Effects of a mouthwash with chlorine dioxide on oral malodor and salivary bacteria: a randomized placebo-controlled 7-day trial

Abstract

BackgroundPrevious 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/DesignA 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 DiscussionThe 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 registrationClinicalTrials.gov NCT00748943

Effect of Aloe vera, chlorine dioxide, and chlorhexidine mouth rinses on plaque and gingivitis: A randomized controlled trial

“…[17][18][19][20] Similarly, chlorine dioxide also reported to have antibacterial properties by disrupting protein synthesis, inactivating enzymes, and misbalancing electrolytes within cell membranes. 26,31,23 In addition, it oxidizes VSCs, which are also responsible for local inflammation and the progression of periodontal disease. 32 The antimicrobial action of chlorhexidine was established previously in numerous studies.…”

“…[23][24][25] It was also shown to be effective in treating halitosis, plaque, and gingivitis. 26,27 Owing to minimal adverse effects of these newer materials when compared to clinical gold standard (chlorhexidine), it is worthwhile to evaluate the effectiveness of these agents among patients undergoing fixed orthodontic treatment. Hence, we aimed to conduct a randomized controlled trial to evaluate the effect of Aloe vera, chlorine dioxide, and chlorhexidine mouth rinses on plaque and gingivitis in orthodontic patients.…”

Halitosis: an overview of epidemiology, etiology and clinical management

“…Intervention studies which achieve a clinically significant effect in reducing halitosis exhibit a reduction in these bacteria. 19,20 Therefore, the clinical management should also include microbiological targets, with antimicrobial approaches -mechanical and chemical -being part of the strategy.…”

Direct effect of chlorine dioxide, zinc chloride and chlorhexidine solution on the gaseous volatile sulfur compounds

“…Various anti-VSC agents have been introduced and proved to be effective in reducing VSC concentration in the breath [5][6][7][8][9][10][11][12][13][14][15][16][17][18]. Chlorine dioxide, a stable free radical solution, has been reported to show anti-VSC effects that last for 4 h immediately after a single mouth rinsing [5] and also after the clinical use for 7 days [6] when compared with placebo solution.…”