Extraoral Halitosis due to Exhaled Acetone in Patients Undergoing Sleeve Gastrectomy

Abstract

Introduction: Bariatric surgery is widely used and considered as one of the most effective treatments for morbid obesity, but it can be associated with medical and dental adverse side-effects. It is frequently associated with major metabolic changes that may lead to extraoral halitosis. Aim: To assess the role of exhaled acetone produced as a result of weight loss in the production of extra-oral halitosis in patients undergoing bariatric surgery. Materials and Methods: A prospective longitudinal cohort study was designed from October 2018 to November 2019 and monitored for six months postsurgery. The subjects were patients undergoing sleeve gastrectomy surgery with a Body Mass Index (BMI) of 35-50 kg/m2. Subjects were divided into two groups of low BMI loss (<5 Kg/m2) and high BMI loss (≥5 Kg/m2) postsurgery, Breath samples were collected with a portable breath ketone analyser for measurement of acetone concentrations, and blood samples were taken for measurement of 3-hydroxybutyrate levels. Breath and blood samples were taken at baseline then at one month, three months, and six months postsurgery. All statistical analysis were performed using the SPSS version 22.0 with a significance value of p-value set at p<0.05. Results: Out of 43 patients enrolled initially, eventually 39 patients completed the study. The mean level of breath acetone was 4.1, 3.4, and 3.8 ppm at one month, three months, and six months, respectively (p=0.018). There was a statistically significant increase in breath acetone at one month in patients with a high rate of BMI loss. At one month, the mean blood level of 3-hydroxybutyrate was higher in patients with a high rate of BMI loss than in those with a low rate of BMI loss (1.9 vs. 1.2 mmol/L; p=0.049). The levels of breath acetone and blood 3-hydroxybutyrate were significantly correlated at one month (r=0.6, p<0.05). Conclusion: Rapid weight loss one month after gastric sleeve surgery resulted in high acetone levels suggestive of increased extraoral halitosis in such patients. Increased Acetone levels in breath and 3-hydroxybutyrate in blood are suggestive of increased extraoral halitosis in patients undergoing gastric sleeve surgery particularly within a month after surgery.