Oral Malodor Management

Reference (No. of subjects)
Oral hygiene activities
Criteria and malodor parameters
Follow up duration and outcome
Tonzetich and Ng (1976)
(n  =  8)
Single activity
Brushing:
Teeth
Tongue
Tongue and teeth
Eating
VSC (H2S, GC)
1 h follow up
29% reduction
74% reduction
76% reduction
83% reduction
Suarez et al. (2000)
(n  =  8)
Single activity
Brushing:
Teeth
Tongue
Rinsing:
3% H2O2
Eating
No treatment
VSC (H2S, GC)
8 h follow up
25% reduction
65% reduction
90% reduction
40% reduction
10% reduction
Seemann et al. (2001a)
(n  =  28)
Single activity tongue
Cleaning using:
Tongue cleaner
Tongue scraper
Toothbrush
VSC (Halimeter) >130 ppb included
Up to 30 min follow up
42% reduction
40% reduction
33% reduction
Pedrazzi et al. (2004)
(n  =  10)
Tongue cleaning (three times a day for 1 week):
Tongue scraper
Toothbrush
VSC (hand held sulfide monitor)
Follow up time not stated
75% reduction
40% reduction
Faveri et al. (2006)
(n  =  19)
Three times a day for 1 week (following professional cleaning):
Tooth brushing (TB)
TB  +  Flossing (Fl)
TB  +  Tongue scraping (TS)
TB  +  Fl  +  TS
Odor judge scores (single judge) 0–3 scale
8 h follow up
90% increase (1.1–2.0)
85% increase (1.1–1.9)
20% increase (1.1–1.3)
24% increase (0.9–1.1)
Farrell et al. (2006)
(n  =  26)
Four times in 24h
Tooth brushing (NaF)
Tooth brushing (triclosan)
Tooth  +  tongue brushing (triclosan)
VSC (Halimeter)
3 h follow up
159 ppb
143 ppb
126 ppb (significantly better than tooth brushing alone, p  =  0.035)
The data presented in this table suggest that tongue cleaning is the most effective oral hygiene activity in reducing oral malodor and related parameters. Furthermore, it is evident that not all tongue cleaning methods are equally effective. For instance, cleaning the tongue using a toothbrush appeared to be less effective than using a tongue cleaner designed specifically for this purpose (Pedrazzi et al. 2004; Seemann et al. 2001a). The effect of eating, especially abrasive foods, on malodor reduction was also attributed in part to its tongue cleaning properties (Suarez et al. 2000) (Fig. 13.1).

A978-3-642-19312-5_13_Fig1_HTML.gif
Fig. 13.1

Tongue cleaning

Chemical Therapy

Although tongue cleaning seems to be very effective in reducing malodor and malodor-related parameters (e.g., VSC), its effectiveness is relatively short term (under 2 h). Research done by Quirynen and colleges (Quirynen et al. 2004) showed that although tongue cleaning did reduce tongue coating, it did not reduce the bacterial load on the tongue. In other words, the mechanical cleaning of the tongue appears to affect their food supply (substrate) rather than the bacteria themselves. Therefore, antimicrobial agents must be incorporated into the treatment protocol in order to achieve long-term efficacy of the treatment.
Various chemical agents such as chlorhexidine, cetylpyridinium chloride, essential oils, triclosan, chlorine dioxide, hydrogen peroxide and zinc, have been shown to be, individually or combined, effective in reducing oral malodor (Tables 13.2 and 13.3). The proposed mechanism of action for these agents is mostly antibacterial or antiseptic; however, some of them are able to chemically bind or alter malodor components (e.g., binding of sulfide ions by zinc), thus rendering them non-malodorous. Therefore, combining different agents with different mechanisms of action (e.g., antibacterial and sulfide binding) may result in a superior outcome.

Table 13.2

Effect of mouthrinses containing various active ingredients on oral malodor and related parameters
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Reference (No. of subjects)
Delivery system, application and active ingredients
Criteria and malodor parameters
Follow up duration and outcome
Rosenberg et al. (1992)
Mouthrinse (twice for 1 day)
Odor judge scores (single judge)
8–10 h follow-up
(n = 60)
TPM/CPC
0–5 scale
33% reduction (1.5–1)
 
0.2% CHX
 
76% reduction (1.7–0.4)
Kozlovsky et al. (1996)
Mouthrinse (twice a day for 6 weeks)
Odor judge scores (two judges)
≥8 h follow-up
(n = 50)
TPM/CPC
0–5 scale
80% reduction (2.1–0.4)
 
EO
 
70% reduction (2.4–0.7)
Yaegaki and Sanada (1992)
Mouthrinse (single use)
VSC (Halimeter)
3.5 h follow-up
   
Subjects with ≥75 ppb included
80% reduction
 
TPM/CPC
   
(n = 9)
Control mouthrinse
 
30% reduction
Bosy et al. (1994)
Mouthrinse (twice a day for 1 week)
Odor judge scores (two judges)
Follow up time not reported
(n = 101)
0.2% CHX
0–5 scale
64% reduction (2.8–1)
   
Subjects with ≥2 included
 
Frascella et al. (2000)
Mouthrinse (single use)
Odor judge scores (three judges)
8 h follow-up
(n = 31)
0.1% CD
0–4 intensity scale (−3 to +3 pleasantness scale)
50% reduction (1.2–0.6)
 
Control (water)
Subjects with ≤−1 included
9% reduction (1.4–1.3)
Borden et al. (2002)
Mouthrinse (twice a day for 4 weeks)
Odor judge scores (two judges)
4 h follow-up
(n = 95)
EO
0–5 scale
11% reduction (4.1–3.7)
 
CPC
Subjects with >2 included
23% reduction (4.2–3.2)
 
Placebo
 
No reduction (3.9–3.9)
 
CD/Zn
 
11% reduction (4–3.6)
Schmidt and Tarbet (1978)
Mouthrinse (single use)
Odor judge scores (three judges)
3 h follow-up
(n = 62)
ZnCl
0–3 scale
37% reduction (1.6–1)
 
Control (saline)
Subjects with ≥1 included
14% increase (1.5–1.7)
 
No treatment
 
15% increase (1.6–1.9)
De Boever and Loesche (1995)
Mouthrinse (twice a day for 1 week)
Odor judge scores (single judge)
Follow up time not reported
 
0.12% CHX
0–4 scale
69% reduction (2.9–0.9)
(n = 16)
     
Winkel et al. (2003)
Mouthrinse (twice a day for 2 weeks)
Odor judge scores (single judge)
Follow up time not reported (morning)
(n = 40)
CHX/CPC/ZnLc
0–5 scale
46% reduction (2.8–1.5)
 
(0.05, 0.05, 0.14%)
Subjects with >1 included
 
 
Placebo
 
7% reduction (2.7–2.5)
Wigger-Alberti et al. (2010)
(n = 174)
Mouthrinse (twice a day for 3 weeks)
Odor judge scores (seven judges)
Follow up time not reported (morning)
 
AmF-SnF/ZnLc
0–5 scale
22% reduction (3.2–2.5)
 
(0.025, 0.2, 0.12%)
   
 
CHX/CPC/ZnLc
Subjects with >2 included
26% reduction (3.1–2.3)
 
(0.05, 0.05, 0.14%)
   
 
0.12% CHX
 
27% reduction (3.3–2.4)
 
Control (water)
 
6% reduction (3.2–3)
van Steenberghe et al. (2001)
Mouthrinse (twice a day for 12 days)
Odor judge scores (single judge)
20–30 min Follow up
(n = 12)
0.2% CHX
0–4 scale
78% reduction (1.8–0.4)
 
CHX/NaF
 
89% reduction (1.8–0.2)
 
(0.12, 0.05%)
   
 
CHX/CPC/ZnLc
 
100% reduction (1.8–0)
 
(0.05, 0.05, 0.14%)
   
Shinada et al. (2010)
Mouthrinse (twice a day for 7 days)
Odor judge scores (two judges)
Over night (average 8 h) follow up
(n = 15)
0.1% CD
0–5 scale
32% reduction (2.1–1.4)
 
Placebo
 
7% reduction (1.9–1.7)
Rassamee-masmaung et al. (2007)
(n = 60)
Mouthrinse
VSC (Halimeter)
3 h follow up
 
(single use)
Subjects with ≥80 ppb included
 
 
Herbal
 
38% reduction
 
Placebo
 
23% reduction
 
(twice a day for 2 weeks)
 
Follow up time not reported (morning)
 
Herbal
 
60% reduction
 
Placebo
 
26% reduction
Quirynen et al. (2002)
Mouthrinse (twice a day for 7 days)
Odor judge scores (single judge)
20–30 min Follow up
(n = 16)
0.2% CHX
0–4 scale
88% reduction (1.6–0.2)
 
CHX/CPC/ZnLc
   
 
(0.05, 0.05, 0.14%)
 
81% reduction (1.6–0.3)
 
AmF-SnF
 
72% reduction (1.8–0.5)
 
Placebo
 
11% reduction (1.8–1.6)
Pitts et al. 1981
Mouthrinse (single use)
Odor judge scores (five judges)
2 h follow up
(n = 17)
EO
1–9 pleasantness scale
9% reduction (6.7–6.1)
 
Control (water)
 
3% increase (6.1–6.3)
Pitts et al. (1983)
Mouthrinse (single use)
Odor judge scores (five judges)
3 h follow up
(n = 30)
EO
1–9 pleasantness scale
6% reduction (6.7–6.3)
 
Placebo
 
2% increase (6.6–6.7)
 
Control (water)
 
No reduction (6.7–6.7)
Peruzzo et al. (2007)
Mouthrinse (3 times a day for 4 days)
VSC (Halimeter)
12 h follow up (morning breath)
(n = 14)
0.1% CD
 
12% reduction
 
Placebo
 
112% increase
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Nov 30, 2015 | Posted by in General Dentistry | Comments Off on Oral Malodor Management
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