published research & articles
Published Articles :- A Review of Oral Products for the Treatment of Oral Malodor
- Oral Malodor: One Approach to Treatment (Case Study)
- Oral Malodor - Cosmetic Problem or Chronic Infection?
- Oral Malodor – Up Close and Personal
- Oral Malodor
- Bad Taste: An Indicator of Bad Breath
- Oral Malodor: Philosophical and Practical Aspects
- Oral Malodor: New Directions
- What We Do Will Take Your Breath Away
- Oral Malodor - Clearing the Air
- Relationship of Oral Malodor and Periodontitis: Research Perspectives
- Relationship of Oral Malodor to Periodontitis: Evidence of Independence in Discrete Sub-Populations
- Reproducibility and Sensitivity of Oral Malodor Measurements with a Portable Sulphide Monitor
- An Updated Protocol for the Treatment of Dry Mouth and Bad Breath
- Correlations of Microbiological and Clinical Data from a Halitosis Clinic Population
- Immunologic Functioning, Stress and Malodor: Is There a Relationship?
Published Articles
A Review of Oral Products for the Treatment of Oral Malodor
SUMMARY: Oral malodor can be either a short-term, transient problem that includes morning breath or food odors or it can be a long-term, chronic problem. Commercial products support the short-term problem, but the duration of relief varies with the active ingredient. Long term, chronic problems are difficult to eliminate and require a more aggressive treatment with antimicrobial rinses such as chlorhexidine.
Bosy, A. (2002) "A Review of Oral Products for the Treatment of Oral Malodor", The Journal of Practical Hygiene July/August 2002. Supplement.
Oral Malodor: One Approach to Treatment (Case Study)
SUMMARY: Casey M., a 48 year old woman was first seen 3 years ago with the complaint of oral malodor. A nonsmoker with good oral hygiene, she saw her dentist routinely and had a dental examination and cleaning 3 weeks before the initial visit for breath odor.
Her concern was the bitter and very unpleasant taste that persisted though out the day. She had experienced this taste for the last 20 years and associated it with bad breath. She felt very embarrassed about her breath and kept a safe distance from her co-workers and friends. However, she did not feel that this interfered with work or relationships. If the situation required close contact, gum and mints were used to decrease the possibility of the odor being noticed.
Assessment of the complaint included odor analysis, oral examination and microbial reports. Treatment consisted of rinsing with 5 cc. of 0.2% chlorhexidine twice daily. At the end of a two week period a considerable reduction in all measurements was noted. No odor was detected on the breath, tongue base and dorsum. A very slight and fleeting odor was noted in between the teeth. Casey felt comfortable using the chlorhexidine rinse and was to continue rinsing, decreasing to once a day and to return for observation. At the one year re-evaluation the mouth air was normal but there were slight odors in between the teeth and on the tongue as well as some probing. The microbial report showed an increase in gram-negative bacteria and spirochetes. Feedback from her family indicated that if she stopped using chlorhexidine for more than two days at a time, the breath odor became noticeable. Casey elected to continue with chlorhexidine rinsing once a day to see if she could improve this condition. At the two year evaluation the mouth odors were definitely noticeable. At this time, the rinsing with chlorhexidine was increased to twice a day. A subsequent evaluation has shown that the odors had subsided.
In conclusion, this method of treatment has been successful, however the client must be made aware of possible side effects such as staining, change in taste perception and potential allergies. Staining seems to be the most common side effect. However, clients who suffer from oral malodor may often overlook the staining if the chlorhexidine is effective at reducing bad breath. If the side effects are problematic or chlorhexidine is not effective, other rinses such as those containing zinc chloride or active Zn++ ions, or even herbal rinses need to be examined for suitability to the client's needs.
Bosy, A. (2002) "Oral Malodor: One Approach to Treatment (Case Study)", Contemporary Oral Hygiene January/February 25-31.
Oral Malodor - Cosmetic Problem or Chronic Infection?
SUMMARY: The most common cause of oral malodor is elevated levels of volatile sulfur compounds. The production of these gases results from the action of gram-negative anaerobic bacteria on protein matter. Individuals who suffer from oral malodor experience anxiety and may exhibit antisocial behavior. Some develop a psychosomatic condition called halitophobia. Interest in treating oral malodor has increased in recent years but dentists and dental hygienists are still reluctant to address the problem. Treatment of this condition consists of good oral hygiene along with the use of antimicrobial agents, oxidizing agents, and anti-odorants such as sodium bicarbonate. Not commonly used for the treatment of oral malodor in the past, studies indicate that sodium bicarbonate should be given serious consideration. Dentifrices containing 20% or more baking soda can significantly reduce odor for up to 3 hours. Dentifrices with the zinc ion and baking soda, although still not available commercially, have an enhanced anti-odor effect.
Bosy, A. (2001) "Oral Malodor - Cosmetic Problem or Chronic Infection?" Compendium of Continuing Education in Oral Hygiene 8(2) 3-11
Oral Malodor – Up Close and Personal
SUMMARY: The facts indicate that up to 50% of the population suffer from oral
malodor, many finding it a chronic condition. When do people become aware
of their bad breath? How do you distinguish between bad breath and normal
breath? This paper discusses these issues and reviews current assessment
and treatment options.
Bosy, A. (2000): "Oral Malodor - Up Close and
Personal",
D.A.M. Dental Auxiliary Magazine 1(1) 7-9
Oral Malodor
SUMMARY: Although their quality of life is diminished, people often go for long periods of time prior to seeking professional treatment for their bad breath problem. There is a feeling of isolation and deep embarrassment. The most common cause of oral malodor is anaerobic bacteria and fungi as the major contributors. Factors, such as stress and decreased salivary flow, help to increase the density of microbes and result in greater odor production. Bad breath can be treated with a variety of different antimicrobial rinses.
Bosy, A. (1998): "Oral Malodor", P.H.D. Services
5(6) 2-4
Bad Taste: An Indicator of Bad Breath
SUMMARY: The production of oral malodor is primarily the result of degradation
of certain amino acids by gram-negative microorganisms. There is sufficient
evidence that the tongue coating is one of the main sites of hydrogen sulfide
production in healthy mouths since large numbers of bacteria are present
on the tongue dorsum. This article discusses the possibility of taste as
an indicator that sufficient bacteria are present in the oral cavity to
cause breath odor. The effect of stress is another factor that is examined
in this article. Stress may impact upon the immune system creating an ineffective
response against invading bacteria. Secondly, stress decreases the flow
of saliva, thus allowing the volatile sulphide compounds to contaminate
the mouth air.
Bosy, A and Geller, J.: "Bad Taste: An Indicator
of Bad Breath", Aorta June 1998.
Oral Malodor: Philosophical and Practical Aspects
SUMMARY: Although oral malodor or bad breath is an unpleasant condition experienced
by most individuals, it typically results in transient discomfort. At least
50% of the population suffer from chronic oral malodor, and approximately
half of these individuals experience a severe problem that creates personal
discomfort and social embarrassment. The mouth air of chronic malodor
sufferers is tainted with compounds such as hydrogen sulphide, methyl mercaptan
and organic acids, which produce a stream of foul air that is gravely offensive
to people in their vicinity. Sufferers often make desperate attempts to
mask their odor with mints and chewing gum, compulsive brushing and repeatedly
rinsing with commercial mouthwashes. While dental diseases have been strongly
associated with this condition, there is considerable evidence that dentally
healthy individuals can exhibit significant levels of mouth odor. Proteolytic
activity by microorganisms residing on the tongue and teeth results in
foul-smelling compounds and is the most common cause of oral malodor.
A specialized device called the halimeter is available to measure the volatile
sulphur compounds in mouth air. Many manufacturers of bad breath remedies
claim that their products contain antibacterial mechanisms with sufficient
strength to control oral malodor over long periods of time. None, however,
effectively eliminate the problem. Interest in oral malodor research and
clinical treatment has increased in the last few years and this distressing
problem is finally getting the attention it deserves.
Bosy, A. (1997): "Oral Malodor: Philosophical
and Practical Aspects", J. Canadian Dental Association, March 1997,
63 (3) 196-201
Oral Malodor: New Directions
SUMMARY: Probable causes and various factors affecting offensive breath are discussed.
New approaches for assessment and treatment of oral malodor are explored
in this article.
Bosy, A. (1997): "Oral Malodor: New Directions",
The
Colgate Oral Care Report 7 (2) 10-12)
What We Do Will Take Your Breath Away
SUMMARY: Ignored and misunderstood by the medical and dental profession for decades, there has been an increasing amount of attention focused on oral malodor within the last few years.
Breath becomes odorous when certain unpleasant chemicals are present in mouth air. The most common and abundant chemicals present in bad breath are volatile sulphur compounds such as hydrogen sulphide, methyl mercaptan and in smaller amounts, methyl disulphide and dimethyl disulphide. The composition and malodor of the mouth air depends on the underlying cause of the problem.
Responding to a growing need for relief from the problem of oral malodor, a new clinic has recently opened which specializes solely in the treatment of this condition. The Fresh Breath Clinic began over two years ago and has now developed into a one of a kind operation, specializing in the assessment and treatment of bad breath on a full time basis.
Bosy, A and Geller, J. (1996) "What We Do Will Take Your Breath Away", The Journal - Ontario Dental Nurses and Assistants Association. July-September 2(3) 10-11.
Oral Malodor - Clearing the Air
SUMMARY: Ignored by dental science and research, oral malodor or halitosis sufferers have been at the mercy of commercial enterprises. Millions of consumer dollars have been spent on mouthwashes, mints and gums resulting in little or no relief for the problem. The first documented rinse was prepared by Hippocrates (ca. 460-400 B.C.) whose mouthwash of unadulterated wine, anise, dill seed and myrtle was essential for every young girl. Cosmus, a Roman cosmetics manufacturer, became immensely weathly by producing and selling aromatic pastilles which he claimed would chase away the bad odor from the mouth and turn it into the fragrance of violets. In present times personal concern with breath odors is reflected in the popularity of commercial mouthwashes, mints and gums that claim will make the breath sweet. More recently product-based treatment centres have opened throughout the continent claiming to have the answer to this age-old problem.
It has been established that although oral malodor has multiple etiologies, degradation of specific amino acids by anaerobic bacteria is one of the major causes. Colonization of these bacteria in the oral cavity may be influenced in part by immunoglobulins, including immunoglobulin A (IgA). The presence of IgA in saliva inhibits bacterial attachment through agglutination. Thus, it is possible that IgA deficiency may be the underlying cause for an imbalance in the microflora that resulting in increased numbers of anaerobic bacteria. Selective IgA deficiency may be hereditary and occurs in 0.1% of the population. However, there is also evidence that IgA deficiency can be acquired and that this may be due, in part, to a decreased synthesis or secretion of IgA. Further, individuals with decreased amounts of IgA suffer from sinopulmonary infections, multiple allergies, arthritis and a variety of autoimmune conditions. Medical histories of 218 self-assessed oral malodor subjects who attended the Halitosis Assessment Clinic (HAC) at the University of Toronto were analyzed for any possible reported condition that would indicate IgA deficiency. The analysis showed that a high proportion of these subjects suffered from one or more IgA mediated conditions.
Bosy, A., Geller J. (1996) "Oral Malodor - Clearing the Air", Alpha Omegan 89:25-28
Relationship of Oral Malodor and Periodontitis: Research
Perspectives
SUMMARY: Early detection of periodontal diseases can lead to improved outcomes
in treatment. Among other tests, oral malodor has been considered as a
potential screening test for the detection of periodontitis. The study
found that oral malodor was not a reliable test for these diseases because
reduction in bad breath could be obtained independent of improvements in
periodontal health.
McCulloch, C and Bosy, A.: "Relationship of Oral
Malodor and Periodontitis", Bad Breath: Research Perspectives, ed. M.
Rosenberg, Tel-Aviv University, Ramot Publishing, 1995.
Relationship of Oral Malodor to Periodontitis: Evidence
of Independence in Discrete Sub-Populations
SUMMARY: Associations between oral malodor, measures of periodontal disease
and trypsin-like activity of periodontal pathogens on teeth and tongue
were examined in 127 subjects. The volatile sulphur compounds present in
mouth air were measured by halimeter and by organoleptic methods. The study
showed that there was a significant contribution to oral malodor by the
tongue surface. Subjects were treated with chlorhexidine gluconate to study
the effect of reducing microbial colonization on oral malodor. Reductions
of volatile sulphur compound levels were significant. Oral malodor in
subjects with and without periodontitis was measured and the two groups
were compared. The average volatile sulphur compound measurement in the
37 subjects with periodontitis was only slightly higher than the average
measurement of the 90 healthy subjects. The data in this study indicate
that a large proportion of individuals with oral malodor are periodontally
healthy and that the surface of the tongue is a major site of oral malodor
production.
Bosy, A.; Kulkarni, G.V.; Rosenberg, M. and McCulloch,
C.A.G. (1994): "Relationship of Oral Malodor to Periodontitis: Evidence
of Independence in Discrete Sub-Populations", Journal of Periodontology
65(1):37-46
Reproducibility and Sensitivity of Oral Malodor Measurements
with a Portable Sulphide Monitor
SUMMARY: The aim of this study was to test the use and reliability of the halimeter.
Forty-one subjects were measured on three occasions over a period of three
weeks. The first two measurements taken one week apart were to determine
if the odor would measure the same over time. At the second measurement
the subjects were given a chlorhexidine rinse to use for one week. Measurements
taken on the third week indicated that the halimeter was able to detect
the reduction of sulphur compounds in mouth air.
Rosenberg, M.; Kulkarni, G.V.; Bosy, A. and McCulloch,
C.A.G. (1991): "Reproducibility and Sensitivity of Oral Malodor Measurements
with a Portable Sulphide Monitor", Journal of Dental Research 70(11):1436-1440.
Bad Breath Research - Oral Presentations
An Updated Protocol for the Treatment of Dry Mouth and Bad Breath
SUMMARY: Studies indicate that individuals with dry mouth (xerostomia) are very susceptible to decay, periodontal disease and other oral conditions such as bad breath (oral malodor). As health care professionals it is our responsibility to effectively recognize, inform and treat our client's dry mouth and reduced salivary flow in order to prevent dental complications and disease.
This seminar provided dental professionals with a comprehensive approach to the assessment, treatment and prevention of dry mouth and bad breath.
Dynamic Seminars presentation by:
Dr. Miriam Grushka DDS, M.Sc., M.Ed., Ph.D, Oral Medicine Specialist
Anne Bosy, RDH, M.Sc., M.Ed., Professor, Clinician and Co-founder, Fresh Breath Clinic®.
M. Grushka, A. Bosy: "An Updated Protocol for the Treatment of Dry Mouth and Bad Breath" Presented at Dynamic Seminars, Burlington, Ontario (October, 2001), and Barrie, Ontario (December 2, 2001)
Correlations of Microbiological and Clinical Data From a Halitosis Clinic Population
SUMMARY: This presentation provided preliminary results of a study of 280 cases. Correlations were explored between a wide range of clinical parameters and microscopic counts of spirochetes, neutrophils and the ratios of Gram-negative cocci, rods, Gram-positive cocci and rods. Microscopic counts were made of spirochetes and neutrophils from tongue scrapings and supragingival and subgingival plaque samples taken from interproximal surfaces of teeth. The findings seem to be consistent with a hypothesis that salivary flow and viscosity changes lead to changes in flora indicative of less washout of motile organisms and an increased retention of organisms and neutrophils on the tongue.
A. Bosy: "Correlations of Microbiological and Clinical Data From a Halitosis Clinic Population" Presented at the Fifth International Conference on Breath Odor, National Center of Science, Tokyo, Japan (July, 2001)
Immunologic Functioning, Stress and Oral Malodor:
Is There a Relationship?
SUMMARY: Evidence from human studies and animal models suggests that stress can
impair immunologic competence and identifies a relationship between stress
and the salivary secretion of immunoglobulin A (IgA). Secretion of this
immunoglobulin is decreased during periods of high stress. This is an important
factor, since the presence of IgA in saliva maintains the balance of oral
bacteria and aids in the resistance to oral infections. Subjects suffering
from oral malodor also exhibited a high proportion of immunodepressed
conditions such as allergies, upper respiratory problems and skin rashes.
A statistical analysis was conducted to determine if there was an association
between immunodepressed conditions and subjects with oral malodor. It
was shown that there is some evidence in support of such an association.
Although it is apparent that there is some link between stress, impaired
immunologic competence and oral malodor, more research is clearly indicated.
Bosy, A. and Limeback H.: "Immunologic Functioning,
Stress and Oral Malodor: Is There a Relationship?" Presented at the Second
International World Workshop on Oral Malodor (October 1995).
A. Bosy, G.V. Kulkarni, M. Rosenberg and
C.A.G. McCulloch: "Relationship between oral malodor and periodontal disease",
Journal of Dental Research 72:409. Presented at the 71st Annual
Meeting of the International Association for Dental Research, Chicago,
USA (1993).
M. Rosenberg, G. Kulkarni, A. Bosy and C.A.G.
McCulloch : "Relationship between oral malodor and periodontal parameters",
Journal
of Dental Research 70:586. Presented at the 69th Annual Meeting
of the International Association for Dental Research, Acapulco, Mexico
(1991).
Books, magazine & newspaper articles, radio & TV interviews featuring Anne Bosy and the Fresh Breath Clinic®
BOOKS
The Doctors Book® of Herbal Home Remedies
Editors: Prevention Health Books, Rodale Press 1999.
(excerpt from the section on Bad Breath:)
It may seem that halitosis has chosen you, and only you, to grace with its signature smell, but rest assured, many others have dealt with it all along. "It's been a problem forever", says Anne Bosy, a researcher in oral malodor and founder of the Fresh Breath Clinic in Toronto.
Parsley, says Bosy, contains chlorophyll, the same stuff used in some commercial breath fresheners. Fresh parsley costs much less, and you can use whatever is left over for cooking. Pick up a bunch of the herb at any grocery store, cut off a few sprigs, and chew them slowly, a sprig at a time. The longer it is in your mouth, the better. "Parsley doesn't just mask the smell, it actually deodorizes your mouth," she says.
POPULAR PRESS
Featured in articles in the following magazines and newspapers:
- Canadian Reader's Digest (August 2004) "Just Too Embarrassing" by Paula Wild
- glow magazine (Oct/Nov 2003)
- elevate magazine
- Today
- Chatelaine
- Cosmopolitan: Life After College
- Woman's World
- Canadian Living
- Jane magazine
- Readers Digest
- Health Watch (Shoppers Drug Mart) in three publications - 1992, 1994, 1998
- Metro News Toronto edition, March 21, 2006: "Bad breath fouls up careers"
- Medical Post
- National Post (May 2003)
- Calgary Herald (May 2003)
- Toronto Star (Front page news)
- Toronto Sun (Front page of the Life Section)
- Globe and Mail
- Ottawa Citizen (Front page)
- ROGERS TV March 21, 2006
- AM740 From a Woman's Perspective with Marilyn Wetston - Anne Bosy featured several times per year 2004-2005
- tfo - VOLT, french language current events show for 13+ - October 14, 2003
- Discovery Health Channel & The Life Network, Health On The Line - October, 2002
- Several radio interviews including an hour on CCBC, a Chinese radio show - 2002
- Global News: Discussion about Listerine wafers and their effectiveness - April, 2001
- CFRB AM1010 with Karen Horsman - March 2001
- CITY TV Breakfast Television - 2001 (also 1999, 1997)
- CBC News Health Matters, 2000
- WTN (Women's Television Network) "Stone Soup" 1997
- Doctor on Call - March 1997
- Global Television
- interview on Dec. 31, 1997 on evening news
- interview on midday news - 1994
- interview with Avis Favro - 1992
- Discovery Channel - interview - 1997
- Rogers Cable (several community television interviews) 1995 - 1997
- Market Place - 1996
- Discovery Channel - Scientific program - 1995
- Channel 47 (Italian program) - 1993
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