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Szalai E, Tajti P, Szabó B, Kói T, Hegyi P, Czumbel LM, Varga G, Kerémi B. ORGANOLEPTIC AND HALITOMETRIC ASSESSMENTS DO NOT CORRELATE WELL IN INTRA-ORAL HALITOSIS: A SYSTEMATIC REVIEW AND META-ANALYSIS. J Evid Based Dent Pract 2023; 23:101862. [PMID: 37689445 DOI: 10.1016/j.jebdp.2023.101862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 03/12/2023] [Accepted: 03/25/2023] [Indexed: 09/11/2023]
Abstract
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 March 23, 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 5 databases. After the selection process, 76 articles were eligible for the systematic review, and 14,635 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 < .01. The pooled Spearman's c.c. for portable gas chromatographs was 0.69; 95% CIs: [0.63-0.74]; I2 = 12%, P < .01. The pooled Spearman's c.c. for gas chromatographs was 0.76; 95% CIs: [0.67-0.83]; I2 = 0%, P < .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.
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Affiliation(s)
- Eszter Szalai
- Department of Restorative Dentistry and Endodontics, Semmelweis University, Budapest, Hungary; Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Péter Tajti
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Department of Prosthodontics, Semmelweis University, Budapest, Hungary
| | - Bence Szabó
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Tamás Kói
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Department of Stochastics, Institute of Mathematics, Budapest University of Technology and Economics, Budapest, Hungary
| | - Péter Hegyi
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary; Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | - László Márk Czumbel
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Department of Periodontology, Semmelweis University, Budapest, Hungary
| | - Gábor Varga
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Department of Oral Biology, Semmelweis University, Budapest, Hungary
| | - Beáta Kerémi
- Department of Restorative Dentistry and Endodontics, Semmelweis University, Budapest, Hungary; Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.
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Efficacy of a Zinc Lactate Mouthwash and Tongue Scraping in the Reduction of Intra-Oral Halitosis: A Single-blind, Controlled, Crossover Clinical Trial-A Pilot Study. J Clin Med 2021; 10:jcm10235532. [PMID: 34884234 PMCID: PMC8658071 DOI: 10.3390/jcm10235532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 11/22/2021] [Accepted: 11/25/2021] [Indexed: 11/17/2022] Open
Abstract
Intra-oral halitosis is defined as an unpleasant odor that comes out of the mouth. The aim of this study was to investigate the effect of zinc lactate mouthwash and tongue scraping on intra-oral halitosis. The study was conducted on 60 volunteers that were divided into two groups and fol-lowed two types of 14-day oral hygiene protocols on a cross-over basis after a 7-day wash-out period. One protocol was based on tooth brushing only, while the other was based on additional mouth rinsing with a zinc lactate product and tongue scraping. Morning mouth breath was as-sessed organoleptic and by volatile sulfur compound concentrations. The highest mean organo-leptic and volatile sulfur compound measurement values were found in the tooth brushing without mouth washing and tongue scraping oral hygiene protocol (p < 0.05). The zinc lactate mouthwash combined with tongue scraping appears to be an important hygienic procedure to reduce breath odor.
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Poormoradi B, Gholami L, Fekrazad R, Hooshyarfard A, Noorani AR, Loft Haghpanah Z, Farhadian M. Comparison of the Effect of Er,Cr:YSGG Laser and Halita Mouthwash on Oral Malodor in Patients With Chronic Periodontitis: A Randomized Clinical Trial. J Lasers Med Sci 2021; 12:e26. [PMID: 34733749 DOI: 10.34172/jlms.2021.26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 03/09/2021] [Indexed: 11/09/2022]
Abstract
Introduction: Periodontal disease and tongue coatings are among the major factors associated with oral malodor. The present study, comparatively evaluated the effects of the Er,Cr:YSGG laser and Halita mouthwash as adjunctive treatments to nonsurgical periodontal debridement on oral malodor reduction in chronic periodontitis patients. Methods: Sixty patients with stage II and III chronic periodontitis and bad breath. The patients were randomly divided into two groups (n=30). After conventional scaling and root planing, patients in group 1 underwent Er,Cr:YSGG laser (Waterlase; Biolase, San Clemente, CA, USA) irradiation of the internal surface of the pockets (1.5 W, 30 Hz, 20% A, 40% W) and the dorsum of the tongue (1 W, 30 Hz, 20% A, 40% W) immediately after SRP and on the third and seventh days. Group 2 patients were asked to use Halita mouthwash twice daily for one week. Baseline, 1 and 3-month post-treatment measurements of plaque index (PI), probing pocket depth (PPD), clinical attachment level (CAL), gingival index (GI), bleeding on probing (BOP) and organoleptic assessment of Halitosis severity were performed. Results: Significant improvement in all parameters was noted in both groups after 1 and 3 months, compared with baseline (P < 0.05). The two groups had significant reductions which occurred in PPD, CAL and BOP levels and the organoleptic score in 1 and 3 months after the intervention (P < 0.05). Conclusion: Er,Cr:YSGG laser irradiation and Halita mouthwash as adjuncts to non-surgical periodontal therapy are both effective in the treatment of oral malodor and improvement of periodontal parameters.
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Affiliation(s)
- Banafsheh Poormoradi
- Dental Research Center, Department of Periodontology, Dentistry Faculty, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Leila Gholami
- Assistant Professor, Dental Research Center, Department of Periodontology, Dentistry Faculty, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Reza Fekrazad
- Radiation Sciences Research Center, Laser Research Center in Medical Sciences, AJA University of Medical Sciences, Tehran, Iran.,International Network for Photo Medicine and Photo Dynamic Therapy (INPMPDT), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Amirarsalan Hooshyarfard
- Dental Research Center, Department of Periodontology, Dentistry Faculty, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ali Reza Noorani
- Orthodontic Department, Dentistry Faculty, Kashan University of Medical Sciences, Kashan, Iran
| | | | - Maryam Farhadian
- Department of Biostatistics, School of Public Health and Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
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The effect of Brazilian propolis type-3 against oral microbiota and volatile sulfur compounds in subjects with morning breath malodor. Clin Oral Investig 2021; 26:1531-1541. [PMID: 34392403 DOI: 10.1007/s00784-021-04125-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 08/03/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To evaluate propolis type-3 mouthrinse effects on the concentration of volatile sulfur compounds (VSCs) and on tongue dorsum microbial profile. MATERIALS AND METHODS A three-step double-blind, crossover, randomized study with 10 individuals divided into three groups: I-placebo (P); II-ethanolic extract of propolis type-3 3% (EEP); and III-chlorhexidine 0.12% (CHX) and instructed to rinse twice daily for 5 days. Each experimental period was followed by a 21-day washout interval. Morning mouth breath was assessed by VSC concentrations and microbiological samples were obtained from tongue dorsum at baseline and the end of period of rinses and analyzed using checkerboard DNA-DNA hybridization technique for 39 bacterial species. RESULTS CHX and EEP presented the lowest VSC concentration when compared with placebo (p < 0.05). Even in the absence of mechanical plaque control, CHX and EEP treatments reduced VSC levels and there were no statistical differences for VSC measurement between CHX and EEP. There was a significant reduction in mean counts of 10 species including some VSC producers (Prevotella intermedia, Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia) by EEP. Total counts of organisms, gram-negative and gram-positive bacterial species showed a decrease for EEP and CHX (p < 0.05). In addition, no statistical difference was observed between EEP and CHX (p > 0.05). A positive correlation was observed between decrease of bacterial counts and decrease of VCSs concentration for the EEP and CHX. CONCLUSIONS The use of a 3% propolis type-3 mouthrinse is an effective way to prevent morning bad breath. Thus, propolis may be a promising agent for the treatment of halitosis. CLINICAL RELEVANCE Propolis type-3 may be used as adjuvant treatment for morning breath malodor.
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Alsaffar D, Alzoman H. Efficacy of antioxidant mouthwash in the reduction of halitosis: A randomized, double blind, controlled crossover clinical trial. J Dent Sci 2020; 16:621-627. [PMID: 33854711 PMCID: PMC8025192 DOI: 10.1016/j.jds.2020.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/06/2020] [Indexed: 01/09/2023] Open
Abstract
Background/purpose Halitosis is the unpleasant and offensive odour in exhaled air, which is linked to the presence of volatile sulphur compounds (VSC). Different mouthwashes have been used to treat halitosis. The objective of this study was to test the effect of an antioxidant (AO) mouthwash, and mouthwash containing [0.05% chlorhexidine, 0.05% cetylpyridinium chloride, and 0.14% zinc lactate (CHX-CPC-Zn)] on VSC. Material and methods Thirty-five subjects with halitosis participated in this clinical trial. At the baseline visit, a breath sample was taken and analyzed for the level of hydrogen sulphide (H2S), methyl mercaptan (CH3SH), and dimethyl sulphide (CH3SCH3) using portable gas chromatography (OralChroma™). Two mouthwashes were randomly provided to each subject in addition to saline solution (NaCl 0.9%) as control. Subjects were instructed to rinse with 20 ml of the mouthwash for 1 min twice daily for 2 weeks. At second visit, post-treatment breath sample was taken. Afterward, the patient was asked to refrain from using mouthwash for a washout period of 1 week. A similar procedure was repeated for each mouthwash interval. Results No significant differences in VSC level between all three groups were detected at baseline. A significant reduction in VSC level was obtained after using CHX-CPC-Zn mouthwash. On other hand, both AO mouthwash and saline had no significant impact on the level of VSC. Conclusion CHX-CPC-Zn mouthwash has a significant effect on VSC level reduction in subjects with confirmed halitosis. Besides, using AO mouthwash regularly for 2 weeks did not have any impact on improving the level of halitosis.
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Affiliation(s)
- Duaa Alsaffar
- Graduate Program in Periodontics, Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Hamad Alzoman
- Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
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Kumbargere Nagraj S, Eachempati P, Uma E, Singh VP, Ismail NM, Varghese E. Interventions for managing halitosis. Cochrane Database Syst Rev 2019; 12:CD012213. [PMID: 31825092 PMCID: PMC6905014 DOI: 10.1002/14651858.cd012213.pub2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Halitosis or bad breath is a symptom in which a noticeably unpleasant breath odour is present due to an underlying oral or systemic disease. 50% to 60% of the world population has experienced this problem which can lead to social stigma and loss of self-confidence. Multiple interventions have been tried to control halitosis ranging from mouthwashes and toothpastes to lasers. This new Cochrane Review incorporates Cochrane Reviews previously published on tongue scraping and mouthrinses for halitosis. OBJECTIVES The objectives of this review were to assess the effects of various interventions used to control halitosis due to oral diseases only. We excluded studies including patients with halitosis secondary to systemic disease and halitosis-masking interventions. SEARCH METHODS Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 8 April 2019), the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 3) in the Cochrane Library (searched 8 April 2019), MEDLINE Ovid (1946 to 8 April 2019), and Embase Ovid (1980 to 8 April 2019). We also searched LILACS BIREME (1982 to 19 April 2019), the National Database of Indian Medical Journals (1985 to 19 April 2019), OpenGrey (1992 to 19 April 2019), and CINAHL EBSCO (1937 to 19 April 2019). The US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov (8 April 2019), the World Health Organization International Clinical Trials Registry Platform (8 April 2019), the ISRCTN Registry (19 April 2019), the Clinical Trials Registry - India (19 April 2019), were searched for ongoing trials. We also searched the cross-references of included studies and systematic reviews published on the topic. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA We included randomised controlled trials (RCTs) which involved adults over the age of 16, and any intervention for managing halitosis compared to another or placebo, or no intervention. The active interventions or controls were administered over a minimum of one week and with no upper time limit. We excluded quasi-randomised trials, trials comparing the results for less than one week follow-up, and studies including advanced periodontitis. DATA COLLECTION AND ANALYSIS Two pairs of review authors independently selected trials, extracted data, and assessed risk of bias. We estimated mean differences (MDs) for continuous data, with 95% confidence intervals (CIs). We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS We included 44 trials in the review with 1809 participants comparing an intervention with a placebo or a control. The age of participants ranged from 17 to 77 years. Most of the trials reported on short-term follow-up (ranging from one week to four weeks). Only one trial reported long-term follow-up (three months). Three studies were at low overall risk of bias, 16 at high overall risk of bias, and the remaining 25 at unclear overall risk of bias. We compared different types of interventions which were categorised as mechanical debridement, chewing gums, systemic deodorising agents, topical agents, toothpastes, mouthrinse/mouthwash, tablets, and combination methods. Mechanical debridement: for mechanical tongue cleaning versus no tongue cleaning, the evidence was very uncertain for the outcome dentist-reported organoleptic test (OLT) scores (MD -0.20, 95% CI -0.34 to -0.07; 2 trials, 46 participants; very low-certainty evidence). No data were reported for patient-reported OLT score or adverse events. Chewing gums: for 0.6% eucalyptus chewing gum versus placebo chewing gum, the evidence was very uncertain for the outcome dentist-reported OLT scores (MD -0.10, 95% CI -0.31 to 0.11; 1 trial, 65 participants; very low-certainty evidence). No data were reported for patient-reported OLT score or adverse events. Systemic deodorising agents: for 1000 mg champignon versus placebo, the evidence was very uncertain for the outcome patient-reported visual analogue scale (VAS) scores (MD -1.07, 95% CI -14.51 to 12.37; 1 trial, 40 participants; very low-certainty evidence). No data were reported for dentist-reported OLT score or adverse events. Topical agents: for hinokitiol gel versus placebo gel, the evidence was very uncertain for the outcome dentist-reported OLT scores (MD -0.27, 95% CI -1.26 to 0.72; 1 trial, 18 participants; very low-certainty evidence). No data were reported for patient-reported OLT score or adverse events. Toothpastes: for 0.3% triclosan toothpaste versus control toothpaste, the evidence was very uncertain for the outcome dentist-reported OLT scores (MD -3.48, 95% CI -3.77 to -3.19; 1 trial, 81 participants; very low-certainty evidence). No data were reported for patient-reported OLT score or adverse events. Mouthrinse/mouthwash: for mouthwash containing chlorhexidine and zinc acetate versus placebo mouthwash, the evidence was very uncertain for the outcome dentist-reported OLT scores (MD -0.20, 95% CI -0.58 to 0.18; 1 trial, 44 participants; very low-certainty evidence). No data were reported for patient-reported OLT score or adverse events. Tablets: no data were reported on key outcomes for this comparison. Combination methods: for brushing plus cetylpyridium mouthwash versus brushing, the evidence was uncertain for the outcome dentist-reported OLT scores (MD -0.48, 95% CI -0.72 to -0.24; 1 trial, 70 participants; low-certainty evidence). No data were reported for patient-reported OLT score or adverse events. AUTHORS' CONCLUSIONS We found low- to very low-certainty evidence to support the effectiveness of interventions for managing halitosis compared to placebo or control for the OLT and patient-reported outcomes tested. We were unable to draw any conclusions regarding the superiority of any intervention or concentration. Well-planned RCTs need to be conducted by standardising the interventions and concentrations.
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Affiliation(s)
- Sumanth Kumbargere Nagraj
- Faculty of Dentistry, Melaka‐Manipal Medical College, Manipal Academy of Higher Education (MAHE), ManipalDepartment of Oral Medicine and Oral RadiologyJalan Batu HamparBukit BaruMelakaMalaysia75150
| | - Prashanti Eachempati
- Faculty of Dentistry, Melaka‐Manipal Medical College, Manipal Academy of Higher Education (MAHE)Department of ProsthodonticsJalan Batu HamparBukit BaruMelakaMalaysia75150
| | - Eswara Uma
- Faculty of Dentistry, Melaka‐Manipal Medical College, Manipal Academy of Higher Education (MAHE)Department of Paediatric DentistryJalan Batu HamparBukit BaruMelakaMalaysia75150
| | - Vijendra Pal Singh
- Faculty of Dentistry, Melaka‐Manipal Medical College, Manipal Academy of Higher Education (MAHE)Department of Periodontology and ImplantologyJalan Batu HamparBukit BaruMelakaMalaysia75150
| | - Noorliza Mastura Ismail
- Faculty of Dentistry, Melaka‐Manipal Medical College, Manipal Academy of Higher Education (MAHE)Department of Community DentistryJalan Batu HamparBukit BaruMelakaMelakaMalaysia75150
| | - Eby Varghese
- Melaka‐Manipal Medical College, Manipal Academy of Higher Education (MAHE)Department of Paediatric Dentistry, Faculty of DentistryMelakaMalaysia75150
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Shringeri P, Fareed N, Battur H, Khanagar S. Role of probiotics in the treatment and prevention of oral malodor/halitosis: A systematic review. JOURNAL OF INDIAN ASSOCIATION OF PUBLIC HEALTH DENTISTRY 2019. [DOI: 10.4103/jiaphd.jiaphd_171_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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Fedorowicz Z, Aljufairi H, Nasser M, Outhouse TL, Pedrazzi V. WITHDRAWN: Mouthrinses for the treatment of halitosis. Cochrane Database Syst Rev 2016; 2016:CD006701. [PMID: 27228022 PMCID: PMC7388864 DOI: 10.1002/14651858.cd006701.pub3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Cochrane Oral Health withdrew this review as of Issue 5, 2016.
This review is being updated and replaced following the publication of a new expanded protocol on the effects of different interventions for the management of halitosis (Pedrazzi V, do Nascimento C, Mardegan Issa JP, Fedorowicz Z. Interventions for managing halitosis (Protocol). Cochrane Database of Systematic Reviews 2016, Issue 5. Art. No.: CD012213. DOI: 10.1002/14651858.CD012213.). It will remain withdrawn when the new review is published.
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Affiliation(s)
| | - Hamad Aljufairi
- Royal College of Surgeons in Ireland ‐ BahrainSchool of MedicineP.O. Box 15503AdliyaBahrain
| | - Mona Nasser
- Plymouth University Peninsula Schools of Medicine and DentistryPeninsula Dental SchoolThe John Bull Building, Tamar Science Park,PlymouthUKPL6 8BU
| | | | - Vinícius Pedrazzi
- School of Dentistry of Ribeirão Preto, University of São PauloDepartment of Dental Materials and ProsthesisAv do Café s/nºRibeirão PretoSão PauloBrazil14040‐904
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De Geest S, Laleman I, Teughels W, Dekeyser C, Quirynen M. Periodontal diseases as a source of halitosis: a review of the evidence and treatment approaches for dentists and dental hygienists. Periodontol 2000 2016; 71:213-27. [DOI: 10.1111/prd.12111] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2015] [Indexed: 11/28/2022]
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Marchetti E, Casalena F, Capestro A, Tecco S, Mattei A, Marzo G. Efficacy of two mouthwashes on 3-day supragingival plaque regrowth: a randomized crossover clinical trial. Int J Dent Hyg 2015; 15:73-80. [PMID: 26522915 DOI: 10.1111/idh.12185] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the antiplaque effects of an alcohol-free essential oil (alcohol-free EO) mouthwash and an amine fluoride/stannous fluoride with zinc lactate (SnFl-Zn) mouthwash compared to a positive control of chlorhexidine (CHX) mouthwash, using an in vivo plaque regrowth model of 3 days. MATERIALS AND METHODS The study was designed as a double-masked, randomized, crossover clinical trial, involving 20 volunteers to compare two different mouthwashes, using a 3-day plaque accumulation model. After receiving thorough professional prophylaxis at baseline, over the next 3 days, each volunteer refrained from all oral hygiene measures and performed two daily rinses with 20 ml of the test mouthwashes. A 0.20% CHX rinse served as a positive control. At the end of each experimental period, plaque was assessed, and the panellists completed a questionnaire. Each subject underwent a 14-day washout period, and then, there was another allocation. RESULTS The SnFl-Zn mouthwash has shown a better inhibitory activity on plaque regrowth compared to the alcohol-free EO mouthwash in the whole mouth (plaque index = 1.93 against 2.45, respectively), but there was less of an effect compared to the CHX group, with an overall plaque index of 1.41. The differences of 0.52 between alcohol-free EO and SnFl-Zn and between SnFl-Zn and CHX and of 0.96 between alcohol-free EO and CHX were all statistically significant (P < 0.001). CONCLUSION The alcohol-free EO mouthwash seemed to have less of an inhibiting effect on plaque regrowth than the amine fluoride/SnFl-Zn mouthwash and the CHX control.
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Affiliation(s)
- E Marchetti
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - F Casalena
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - A Capestro
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - S Tecco
- Research Area in Dentofacial Orthopedics, Orthodontics and Pediatric Dentistry, IRCCS San Raffaele Hospital, Milan, Italy
| | - A Mattei
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - G Marzo
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
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Van der Sluijs E, Slot DE, Bakker EWP, Van der Weijden GA. The effect of water on morning bad breath: a randomized clinical trial. Int J Dent Hyg 2015; 14:124-34. [PMID: 26081039 DOI: 10.1111/idh.12149] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the effects of water on the parameters of 'morning bad breath' (MBB) and to evaluate whether there is a difference between rinsing with water and drinking a glass of water. MATERIALS AND METHODS A total of 50 participants were recruited and were randomly divided into two equal groups. One group rinsed with 15 ml of water for 30 s, and another group drank 200 ml of water within 30 s. Clinical assessments were carried out during one visit between 7:30 am and 12:00 pm. Pre- and post-intervention measures were assessed organoleptically as primary outcome parameters, and a secondary outcome parameter was assessed using both the Halimeter(®) and OralChroma(™) apparatuses to evaluate volatile sulphur compounds (VSCs), hydrogen sulphide (H2 S), methyl mercaptan (CH3 SH) and dimethyl sulphide ((CH3 )2 S). In addition, the presence of tongue coating (discoloration/thickness) and tongue fissures was assessed. RESULTS All 50 participants completed the study. In both groups, a significant reduction in the organoleptic score and the OralChroma(™) H2 S and CH3 SH readings was obtained after the intervention. Both regimens resulted in a CH3 SH reduction of approximately 60%, whereas the reduction in H2 S was between 30% and 50%. The acceptable change between pre- and post-assessments of the clinical parameters was not significantly different between the drinking and rinsing groups. CONCLUSION Rinsing with water or drinking a glass of water had a statistically significant effect on the MBB parameters. No significant difference was obtained between the two regimens.
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Affiliation(s)
- E Van der Sluijs
- Department of Periodontology, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University, Amsterdam, The Netherlands
| | - D E Slot
- Department of Periodontology, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University, Amsterdam, The Netherlands
| | - E W P Bakker
- Master Degree Program Evidence Based Practice AMC-UvA, Amsterdam, The Netherlands
| | - G A Van der Weijden
- Department of Periodontology, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University, Amsterdam, The Netherlands
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Erovic Ademovski S, Lingström P, Renvert S. The effect of different mouth rinse products on intra-oral halitosis. Int J Dent Hyg 2015; 14:117-23. [DOI: 10.1111/idh.12148] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2015] [Indexed: 11/27/2022]
Affiliation(s)
- S Erovic Ademovski
- Section for Health and Society; Kristianstad University; Kristianstad Sweden
| | - P Lingström
- Department of Cariology; Institute of Odontology; The Sahlgrenska Academy; University of Gothenburg; Sweden
| | - S Renvert
- Section for Health and Society; Kristianstad University; Kristianstad Sweden
- School of Dental Science; Trinity College; Dublin Ireland
- Blekinge Institute of Technology; Karlskrona Sweden
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Lee SH, Baek DH. Effects of Streptococcus thermophilus on volatile sulfur compounds produced by Porphyromonas gingivalis. Arch Oral Biol 2014; 59:1205-10. [DOI: 10.1016/j.archoralbio.2014.07.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 07/16/2014] [Accepted: 07/16/2014] [Indexed: 11/28/2022]
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14
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Prevalence of oral malodour and its relationship with oral parameters in Indian children aged 7–15 years. Eur Arch Paediatr Dent 2014; 15:251-8. [DOI: 10.1007/s40368-014-0109-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 01/08/2014] [Indexed: 02/01/2023]
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15
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Dadamio J, Van Tournout M, Teughels W, Dekeyser C, Coucke W, Quirynen M. Efficacy of different mouthrinse formulations in reducing oral malodour: a randomized clinical trial. J Clin Periodontol 2013; 40:505-13. [PMID: 23489103 DOI: 10.1111/jcpe.12090] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2013] [Indexed: 11/28/2022]
Abstract
AIMS The aim of this study was to assess the efficacy of mouthrinses formulations in oral malodour. MATERIAL & METHODS This single-centre, double-blind, randomized, parallel group clinical trial compared the efficacy of Halita™ and meridol(®) with and without zinc lactate versus negative and positive control. Volunteers with confirmed oral malodour (18/group) rinsed with one mouthrinse during 7 days (15 ml, 2x/day for 1 min.). 15 min. after a first rinse (masking effect), and after 7 days (therapeutic effect) the change in organoleptic scores and level of sulphur compounds was recorded. RESULTS All rinses showed a masking effect (OLS 1 to 2 values reduced), only the rinses with antimicrobial ingredients showed a therapeutic effect (OLS 1 to 1.5 value less). The addition of zinc resulted in a more pronounced masking effect. Halita™ and meridol(®) with zinc showed the best therapeutic effect. CONCLUSION Although the masking effect of the rinses can be attributed partially to a dilution and the effect of aromas, the therapeutic effect should be linked to the anti-microbial action of active ingredients and counter action of zinc ions on VSC. A complete resolution of the unpleasant breath by additional mechanical intervention remains to be proven.
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Affiliation(s)
- Jesica Dadamio
- Department of Periodontology, Catholic University Leuven, Leuven, Belgium
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16
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Raangs GC, Winkel EG, van Winkelhoff AJ. In vitro antimicrobial effects of two antihalitosis mouth rinses on oral pathogens and human tongue microbiota. Int J Dent Hyg 2013; 11:203-7. [PMID: 23368885 DOI: 10.1111/idh.12014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2012] [Indexed: 01/10/2023]
Abstract
OBJECTIVES The aim of the study was to compare the antimicrobial activity of a mouth rinse containing chlorhexidine and cetylpyridinium chloride (MR1) with a stannous fluoride-based mouth rinse (MR2) in vitro. MATERIALS AND METHODS Samples of the tongues from 10 subjects with and 10 subjects without halitosis were inoculated on blood agar plates. The agar was perforated, and the cylindrical holes were filled either with mouth rinse MR1 or with mouth rinse MR2. After incubation, inhibition zones of the whole tongue microbiota and Fusobacterium nucleatum were measured. In addition, MR1 and MR2 were applied in a short interval killing test (SIKT) on four oral pathogens Porphyromonas gingivalis, Prevotella intermedia, F. nucleatum and Aggregatibacter actinomycetemcomitans. Total viable cell counts were made after two minutes of incubation with increasing concentrations of MR1 and MR2. RESULTS MR1 showed a significantly higher in vitro antimicrobial activity against the whole tongue microbiota and F. nucleatum than MR2 in both groups of subjects. In the SIK test, MR1 showed a significantly greater killing capacity than MR2. The results show that a mouth rinse with low concentrations of chlorhexidine and 0.05% cetylpyridinium chloride appears to be more effective in inhibiting growth of the human tongue microbiota in vitro than a fluoride/stannous fluoride-containing mouth rinse. CONCLUSION This in vitro observation supports the use of chlorhexidine and cetylpyridinium chloride in the treatment of oral halitosis.
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Affiliation(s)
- G C Raangs
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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17
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Erovic Ademovski S, Lingström P, Winkel E, Tangerman A, Persson GR, Renvert S. Comparison of different treatment modalities for oral halitosis. Acta Odontol Scand 2012; 70:224-33. [PMID: 22149929 DOI: 10.3109/00016357.2011.635601] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To assess the effects on intra-oral halitosis by a mouth rinse containing zinc acetate (0.3%) and chlorhexidine diacetate (0.025%) with and without adjunct tongue scraping. MATERIALS AND METHODS Twenty-one subjects without a diagnosis of periodontitis were randomized in a cross-over clinical trial. Organoleptic scores (OLS) were assessed to define intra-oral halitosis by total volatile sulfur compound (T-VSC) measurements and by gas chromatography. RESULTS Twenty-one subjects with a mean age of 45.7 years (SD: ±13.3, range: 21-66). The OLS were significantly lower following active rinse combined with tongue scraping (p < 0.001) at all time points. Immediately after, at 30 min, and at day 14, the T-VSC values were lower in the active rinse sequence than in the negative rinse sequence (p < 0.001, p < 0.001 and p < 0.05, respectively). At 30 min and at day 14, the hydrogen sulfide (H(2)S) and methyl mercaptan (MM) values were lower in the active rinse sequence compared to the inactive rinse sequence (p < 0.001). The inactive rinse sequence with tongue scraping reduced T-VSC at 30 min (p < 0.001) but not at 14 days. Similar reductions in T-VSC, H(2)S and MM were found in the active rinse sequence with or without tongue scraping. CONCLUSION The use of a tongue scraper did not provide additional benefits to the active mouth rinse, but reduced OLS and tongue coating index.
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Affiliation(s)
- Seida Erovic Ademovski
- Department of Oral Health Science, Section for Health and Society, Kristianstad University, Sweden
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18
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Blom T, Slot DE, Quirynen M, Van der Weijden GA. The effect of mouthrinses on oral malodor: a systematic review. Int J Dent Hyg 2012; 10:209-22. [PMID: 22429551 DOI: 10.1111/j.1601-5037.2012.00546.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of this study is to systematically review the literature regarding the impact of mouthrinses on oral malodor and present evidence for the treatment effects of mouthrinses on oral malodor. MATERIAL AND METHODS PubMed-MEDLINE, the Cochrane-CENTRAL and EMBASE were searched through February 10, 2012 to identify appropriate studies. Volatile sulphur compound measurements, organoleptic measurements and tongue coating were selected as outcome variables. SEARCH RESULTS: The independent screenings of 333 unique titles and paper abstracts revealed 12 publications (12 experiments) that met the eligibility criteria. Means and standard deviations were extracted. The results were separated into short-term (<3 weeks) and longer-term (≥3 weeks) studies. CONCLUSION In this review, nearly all mouthwashes with active ingredients had beneficial effects in reducing oral malodor in both short- and longer-term studies. The most compelling evidence was provided for chlorhexidine mouthwashes, and those that contained a combination of cetyl pyridinum chloride and zinc provided the best evidence profile on oral malodor. Little data with respect to tongue coating were available, and none of the studies showed a beneficial effect for this parameter.
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Affiliation(s)
- T Blom
- School of Dental Hygiene, INHOLLAND University of Applied sciences, Amsterdam, The Netherlands
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19
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Young A, Jonski G. Effect of a single brushing with two Zn-containing toothpastes on VSC in morning breath: a 12 h, randomized, double-blind, cross-over clinical study. J Breath Res 2011; 5:046012. [DOI: 10.1088/1752-7155/5/4/046012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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20
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Campisi G, Musciotto A, Di Fede O, Di Marco V, Craxì A. Halitosis: could it be more than mere bad breath? Intern Emerg Med 2011; 6:315-9. [PMID: 21140240 DOI: 10.1007/s11739-010-0492-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Accepted: 11/10/2010] [Indexed: 11/25/2022]
Abstract
Halitosis is a generic term used to describe unpleasant odor emanating from the mouth air and breath, independent of the source where the odor substances originate. It affects between 50 and 65% of the population, but despite its frequency, this problem is often unaccepted and declared as taboo. Ninety percent of patients suffering from halitosis have oral causes: a small, but important percentage, of oral malodor cases have an extra-oral etiology, very often falling into the category of "blood-borne halitosis". Several systemic diseases have been found to provoke malodor or to be a cofactor; bad breath may be an early sign of a serious local or systemic condition. A psychogenic halitosis also exists including the variant "pseudo-halitosis", when the oral malodor does not exist, but the patient believes he or she is suffering severely from it, and the halitophobia, when, instead, there is an exaggerated fear of having halitosis. The aims of this paper are to review both oral and extra-oral causes of halitosis, especially those related to underlying systemic diseases, and to provide the primary care clinician a helpful means for its diagnosis and management. In fact, it is important to determine quickly whether the odor comes from an oral cause or not: if so, it requires referral to a dentist; if not (extra-oral origin alone or combined), its management requires the treatment of the underlying causes. Extra-oral disorders can be the cause in up to 15% of cases.
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Affiliation(s)
- Giuseppina Campisi
- Sector of Oral Medicine, Department of Oral Sciences, University of Palermo, Via del Vespro 129, 90127, Palermo, Italy.
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21
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Abstract
Halitosis is a common complaint of one third of the population. It is commonly known as ‘bad breath’. The causes of halitosis can both be intraoral (90%) as well as extraoral (10%). Malodor of oral etiology results from the oral cavity itself. Non oral etiology may include various systemic diseases and use of certain drugs. Halitosis can act as a biomarker for various systemic diseases. Organoleptic examination, gas chromatography and portable sulfide monitors are the common methods of measurement of halitosis. Brushing twice daily with tongue cleaning can sufficiently manage halitosis in majority of the population while antimicrobial oral rinses can be prescribed to the non respondents. Necessary investigations and treatment should follow for those having extra oral cause of halitosis.
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Affiliation(s)
- K L Veeresha
- Department of Public Health Dentistry, M. M. College of Dental Sciences and Research, Mullana, India
| | - M Bansal
- Department of Public Health Dentistry, M. M. College of Dental Sciences and Research, Mullana, India
| | - V Bansal
- Department of Public Health Dentistry, M. M. College of Dental Sciences and Research, Mullana, India
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22
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Schaefer I, Braumann B. Halitosis, oral health and quality of life during treatment with Invisalign(®) and the effect of a low-dose chlorhexidine solution. J Orofac Orthop 2010; 71:430-41. [PMID: 21082306 DOI: 10.1007/s00056-010-1040-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2010] [Accepted: 09/30/2010] [Indexed: 11/26/2022]
Abstract
AIM This study examined how halitosis, oral dryness and general oral health were impacted during treatment with the Invisalign(®) system. Furthermore, the effect of a lowdose chlorhexidine solution (CHX) was evaluated. PATIENTS AND METHODS Thirtyone patients with good periodontal health participated in this crossover study and were divided into two groups (group 1: CHX/no CHX, group 2: no CHX/CHX). The following parameters were recorded during the first 8 months of Invisalign(®) treatment: stimulated saliva flow rate, organoleptic index, tongue coating index, measurement of the oral volatile sulfur compound level (ppb), modified gingival and plaque index and bleeding on probing index. Professional oral cleaning was performed at the beginning of each period lasting 3 months. The patients received a questionnaire at the first, third, fourth, sixth and eighth control visits. RESULTS The very low volatile sulfur compound level was significantly decreased by CHX (0.06%) during the first examination period (p = 0.02), i.e. for the first group of patients only. Neither halitosis, nor oral dryness, nor high plaque or gingival index measurements were observed. Oral health-related quality of life was hardly influenced by wearing aligners and oral hygiene habits were very good. CONCLUSIONS This study provides evidence that Invisalign(®) treatment is characterized by only minimal impairment of overall oral health and the associated quality of life. Consequently, it appears unnecessary to recommend the general adjunctive use of a low-dose chlorhexidine mouthwash during treatment with Invisalign(®).
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Affiliation(s)
- Isabelle Schaefer
- Department of Orthodontics, University of Cologne, Cologne, Germany.
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23
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Troccaz M, Haefliger OP, Cayeux I, Beccucci S, Jeckelmann N, Barra J, Clark AJ, Schrenzel J, Baehni P. Effects of Flavoured Mouth Rinses on Morning Breath Odour: a Sensory, Analytical and Microbial Evaluation. FLAVOUR FRAG J 2010. [DOI: 10.1002/ffj.2018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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24
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Wilhelm D, Gysen K, Himmelmann A, Krause C, Wilhelm KP. Short-term effect of a new mouthrinse formulation on oral malodour after single use
in vivo
: a comparative, randomized, single-blind, parallel-group clinical study. J Breath Res 2010; 4:036002. [DOI: 10.1088/1752-7155/4/3/036002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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25
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Shinada K, Ueno M, Konishi C, Takehara S, Yokoyama S, Zaitsu T, Ohnuki M, Wright FAC, Kawaguchi Y. Effects of a mouthwash with chlorine dioxide on oral malodor and salivary bacteria: a randomized placebo-controlled 7-day trial. Trials 2010; 11:14. [PMID: 20152022 PMCID: PMC2831889 DOI: 10.1186/1745-6215-11-14] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Accepted: 02/12/2010] [Indexed: 12/02/2022] Open
Abstract
Background Previous research has shown the oxidizing properties and microbiological efficacies of chlorine dioxide (ClO2). Its clinical efficacies on oral malodor have been evaluated and reported only in short duration trials, moreover, no clinical studies have investigated its microbiological efficacies on periodontal and malodorous bacteria. Thus, the aim of this study was to assess the inhibitory effects of a mouthwash containing ClO2 used for 7 days on morning oral malodor and on salivary periodontal and malodorous bacteria. Methods/Design A randomized, double blind, crossover, placebo-controlled trial was conducted among 15 healthy male volunteers, who were divided into 2 groups. Subjects were instructed to rinse with the experimental mouthwash containing ClO2 or the placebo mouthwash, without ClO2, twice per day for 7 days. After a one week washout period, each group then used the opposite mouthwash for 7 days. At baseline and after 7 days, oral malodor was evaluated with Organoleptic measurement (OM), and analyzed the concentrations of hydrogen sulfide (H2S), methyl mercaptan (CH3SH) and dimethyl sulfide ((CH3)2S), the main VSCs of human oral malodor, were assessed by gas chromatography (GC). Clinical outcome variables included plaque and gingival indices, and tongue coating index. The samples of saliva were microbiologically investigated. Quantitative and qualitative analyses were performed using the polymerase chain reaction-Invader method. Results and Discussion The baseline oral condition in healthy subjects in the 2 groups did not differ significantly. After rinsing with the mouthwash containing ClO2 for 7 days, morning bad breath decreased as measured by the OM and reduced the concentrations of H2S, CH3SH and (CH3)2S measured by GC, were found. Moreover ClO2 mouthwash used over a 7-day period appeared effective in reducing plaque, tongue coating accumulation and the counts of Fusobacterium nucleatum in saliva. Future research is needed to examine long-term effects, as well as effects on periodontal diseases and plaque accumulation in a well-defined sample of halitosis patients and broader population samples. Trial registration ClinicalTrials.gov NCT00748943
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Affiliation(s)
- Kayoko Shinada
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan.
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26
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Wigger-Alberti W, Gysen K, Axmann EM, Wilhelm KP. Efficacy of a new mouthrinse formulation on the reduction of oral malodour
in vivo.
A randomized, double-blind, placebo-controlled, 3 week clinical study. J Breath Res 2009; 4:017102. [DOI: 10.1088/1752-7155/4/1/017102] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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27
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Abstract
BACKGROUND Halitosis is an unpleasant odour emanating from the oral cavity. Mouthwashes, which are commonly used for dealing with oral malodour, can be generally divided into those that neutralize and those that mask the odour. OBJECTIVES To investigate the effects of mouthrinses in controlling halitosis. SEARCH STRATEGY We searched the following databases: Cochrane Oral Health Group Trials Register (to August 2008); the Cochrane Central Register of Controlled Trials (The Cochrane Library 2008, Issue 3); MEDLINE (1950 to August 2008); EMBASE (1980 to August 2008); and CINAHL (1982 to August 2008). There were no language restrictions. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing mouthrinses to placebo in adults over the age of 18 with halitosis and without significant other comorbidities or health conditions.The primary outcomes considered were self expressed and organoleptic (human nose) assessments of halitosis, and the secondary outcomes included assessment of halitosis as measured by a halimeter, portable sulphide monitor or by gas chromatography coupled with flame-photometric detection. DATA COLLECTION AND ANALYSIS Two independent review authors screened and extracted information from, and independently assessed the risk of bias in the included trials. MAIN RESULTS Five RCTs, involving 293 participants who were randomised to mouthrinses or placebo, were included in this review.In view of the clinical heterogeneity between the trials, pooling of the results and meta-analysis of the extracted data was not feasible and therefore only a descriptive summary of the results of the included trials is provided.0.05% chlorhexidine + 0.05% cetylpyridinium chloride + 0.14% zinc lactate mouthrinse significantly reduced the mean change (standard deviation (SD)) of organoleptic scores from baseline compared to placebo (-1.13 (1.1) P < 0.005 versus -0.2 (0.7)) and also caused a more significant reduction in the mean change (SD) in peak level of volatile sulphur compounds (VSC) (-120 (92) parts per billion (ppb) versus 8 (145) ppb in placebo). The chlorhexidine cetylpyridinium chloride zinc lactate mouthrinse showed significantly more tongue (P < 0.001) and tooth (P < 0.002) staining compared to placebo.However, in view of the incomplete reporting of results in three of the trials and the sole use of the halimeter for assessment of VSC levels as outcomes in two further trials, caution should be exercised in interpreting these results. AUTHORS' CONCLUSIONS Mouthrinses containing antibacterial agents such as chlorhexidine and cetylpyridinium chloride may play an important role in reducing the levels of halitosis-producing bacteria on the tongue, and chlorine dioxide and zinc containing mouthrinses can be effective in neutralisation of odouriferous sulphur compounds.Well designed randomised controlled trials with a larger sample size, a longer intervention and follow-up period are still needed.
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Affiliation(s)
- Zbys Fedorowicz
- UKCC (Bahrain Branch), Ministry of Health, Bahrain, Box 25438, Awali, Bahrain.
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28
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Cortelli JR, Barbosa MDS, Westphal MA. Halitosis: a review of associated factors and therapeutic approach. Braz Oral Res 2008; 22 Suppl 1:44-54. [DOI: 10.1590/s1806-83242008000500007] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2008] [Accepted: 06/20/2008] [Indexed: 11/22/2022] Open
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van den Broek AMWT, Feenstra L, de Baat C. A review of the current literature on management of halitosis. Oral Dis 2008; 14:30-9. [PMID: 18173446 DOI: 10.1111/j.1601-0825.2006.01350.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Halitosis is an unpleasant or offensive odour, emanating from the oral cavity. In approximately 80% of all cases, halitosis is caused by microbial degradation of oral organic substrates. Major degradation products are volatile sulphur-containing compounds. In this review, the available management methods of halitosis and their effectiveness and significance are presented and discussed. Undoubtedly, the basic management is mechanically reducing the amount of micro-organisms and substrates in the oral cavity. Masking products are not, and antimicrobial ingredients in oral healthcare products are only temporary effective in reducing micro-organisms or their substrates. Good short-term results were reported with chlorhexidine. Triclosan seems less effective, essential oils and cetylpyridinium chloride are only effective up to 2 or 3 h. Metal ions and oxidizing agents, such as hydrogen peroxide, chlorine dioxide and iminium are active in neutralizing volatile sulphur-containing compounds. Zinc seems to be an effective safe metal at concentrations of at least 1%. The effectiveness of active ingredients in oral healthcare products is dependent on their concentration and above a certain concentration the ingredients can have unpleasant side effects. Tonsillectomy might be indicated if (i) all other causes of halitosis are managed properly; (ii) halitosis still persists and (iii) crypts in tonsils are found to contain malodorous substrates.
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Affiliation(s)
- A M W T van den Broek
- Department of Oral and Maxillofacial Surgery and Special Dental Care, Erasmus University Medical Center, Rotterdam, The Netherlands.
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30
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Faveri M, Hayacibara MF, Pupio GC, Cury JA, Tsuzuki CO, Hayacibara RM. A cross-over study on the effect of various therapeutic approaches to morning breath odour. J Clin Periodontol 2006; 33:555-60. [PMID: 16899098 DOI: 10.1111/j.1600-051x.2006.00955.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the effect of tongue scraping and inter-dental flossing on morning bad breath in periodontally healthy subjects. METHODS A four-step blind, cross-over study was conducted in 19 volunteers, divided into four groups: Group I: tooth brushing; Group II: tooth brushing and inter-dental flossing; Group III: tooth brushing and tongue scraping; and Group IV: tooth brushing, inter-dental flossing and tongue scraping. The volunteers performed these oral hygiene procedures three times a day for 7 days. Seven-day wash-out intervals were observed. Morning mouth breath was assessed organoleptically and by volatile sulphur compound concentrations. RESULTS The highest mean organoleptic and volatile sulphur compound measurement values were found in the treatment groups in which tongue scraping was not performed and there were statistical differences between the two groups (p < 0.05). In the organoleptic evaluation (p > 0.05), inter-dental flossing did not show any statistical improvement in the effect of tongue hygiene on morning bad breath, but it significantly reduced the concentration of volatile sulphur compounds (p < 0.05). CONCLUSION The findings suggest that tongue scraping appears to be the most important hygienic procedure to reduce morning bad breath in periodontally healthy subjects.
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31
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Burton JP, Chilcott CN, Moore CJ, Speiser G, Tagg JR. A preliminary study of the effect of probiotic Streptococcus salivarius K12 on oral malodour parameters. J Appl Microbiol 2006; 100:754-64. [PMID: 16553730 DOI: 10.1111/j.1365-2672.2006.02837.x] [Citation(s) in RCA: 162] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS To determine whether dosing with bacteriocin-producing Streptococcus salivarius following an antimicrobial mouthwash effects a change in oral malodour parameters and in the composition of the oral microbiota of subjects with halitosis. MATERIALS AND RESULTS Twenty-three subjects with halitosis undertook a 3-day regimen of chlorhexidine (CHX) mouth rinsing, followed at intervals by the use of lozenges containing either S. salivarius K12 or placebo. Assessment of the subjects' volatile sulphur compound (VSC) levels 1 week after treatment initiation showed that 85% of the K12-treated group and 30% of the placebo group had substantial (>100 ppb) reductions. The bacterial composition of the saliva was monitored by culture and PCR-denaturing gradient gel electrophoresis (PCR-DGGE). Changes in the PCR-DGGE profiles occurred in most subjects following K12 treatment. In vitro testing showed that S. salivarius K12 suppressed the growth of black-pigmented bacteria in saliva samples and also in various reference strains of bacteria implicated in halitosis. CONCLUSIONS Administration of bacteriocin-producing S. salivarius after an oral antimicrobial mouthwash reduces oral VSC levels. SIGNIFICANCE AND IMPACT OF THE STUDY The outcome of this preliminary study indicates that the replacement of bacteria implicated in halitosis by colonization with competitive bacteria such as S. salivarius K12 may provide an effective strategy to reduce the severity of halitosis.
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Affiliation(s)
- J P Burton
- BLIS Technologies, Center for Innovation, University of Otago, Dunedin, New Zealand.
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32
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Abstract
Halitosis is a common problem. Its aetiology is multifactorial, but oral malodour is usually caused by microbial metabolism from the tongue, saliva or dental plaque. Mouthwashes are only effective against halitosis caused by intraoral factors. The principal causative agents of oral malodour are volatile sulphide compounds (VSCs), including hydrogen sulphide, methyl mercaptan and dimethyl sulphide. Data suggest that oral VSC levels correlate with the depth of periodontal pockets. Trials have shown that both mechanical oral care and mouthwash use can reduce halitosis levels. The majority of studies involving mouthwashes have investigated chlorhexidine and essential oil mouthwashes, although comparative studies are sparse.
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Affiliation(s)
- M Quirynen
- Catholic University Leuven, Faculty of Medicine, Leuven, Belgium
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