Background : The gold standard method for diagnosing oral halitosis is the subjective
organoleptic measurement. Device-supported methods are also widespread worldwide.
The challenges and safety concerns around performing organoleptic measurements during
pandemics and the diversity of measuring device alternatives raised our clinical question:
which halitometer is the most suitable for diagnosing halitosis? Methods : This systematic
review was registered in PROSPERO (ID CRD42022320024). The search was performed on
23rd March 2022 in the following electronic databases: MEDLINE, Embase, Scopus, Web
of Science, and CENTRAL. Adult populations with or without halitosis were included,
and patients with systemic diseases were excluded. Organoleptic (subjective) measurement
and the device-supported (objective) methods were compared; the primary outcome was
the correlation coefficient, and the secondary was the specificity and sensitivity
of the devices. QUADAS-2 and QUADAS-C were used to evaluate the risk of bias in the
studies. Random-effects meta-analyses were performed on the outcomes, and the secondary
outcomes were plotted on a common ROC plot. Results : A total of 1231 records were
found in the five databases. After the selection process, 76 articles were eligible
for the systematic review, and 14635 patients were involved in the qualitative analysis.
The pooled Spearman's correlation coefficient (c.c.) for sulfide monitors was 0.65;
95% CIs: [0.53 – 0.74]; I2= 95%, p<0.01. The pooled Spearman's c.c. for portable gas
chromatographs was 0.69; 95% CIs: [0.63 – 0.74]; I2= 12%, p<0.01. The pooled Spearman's
c.c. for gas chromatographs was 0.76; 95% CIs: [0.67 – 0.83]; I2= 0%, p<0.01. Discussion
: None of the most commonly used halitometers proved to be significantly superior
to the others. Halimeter and OralChroma measurements did not correlate well with the
organoleptic level of oral halitosis in adults. Therefore, better halitometers need
to be developed as an alternative to organoleptic measurements.
