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128 rev port estomatol med dent cir maxilofac. 2019;60(3):125-129

Table 2. Performance of oral hygiene practices and oral malodor perception by others at baseline and after 27 days.
After 27 days
Concordance κ p-value
No Sometimes Yes

No 0 0 33
Performance of oral
hygiene practices Baseline Sometimes 0 0 4 10.0%
Yes 0 0 3
Never/almost Frequently/
never Sometimes always
Never/almost 0
never 15 0
Oral malodor perception Baseline 37.5% 0.04 0.613
by others Sometimes 10 0 0
Frequently/always 7 8 0
Kappa statistic was not calculated because the variable “performance of oral hygiene practices after 27 days” was constant.

days, the oral malodor scores had significantly decreased com-
Table 3. Self-perception of halitosis, oral malodor
measurements and tongue coating at baseline and after pared to the baseline, although the clinical study indicated an
27 days. increase after the braces were applied. 3,13 This disparity may
be explained by the variability of oral hygiene methodology,
Variable Baseline After 27 days p-value
considering that the participants were adolescents. Adoles-
Self perception cents need a unique approach to be motivated about their oral
of halitosis 52.50 ± 28.7 85.00 ± 25 < 0.001 health issues, which are substantially associated with their
Oral malodor 4.00 ± 2 1.00 ± 2 < 0.001 social interactions.
measurement Organoleptic measurement has been suggested as the gold
standard clinical method for halitosis assessment, but its in-
Tongue coating 2.50 ± 1 0.00 ± 1 < 0.001
15
herent subjectivity compels the use of other methods. Addi-
Values are expressed as median ± interquartile range. tionally, an interventional clinical study has demonstrated
16
that total VSC-level measurement positively correlates with
the organoleptic test and tongue-coating scores.
The subjects in this study revealed an excellent improve-
Discussion ment following the implementation of the oral education pro-
gram that was particularly attributed to the routine use of
The influence of conventional fixed orthodontic appliances tongue scrapers. The tongue constitutes the largest microcosm
on oral health was investigated based on gingival bleeding, of the oral cavity and is inhabited by a highly-diversified body
9
oral health procedures, and oral malodor perception and of microorganisms. Scientific evidence has demonstrated that
measurement. Although oral malodor self-perception is a mechanical approaches, such as tongue brushing or scraping,
subjective evaluation, the participants followed an objective have the potential to control oral odor successfully. 17,18 Al-
measuring method. though studies have pointed out that tongue coating and
Gingival bleeding was a prevalent complaint in patients plaque are increased in fixed-orthodontic patients, the pres-
19
undergoing fixed orthodontic therapy. This finding is mainly ent investigation demonstrated a decrease in those indexes 27
attributed to the orthodontic appliance components, which days after implementation of the oral education program.
represent an important focus for biofilm accumulation, there- In this investigation, malodor was related to inadequate
by promoting gingivitis. Despite the taught oral hygiene mea- oral hygiene practices, which is consistent with the findings
sures, the clinical study detected moderate gingivitis in all of other studies; however, those studies did not consider ado-
fixed orthodontics patients. In addition, fixed appliances re- lescents under orthodontic therapy. 20,21
strict the ability of the tongue and lips to clean the teeth and With regard to the sample’s social demographics, although
gingiva mechanically, 1,12 which contributes to a pathological the subjects had middle education, it was deduced that they
microbial environment associated with a high prevalence of were not fully aware of oral malodor etiopathogeny and, con-
halitosis. sequently, its management.
The portable dispositive Breath Checker used in this inves- One limitation of this study was the short time of the fol-
tigation provided an objective measurement, as well as the low-up (27 days) since the results could change over a longer
advantage of being portable, inexpensive and simple to use. period of monitoring. As patients’ oral health practices im-
Recent studies have pointed out that portable devices show prove over time, a different oral ecosystem is expected to be-
14
good concordance with organoleptic measurements. After 27 come established. Orthodontists should be aware that patients