New pubmed paper on halitosis : fetor hepaticus

http://www.ncbi.nlm.nih.gov/pubmed/18938115

GC-MS analysis of breath odor compounds in liver patients.

Van den Velde S, Nevens F, Van Hee P, van Steenberghe D, Quirynen M. Department of Periodontology, Faculty of Medicine, Catholic University of Leuven, Kapucijnenvoer 33, BE-3000 Leuven, Belgium.

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There seems to have been a few halitosis papers published on pubmed recently, probably to coincide with the upcoming ISBOR and IABR joint-conference in Dortmund on April 26-30

This one includes Professor Daniel van Steenberghe as a researcher, who co-founded ISBOR. The paper explains that when some people have liver disease, their breath can smell musty and/or sweet. Using 2 groups of people (liver diseased and normal), they suggest the musty smell from liver diseased individuals was mainly due to raised dimethyl sulfide. The source of the smells would be from the lungs, in what is known as the alveolar breath.

Whilst it is helpful to prove that the principle of alveolar breath can be a source of halitosis, unfortunately we know that the person can be completely damage-free and the smell can be the whole 'bowel' range of odors (amongst other things). An email will be sent to them to ask their thoughts on this. An ideal situation would be to test those with 'fecal/gas breath' in the manner this group of people were tested. The main hurdles would likely be making sure the person's breath smelt at the time of testing, and also convincing the researchers this problem seems to exist. Apart from trimethylaminuria, metabolic odors are not really accepted as possible or common.

BACKGROUND: Liver diseases can cause a sweet, musty aroma of the breath, called fetor hepaticus. Even in a stage of cirrhosis, the disease can be asymptomatic for many years. Breath analysis might be helpful to detect occult liver pathology. STUDY OBJECTIVE: This study examined whether specific breath odor compounds can be found in liver patients, suffering from cirrhosis, which might be useful for diagnosis. MATERIALS AND METHODS: Fifty-two liver patients and 50 healthy volunteers were enrolled. Alveolar air was analyzed by gas chromatography-mass spectrometry. Using discriminant analysis a model for liver disease was built. RESULTS: Dimethyl sulfide, acetone, 2-butanone and 2-pentanone were increased in breath of liver patients, while indole and dimethyl selenide were decreased. Sensitivity and specificity of the model were respectively 100% and 70%. CONCLUSIONS: Fetor hepaticus is caused by dimethyl sulfide and to a lower extent by ketones in alveolar air. Breath analysis by GC-MS makes it possible to discriminate patients with breath malodor related to hepatic pathologies.