Bad breath detectors / testing devices for halitosis. - 6 methods dentists and researchers use to detect and quantify a patient's halitosis:

Halimeter,  Gas chromatography,  Organoleptic testing,  BANA test strips,  Chemical sensors,  Hand-held (Tanita) breath checkers. | Which types of detectors does a dentist usually have? Which ones can a person buy?

Testing devices for halitosis.

Before a researcher can evaluate the effectiveness of a bad breath cure, or a dentist can determine the progress their patient has made with their condition, each needs a way to test for and quantify oral odors.

This page covers the following 6 methods that dentists/researchers may use when evaluating and quantifying a patient's oral odor:

 

What level of testing do most patients' cases need?

Smell vs. device testing.

Organoleptic testing.

The first method we discuss on this page is organoleptic testing, which means the clinician performs a smell test.

In formal use, this type of testing is performed under controlled conditions (explained below) so its results are reliable and reproducible. But of course, at least to some degree, anyone can perform this type of evaluation.

Device-oriented testing.

The other methods we describe on this page are more technical in nature, in the sense that they involve the use of some type of special device (detector, analyzer, strips, etc...) that's been designed to identify compounds that are usually/frequently associated with halitosis cases.

However, to be a valid test for your specific condition, obviously those particular compounds must play a role in creating your breath odors (which isn't always the case).

A quick self-test may be all that you need.

We mention this because quantifying your condition may not be as important as simply knowing that it exists. After all, the same first steps are always taken with all cases.

And just a simple smell test can accomplish this, whether it's performed by your dentist or hygienist. Or even by yourself via an at-home method that allows you to accurately smell your own breath.


Scientific testing methods for bad breath -

This page covers the following 6 methods that dentists/researchers may use when evaluating and quantifying a patient's oral odor:

 

a) Organoleptic testing.

This is just a fancy way of saying that the tester uses their own nose to make the judgment. We mention it first because this is the oldest method of making an evaluation.

It's been used in numerous studies, and it's easy enough to see why. A human nose is always readily available, and doesn't cost anything to operate. And despite what you might think initially, it's a pretty sophisticated piece of equipment in the sense that one can detect up to 10,000 different smells.

Considerations involving the tester.

Bias.

One obvious problem with organoleptic testing is that it's not totally objective in the way machine testing is. Unrelated factors might be evident to the tester and influence the outcome of their determination.

Additionally, when repeatedly exposed to a bad odor a person's sense of smell tends to acclimate to it, and therefore loses much of its sensitivity.

(This is a biological process referred to as "adaptation." And due to it, a person's breath that seems exceedingly objectionable at the beginning of testing may seem much less so as their evaluation continues.)

Additional issues.

Another difficulty is that certain factors may influence the tester's judgment. For example, studies have shown that hunger, head position, degree of attentiveness and level of expectation may each influence the evaluation. Additionally, people who smoke, are pregnant, have chronic allergies or asthma tend not to make good judges.

Considerations involving the subject.

Factors associated with the person being tested need to be controlled for too.

  • The consumption of garlic, onions or spicy foods should be stopped 48 hours prior to testing.
  • Scented cosmetics should not be used during the preceding 24 hour period.
  • The subject should avoid consuming foods, drinks or tobacco products for 12 hours before their assessment.
  • They should also refrain from using oral rinses, breath fresheners and omit usual oral hygiene practices 12 hours prior.

Section references - Yaegaki

How available is this type of testing?

There actually are methods you can use to objectively perform organoleptic testing at-home on your own, and of course, your dentist or dental hygienist can also perform cursory versions of this type of evaluation when you see them.

Formal analysis (making evaluations under controlled conditions) is theoretically possible almost anywhere, as long as the tester strictly follows the steps of established protocol.

b) Halimeter testing.

A Halimeter is a type of breath testing device designed to identify levels of sulfide gases. (Sulfides, such as hydrogen sulfide and methyl mercaptan, collectively referred to as volatile sulfur compounds or "VSC's," are known to be causative agents of halitosis.) Halimeter testing was first introduced in 1991.

Drawbacks.
  • Halimeters only detects sulfides as a class and not as individual compounds.

    [In comparison, a gas chromatograph (discussed below) provides a more detailed breakdown of both the compounds present and their concentration.]

  • The effectiveness/benefit of performing Halimeter testing is limited to situations where the types of gases it is able to detect are in fact problem compounds associated with the subject's case. (This means that a Halimeter won't be able to identify all cases of halitosis.)
  • Ethanol (drinking alcohol) and essential oils, both of which are frequently found in mouthwash, can interfere with Halimeter measurements.
Advantages.

Halimeter testing does not require extensive training to perform, measurements can be made quickly, the units are portable, and the device is relatively inexpensive. (On the order of $3000, which for dental equipment isn't so bad.)

How available is Halimeter testing?

Related to its ease of use and affordability, dentists who take a special interest in treating halitosis cases often have one of these detectors in their office. However, most general dentists probably will not own one.

We continue our discussion about Halimeter testing in our next section.


c) Portable (at-home, pocket) bad breath testers/checkers.

This type of device is similar to a Halimeter, in the sense that it detects the presence of sulfide gases in the subject's breath. The function of these devices is based on a semiconductor gas sensor.

How available is this type of breath analyzer?

We've seen two products for sale. One is the Tanita FitScan Bad Breath Checker (Tanita, Inc.). The other we see termed as the "Pocket Bad Breath Tester Odor Detector" but we're unclear who makes this device.

Both are small one-hand devices that retail for around $50 or less. Some publications suggest that dentists might use this type of unit in their clinical practice.

What does research say about the effectiveness of portable halitosis monitors?

We ran across a study by Falcao that specifically compared the use of organoleptic (smell) evaluation vs. Halimeter testing vs. the use of a device named the Breath Alert (a previous Tanita model).

The goal of the study was to compare the accuracy of each method in identifying cases of halitosis with patients for whom that was not a complaint. (One might assume that since the person was unaware of their condition that these were slight or marginal cases.)

Study findings.

The conclusions stated were generally critical of the ability of a Halimeter or Tanita device in identifying these types of cases. And the accuracy of these units was generally considered to be low (as compared to organoleptic testing).

Out of the subjects determined to have bad breath (by organoleptic testing), Halimeter use was only able to identify 33% of the cases. The Tinita breath checker identified only 24%.

Just like we mentioned above, discussion in the paper points out that the use of a sensor device is limited by the number or class of compounds it has been designed to detect, and of course its sensitivity/calibration. In comparison, smell testing does not share this type of constraint.

Section references - Falcao

d) The BANA test.

Some of the types of bacteria that cause periodontal disease (gum disease) also produce smelly waste products that cause bad breath. The BANA test is used to check for the presence of these types of bacteria, by way of evaluating a sample of the subject's saliva, dental plaque or a tongue swab.

The types of bacteria in question produce an enzyme that degrades the compound benzoyl-D, L-arginine-naphthylamide (abbreviated BANA). When this reaction occurs, it produces a color change in the BANA test strip.

How available is BANA testing?

The materials needed (test strips and incubator) are relatively inexpensive, and from that standpoint makes this an affordable test for a dentist to have available in their office.

However, since gum disease is not the most common cause of bad breath, probably only those dentists who have an advanced interest in treating halitosis cases (or diagnosing specifics about patient periodontal conditions) will have it on hand.

Related to the need to incubate the BANA strips for 5 to 15 minutes at 55 degrees C (131 F), there is no at-home version of this test.


e) Gas chromatography.

A gas chromatograph is a scientific apparatus that can identify and precisely measure compounds in test samples, even when found in very low concentrations. The use of one of these machines is considered to be the gold standard for breath testing because the results are highly objective, reproducible and reliable.

How available is this type of testing?

While being a very precise method, the use of gas chromatography hasn't been extensively used in scientific studies.

That's because these machines are relatively expensive, they're not portable, they require special training to operate and require a significant amount of time to take each measurement. We'll also say that it's unlikely that your dentist has one.


 

f) Chemical sensors.

As a way of improving sensitivity (as compared to a Halimeter), and providing greater convenience for the dentist (as compared to a gas chromatograph), chemical sensors have been developed for halitosis testing.

This type of device usually takes the form of a probe that can be used to take readings from both the surface of the tongue and below the gum line (the two areas most associated with bad breath).

Newer types of sensors can measure multiple types of sulfur-containing compounds separately (an improvement over Halimeter technology) but generally, this type of detection is still considered to be in the development stage.

Section references - (Primary source for all of the scientific methods described above.) - Aylikci, Bicak


Our next page explains what the odors you smell are and where they come from. Once you know that, you'll know how to cure your breath problems.

Or if instead you'd like to learn more about the scientific side of evaluating halitosis, you might be interested in our page: Classifications used to categorize patients' halitosis.

 
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