Accuracy of two methods to detect the presence of halitosis: the volatile sulfur compounds concentration in the mouth air and the information from a close person

RODRIGUES, Nádia Cristina Pinheiro; ABRÃO NETO, Alexandre; NADANOVSKY, Paulo

doi:10.1590/1678-7757-2022-0412

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Brasil

Journal of Applied Oral Science

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Original Article • J. Appl. Oral Sci. 31 • 2023 • https://doi.org/10.1590/1678-7757-2022-0412 copy

Accuracy of two methods to detect the presence of halitosis: the volatile sulfur compounds concentration in the mouth air and the information from a close person

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This study aimed to analyze the accuracy of two methods for detecting halitosis, the organoleptic assessment by a trained professional (OA) with volatile sulfur compounds (VSC) measurement via Halimeter^® (Interscan Corporation) and information obtained from a close person (ICP).

Methodolody

Participants were patients and companions who visited a university hospital over one year period to perform digestive endoscopy. A total of 138 participants were included in the VSC test, whose 115 were also included in the ICP test. ROC curves were constructed to establish the best VSC cut-off points.

Results

The prevalence of halitosis was 12% (95%CI: 7% to 18%) and 9% (95%CI 3% to 14%) for the OA and ICP, respectively. At the cut-off point >80 parts per billion (ppb) VSC, the prevalence of halitosis was 18% (95%CI: 12% to 25%). At the cut-off point >65 ppb VSC, sensitivity and specificity were 94% and 76%, respectively. At the cut-off point >140 ppb, sensitivity was 47% and specificity 96%. For the ICP, sensitivity was 14% and specificity 92%.

Conclusions

VSC presents high sensitivity at the cut-off point of >65 ppb and high specificity at the cut-off point of >140 ppb. ICP had high specificity, but low sensitivity. The OA can express either occasional or chronic bad breath, whereas the ICP can be a potential instrument to detect chronic halitosis.

Halitosis; Mouth; Data accuracy; Reproducibility of results; Oral diagnosis; Epidemiology

Agreement of scores		Information from a Close Person (ICP)
two weeks apart		Very bad odor	Bad odor	Moderate odor	Good odor	Very good odor	Total
Retest Information from the same Close Person after two weeks	Very bad odor	0	0	0	0	0	0
	Bad odor	0	2	0	0	0	2
	Moderate odor	0	0	8	7	1	16
	Good odor	0	1	2	14	4	21
	Very good odor	0	0	0	0	1	1
	Total	0	3	10	21	6	40

n	Agreement	Kappa		Kappa		Kappa (w²)
n	Global Kappa (cut-off: score ≥ 3)	(2 cat; cut-off: score ≥ 2)		(2 cat; cut-off: score ≥ 3)		(5 cat)

40	0,98	0,52		0,79		0,51
40		(CI 95% 0.30 – .74)		(CI 95% 0.38 – 1)		(p-value<0.001)

Halitosis		Organoleptic Judgment (OJ) – specific cut-off		Total
		Yes	No
Test:	Yes	16	29 (24%)¹	45
VSC	No	1 (6%)²	92	93
Cut off = 65ppm	Total	17	121	138
Test:	Yes	11	14 (12%)	25
VSC	No	6 (35%)	107	113
Cut off = 80ppm	Total	17	121	138
Test:	Yes	8	5 (4%)	13
VSC	No	9 (53%)	116	125
Cut off = 140ppb	Total	17	121	138
	Yes	5	37 (41%)	42
Test:	No	9 (64%)	54	63
ICP Cut off sensitive	Total	14	91	105
Test:	Yes	2	7 (8%)	9
ICP Cut off specific	No	12 (86%)	84	96
	Total	14	91	105

Halitosis		Organoleptic Judgment (OJ) – sensitive cut-off		Total
		Yes	No
Test:	Yes	84	21 (49%)¹	105
VSC	No	11 (12%)²	22	33
Cut off = 35ppm	Total	95	43	138
Test:	Yes	68	9 (21%)	77
VSC	No	27 (28%)	34	61
Cut off = 50ppm	Total	95	43	138
Test:	Yes	23	2 (5%)	25
VSC	No	72 (76%)	41	113
Cut off = 80ppb	Total	95	43	138
Test:	Yes	34	8 (26%)	42
ICP Cut off sensitive	No	40 (54%)	23	63
	Total	74	31	105
Test:	Yes	7	2 (6%)	9
ICP Cut off specific	No	67 (91%)	29	96
	Total	74	31	105

	OJ (cut-off: score >=3) vs. VSC (cut-off>=65ppb)	OJ (cut-off: score >=3) vs. VSC (cut-off >=80ppb)	OJ (cut-off: score >=3) vs. VSC (cut-off >=140ppb)
Agreement global	0,78	0,86	0,9
Kappa 95%CI	0.41 (0.26 to 0.57)	0.40 (0.27 to 0.53)	0.48 (0.25 to 0.71)
MacNemar X2	26.13 (p-v < 0.001)	3.20 (p-v < 0.07)	1.14 (p-v < 0.29)
Sensitivity 95%CI	0.94 (0.90 to 0.98)	0.65 (0.57 to 0.73)	0.47 (0.39 to 0.55)
Specificity 95%CI	0.76 (0.69 to 0.83)	0.88 (0.83 to 0.94)	0.96 (0.93 to 0.99)
PPV 95%CI	0.36 (0.28 to 0.44)	0.44 (0.36 to 0.52)	0.62 (0.53 to 0.70)
NPV 95%CI	0.99 (0.97 to 1.07)	0.95 (0.91 to 0.98)	0.93 (0.88 to 0.97)
OJ Prev (Gold Standard)	0.12 (0.07 to 0.18)
VSC prev 95%CI	0.33 (0.25 to 0.40)	0.18 (0.12 to 0.25)	0.09 (0.05 to 0.14)

	OJ (cut-off: score >=2) vs. VSC (cut-off >=35ppb)	OJ (cut-off: score >=2) vs. VSC (cut-off >=50ppb)	OJ (cut-off: score >=2) vs. VSC (cut-off >=80ppb)
Agreement global	0,77	0,74	0,46
Kappa 95%CI	0.42 (0.26 to 0.59)	0.45 (0.31 to 0.60)	0.14 (0.05 to 0.22)
Mac Nemar X²	3.13 (p-v < 0.08)	9.00 (p-v < 0.001)	62.22 (p-v < 0.001)
Sensitivity 95%CI	0.88 (0.83 to 0.94)	0.72 (0.64 to 0.79)	0.24 (0.17 to 0.31)
Specificity 95%CI	0.51 (0.43 to 0.60)	0.79 (0.72 to 0.86)	0.95 (0.92 to 0.99)
PPV 95%CI	0.80 (0.73 to 0.87)	0.88 (0.83 to 0.94)	0.92 (0.87 to 0.97)
NPV 95%CI	0.67 (0.59 to 75)	0.56 (0.47 to 0.64)	0.36 (0.28 to 0.44)
OJ prev (Gold Standard)	0.69 (0.61 to 0.77)
VSC prevalence 95%CI	0.76 (0.69 to 0.83)	0.56 (0.47 to 0.64)	0.18 (0.12 to 0.25)

	OJ (cut-off: score >=2) vs. ICP (cut-off: score >=2)	OJ (cut-off: score >=3) vs. ICP (cut-off: score >=3)
Agreement global	0,54	0,82
Kappa 95%CI	0.16 (0 to 0.30)	0.08 (-0.15 to 0.3)
MacNemar X2 95%CI	21.33 (p-v < 0.001)	1.32 (p-v < 0.25)
Sensitivity 95%CI	0.46 (0.36 to 0.55)	0.14 (0.08 to 0.21)
Specificity 95%CI	0.74 (0.66 to 0.83)	0.92 (0.87 to 0.97)
PPV 95%CI	0.81 (0.73 to 0.88)	0.22 (0.14 to 0.30)
NPV 95%CI	0.37 (0.27 to 0.46)	0.86 (0.81 to 0.94)
OJ prev (Gold Standard)	0.69 (0.61 to 0.77)	0.12 (0.07 to 0.18)
ICP 95%CI	0.35 (0.28 to 0.41)	0.09 (0.03 to 0.14)

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[1] Corresponding address: Nádia Cristina Pinheiro Rodrigues Universidade do Estado do Rio de Janeiro - Rua São Francisco Xavier, 524 - Maracanã - 20559-900 - Rio de Janeiro - RJ - Brasil. e-mail: nadiacristinapr@gmail.com