Clinical reliability of non-organoleptic oral malodour measurements

J Clin Periodontol. 2009 Nov;36(11):964-9. doi: 10.1111/j.1600-051X.2009.01473.x.


Aim: Measurement of volatile sulphur compounds (VSC) by portable sulphur monitors (Halimeter, OralChroma) is a common practice for diagnosis of oral malodour. In this study, the clinical value of these devices was examined.

Materials and methods: Two hundred and eighty patients with bad breath complaints attending a halitosis consultation were enrolled. Organoleptic scores were given by a trained and calibrated judge, before measurement of the VSC levels (Halimeter, OralChroma), to avoid any bias.

Results: Significant correlations were found between the organoleptic assessment, the Halimeter, and the OralChroma (R=0.74 for organoleptic versus Halimeter; 0.66 for organoleptic versus OralChroma; 0.63 for Halimeterversus OralChroma). The sensitivity and specificity (with regard to the organoleptic score) to detect patients with/without oral malodour for the Halimeter were 63% and 98%, respectively, and for the OralChroma 69% and 100% when using the cutoffs suggested by the manufacturer. By lowering these values, sensitivity could be improved without a significant decrease in specificity (both devices).

Conclusions: We concluded that the measurement of the VSC levels can be used as an adjunct to the organoleptic assessment. Thresholds should be revisited in order to improve their clinical utility. These devices can prove the absence of malodour in case of pseudo-halitosis.

MeSH terms

  • Adult
  • Breath Tests / instrumentation*
  • Chromatography, Gas / instrumentation
  • Chromatography, Gas / statistics & numerical data
  • Female
  • Halitosis / diagnosis*
  • Humans
  • Hydrogen Sulfide / analysis
  • Male
  • Oral Hygiene Index
  • Periodontal Index
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Smell / physiology
  • Sulfhydryl Compounds / analysis
  • Sulfur Compounds / analysis*
  • Tongue / pathology
  • Volatile Organic Compounds / analysis
  • Xerostomia / classification


  • Sulfhydryl Compounds
  • Sulfur Compounds
  • Volatile Organic Compounds
  • Hydrogen Sulfide