***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Volatile sulfur compounds ( VSCs ) produced by bacteria in niches of the oral cavity play a major role in the etiology of bad breath , and can be easily detected by a portable sulfide monitor ( Halimeter ) . To investigate the effect of an oral hygiene program on VSC levels , Halimeter readings were taken from 55 healthy dental students during a course in oral hygiene training , including instruction on brushing , flossing and professional tooth cleaning .  Ten students who received no oral hygiene training served as a negative control . The oral hygiene status was measured using the papillary bleeding index ( PBI ) . PBI and VSC values did not show significant changes during the study period of 10 weeks in the control group . In the test group , PBI values significantly decreased compared to baseline and the control , indicating that the oral hygiene program had a benefit on the oral hygiene status . The VSC values also decreased significantly during the study period compared to baseline and the control . It was concluded that in a group of dental students , a thorough oral hygiene training program was capable of reducing the oral level of VSC Halimeter readings OBJECTIVE A controlled clinical trial was conducted to evaluate the effects of oral prophylaxis on halitosis-associated , immunological and microbiological parameters . METHODS Thirty subjects were included in this controlled clinical trial ( patients with generalized chronic periodontitis and controls without clinical attachment loss ; each n = 15 ) .  Before oral prophylaxis and 14 days after ( including tongue cleaning ) volatile sulphur compounds ( VSC ) , organoleptic scores and a tongue coating index were evaluated . The levels of IL-1β , IL-8 , IL-10 and MMP-8 were measured in GCF , and also major periodontal pathogens were detected . Data were statistically analysed using anova and paired t-test . RESULTS Supragingival plaque and calculus removal with combined tongue cleaning was able to reduce significantly ( P < 0.05 ) the VSC values in both groups ( no significant differences between both groups ) . Two weeks after periodontal debridement , the VSC values were observed in the periodontitis group , but not in the control group , similar to the baseline values . The difference between the groups was statistically significant ( P < 0.05 ) . Only a repeated prophylaxis session in the periodontitis group was able to reduce VSC values significantly in comparison with baseline ( P < 0.05 ) . Organoleptic scores ( 10 and 30 cm ) were significantly different ( P < 0.05 ) between both groups before and after the treatment . Periodontal pathogens and host-derived markers were not significantly affected by a single prophylaxis session . CONCLUSIONS Oral prophylaxis may result in a significant decrease in VSC values . However , in periodontal diseases , a more complex treatment seems to be necessary BACKGROUND Bad breath is often caused by periodontitis and /or tongue coating . This study followed the impact of initial periodontal therapy on several halitosis-related outcome variables over a 6-month period . Organoleptic ratings are often uncomfortable for the patient and have several disadvantages . They are , for instance , influenced by external parameters ( e.g. , food intake and cosmetics ) and need to be calibrated among research ers worldwide . A second aim was to evaluate the reliability of saliva incubation as an in vitro indirect test for breath recording . METHODS In this double-blind , r and omized , medium-term , parallel study 45 moderate periodontitis patients without obvious tongue coating were enrolled . Besides a one-stage , full-mouth disinfection and oral hygiene improvement ( including daily tongue scraping ) , patients were instructed to rinse daily for 6 months with one of the following products ( r and omly allocated ) : chlorhexidine ( CHX ) 0.2 % + alcohol , CHX 0.05 % + cetyl pyridinium chloride ( CPC ) 0.05 % without alcohol ( a new formulation ) , or a placebo solution . At baseline and 3 and 6 months , a series of parameters were recorded including : concentration of volatile sulfide compounds ( VSC ) , tongue coating , and an estimation of the microbial load ( at anterior and posterior parts of the tongue , saliva , dental plaque ) . The intraoral VSC ratings were compared to in vitro VSC recordings and organoleptic evaluations of the headspace air from 1 and 2 hours incubated saliva ( 0.5 ml , 37 degrees C , anaerobic chamber ) . RESULTS Even though the initial VSC values were not high ( + /-90 ppb with only 18 patients revealing more than 100 ppb ) , significant ( P < 0.05 ) reductions could be achieved in the CHX and CHX + CPC group , and to a lower extent in the placebo group ( P = 0.10 ) . Tongue scraping result ed in a significant reduction ( P < or = 0.05 ) of the tongue coating up to month 6 in the placebo and CHX + CPC group , but not in the CHX group ( confusion due to staining ) . The CHX and CHX + CPC group showed , in comparison to baseline , significant ( P < 0.001 ) reductions in the number of anaerobic species in the supragingival plaque , in the saliva , and on the anterior part of the tongue . For the posterior part of the tongue the microbial changes remained < or = 0.3 log values ( P > 0.05 ) . For the placebo group , the microbial changes never reached a level of significance ( < or = 0.3 log values ) . A strong correlation was found between the intraoral VSC ratings and the 1-hour ( r = 0.48 , P < 0.0001 ; r = 0.54 , P = 0.0003 for baseline data only ) and 2-hour ( r = 0.43 , P < 0.0001 ) VSC production of incubated saliva . The latter also correlated very strongly ( r = 0.71 ) with the number of anaerobic species in the saliva . The VSC values and organoleptic ratings of the incubated saliva also correlated strongly with each other ( r = 0.64 for 1-hour and 0.73 for 2-hour incubation ) . CONCLUSIONS The results of this study indicate that in patients with moderate periodontitis , initial periodontal therapy including tongue scraping did not have a significant effect on the microbial load of the tongue and had only a weak impact on the VSC level , except when combined with a mouthrinse . Saliva incubation can be used as an indirect way to score breath odor . It offers simplicity , objectivity , and is less invasive PURPOSE The aim of the study was to determine the longitudinal effect of an oral hygiene program on oral levels of volatile sulfur compounds ( VSC ) . MATERIAL S AND METHODS The study subjects were r and omly selected from patients attending a student course in operative dentistry and from staff members of our dental clinic . The test group ( n = 30 ) received an oral hygiene training including professional toothcleaning ( PTC ) , oral hygiene instruction , and motivation . The control group ( n = 10 ) received no particular treatment .  None of the subjects suffered from bad breath nor performed regular tongue cleaning . At baseline , immediately after PTC , one week , and four weeks thereafter we measured the oral hygiene status by means of the  papillary bleeding index ( PBI ) and the oral concentrations of VSC by using a  portable sulfide monitor ( Halimeter ) . RESULTS Immediately after PTC , as well as one week , and four weeks after entering the program the PBI and the VSC-levels were significantly decreased as compared to the baseline values and the control group . VSCs were decreased by 34.9 % ( + /- 6.3 ) after PTC , 33.2 % ( + /- 7.1 ) one week , and 27.9 % ( + /- 5.8 ) four weeks thereafter . CONCLUSION The present study shows that in a group of patients without bad breath , an oral hygiene training program including professional toothcleaning , motivation and instruction of self-applied oral hygiene procedures is capable of reducing both papillary bleeding and oral levels of VSC Halimeter readings over the observation period of four weeks BACKGROUND AND OBJECTIVE Only a few clinical research studies have assessed different therapeutic approaches to oral malodor in subjects affected by periodontal diseases . The aim of this study was to evaluate the effects of periodontal treatment and tongue cleaning on oral malodor parameters in periodontitis and gingivitis patients . MATERIAL AND METHODS The subjects were 102 periodontitis and 116 gingivitis patients with oral malodor . Oral malodor was measured by organoleptic test and Oral Chroma ™ . Oral health status , including tooth conditions , periodontal health , tongue coating and proteolytic activity of the BANA test in tongue coating were assessed . Subjects in each periodontal disease group were r and omly assigned into two subgroups depending on the sequence of treatment : periodontal treatment and tongue cleaning . Oral malodor and oral health parameters were compared by groups and sequence of treatment . RESULTS For subjects in the periodontitis group , there were statistically significant reductions in oral malodor after periodontitis treatment or tongue cleaning ; however , major reductions were found after periodontitis treatment . For those in the gingivitis group , there were also statistically significant reductions in oral malodor after gingivitis treatment or tongue cleaning , but the most marked reductions were observed after tongue cleaning . At the completion of treatment , all oral malodor parameters fell below the threshold levels in all subgroups . CONCLUSION The present study indicated that periodontal treatment played an important role and tongue cleaning contributed to a lesser extent to reduction in oral malodor in periodontitis patients . In contrast , tongue cleaning alone can be the primary approach to reduce oral malodor in gingivitis patients 
    Output:
    
Based on best available evidence , PTC and SRP in combination with oral hygiene instructions reduced  VSC values in patients with oral halitosis and /or periodontal diseases , independent of tongue cleaning and the use of mouth rinses