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Original Research

The association of periodontal disease with oral

malodor before and after antibiotic rinse using
FITSCAN® breath checker: A clinical study
M. P. Singh, Preetika Bansal, Satinder Kaur
Department of Periodontology and Oral Implantology, Dasmesh Institute of Research and Dental Sciences, Faridkot, Punjab, India

ABSTRACT
Context: The term “oral malodor” is used to describe a foul or offensive odor emanating from oral cavity.
Dentist is the first professional whom individuals turn up for help. Gram-negative anerobic pathogens
implicated in periodontal disease have also been linked to oral malodor. A semi-conductor, hand-held gas
sensor with 6 levels of display, brand name FITSCAN® Breath Checker (Tanita Corporation, USA) used
to detect oral malodor. Antibiotics are now being tried and used to treat oral malodor and periodontal
disease. Aims: To evaluate the association between malodor and periodontal status of patients before
and after antibiotic rinse. Materials and Methods: Systemically healthy subjects were divided into
three groups — control group, gingivitis group, periodontitis group. Measurement of oral malodor was
done by FITSCAN® Breath Checker. Antibiotic rinse preparation containing metronidazole was given to Access this article online
patients. An association between oral malodor and periodontal disease status of patients was determined. Website: www.jicdro.org
Statistical analysis used: For intragroup analysis paired “t” test and for intergroup analysis of halitosis DOI: 10.4103/2231-0754.143493
and gingival index “Kruskal-Wallis test” and “Mann-Whitney U test” were applied. Results: Intragroup — Quick Response Code:
Statistical significant decrease in halitosis, Gingival Index (GI) at baseline and 14 days in persons with
gingivitis and periodontitis group, no statistical significant decrease in pocket depth before and after antibiotic
rinse. Intergroup — Statistical significant decrease in Gingival Index status at baseline and 14 days in both
gingivitis andperiodontitisgroups. Conclusion: Strong correlation exists between malodor and periodontal
status and antibiotic rinse is effective in reducing oral malodor.

Key words: Metronidazole, oral malodor, periodontitis

INTRODUCTION of gingival tissues, inducing an inflammatory response.[4] In

The term “oral malodor” is used to describe a foul or
offensive odor emanating from oral cavity. Oral malodor, like
periodontal disease, has been linked to the Gram-negative
anerobic pathogens that are implicated in periodontal
disease, including Porphyromonas gingivalis, Prevotella
intermedia, and Fusobacterium nucleatum. These bacteria are
capable of producing substantial levels of volatile sulfur
compounds (VSCs). [1,2] These compounds are produced
by putrefaction of glycoprotein’s and proteins by micro-
organisms in the oral cavity, including the gingival sulcus,
periodontal pockets, tongue dorsal surfaces, and other
mucous surfaces.[3] VSCs are able to alter the permeability
Address for correspondence:
Dr. M.P. Singh, Department of Periodontology and Oral Implantology,
Dasmesh Institute of Research and Dental Sciences,
Faridkot - 151203, Punjab, India.
E-mail: dr_mpsingh@yahoo.co.uk
addition, VSCs can penetrate deeply into other tissues and
damage the epithelium, basement membrane, and underlying
lamina propria.[5]
Decreasing concentrations of VSCs may be a significant
adjunct to periodontal therapy and in the prevention of
periodontal disease.
The aim of this study was to demonstrate the association
between malodor and periodontal status of patients before
and after use of antibiotic rinse.
MATERIALS AND METHODS
The study comprised 30 subjects recruited from Department
of Periodontology and Oral Implantology, Dasmesh Institute
of Research and Dental Sciences, Faridkot, Punjab. The
patients with age 30 years or more, with minimum of 20
teeth present, and patients without any systemic disorder

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Singh, et al.: Association of oral malodor with periodontitis
like diabetes, hypertension, blood disorders were included
in the study.
While pregnant females, nursing mothers, and smokers were
excluded from the study.
Patients were equally divided into three groups of 10 patients
each were made where Group 1 Control group, Group 2
Gingivitis group and Group 3 Periodontitis group (Pocket depth
5 mm or more). Subjects were screened for periodontal status
by a single examiner on a dental chair and observations were
recorded on a printed proforma. Among clinical parameters
gingival index (Loe&Sillness, 1963) and periodontal pocket
depth using University of North Carolina (UNC)-15 probe were
measured at baseline (day 0) and after 14 days.
Oral malodor score was measured at baseline (day 0) using
FITSCAN® Breath Checker [Figure 1], which is an innovative
palm-size monitor that detects and measures the presence of
breath odors (VSCs). On turning it on, start is displayed and
patient has to breathe into the sensor until it beeps (breath
for about 4 seconds). The opening has to be 1 cm away from
mouth keeping the thumb on to the chin so that the sensor
is right in front of the mouth and a reading appears on the
digital display. It measures odor in seconds and results are
displayed in six levels similar to organoleptic method. A 0
reading means no odor, 1 is slight odor, 2 is moderate odor,
3 is heavy odor, 4 is strong odor, 5 is intense odor, and E is
error sign which means to try again.
Patients with oral malodor score were given metronidazole
antibiotic mouth rinse. No placebo was given. Metronidazole
rinse was available under the trade name of Flagyl syrup
in market and the rinse was diluted to the concentration
of 4% with the help of pharmaceutics and patients were
instructed to use the rinse thrice daily for 14 days. Verbal
instructions were given to the patients about the use
of oral rinse and oral hygiene maintenance. No phase I
Figure 1: FITSCAN® Breath Checker
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therapy was done to any subject. Patients were recalled
after 14 days.
Data analysis was conducted and “paired t-test” was used to
assess the relationship between halitosis and gingival index
in both the groups. The Kruskal-Wallis test was applied to
compare halitosis at baseline and 14 days in three groups and
the Mann-Whitney test was applied to compare gingivitis at
baseline and 14 days in three groups.
RESULTS
The clinical results were encouraging, and patients
provided positive feedback on the use of this antibiotic
rinse for reduction of oral malodor. Patients also reported
decrease in gingival bleeding. Differences in baseline
and post-treatment measurements of breath odor were
compared using a paired t test, and all reductions were
significant (P  < 0.0001) (Graph 1 and 3). There was
significant correlation between halitosis and gingival status
of the patients in group B and C (Graph 2 and 4) but there
was no statistical significance between pocket depth before
and after antibiotic rinse in group C (P < 0.0001; Graph 5).
On intergroup comparison, statistical significant values
were found on comparing halitosis and gingival index in
all three groups at baseline and 14 days interval showing
positive correlation between halitosis and periodontal
health of the patients.
DISCUSSION
The treatment with the antibiotic rinse had a positive
change in the periodontal status of these patients, and
resulted in substantial reduction in bleeding points
but without much change in periodontal pocket depth.
There was significant decrease in breath odor after use
of an antibiotic rinse. Although scaling and root planning
are considered the gold standard in the treatment of
periodontal disease and have been used to decrease
breath odor, recolonization of pathogens — along with the
recurrence of the disease and breathodor — is common
after scaling.[6] The adjunctive use of antimicrobial therapy
Graph 1: Showing baseline and 14 days data of halitosis in gingivitis group
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Singh, et al.: Association of oral malodor with periodontitis
Graph 2: Showing baseline and 14 days data of gingival index in gingivitis group
Graph 4: Showing baseline and 14 days data of gingival index in periodontitis
along with scaling and root planning proves to be beneficial
and should be incorporated as a part of conventional
therapy only. Antibiotics can be administered either by
systemic route or locally. [7] Since micro-organisms vary
considerably in sensitivity to antibiotics, choosing the
appropriate antimicrobial chemotherapy is essential for
success of the treatment. Most successful treatments
address both the bacterial and inflammatory component of
the condition.[8] It has been found out that metronidazole
is effective in treating periodontal infections. The low
minimum inhibitory concentration of metronidazole
made it a useful chemotherapeutic agent for treating
anaerobic infections.[7] Various other studies have shown
improvement in clinical outcomes with the systemic use
of metronidazole/ amoxicillin, together with full mouth
periodontal debridement.[9,10] Systemic administration of
antimicrobial provides availability of drug to multiple sites
of disease activity. However, topical application of antibiotic,
will coat all oral tissues, as well as the tonsillar areas,
achieving an overall decrease in halitosis and periodontal
disease markers without the risk of the systemic effects
of an oral antibiotic.[7] Better results are achieved because
of venturi effect when vigorous rinsing is done in which
particles enter the gingival sulcus and float over a pocket,
the crevicular fluid drops, pulling the particle deeper into
the pocket. The concentrated antibiotic particles can then
act on the biofilm found at the base of these pockets.[7]
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Graph 3: Showing baseline and 14 days data of halitosis in periodontitis group
Graph 5: Showing baseline and 14 days data of pocket depth in periodontitis
group
CONCLUSION
This study of cases shows that there is strong correlation
between oral malodor and periodontal health status of
patients. As there is increase in number of pathogenic
microorganisms in periodontal disease, it results in increased
oral malodor. Also, with the use of oral metronidazole
antibiotic rinse it has been found that there is potential of
using antibioticrinses to treat periodontal disease andoral
malodor caused by oral pathogens.
Clinical implications
FITSCAN® Breath Checker is an innovative portable device
which can be used to detect oral malodor in patients. Also,
this study shows that there is strong correlation between
oral malodor and periodontal disease status and antibiotic
mouth rinses can be effectively used to treat oral malodor
and periodontal disease.
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Cite this article as: Singh MP, Bansal P, Kaur S. The association of periodontal
disease with oral malodor before and after antibiotic rinse using FITSCAN®
breath checker: A clinical study. J Int Clin Dent Res Organ 2014;6:103-6.
Source of Support: Nil. Conflict of Interest: None declared.

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