Halitosis is a common condition with a significant impact on individuals’ quality of life. The Halitosis Associated Life-Quality Test (HALT) is a reliable instrument for measuring this impact. This study aimed to introduce and validate the Romanian translation of the HALT questionnaire (R-HALT). We hypothesized that the R-HALT would demonstrate good reliability and validity in measuring the impact of halitosis on quality of life among Romanian teenagers and young adults. Our objectives were to translate and adapt the HALT, validate it among a cross-sectional group, and evaluate the extent of halitosis in this population. A multicentric cross-sectional design followed, which was approved by the Ethics Research Committee in Romania. The translation process involved independent translations, retro-translations, expert review, and pre-testing. The psychometric properties were evaluated among 150 patients (mean age 23.6 ± 1.8; 51% males) at dental clinics, including reliability, convergent, and discriminant validity, using accepted statistical measures such as Cronbach’s alpha and Intraclass Correlation Coefficient (ICC). The R-HALT revealed strong internal consistency with Cronbach’s alpha values ranging from 0.93 to 0.96, and an ICC value of 0.87 (95% CI = 0.70–0.99), demonstrating excellent test–retest reliability. Mean scores of individual items ranged from 0.82 ± 0.94 (Q3) to 3.23 ± 1.15 (Q11). The corrected item–total correlation ranged from 0.30 (Q2) to 0.90 (Q19). Organoleptic test scores diagnosed 41% (62 patients) with a score of 2, with increasing severity in 9% (13 patients) with a score of 5. The R-HALT exhibited robust reliability and validity in assessing the impact of halitosis among Romanian teenagers and young adults. The questionnaire is a strong tool for understanding, diagnosing, and managing halitosis in Romania, ultimately aiming to improve the quality of life of affected individuals. Further studies with diverse populations could enhance the applicability of the R-HALT.

Background and Objectives: Halitosis is a common condition with substantial psychosocial impact, frequently driven by intra-oral biofilm, tongue coating, and reduced salivary clearance. This study compared the short-term effectiveness of standardized counseling alone, probiotic lozenges containing Streptococcus salivarius K12, and a zinc-containing mouthrinse in adults with persistent intra-oral halitosis. Materials and Methods: In this 4-week, parallel-group, randomized pragmatic trial, 117 adults with bothersome halitosis for at least 3 months and baseline organoleptic score ≥ 2 were allocated 1:1:1 to standard care, probiotic lozenges, or zinc mouthrinse. All participants received standardized counseling and tongue cleaning instructions. The primary endpoint was change in volatile sulfur compounds (VSCs) measured by portable sulfide monitoring. Secondary outcomes included organoleptic score, Halitosis Associated Life-Quality Test (HALT), Oral Health Impact Profile-14 (OHIP-14), tongue coating, plaque, and salivary Solobacterium moorei quantified by qPCR. Results: Baseline demographic, clinical, and biochemical characteristics were comparable across groups. All interventions improved outcomes over 4 weeks, but improvements followed a consistent gradient favoring zinc mouthrinse, followed by probiotic lozenges, then standard care. Mean VSC reduction was −12.7 ± 33.9 ppb with standard care, −47.3 ± 42.2 ppb with probiotics, and −78.5 ± 36.3 ppb with zinc mouthrinse (p < 0.001). Organoleptic scores improved by −0.2 ± 0.7, −0.8 ± 0.8, and −1.2 ± 0.8, respectively (p < 0.001). HALT and OHIP-14 scores showed parallel reductions, and moderate/severe halitosis at week 4 remained most frequent in the standard care group (58.9%) and least frequent in the zinc group (20.5%; p = 0.004). Conclusions: Both active adjunctive strategies improved intra-oral halitosis beyond standardized counseling alone, but the zinc-containing mouthrinse produced the greatest short-term benefits across objective, clinician-rated, and patient-reported outcomes. These findings support zinc-based rinses as a practical short-term adjunct for managing persistent intra-oral halitosis in outpatient dental care. Durability after discontinuation and potential relapse beyond 4 weeks were not assessed in this trial.

Background/Objectives: Halitosis in geriatric patients is multifactorial, but the joint contribution of prosthetic rehabilitation type and polypharmacy after routine dental procedures has rarely been quantified. We investigated how prosthesis type, polypharmacy, and salivary function were associated with volatile sulfur compound (VSC) burden and self-perceived halitosis in elderly dental patients. Methods: This cross-sectional study enrolled 88 patients aged ≥65 years, four weeks after completing routine dental procedures. Participants were stratified into three groups: complete denture wearers (n = 30), partial removable denture wearers (n = 28), and fixed prostheses/implants (n = 30). We measured unstimulated salivary flow rate (uSFR), tongue coating index (TCI), denture biofilm index, total VSCs (Halimeter^®), organoleptic score (0–5), and self-perceived halitosis. Polypharmacy, comorbidities, and the Geriatric Oral Health Assessment Index (GOHAI) were recorded. Analyses included one- and two-way ANOVA, Spearman correlations, theory-informed multivariable linear and logistic regression, exploratory mediation analysis, and ROC curves. Results: Forty-two participants (47.7%) reported halitosis. Mean VSC differed across groups (complete dentures 278.2 ± 38.6 ppb; partial 211.2 ± 46.3 ppb; fixed 164.4 ± 43.9 ppb; ANOVA p < 0.001). uSFR correlated inversely with VSC (ρ = −0.61, p < 0.001) and TCI correlated positively (ρ = 0.56, p < 0.001). A significant prosthesis × polypharmacy interaction was observed (F = 3.74, p = 0.029, η²_p = 0.082): polypharmacy was associated with higher VSC most clearly among partial and fixed prostheses wearers, whereas complete denture wearers showed high VSC levels regardless of polypharmacy status. Exploratory mediation findings were consistent with partial indirect association, with 45.9% of the polypharmacy–VSC association statistically explained by reduced uSFR; however, the cross-sectional design precludes causal or temporal interpretation. The full multivariable model showed apparent discrimination for self-perceived halitosis (AUC = 0.92), while the simplified four-item chairside composite model showed AUC = 0.89; neither estimate was optimism-corrected or externally validated. Conclusions: In elderly post-procedure patients, complete denture wearing, polypharmacy, and salivary hypofunction were independently and jointly associated with higher halitosis burden. Reduced salivary flow was consistent with a partial indirect statistical pathway in the polypharmacy–VSC association, supporting hydration counseling and meticulous prosthesis hygiene as low-cost geriatric interventions. Sensitivity analyses excluding implant-supported restorations, participants with MMSE scores of 24–26, and expanded mediation models including TCI and biofilm/plaque did not materially change the main inference.

Background and Objectives: Halitosis is a prevalent oral concern that meaningfully affects oral health-related quality of life (OHRQoL), yet how active dental treatment is associated with short-term changes in the objective–subjective halitosis–QoL nexus remains poorly quantified. Interpretation is complicated by the multifactorial nature of malodor and by baseline differences between patients selected for different dental procedures. We compared changes in volatile sulfur compound (VSC) emissions, organoleptic ratings, tongue-coating burden, and OHIP-14 across three contrasting treatment modalities and explored whether VSC change statistically accounted for OHRQoL change. Methods: In a non-randomized prospective comparative study, 119 adults (18–67 y) commencing one of three procedures were assessed at baseline and at 8 weeks: scaling and root planing (Group A, n = 42), fixed prosthodontic rehabilitation (Group B, n = 38), or fixed orthodontic appliance bonding (Group C, n = 39). Outcomes included Halimeter^® VSC (ppb), Rosenberg organoleptic score (0–5), Winkel tongue-coating index (TCI), self-perceived halitosis, and OHIP-14 total and seven-domain scores. Mixed-design ANOVA, ANCOVA, prespecified multivariable regression, mediation (5000 bootstrap resamples), receiver operating characteristic analysis, and four-class latent class analysis were performed. A sensitivity-analysis framework including expanded covariate adjustment, propensity-score overlap weighting, and baseline-severity strata was also applied to address residual baseline imbalance. Secondary mediation, ROC, and latent-class analyses were considered exploratory. Results: At 8 weeks, VSCs fell by 116.4 ± 38.7 ppb in Group A and 35.4 ± 29.1 ppb in Group B but rose by 34.3 ± 28.6 ppb in Group C (p < 0.001). OHIP-14 improved by 10.3 and 4.9 points in A and B and worsened by 3.7 in C (p < 0.001). ΔVSC correlated with ΔOHIP-14 (ρ = 0.51, p < 0.001) and most strongly with the psychological discomfort domain (ρ = 0.58). VSC change mediated 35.1% of the periodontal-versus-orthodontic association on QoL (indirect β = −4.7; 95% CI −6.3 to −3.1). Because VSC and OHIP-14 changes were measured over the same interval, mediation was interpreted cautiously. A ΔVSC threshold of −63 ppb predicted clinically meaningful OHIP-14 improvement (AUC = 0.81). Latent class analysis identified four distinct responder phenotypes. The cutoff and responder classes were internally derived and require external validation. Sensitivity analyses preserved the direction of the primary contrasts, but residual confounding remains possible. Conclusions: Treatment modality was associated with the direction and magnitude of halitosis and QoL change, with orthodontic patients constituting a vulnerable subgroup. Targeted oral-hygiene reinforcement during fixed-appliance therapy is warranted.

Background: Intra-oral halitosis is sustained by tongue-coating biofilm, but ecological and host inflammatory responses to adjunctive therapy remain unclear. Methods: In a 4-week randomized pragmatic trial (117 adults; 39 per arm; ClinicalTrials.gov NCT05876321), we compared standard care, Streptococcus salivarius K12 lozenges, and a zinc lactate/CPC/chlorhexidine rinse. Mechanistic endpoints reported here included a qPCR-derived tongue-coating dysbiosis index and salivary IL-6, IL-8, TNF-α, and MMP-8. Between-arm effects were assessed by baseline-adjusted ANCOVA, with correlation, responder, GEE, PCA, and mediation analyses. Results: Baseline values were comparable. The probiotic produced the largest dysbiosis-index reduction (−0.7 ± 0.5 vs. −0.5 ± 0.3 with zinc and −0.2 ± 0.4 with standard care, although this difference was attenuated in sensitivity analyses that removed S. salivarius from the index denominator; p < 0.001), whereas the zinc lactate/CPC/chlorhexidine rinse produced the greatest reductions in IL-8, TNF-α, and MMP-8 (all p < 0.001). Dysbiosis-index change correlated strongly with VSC change (ρ = 0.82). The probiotic effect on malodor was statistically consistent with near-complete mediation by dysbiosis reduction, versus approximately half for the rinse. Conclusions: The two adjunctive strategies showed complementary ecological and inflammatory response patterns. The dysbiosis index and mediation findings warrant external validation, and durability beyond 4 weeks remains unknown. Because S. salivarius is both a denominator constituent of the index and the administered probiotic, and because the rinse delivers three active agents together, effects cannot be attributed to a single organism or ingredient; local adverse events were more frequent with the rinse (53.8% vs. 15.4% and 10.3%).

Background: Halitosis in elderly dental patients is rarely attributable to a single etiology; tongue coating, periodontal inflammation, denture biofilm, and reduced salivary flow may coexist and modify treatment response. We compared three procedure pathways and examined whether tongue-coating reduction mediates procedure-related improvement. Methods: A prospective cohort of 94 patients aged 65 years or older was assigned by dominant indication to periodontal debridement with tongue cleaning (PDT, n = 33), denture biofilm management (DBM, n = 31), or restorative/prosthetic maintenance (RPM, n = 30). This was a single-center, nonrandomized prospective cohort study; assignment followed the dominant clinical indication rather than randomization. All clinical assessments were made by a single examiner who was masked to the formal procedure-group assignment; masking was partial because the clinical picture at follow-up could sometimes reveal the care delivered. The primary outcome was percentage reduction in volatile sulfur compound (VSC) concentration at 8 weeks. Secondary outcomes included organoleptic score, HALT, OHIP-14, tongue-coating index, denture plaque index, and a composite clinical response (≥30% VSC reduction plus ≥ 1-point organoleptic improvement plus ≥ 8-point HALT improvement). Linear mixed-effects, multivariable regression, and bootstrap mediation analyses were performed. Results: All three procedures reduced VSC at 8 weeks, but PDT produced the largest absolute reduction (−102.6 ± 20.2 ppb) and the highest composite response rate (57.6%), versus 9.7% in DBM and 3.3% in RPM (p < 0.001). Adjusted analyses showed PDT improved VSC reduction by 22.8 percentage points and DBM by 11.7 percentage points relative to RPM. Tongue-coating reduction mediated 29.5% of the PDT effect and 35.6% of the DBM effect. Xerostomia and reduced salivary flow attenuated the response in DBM and RPM but not in PDT. Conclusions: Periodontal debridement with tongue cleaning was the most effective procedure pathway for elderly halitosis. Tongue-coating reduction was a meaningful, though statistically rather than experimentally established, mediator of treatment benefit, supporting an oral-ecological framework for managing geriatric oral malodor that warrants confirmation in randomized studies.