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).
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
|
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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