Hostname: page-component-848d4c4894-4rdrl Total loading time: 0 Render date: 2024-06-18T18:41:30.607Z Has data issue: false hasContentIssue false

Environmental and Genetic Contributions to Indicators of Oral Malodor in Twins

Published online by Cambridge University Press:  21 February 2012

Walter A. Bretz
New York University, College of Dentistry, United States of America
Aaron Biesbrock
Procter & Gamble Co., Cincinnati, United States of America
Patricia M. Corby
New York University, College of Dentistry, United States of America
Andrea L. Corby
Twins Institute for Genetics Research, Montes Claros, Brazil
Walter G. Bretz*
Twins Institute for Genetics Research, Montes Claros, Brazil
Jennifer Wessel
Indiana University, Indianapolis, United States of America
Nicholas J. Schork
Scripps Genomic Medicine and The Scripps Research Institute, San Diego, United States of America
ADDRESS FOR CORRESPONDENCE: Walter A. Bretz, New York University College of Dentistry, 345 East 24th Street, Room 1005, New York, NY, 10010, USA. E-mail:


Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

This study aimed to: (1) determine concordance rates of self-reported and subjectively determined indicators of oral malodor in twins; (2) determine the relative contributions of genetic and environmental factors to levels of volatile sulfur compounds (VSCs) in intraoral and exhaled breath. Fifty-one twin pairs participated in the study. Measurements of VSCs were obtained by a halimeter. The presence of tongue coatings was determined and twins filled out a 32-item questionnaire on oral malodor indicators independently of one another. Estimates of heritability (h2) for halimeter measurements were computed by SOLAR. The concordance rates for the presence of tongue coating among identical and fraternal twins were 67% and 11%, respectively. In the 10 most informative items, 70% exhibited higher concordance rates for identical than for fraternal twins. Of particular interest were the differences in concordance rates for dry mouth, sinus infection and unusual sweating. The h2 for intra-oral breath was 0.28 ± 0.17 (NS), whereas the h2 for exhaled breath was 0.50 ± 0.20 (p = .0207). The concordance rates of tongue coatings and malodor indicators were higher in identical twins than in fraternal twins. Intraoral breath VSC values were primarily attributable to environmental factors, whereas exhaled breath VSC values were partially explained by genetic factors.

Copyright © Cambridge University Press 2011


Corby, P. M., Bretz, W. A., Hart, T. C., Schork, N. J., Wessel, J., Lyons-Weiler, J., & Paster, B. J. (2007). Heritability of oral microbial species in caries-active and caries-free twins. Twin Research and Human Genetics, 10, 821828.CrossRefGoogle ScholarPubMed
De Boever, E. H., De Uzeda, M., & Loesche, W. J. (1994). Relationship between volatile sulfur compounds, BANA-hydrolyzing bacteria and gingival health in patients with and without complaints of oral malodor. Journal of Clinical Dentistry, 4, 114119.Google ScholarPubMed
De Boever, E. H., & Loesche, W. J. (1995). Assessing the contribution of anaerobic microflora of the tongue to oral malodor. Journal of the American Dental Association, 126, 13841393.CrossRefGoogle ScholarPubMed
Frexinos, J., Denis, P., Allemand, H., Allouche, S., Los, F., & Bonnelye, G. (1998). Descriptive study of digestive functional symptoms in the French general population. Gastroenterology and Clinical Biology, 22, 785791.Google ScholarPubMed
Hartley, M. G., El-Maaytah, M., McKenzie, C., & Greenman, J. (1996). The tongue microbiota of low odour and malodorous individuals. Microbial Ecology in Health and Disease, 9, 215223.CrossRefGoogle Scholar
Kazor, C. E., Mitchell, P. M., Lee, A. M., Stokes, L. N., Loesche, W. J., Dewhirst, F. E., & Paster, B. J. (2003). Diversity of bacterial populations on the tongue dorsa of patients with halitosis and healthy patients. Journal of Clinical Microbiology, 41, 558563.CrossRefGoogle ScholarPubMed
Kirtsreesakul, V., Luxameechanporn, T., Klemens, J. J., Thompson, K., & Naclerio, R. M. (2006). Effect of genetic background on the response to bacterial sinusitis in mice. Archives of Otolaryngology – Head and Neck Surgery, 132, 11021108.CrossRefGoogle ScholarPubMed
Krespi, Y. P., Shrime, M. G., & Kacker, A. (2006). The relationship between oral malodor and volatile sulfur compound-producing bacteria. Otolaryngology — Head and Neck Surgery, 135, 671676.CrossRefGoogle ScholarPubMed
Loesche, W. J., & Kazor, C. (2002). Microbiology and treatment of halitosis. Periodontology 2000, 28, 256279.CrossRefGoogle ScholarPubMed
Miyazaki, H., Sakao, S., Katoh, Y., & Takehara, T. (1995). Correlation between volatile sulphur compounds and certain oral health measurements in the general population. Journal of Periodontology, 66, 679684.CrossRefGoogle ScholarPubMed
Monteiro-Amado, F., Chinellato, L. E. M., & Rezende, M. L. R. (2005). Evaluation of oral and nasal halitosis parameters in patients with repaired cleft lip and/or palate. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontics, 100, 682687.CrossRefGoogle ScholarPubMed
Morita, M., & Wang, H. L. (2001). Association between oral malodor and adult periodontitis: A review. ournal of Clinical Periodontology, 28, 813819.CrossRefGoogle ScholarPubMed
Preti, G., Clark, L., Cowart, B. J., Feldman, R. S., Lowry, L. D., Weber, E., & Young, I. M. (1992). Non-oral etiologies of oral malodor and altered chemosensation. Journal of Periodontology, 63, 790796.CrossRefGoogle ScholarPubMed
Quirynen, M., Dadamio, J., Van den Velde, S., De Smit, M., Dekeyser, C., Van Tornout, M., & Vandekerckhove, B. (2009). Characteristics of 2000 patients who visited a halitosis clinic. Journal of Clinical Periodontology, 36, 970975.CrossRefGoogle ScholarPubMed
Raven, S. J., Matheson, J. R., Huntington, E., & Tonzetich, J. (1996). The efficacy of a combined zinc and triclosan system in the prevention of oral malodor1. In van Steenberghe, D. & Rosenberg, M. (Eds.). Bad breath: A multidisciplinary approach (pp. 241254). Leuven: Leuven University Press.Google Scholar
Roldán, S., Winkel, E. G., Herrera, D., Sanz, M., & Van Winkelhoff, A. J. (2003). The effects of a new mouthrinse containing chlorhexidine, cetylpyridinium chloride and zinc lactate on the microflora of oral halitosis patients: A dual-centre, double-blind placebo-controlled study. Journal of Clinical Periodontology, 30, 427434.CrossRefGoogle ScholarPubMed
Roldán, S., Herrera, D., & Sanz, M (2003). Biofilms and the tongue: Therapeutical approaches for the control of halitosis. Clinical Oral Investigation, 7, 189197.CrossRefGoogle ScholarPubMed
Roldan, S., Herrera, D., O'Connor, A., Gonzalez, I., & Sanz, M. (2005). A combined therapeutic approach to manage oral halitosis: A 3-month prospective case series. Journal of Periodontology, 76, 10251033.CrossRefGoogle ScholarPubMed
Rosenberg, M., Septon, I., Eli, I., Bar-Ness, R., Gelernter, I., Brenner, S., & Gabbay, J. (1991) Halitosis measurement by an industrial sulphide monitor. Journal of Periodontology, 62, 487489.CrossRefGoogle ScholarPubMed
Španěl, P., Dryahina, K., & Smith, D. (2007). The concentration distributions of some metabolites in the exhaled breath of young adults. Journal of Breath Research, 1, 18.CrossRefGoogle ScholarPubMed
Tarzia, O. (2000). Halitose: Um desafio que tem cura. São Paulo, Brasil: Publicações Biomédicas.Google Scholar
van den Broek, A. M., Feenstra, L., & de Baat, C. (2008). A review of the current literature on management of halitosis. Oral Diseases, 14, 3039.CrossRefGoogle ScholarPubMed
Waler, S. M. (1997). The effect of zinc-containing chewing gum on volatile sulfur-containing compounds in the oral cavity. Acta Odontologica Scandinavica, 55, 198200.CrossRefGoogle ScholarPubMed
Winkel, E. G., Roldán, S., van Winkelhoff, A. J., Herrera, D., & Sanz, M. (2003). The clinical effects of a new mouthrinse containing chlorhexidine, cetylpyridinium chloride and zinc-lactate on oral halitosis: A dual-center, double-blind placebo-controlled study. Journal of Clinical Periodontology, 30, 300306.CrossRefGoogle ScholarPubMed