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Photodynamic Therapy as Novel Treatment for Halitosis in Adolescents: A Case Series Study

Rubia Garcia Lopes, Maria Eugenia Simões Onofre Santi, Bruno Edin Franco, Alesssandro Melo Deana, Renato Araujo Prates, Cristiane Miranda França, Kristiane Porta Santos Fernandes, Raquel Agnelli Mesquita Ferrari, Sandra Kalil Bussadori




Introduction: Halitosis is a common problem that affects a large portion of the population worldwide. The origin of this condition is oral in 90% of cases and systemic in 10% of cases. The foul odor is caused mainly by volatile sulfur compounds produced by Gram-negative bacteria. However, it has recently been found that anaerobic Gram-positive bacteria also produce hydrogen sulfide (H2S) in the presence of amino acids, such as cysteine. Light with and without the combination of chemical agents has been used to induce therapeutic and antimicrobial effects. In photodynamic therapy, the antimicrobial effect is confined to areas covered by the photosensitizing dye. The aim of the present case series study was to evaluate the antimicrobial effect of photodynamic therapy on halitosis in adolescents through the analysis of volatile sulfur compounds measured using a sulfide meter (Halimeter®).

Methods: Five adolescents aged 14 to 16 years were evaluated using a sulfide meter before and one hour after photodynamic therapy, which involved the use of methylene blue 0.005% on the middle third and posterior thirds of the dorsum of the tongue and nine points of laser irradiation in the red band (660 nm) with an energy dose of 9 J, power output of 100 mW and 90-seconds exposure time.

Results: A 31.8% reduction in the concentration of volatile sulfur compounds was found in the comparison of the initial and final readings. The statistically significant reduction (p = 0.0091) led to an absence of halitosis following treatment (mean: 58.2 ppb).

Conclusion: Photodynamic therapy seems to be effective on reduction the concentration of volatile sulfur compounds.Considering the positive effects of photodynamic therapy in this case series, further studies involving microbiological analyses should be conducted to allow comparisons of the results.


photodynamic therapy; laser; adolescent.


Shimura M, Watanabe S, Iwakura M, Oshikiri Y, Kusumoto M, Ikawa K, et al. Correlation between measurements using a new halitosis monitor and organoleptic assessment. J Periodontol 1997;68(12):1182–5.

Quirynen M, Avontroodt P, Soers C, Zhao H, Pauwels M, Van Steenberghe D. Impact of tongue cleansers on microbial load and taste. J Clin Periodontol 2004;31:506–10.

Rosenberg M, McCulloch CA. Measurement of oral malodor: current methods and future prospects. J Periodontol 1992;63(9):776–82.

Kizhner V, Xu D, Krespi YP. A new tool measuring oral malodor quality of life. Eur Arch Otorhinolaryngol 2011;268:1227–32.

Amir E, Shimonov R, Rosenberg M. Halitosis in children. J Pediatr 1999;134(3):338–43.

Bollen CML, Beikler T. Halitosis: the multidisciplinary approach. Int J Oral Sci 2012;4(2):55–63.

Dal Rio AC, Passos C a C, Nicola JH, Nicola EMD. CO2 laser cryptolysis by coagulation for the treatment of halitosis. Photomed Laser Surg 2006;24(5):630–6.

Marocchio LS, Conceição MD da, Tárzia O. Remoção da saburra lingual: comparação da eficiência de três técnicas. RGO 2009;57:443–8.

Liu P-F, Zhu W-H, Huang C-M. Vaccines and Photodynamic Therapies for Oral Microbial-Related Diseases. Curr Drug Metab 2009;10(1):90–4.

Raangs G, Winkel E, van Winkelhoff A. In vitro antimicrobial effects of two antihalitosis mouth rinses on oral pathogens and human tongue microbiota. Int J Dent Hyg 2013;11(3):203–7.

Salako NO, Philip L. Comparison of the use of the Halimeter and the Oral ChromaTM in the assessment of the ability of common cultivable oral anaerobic bacteria to produce malodorous volatile sulfur compounds from cysteine and methionine. Med Princ Pr 2011;20(1):75–9.

Tolentino EDS, Chinellato LEM, Tarzia O. Saliva and tongue coating pH before and after use of mouthwashes and relationship with parameters of halitosis. J Appl Oral Sci 2011;19(2):90–4.

Calil CM, Marcondes FK. Influence of anxiety on the production of oral volatile sulfur compounds. Life Sci 2006;79(7):660–4.

Springfield J, Suarez F, Majerus G, Lenton P, Furne J, Levitt M. Spontaneus fluctuations in the concentrations of oral súlfur-containing gases. J Dent Res 2001;80(5):1441–4.

Tangerman a, Winkel EG. The portable gas chromatograph OralChromaTM: a method of choice to detect oral and extra-oral halitosis. J Breath Res 2008;2(1): 017010.

Rosenberg M, Kulkarni G, Bosy A, McCulloch C. Reproductibility and sensitivity of oral malodor measurements with a portable sulfide monitor. J Dent Res 1991;70(11):1436–40.

Tanabe S, Grenier D. Characterization of volatile sulfur compound production by Solobacterium moorei. Arch Oral Biol. Elsevier Ltd 2012;57(12):1639–43.

Haraszthy VI, Gerber D, Clark B, Moses P, Parker C, Sreenivasan PK, et al. Characterization and prevalence of Solobacterium moorei associated with oral halitosis. J Breath Res 2008;2(1):017002.

Silvestri L, Weir I, Gregori D, Taylor D, Van Saene J, Van Saene H. Effectiveness of oral chlorhexidine on nosocomial pneumonia, causative microorganisms and mortality in critically ill patients: a systematic review and meta-analysis. Minerva Anestesiol 2013; [Epub ahead of print]

Christensen G. Why clean your tongue? J Am Dent Assoc 1998;129(11):1605–7.

Tarzia O. Halitose: um desafio que tem cura. 1st ed. São Paulo: EPUB; 2003.

Tanaka M, Yamamoto Y, Kuboniwa M, Nonaka A, Nishida N, Maeda K. Contribution of periodontal pathogens on tongue dorsa analyzed with real-time PCR to oral malodor. Microbes Infect 2004;6(12):1078–83.

Bansal M, Khatri M, Taneja V. Potential role of periodontal infection in respiratory diseases - a review. J Med Life 2013;6(3):244–8.

Kara C, Demir T, Orbak R, Tezel A. Effect of Nd: YAG laser irradiation on the treatment of oral malodour associated with chronic periodontitis. Int Dent J 2008;58:151–8.

Kara C, Tezel A, Orbak R. Effect of oral hygiene instruction and scaling on oral malodour in a population of Turkish children with gingival inflammation. Int J Paediatr Dent 2006;16(6):399–404.

Rosenberg M. Bad breath, diagnosis and treatment. Univ Tor Dent J 1990;3(2):7–11.

Donaldson AC, Riggio MP, Rolph HJ, Bagg J, Hodge PJ. Clinical examination of subjects with halitosis. Oral Dis 2007;13(1):63–70.

Furne J, Majerus G, Lenton P, Springfield J, Levitt D G, Levitt M D. Comparison of volatile sulfur compound concentrations measured with a sulfide detector vs. gas chromatography. J Dent Res 2002;81:140–3.

Dai T, Fuchs BB, Coleman JJ, Prates RA, Astrakas C, St Denis TG, et al. Concepts and principles of photodynamic therapy as an alternative antifungal discovery platform. Front Microbiol 2012;3:120.

Pervaiz S, Olivo M. Art and science of photodynamic therapy. Clin Exp Pharmacol Physiol 2006;33:551–6.

Fontana CR, Abernethy a D, Som S, Ruggiero K, Doucette S, Marcantonio RC, et al. The antibacterial effect of photodynamic therapy in dental plaque-derived biofilms. J Periodontal Res 2009;44(6):751–9.

Hope C, Wilson M. Induction of lethal photosensitization in biofilms using a confocal scanning laser as the excitation source. J Antimicrob Chemother 2006;57:1227–30.

Wilson M. Lethal photosensitisation of oral bacteria and its potential application in the photodynamic therapy of oral infections. Photochem Photobiol Sci 2004;3:412–8.

Wainwright M. Photodynamic antimicrobial chemotherapy (PACT). J Antimicrob Chemother 1998;42:13–28.

Saad S, Greenman J, Shaw H. Comparative effects of various commercially available mouthrinse formulations on oral malodor. Oral Dis 2011;17(2):180–6.

Quirynen M, Mongardini C, Van Steenberghe D. The effect of a 1-stage full-mouth disinfection on oral malodor and microbial colonization of the tongue in periodontitis. A pilot study. J Periodontol 1998;69(3):374–82.

Saad S, Hewett K, Greenman J. Effect of mouth-rinse formulations on oral malodour processes in tongue-derived perfusion biofilm model. J Breath Res [Internet] 2012;6(1):016001.

Collins L M, Dawes C. The surface area of the adult human mouth and thickness of the salivary film covering the teeth and oral mucosa. J Dent Res 1987;66(8):1300–2.

Aizawa F, Kishi M, Moriya T, Takahashi M, Inaba D, Yonemitsu M. The analysis of characteristics of elderly people with high VSC level. Oral Dis 2005;11(1):80–2.

Pham T, Ueno M, Zaitsu T, Takehara S, Shinada K, Lam P, et al. Clinical trial of oral malodor treatment in patients with periodontal diseases. J Periodont Res 2011;46(6):722–9.

Casemiro LA, Martins CHG, de Carvalho TC, Panzeri H, Lavrador MAS, Pires-de-Souza FDCP. Effectiveness of a new toothbrush design versus a conventional tongue scraper in improving breath odor and reducing tongue microbiota. J Appl Oral Sci 2008;16(4):271–4.

Motta L J, Bachiega J C, Guedes C C, Laranja L T, BussadoriI S K. Association between halitosis and mouth breathing in children. Clinics 2011;66(6):939–42.

Vandekerckhove B, Van den Velde S, De Smit M, Dadamio J, Teughels W, Van Tornout M, et al. Clinical reliability of non-organoleptic oral malodour measurements. J Clin Periodontol 2009;36(11):964–9.

Quirynen M, Dadamio J, Van den Velde S, De Smit M, Dekeyser C, Van Tornout M, et al. Characteristics of 2000 patients who visited a halitosis clinic. J Clin Periodontol [Internet] 2009;36(11):970–5.

Berakdar M, Callaway A, Eddin MF, Roß A, Willershausen B. Comparison between scaling-root-planing ( SRP ) and SRP / photodynamic therapy: six-month study. Head Face Med. BioMed Central Ltd 2012;8(1):12.

Braun A, Dehn C, Krause F, Jepsen S. Short-term clinical effects of adjunctive antimicrobial photodynamic therapy in periodontal treatment: a randomized clinical trial. J Clin Periodontol 2008;35(10):877–84.

Dilsiz A, Canakci V, Aydin T. Clinical Effects of Potassium–Titanyl– Phosphate Laser and Photodynamic Therapy on Outcomes of Treatment of Chronic Periodontitis: A Randomized Controlled Clinical Trial. J Periodontol 2013;84(3):278–86.

Giannelli M, Formigli L, Lorenzini L, Bani D. Combined photoablative and photodynamic diode laser therapy as an adjunct to non-surgical periodontal treatment . A randomized split-mouth clinical trial. J Clin Periodontol 2012;39:962–70.

Lui J, Corbet E, Jin L. Combined photodynamic and low-level laser therapies as an adjunct to nonsurgical treatment of chronic periodontitis. J Periodontal Res 2011;46:89–96.

Lulic M, Leiggener GI, Salvi GE, Ramseier CA, Mattheos N, Lang NP. One-year outcomes of repeated adjunctive photodynamic therapy during periodontal maintenance: a proof-of-principle randomized controlled clinical trial. J Clin Periodontol 2009;36:661–6.

Polansky R, Haas M, Heschl A, Wimmer G. Clinical effectiveness of photodynamic therapy in the treatment of periodontitis. J Clin Periodontol 2009;36:575–80.

Kleinberg I, Codipilly D. Cysteine challenge testing: a powerful tool for examining oral malodour processes and treatments in vivo. Int Dent J 2002;3:221–8.

Hamblin MR, Hasan T. Photodynamic therapy: a new antimicrobial approach to infectious disease? Photochem Photobiol Sci 2004;3(5):436–50.

Dahl T, Midden W, Hartman P. Comparison of killing of gram-negative and gram-positive bacteria by pure singlet oxygen. J Bacteriol 1989;171:2188–94.

Komerik N, MacRobert AJ. Photodynamic therapy as an alternative antimicrobial modality for oral infections. J Environ Pathol Toxicol Oncol 2006;25(1-2):487–504.

De Boever E H, Loesche W J. Assessing the contribution of anaerobic microflora of the tongue to oral malodor. J Am Dent Assoc 1995;126(10):1384–93.

Betsy J, Prasanth C, Baiju K, Prasanthila J, Subhash N. Efficacy of antimicrobial photodynamic therapy in the management of chronic periodontitis: a randomized controlled clinical trial. J Clin Periodontol 2014;

Sgolastra F, Petrucci A, Gatto R, Marzo G, Monaco A. Photodynamic therapy in the treatment of chronic periodontitis: a systematic review and meta-analysis. Lasers Med Sci 2013;28(2):669–82.

Demir T, Orbak R, Tezel A, Canakç V, Kaya H. The changes in the T-lymphocyte subsets in a population of Turkish children with puberty gingivitis. Int J Paediatr Dent 2009;19(3):206–12.

Sakai V T, Campos M R, Machado MAA M, Lauris JR P, Greene A S, Santos C F. Prevalence of four putative periodontopathic bacteria in saliva of a group of Brazilian children with mixed dentition: 1-year longitudinal study. Int J Paediatr Dent 2007;17(3):192–9.

Joda J, Olukoju O. Halitosis amongst students in tertiary institutions in Lagos state. Afr Health Sci [Internet] 2012;12(4):473–8.

DOI: https://doi.org/10.22037/jlms.v5i3.5930