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. 2024 Jun;36(6):940-946.
doi: 10.1016/j.sdentj.2024.04.005. Epub 2024 Apr 18.

Effect of sleeve gastrectomy on the levels of oral volatile sulfur compounds and halitosis-related bacteria

Hanadi G Alzahrani  1 , Mohammed A AlSarhan  2 , Abdullah Aldohayan  3 , Fahad Bamehriz  3 , Hamad A Alzoman  2
Affiliations

Effect of sleeve gastrectomy on the levels of oral volatile sulfur compounds and halitosis-related bacteria

Hanadi G Alzahrani et al. Saudi Dent J. 2024 Jun.

Abstract

Background: The association between sleeve gastrectomy and halitosis remains relatively unknown. Therefore, this study aimed to evaluate the effect of sleeve gastrectomy on halitosis and the oral bacterial species associated with halitosis in patients with obesity.

Methods: This was a prospective longitudinal cohort study that examined patients before and after sleeve gastrectomy and followed the patients at three time intervals (1, 3, and 6 months) after sleeve gastrectomy. Clinical periodontal measurements (plaque index [PI], gingival index [GI], and probing depth [PD]) were obtained. In addition, plaque samples were collected for quantification of the periodontopathogenic bacteria: Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, and Fusobacterium nucleatum using real-time quantitative polymerase chain reaction (qPCR). In addition, breath samples were collected to analyze the concentration of volatile sulfur compounds (VSCs), namely hydrogen sulfide (H2S), methyl mercaptan (CH3SH), and dimethyl sulfide (CH3SCH3), via portable gas chromatography (Oral Chroma™).

Results: Of the 43 patients initially included, 39 completed the study, with a mean age of 32.2 ± 10.4 years. For PI and GI repeated measurements one way analysis of variance showed a significant increase (p-value < 0.001 for both) one month after surgery, with mean values of 1.3 and 1.59, respectively, compared to the baseline. During the same period, the number of P. gingivalis increased, with a p-value = 0.04. Similarly, the levels of hydrogen sulfide (H2S) and methyl mercaptan (CH3SH) increased significantly in the first month after surgery (p-value = 0.02 and 0.01, respectively).

Conclusion: This study demonstrated that sleeve gastrectomy may lead to increased halitosis one month post-surgery, attributed to elevated and P. gingivalis counts, contributing to the development of gingivitis in obese patients who underwent sleeve gastrectomy. This emphasizes the importance of including oral health professionals in the multidisciplinary team for the management of patients undergoing bariatric surgery.

Keywords: Bariatric surgery; Breath tests; Halitosis; Obesity; Periodontal disease; Periodontal pathogens.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr. Hanadi Alzahrani reports financial support was provided by King Abdulaziz City for Science and Technology grant no (1-18-03-001-0050). If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
(A) Subgingival plaque sample collection using sterile paper point size 35. (B) Plaque samples placed in an Eppendorf tube containing 1.5 mL of PBS.
Fig. 2
Fig. 2
Median bacterial RQ values at baseline and at 1, 3, and 6 months. Friedman nonparametric test.
See this image and copyright information in PMC

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