Halitosis in young patients with chronic kidney disease: findings from a randomized controlled trial

Karolin Charlotte Hoefer; Anna Greta Barbe; Anne Adams; Christoph Schoppmeier; Michael Jochen Wicht; Lutz T Weber; Michael J Noack; Isabelle Graf

doi:10.1186/s13005-024-00428-y

Halitosis in young patients with chronic kidney disease: findings from a randomized controlled trial

Head Face Med. 2024 May 15;20(1):32. doi: 10.1186/s13005-024-00428-y.

Authors

Karolin Charlotte Hoefer¹, Anna Greta Barbe¹, Anne Adams², Christoph Schoppmeier¹, Michael Jochen Wicht¹, Lutz T Weber³, Michael J Noack¹, Isabelle Graf⁴

Affiliations

¹ Department of Operative Dentistry and Periodontology, Faculty of Medicine, University Hospital of Cologne, University of Cologne, Cologne, Germany.
² Institute of Medical Statistics and Computational Biology, Medical Faculty, University of Cologne, Cologne, Germany.
³ Department of Pediatric Nephrology, Children's and Adolescents' Hospital, Faculty of Medicine, University Hospital of Cologne, University of Cologne, Cologne, Germany.
⁴ Department of Orthodontics, Faculty of Medicine, University Hospital of Cologne, University of Cologne, Cologne, Germany. isabelle.graf@uk-koeln.de.

Abstract

Background: Chronic kidney disease (CKD) directly affects oral health. Yet data about halitosis in young CKD patients and the impact of dental prophylaxis is limited. Therefore, as part of this randomized clinical trial, halitosis in young CKD patients undergoing intensive or standard oral preventive procedures was to be explored.

Methods: Three volatile sulfur compounds (hydrogen sulfide, methyl mercaptan and dimethyl sulfide) were measured in 30 young patients with CKD (mean age 14.2 years; 16 males, 14 females). Breath samples were taken after 3 and 6 months and analyzed with selective gas chromatography (OralChroma). Tongue coating (Winkel Index) and clinical indices to determine local inflammation or oral hygiene (Papillary Bleeding Index and Quigley-Hein Index) were assessed. Within an extended anamnesis, patients and their mothers and nurses were questioned about the perceived halitosis. Corresponding quotes were noted verbatim. Patients were randomized to either intensive need-related oral health care measures (oral preventative program, OPP) or a one-stage standard prevention (treatment as usual, TAU).

Results: While there were no differences in volatile sulfur compound levels between TAU and OPP at the three time points of measurements (p > 0.05), there was a tendency towards a reduction in dimethyl sulfide and hydrogen sulfide of affected patients within the OPP group over time. Looking at potential differences between both groups with regard to tongue coating, significant differences were observed between baseline and 3 months after study start in the OPP group, and between baseline and 6 months after study start in the TAU group (p < 0.05). The burden of halitosis was frequently reported by patients' mothers and nurses.

Conclusions: Young CKD patients regularly suffered from halitosis and dimethyl sulfide was its main source. Preventive measures mainly resulted in a reduction of tongue coating.

Trial registration: The German Clinical Trial Register (# DRKS00010580).

Keywords: Adolescents; Children; Chronic kidney disease; Halitosis.

Publication types

Randomized Controlled Trial

MeSH terms

Adolescent
Breath Tests / methods
Child
Chromatography, Gas / methods
Female
Halitosis* / etiology
Halitosis* / prevention & control
Humans
Hydrogen Sulfide
Male
Oral Hygiene
Renal Insufficiency, Chronic* / complications
Sulfur Compounds / analysis