Modern Diagnostic and Therapeutic Approaches for Halitosis in Children and Adults

✅ Abstract
Halitosis, or oral malodor, remains a prevalent condition affecting both children and adults. Advances in diagnostic tools and modern therapeutic approaches now allow for more accurate identification and management of its multifactorial causes.

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This article reviews the latest scientific evidence on diagnostic innovations, such as AI-based monitoring and endoscopic evaluation, as well as contemporary treatments including probiotics, photodynamic therapy, and multidisciplinary management.

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✅ Introduction
Halitosis, commonly referred to as bad breath, is an unpleasant odor emanating from the oral cavity that can arise from intraoral or extraoral sources. It affects approximately 30–50% of the global population and has significant psychosocial implications (Murata et al., 2023). Recent studies have focused on refining diagnostic methods and developing less invasive, more effective treatments tailored to both pediatric and adult patients.

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✅ Modern Diagnostic Methods
Accurate diagnosis of halitosis requires a combination of sensory, chemical, and digital evaluations. Traditional methods such as organoleptic tests remain common, yet newer innovations—including gas chromatography, Halimeter®, and AI-based devices—are improving precision and accessibility.
Endoscopic and complementary tests have also gained clinical importance, especially in identifying extraoral origins such as Helicobacter pylori infection or gastroesophageal reflux disease (Lee et al., 2022).

📊 Comparative Table: Modern Diagnostic Methods for Halitosis

Aspect	Advantages	Limitations
Organoleptic Test	Simple, low-cost method providing direct sensory evaluation of odor intensity	Subjective results; depends on examiner’s perception and consistency
Gas Chromatography	Accurate identification and quantification of volatile sulfur compounds (VSCs)	High operational cost and requires specialized equipment and expertise
Halimeter® Device	Portable, quick results, ideal for clinical screening of sulfur compounds	Limited sensitivity; cannot detect non-sulfur gases contributing to halitosis
Microbiological Culture	Identifies specific anaerobic bacteria related to halitosis etiology	Time-consuming and requires laboratory infrastructure
Digital Sensory Evaluation (AI-based Apps)	Provides at-home monitoring using artificial intelligence and volatile gas sensors	Still under validation; results depend on sensor accuracy and calibration
Endoscopy and Complementary Tests	Detects gastrointestinal causes such as H. pylori infection or reflux-related halitosis	Invasive, costly, and requires referral to medical specialists

✅ Contemporary Therapeutic Strategies
The modern management of halitosis emphasizes both etiological control and microbiome balance. Conventional approaches include chlorhexidine or zinc-based mouthrinses, while current evidence supports additional therapies such as probiotics, laser-assisted biofilm control, and multidisciplinary management when systemic or gastrointestinal factors are present (Kozlovsky et al., 2023; Murata et al., 2023).

📊 Comparative Table: Benefits of Modern Halitosis Treatments

Aspect	Advantages	Limitations
Chlorhexidine Mouthrinses	Effective antimicrobial action reducing oral bacterial load and VSCs	Prolonged use may cause staining and taste alteration
Zinc-Based Formulations	Neutralize volatile sulfur compounds and enhance oral freshness	Requires continuous application to maintain results
Probiotic Therapy	Restores balance in oral microbiota and reduces pathogenic species	Long-term clinical efficacy still under evaluation
Laser and Photodynamic Therapy	Non-invasive bacterial reduction and biofilm elimination	Expensive and requires professional training and devices
Multidisciplinary Management (Probiotics or H. pylori Eradication)	Addresses extraoral causes of halitosis and promotes systemic-microbial balance	Requires collaboration with gastroenterologists and longer treatment periods

💬 Discussion
The integration of technology and biology has revolutionized halitosis management. AI-driven diagnostic tools and portable halimeters allow for personalized tracking, while endoscopic assessments identify systemic causes more effectively. Therapeutically, shifting toward microbiota-centered interventions like probiotics reflects a paradigm change from masking odor to restoring microbial harmony. Multidisciplinary approaches—particularly in patients with gastrointestinal involvement—ensure comprehensive and long-lasting control.

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✍️ Conclusion
Modern halitosis diagnosis and treatment now emphasize precision, accessibility, and patient-centered care. Combining digital diagnostics, microbiological insight, and multidisciplinary management provides the best outcomes in both pediatric and adult populations. Ongoing research in artificial intelligence and probiotic modulation continues to redefine the future of halitosis therapy.

🔎 Recommendations

1. Integrate AI-based halitosis monitoring in clinical and home settings for early detection.
2. Evaluate gastrointestinal conditions when halitosis persists despite oral care.
3. Promote probiotic use as a preventive and adjunctive measure.
4. Encourage collaboration between dentists, gastroenterologists, and pediatricians for systemic cases.
5. Implement photodynamic or laser therapies as safe alternatives for biofilm control in resistant cases.

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📚 References

✔ Kim, J., Lee, S., & Park, Y. (2023). Development of a portable halitosis monitoring device using artificial intelligence-based volatile gas sensors. Sensors, 23(9), 4221. https://doi.org/10.3390/s23094221
✔ Lee, J. H., Han, D. H., & Kim, Y. S. (2022). Correlation between Helicobacter pylori infection and extraoral halitosis: A cross-sectional clinical study. Journal of Breath Research, 16(2), 026001. https://doi.org/10.1088/1752-7163/ac4b90
✔ Kozlovsky, A., Houri-Haddad, Y., & Feuerstein, O. (2023). Probiotic approaches for oral malodor: Evidence-based perspectives and clinical applications. Clinical Oral Investigations, 27(3), 1167–1176. https://doi.org/10.1007/s00784-022-04685-5
✔ Murata, T., Miyazaki, H., & Sakamoto, M. (2023). Current concepts in the diagnosis and management of oral malodor: A multidisciplinary approach. International Journal of Dental Hygiene, 21(4), 565–573. https://doi.org/10.1111/idh.12693
✔ Seerangaiyan, K., Jørgensen, M. G., & Belstrøm, D. (2022). Advances in diagnostic technologies for oral malodor: From organoleptic to AI-based systems. Frontiers in Oral Health, 3, 872198. https://doi.org/10.3389/froh.2022.872198

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