Alternative therapies in controlling oral malodour: a systematic review

Abstract

Is there a role for alternative therapies in controlling intra-oral halitosis? Treatments other than tongue cleaning and anti-halitosis products containing zinc, chlorhexidine and cetylpyridinium chloride were considered as alternative therapies. Four databases were searched (PubMed, EMBASE, Web of Science and The Cochrane Library). Inclusion criteria were: examination of alternative halitosis therapies, study population with oral malodour, a (negative or positive) control group and evaluation of breath odour via organoleptic and/or instrumental assessment. Data were extracted for descriptive analysis. The screening of 7656 titles led to the inclusion of 26 articles. Analysis showed heterogeneity concerning the population of interest (from cysteine-induced to genuine halitosis), the examined treatment and the reported outcomes. This made a meta-analysis impossible. Essential oils, fluoride-containing products and herbal substances were the most studied. Results varied enormously and none of the active ingredients had an unambiguously positive effect on the malodour. The risk of bias was assessed as high in all articles. Given the fact that little evidence was found for each of the investigated treatments, it could be concluded that there is currently insufficient evidence that alternative therapies are of added value in the treatment of halitosis. Clinical relevance Scientific rationale: Halitosis is a common problem causing social isolation. Out of embarrassment, patients search the internet, leading to many questions about alternative solutions (e.g. oil pulling, herbs). This is the first systematic review on these alternative therapies. Principal findings: Results varied among studies. Some promising results were found for fluoride-containing toothpastes and probiotics. For other products (such as herbal and antibacterial products and essential oils) results were inconsistent. Long-term follow-up studies on these products are scarce. Moreover, the quality of the studies was poor. Practical implications: No clear evidence was found to support a certain alternative anti-halitosis therapy.

Efficacy of Topical Intervention for Recurrent Aphthous Stomatitis: A Network Meta-Analysis

“…Imbalance is dangerous and may lead to the occurrence of dental caries [117], periodontal disease [118], fungal disease [119], etc. Probiotics alone or supplemented with other drugs to modulate the composition and structure of the dominant flora in disease states, thus intervening in pathological states such as dental caries [120][121][122], periodontal disease [120,123,124] and breath odor [125,126] are supported by many studies. This also applies to RAS.…”

Daily use of chlorine dioxide effectively treats halitosis: A meta-analysis of randomised controlled trials

“…There is still no evidence-based, definitive treatment protocol for bad breath. As mentioned in a systematic review by Wylleman et al [ 10 ], it was proved that tongue cleaning is effective in reducing oral malodor in addition to toothbrushing. If measures do not help and the supposed cause was also treated well (e.g., periodontitis), further treatment might be necessary [ 11 , 12 ]; namely, the use of mouthwashes (e.g.…”