Treatment of oral malodour. Medium‐term efficacy of mechanical and/or chemical agents: a systematic review

Abstract

Focused question: What is the effect of a dentifrice (DF), a mouthwash (MW), tongue cleaning (TC), or any combination of these as adjunct to toothbrushing on intra-oral malodour and tongue coating as compared to toothbrushing alone in systemically healthy patients, when used for a minimum follow-up period of 2 weeks? Material and Methods: The MEDLINE-PubMed, Cochrane-CENTRAL and EMBASE databases were searched up to August 2014. Measurements of Volatile Sulphur Compounds and organoleptic scores of oral malodour were selected as outcome variables. Data were extracted and a descriptive analysis was performed. Results: Independent screening of 1054 unique papers resulted in 12 eligible clinical trials with a medium-term (≥2 weeks) duration. The majority of studies provided a significant reduction in oral malodour when evaluating products with an active ingredient (incorporated into a DF or a MW) used adjunctively to toothbrushing. The added value of tongue cleaning over a MW was evaluated in one study. Conclusion: Due to very limited evidence, the potential effect of a specifically formulated dentifrice, a mouthwash or a tongue scraper for treating oral malodour is, in general, unclear. For mouthwashes containing the active ingredients chlorhexidine + cetylpyridinium chloride + zinc (CHX + CPC + Zn) and zinc chloride + cetylpyridinium chloride (ZnCl + CPC) most evidence was available. The strength of a recommendation to use these products was graded to be 'weak'.

Can Chemical Mouthwash Agents Achieve Plaque/Gingivitis Control?

“…Systematic reviews have shown that due to very limited evidence, the potential effect of a specifically formulated mouthwash for treating oral malodor is, in general, unclear. 68,69 Publication bias cannot be ruled out. The results as presented in this meta-review may therefore provide a biased estimate of the true effect (overestimation) because there is a tendency to publish mainly positive studies.…”

The effect of periodontal therapy on intra‐oral halitosis: a case series

“…This may explain why tongue scraping has been 55 reported to have limited and short-lived effect on oral halitosis (Outhouse et al 2006). In a recent systematic review, the authors concluded that due to very limited evidence the potential effect of a specifically formulated dentifrice and mouth-wash, or a tongue scraper for the treatment of intra-oral halitosis is unclear (Slot et al 2015).…”

“…CHX splits the disulphide bonds contained within H 2 S and MM to release sulphur ions, which are successively bound by Zn ions to form insoluble and non-odorous zinc-sulphides (Young et al 2003). In a recent systematic review, the authors concluded that due to very limited evidence, the potential effect of a specifically formulated dentifrice and mouth-washes, 35 or a tongue scraper for the treatment of intra-oral halitosis is unclear (Slot et al 2015).…”

Recombinant Sox Enzymes from <i>Paracoccus pantotrophus</i> Degrade Hydrogen Sulfide, a Major Component of Oral Malodor

“…Several attempts have been made to prevent and reduce oral malodor (6, 40, 45). Mechanical prophylaxis using a toothbrush and tongue scraper represents a basic method to remove bacterial cells and substrates from the oral cavity; however, organisms still grow and accumulate.…”

“…Additionally, zinc ions have been used to reduce VSCs through their oxidizing effects on the thiol groups in VSC precursors (1, 16). However, the effects of specifically formulated mouth rinses on oral malodor generally remain unclear (40). Therefore, new methods to control VSCs in the oral cavity need to be established for the prevention of oral malodor.…”