title: Intra- and extra-oral halitosis: finding of a new form of extra-oral blood-borne halitosis caused by dimethyl sulphide.
abstract: OBJECTIVE
  The aim of this study was to unravel the origen and cause of intra-oral and extra-oral halitosis.
  
  
  METHODS
  We studied 58 patients complaining of halitosis, using gas chromatography of volatile sulphur compounds (VSCs) in mouth and nose breath, organoleptic scoring of mouth and nose breath, Halimeter readings of mouth air and tongue-coating inspection. Subjects had no precence or history of periodontitis.
  
  
  RESULTS
  Of 58 patients, 47 patients had halitosis of oral origin, six had halitosis of extra-oral origin and five had no halitosis (halitophobia). A strong correlation was found between the degree of intra-oral halitosis as measured by organoleptic scoring of mouth breath and the concentration of the VSCs hydrogen sulphide (H(2)S) and methyl mercaptan (CH(3)SH) in mouth breath. Taking into account the much larger odour index of CH(3)SH, it was concluded that CH(3)SH is the main contributor to intra-oral halitosis. In all six cases of extra-oral halitosis, halitosis was caused by the presence of elevated levels of dimethyl sulphide (CH(3)SCH(3)) in mouth and nose breath.
  
  
  CONCLUSIONS
  Our study provides evidence that the VSC, CH(3)SH and to a lesser extent H(2)S are the main contributors to intra-oral halitosis and that CH(3)SCH(3) is the main contributor to extra-oral or blood-borne halitosis, due to a hitherto unknown metabolic disorder.
authors: Department of Periodontology, Academic Centre Oral Health, University Medical Centre, Groningen, The Netherlands.
authors: Albert
authors: A
authors: Tangerman
authors: Edwin G
authors: EG
authors: Winkel
mesh_terms: D000328:Adult; D002849:Chromatography, Gas; D006209:Halitosis / Q000097:blood / Q000145:classification / Q000209:etiology*; D006801:Humans; D006862:Hydrogen Sulfide / Q000032:analysis; D008875:Middle Aged; D009055:Mouth / Q000378:metabolism; D009297:Nasal Mucosa / Q000378:metabolism; D009812:Odorants / Q000032:analysis; D013438:Sulfhydryl Compounds / Q000032:analysis; D013440:Sulfides / Q000032:analysis*; D013457:Sulfur Compounds / Q000032:analysis; D014059:Tongue / Q000378:metabolism
chemical_list: D013438:Sulfhydryl Compounds; D013440:Sulfides; D013457:Sulfur Compounds; C005231:methylmercaptan; C004784:dimethyl sulfide; D006862:Hydrogen Sulfide