{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T13:08:48Z","timestamp":1789391328317,"version":"build-2803163510"},"reference-count":37,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T00:00:00Z","timestamp":1789344000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"\u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, Timi\u0219oara"},{"id":[{"id":"https:\/\/ror.org\/00afdp487","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dent. J.","Dentistry Journal"],"abstract":"<jats:p>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 (\u226530% VSC reduction plus \u2265 1-point organoleptic improvement plus \u2265 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 (\u2212102.6 \u00b1 20.2 ppb) and the highest composite response rate (57.6%), versus 9.7% in DBM and 3.3% in RPM (p &lt; 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.<\/jats:p>","DOI":"10.3390\/dj14090595","type":"journal-article","created":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T12:09:51Z","timestamp":1789387791000},"page":"595","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Halitosis: A Prospective Cohort Study Comparing Periodontal Debridement with Tongue Cleaning, Denture Biofilm Management, and Restorative Maintenance"],"prefix":"10.3390","volume":"14","author":[{"given":"Adrian","family":"Bolo\u0219","sequence":"first","affiliation":[{"name":"Department of Oral Rehabilitation, Faculty of Dental Medicine, Specialization of Dental Technology, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 300041 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"software","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"}]},{"given":"Otilia Cornelia","family":"Bolo\u0219","sequence":"additional","affiliation":[{"name":"Department of Dental Aesthetics, Faculty of Dental Medicine, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 300041 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"software","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"}]},{"given":"Edida","family":"Maghet","sequence":"additional","affiliation":[{"name":"Faculty of Dental Medicine, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 300041 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-1059-7582","authenticated-orcid":false,"given":"Romina Georgiana","family":"Bita","sequence":"additional","affiliation":[{"name":"2nd Department, Radiology and Medical Imaging, General and Dento-Maxillary Imaging, Faculty of Dental Medicine, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 300041 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"}]},{"given":"Raluca","family":"Briceag","sequence":"additional","affiliation":[{"name":"Faculty of Dental Medicine, Ovidius University of Constan\u021ba, 900684 Constan\u021ba, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"}]},{"given":"Bogdan Andrei","family":"Bumbu","sequence":"additional","affiliation":[{"name":"Department of Dental Medicine, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"}]},{"given":"Silviu","family":"Brad","sequence":"additional","affiliation":[{"name":"2nd Department, Radiology and Medical Imaging, General and Dento-Maxillary Imaging, Faculty of Dental Medicine, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 300041 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"validation","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"292","DOI":"10.4103\/1305-7456.178294","article-title":"Halitosis: Current concepts on etiology, diagnosis and management","volume":"10","author":"Kapoor","year":"2016","journal-title":"Eur. J. Dent."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1902\/jop.1977.48.1.13","article-title":"Production and origin of oral malodor: A review of mechanisms and methods of analysis","volume":"48","author":"Tonzetich","year":"1977","journal-title":"J. Periodontol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1038\/scientificamerican0402-72","article-title":"The science of bad breath","volume":"286","author":"Rosenberg","year":"2002","journal-title":"Sci. Am."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1111\/j.1600-0765.1992.tb01673.x","article-title":"Volatile sulfur compounds in mouth air from clinically healthy subjects and patients with periodontal disease","volume":"27","author":"Yaegaki","year":"1992","journal-title":"J. Periodontal Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1902\/jop.2003.74.1.32","article-title":"The relationship between volatile sulfur compounds and major halitosis-inducing factors","volume":"74","author":"Lee","year":"2003","journal-title":"J. Periodontol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1111\/j.1601-5037.2009.00366.x","article-title":"The relationship between volatile sulphur compounds, tongue coating and periodontal disease","volume":"7","author":"Calil","year":"2009","journal-title":"Int. J. Dent. Hyg."},{"key":"ref_7","first-page":"13037","article-title":"Investigation of volatile sulfur compound level and halitosis in patients with gingivitis and periodontitis","volume":"13","author":"Lee","year":"2023","journal-title":"Sci. Rep."},{"key":"ref_8","first-page":"12172","article-title":"The problem of halitosis in prosthetic dentistry, and new approaches to its treatment: A narrative review","volume":"18","author":"Wyszynska","year":"2021","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Izidoro, C., Botelho, J., Machado, V., Reis, A.M., Proen\u00e7a, L., Alves, R., and Mendes, J.J. (2022). Revisiting standard and novel therapeutic approaches in halitosis: A review. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph191811303"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Hampelska, K., Jaworska, M.M., Babalska, Z.\u0141., and Karpi\u0144ski, T.M. (2020). The role of oral microbiota in intra-oral halitosis. J. Clin. Med., 9.","DOI":"10.3390\/jcm9082484"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e5","DOI":"10.1016\/j.tripleo.2008.02.016","article-title":"Oral malodor and removable complete dentures in the elderly","volume":"105","author":"Nalcaci","year":"2008","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endodontology"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1111\/j.1601-0825.2005.01083.x","article-title":"Malodour in denture wearers: An ill-defined problem","volume":"11","author":"Verran","year":"2005","journal-title":"Oral Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1177\/014556139907800707","article-title":"Xerostomia: A prevalent condition in the elderly","volume":"78","author":"Astor","year":"1999","journal-title":"Ear Nose Throat J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"18S","DOI":"10.14219\/jada.archive.2008.0351","article-title":"Salivary flow patterns and the health of hard and soft oral tissues","volume":"139","author":"Dawes","year":"2008","journal-title":"J. Am. Dent. Assoc."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1111\/j.1600-0528.1997.tb00941.x","article-title":"Derivation and validation of a short-form oral health impact profile","volume":"25","author":"Slade","year":"1997","journal-title":"Community Dent. Oral Epidemiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1902\/jop.1998.69.3.374","article-title":"The effect of a one-stage full-mouth disinfection on oral malodor and microbial colonization of the tongue in periodontitis: A pilot study","volume":"69","author":"Quirynen","year":"1998","journal-title":"J. Periodontol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1016\/j.jdent.2007.04.009","article-title":"A review of the current literature on aetiology and measurement methods of halitosis","volume":"35","author":"Feenstra","year":"2007","journal-title":"J. Dent."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1111\/j.1601-0825.2011.01890.x","article-title":"Halitology: Breath odour: Aetiopathogenesis and management","volume":"18","author":"Scully","year":"2012","journal-title":"Oral Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1034\/j.1600-051X.2003.00342.x","article-title":"Clinical effects of a new mouthrinse containing chlorhexidine, cetylpyridinium chloride and zinc-lactate on oral halitosis: A dual-center, double-blind placebo-controlled study","volume":"30","author":"Winkel","year":"2003","journal-title":"J. Clin. Periodontol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1016\/S0022-3913(82)80079-6","article-title":"Evaluation of seven proprietary denture cleansers","volume":"47","author":"Augsburger","year":"1982","journal-title":"J. Prosthet. Dent."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1037\/a0020761","article-title":"A general approach to causal mediation analysis","volume":"15","author":"Imai","year":"2010","journal-title":"Psychol. Methods"},{"key":"ref_22","unstructured":"Hayes, A.F. (2018). Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach, Guilford Press. [2nd ed.]."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Hosmer, D.W., Lemeshow, S., and Sturdivant, R.X. (2013). Applied Logistic Regression, Wiley. [3rd ed.].","DOI":"10.1002\/9781118548387"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1198\/000313001300339897","article-title":"The abuse of power: The pervasive fallacy of power calculations for data analysis","volume":"55","author":"Hoenig","year":"2001","journal-title":"Am. Stat."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Dakka, A., Nazir, M.A., Almutairi, H.A., and Alshammari, H.S. (2022). Ill effects and complications associated to removable dentures with improper use and poor oral hygiene: A systematic review. Healthcare, 10.","DOI":"10.7759\/cureus.28144"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1111\/j.1532-849X.2011.00698.x","article-title":"Epidemiology and etiology of denture stomatitis","volume":"20","author":"Gendreau","year":"2011","journal-title":"J. Prosthodont."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.tripleo.2003.04.002","article-title":"Denture stomatitis: A role for Candida biofilms","volume":"98","author":"Ramage","year":"2004","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endodontology"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"14","DOI":"10.4103\/0976-9668.107255","article-title":"Halitosis: From diagnosis to management","volume":"4","author":"Aylikci","year":"2013","journal-title":"J. Nat. Sci. Biol. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1111\/jcpe.12090","article-title":"Efficacy of different mouthrinse formulations in reducing oral malodour: A randomized clinical trial","volume":"40","author":"Dadamio","year":"2013","journal-title":"J. Clin. Periodontol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"898","DOI":"10.4040\/jkan.2012.42.6.898","article-title":"Effects of oral function improvement exercises on salivation, xerostomia and halitosis in elderly people","volume":"42","author":"Kim","year":"2012","journal-title":"J. Korean Acad. Nurs."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1113","DOI":"10.14219\/jada.archive.2007.0325","article-title":"Identification of oral bacterial species associated with halitosis","volume":"138","author":"Haraszthy","year":"2007","journal-title":"J. Am. Dent. Assoc."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"754","DOI":"10.1111\/j.1365-2672.2006.02837.x","article-title":"A preliminary study of the effect of probiotic Streptococcus salivarius K12 on oral malodour parameters","volume":"100","author":"Burton","year":"2006","journal-title":"J. Appl. Microbiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"867","DOI":"10.14219\/jada.2014.44","article-title":"Managing xerostomia and salivary gland hypofunction: Executive summary of a report from the American Dental Association Council on Scientific Affairs","volume":"145","author":"Plemons","year":"2014","journal-title":"J. Am. Dent. Assoc."},{"key":"ref_34","first-page":"45","article-title":"Diagnosis and management of xerostomia and hyposalivation","volume":"11","author":"Villa","year":"2015","journal-title":"Ther. Clin. Risk Manag."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"15S","DOI":"10.14219\/jada.archive.2007.0358","article-title":"Dry mouth and its effects on the oral health of elderly people","volume":"138","author":"Turner","year":"2007","journal-title":"J. Am. Dent. Assoc."},{"key":"ref_36","first-page":"3","article-title":"Measuring oral health: A conceptual framework","volume":"5","author":"Locker","year":"1988","journal-title":"Community Dent. Health"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"591","DOI":"10.2147\/CIA.S1596","article-title":"The stomatognathic system in the elderly: Useful information for the medical practitioner","volume":"2","author":"Kossioni","year":"2007","journal-title":"Clin. Interv. Aging"}],"container-title":["Dentistry Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2304-6767\/14\/9\/595\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T13:00:28Z","timestamp":1789390828000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2304-6767\/14\/9\/595"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,14]]},"references-count":37,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["dj14090595"],"URL":"https:\/\/doi.org\/10.3390\/dj14090595","relation":{},"ISSN":["2304-6767"],"issn-type":[{"value":"2304-6767","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,14]]}}}