6%) but low during fasting (3.6%). Halitosis was reported sometimes by 45.4% and regularly by 32.7%. Tooth sensitivity (45.0%) and dry mouth (23.7%) were the most common oral issues. Only 29.9% had a dental check-up in the past six months and many reported difficulty maintaining oral hygiene during fasting. Overall, 57.1% had poor oral hygiene practices, 14.3% average and 28.6% good. Oral hygiene practices among fasting adults were poor, with low adherence to advanced oral care measures and prevalent misconceptions. Educational interventions are recommended to improve oral health awareness and practices during Ramadan.

Oral healthcare is severely hampered in patients with epidermolysis bullosa simplex (EBS), a rare inherited genodermatosis marked by mucocutaneous fragility and blister formation. This case report describes the dental management of a six-year-old female child clinically diagnosed with EBS presenting with severe periodontal manifestations such as extensive calculus accumulation, gingival bleeding, halitosis, and poor oral hygiene as a result of frequent oral ulcerations. Meticulous behaviour modification technique and atraumatic periodontal intervention were employed to minimize soft tissue injury. This report highlights the importance of early dental referral, preventive-focused care, and a multidisciplinary approach in managing pediatric patients with EBS.