Title Weak Evidence Supports Using Saliva Viscosity as an Independent Indicator for Diagnosing Halitosis
Clinical Question Does high-viscosity saliva contribute to the oral malodor of patients with halitosis?
Clinical Bottom Line The clinical significance on the viscosity of saliva is slight. Many independent variables may contribute to oral malodor. The data suggests a weak correlation between the viscosity of saliva and halitosis.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
25115949Ueno/2014617 patients in an oral malodor cliniccross sectional observation (two groups based on odor score)
Key resultsThe odds ratio of saliva viscosity contributing to oral malodor was 1.10 with a p-value of 0.047, demonstrating a very weak association between an increase in saliva viscosity and oral malodor. The results of this study failed to clearly establish a statistical association between saliva viscosity and malodor.
Evidence Search ("saliva"[MeSH Terms] OR "saliva"[All Fields]) AND ("mouth"[MeSH Terms] OR "mouth"[All Fields] OR "oral"[All Fields]) AND malodor[All Fields]
Comments on
The Evidence
This was a cross sectional/observational study where a sample of 617 subjects was divided into two groups based on their odor score. All subjects were patients at a malodor clinic whose saliva viscosity was evaluated similarly by using a viscometer and organoleptic test (OT). The compliance and completion rates were not reported. The validity of this study was compromised due to multiple confounding factors impacting clinical diagnosis such as: systemic health, age, diet, medication, periodontal status, and oral hygiene compliance. Bias was found due to the nature of the study design comparing the same group with the same characteristics (halitosis). Future studies could include a healthy control group for comparison. The current theory of halitosis espoused by Dr. Joseph Tonzetich was that volatile sulfur compounds (VSCs) that rest on the dorsum of the tongue are the main cause of oral malodor. To date dentistry continues to find a delicate balance between managing halitosis and treating it as part of a systemic health.
Applicability Salivary testing in a dental office will help generate an individualized plan of care to facilitate comprehensive healthcare. Psychological harm could come in isolated cases in the form of embarrassment. This could also impact the ability to speak with confidence and impact quality of life. Potential benefits of saliva viscosity testing include improved salivary pH, reduction in caries risk, reduction of bacteria on the dorsum of the tongue, and reduced oral malodor. When appropriate the dental provider should make appropriate referrals to our medical colleagues for evaluation of systemic disease in conjunction with dental therapy.
Specialty (General Dentistry) (Periodontics)
Keywords Saliva, oral malodor, saliva viscosity, viscometer, organoleptic test
ID# 2909
Date of submission 08/12/2015
E-mail cortezano@livemail.uthscsa.edu
Author Patrisha Cortezano
Co-author(s) Kris Waller
Co-author(s) e-mail wallerk@livemail.uthscsa.edu
Faculty mentor Carol A. Nguyen, MPH, MS
Faculty mentor e-mail NGUYENC@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
None available