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Scientists examine halitosis in COVID‐19 patients

A case series calls for larger epidemiological studies to evaluate the prevalence and pathophysiology of new-onset halitosis in COVID-19 patients. (Image: file404/Shutterstock)
Dental Tribune International

Dental Tribune International

Tue. 29. December 2020


BRNO, Czech Republic: A recent study carried out by scientists from Masaryk University in Brno has suggested that there may be a link between new‐onset halitosis and the course of a SARS-CoV-2 infection.

Dr Abanoub Riad, a research fellow at the Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (CEBHC-KT), spoke to Dental Tribune International about the research. According to him, he and his team had been aware of the fact that the oral cavity might provide a sustainable habitat for SARS-CoV-2 since March 2020. Research from Chinese scientists conducted in February has already shown that xerostomia (abnormal dryness in the mouth) and ageusia (loss of taste functions of the tongue) are among unexpected but prevalent symptoms of COVID-19.

Between May and August 2020, a total of 18 patients sought care because of “an offensive oral malodour that precipitated notable psychosocial distress”. The halitosis intensity was objectively measured with a widely used instrument for the analysis and treatment of chronic halitosis. This device counts the amount of volatile sulphur compounds in parts per billion. “We evaluated halitosis intensity twice: on initial visit, and after one month. Our statistical analysis revealed that there was a significant decrease in halitosis intensity over time in the vast majority of the patients,” Riad stated.

These findings are relevant for future research, Riad said. “Our results support the hypothesis that SARS-CoV-2 is able to trigger epithelial alterations of the tongue dorsum because of the high expression of angiotensin-converting enzyme 2. This hypothesis may explain why salivary flow is disturbed in COVID-19 patients, especially in the ones who reported xerostomia. Although we are not sure why halitosis emerged and declined concurrently with the course of COVID-19, this interesting phenomenon supports the causal relationship between those two entities according to the Bradford Hill criteria,” he commented.

“We couldn’t rule out the role of medications, especially that of unnecessarily prescribed or consumed antibiotics, and the COVID-19 pandemic’s psychological impact on health-related behaviour including on oral hygiene. Although universal masking policies are survival priorities, they may indirectly lead to new-onset halitosis.”

Because the sample group of patients was rather small, Riad added: “I would like to make use of this opportunity to call upon all dental researchers and practitioners worldwide to join forces and allocate resources to carry out larger epidemiological studies for COVID-19 oral manifestations, especially mucocutaneous symptoms.”

The study, titled “Halitosis in COVID-19 patients”, was published on 29 November 2020 in Special Care in Dentistry, ahead of inclusion in an issue.

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