Effectiveness of three oral hygiene regimens on oral malodor reduction: a randomized clinical trial

Ei Ei Aung, Masayuki Ueno, Takashi Zaitsu, Sayaka Furukawa, Yoko Kawaguchi, Ei Ei Aung, Masayuki Ueno, Takashi Zaitsu, Sayaka Furukawa, Yoko Kawaguchi

Abstract

Background: Breath odor is a nuisance problem for many people around the world. Bad breath affects social interactions of people in daily life by causing personal discomfort and emotional stress. There are chemical and mechanical methods for controlling oral malodor. Many studies of various mouth rinse applications and tongue cleaning procedures have been conducted. However, few studies have compared the effect of simultaneous chemical and mechanical procedures on the reduction of volatile sulfur compounds (VSCs) in subjects with oral malodor. The purpose of this study was to assess the effects of different oral hygiene procedures on reduction of VSCs in subjects with oral malodor.

Methods: Thirty male volunteers who matched with study criteria were divided randomly into two groups. Both groups performed tooth brushing, mouth washing with chlorine dioxide, tongue cleaning and combination of those in different sequence for five weeks. Total VSCs of subjects were measured with a Breathtron®, and oral health status was also examined. Quantitative analyses were performed using the Statistical Package for Social Science (SPSS 16.0).

Results: There were no significant differences in oral health status between the two groups at the baseline. No significant decrease in oral malodor was detected after one week of tooth brushing. Significant reductions in VSCs were shown by adding mouthwash or tongue cleaning to tooth brushing from the second week to fourth week (P <0.01). The greatest reduction in VSCs was found at the fifth week after the practice of all three oral hygiene regimens.

Conclusions: Tooth brushing alone does not significantly reduce oral malodor. Mouth washing and tongue cleaning significantly reduce oral malodor, but combining tooth brushing, mouth washing and tongue cleaning regimens is most effective for oral malodor reduction. The results of this study could contribute to the formulation of appropriate preventive strategies against oral malodor not only for the general public but also for dental professionals serving as oral malodor-related service providers.

Trial registration: Registration number - ClinicalTrials.gov NCT02113137 . Registration date - April 7th, 2014.

Figures

Figure 1
Figure 1
Diagram of study protocol.
Figure 2
Figure 2
Changes of mean total VSCs (ppb) in groups A and B.
Figure 3
Figure 3
Changes of the percentage of subjects with oral malodor in groups A and B.

References

    1. Miyazaki H, Sakao S, Katoh Y, Takehara T. Correlation between volatile sulphur compounds and certain oral health measurements in the general population. J Periodontol. 1995;66:679–684. doi: 10.1902/jop.1995.66.8.679.
    1. Liu XN, Shinada K, Chen XC, Zhang BX, Yaegaki K, Kawaguchi Y. Oral malodor-related parameters in the Chinese general population. J Clin Periodontol. 2006;33:31–36. doi: 10.1111/j.1600-051X.2005.00862.x.
    1. Ueno M, Yanagisawa T, Shinada K, Ohara S, Kawaguchi Y. Prevalence of oral malodor and related factors among adults in Akita Prefecture. J Med Dent Sci. 2007;54:159–165.
    1. Tonzetich J. Production and origin of oral malodor: a review of mechanisms and methods of analysis. J Periodontol. 1977;48:13–20. doi: 10.1902/jop.1977.48.1.13.
    1. Quirynen M, Dadamio J, Van den Velde S, De Smit M, Dekeyser C, Van Tornout M, et al. Characteristics of 2000 patients who visited a halitosis clinic. J Clin Periodontol. 2009;36:970–975. doi: 10.1111/j.1600-051X.2009.01478.x.
    1. Yaegaki K, Coil JM. Examination, classification, and treatment of halitosis; clinical perspectives. J Can Dent Assoc. 2000;66:257–261.
    1. Scully C, el-Maaytah M, Porter SR, Greenman J. Breath odor: etiopathogenesis, assessment and management. Eur J Oral Sci. 1997;105:287–293. doi: 10.1111/j.1600-0722.1997.tb00242.x.
    1. Scully C, Greenman J. Halitosis (breath odor) Periodontol 2000. 2008;48:66–75. doi: 10.1111/j.1600-0757.2008.00266.x.
    1. Roldan S, Herrera D, Sanz M. Biofilms and the tongue: therapeutical approaches for the control of halitosis. Clin Oral Investig. 2003;7:189–197. doi: 10.1007/s00784-003-0214-7.
    1. Yaegaki K, Coil JM, Kamemizu T, Miyazaki H. Tongue brushing and mouth rinsing as basic treatment measures for halitosis. Int Dent J. 2002;52(Suppl 3):192–196. doi: 10.1002/j.1875-595X.2002.tb00923.x.
    1. van den Broek AM, Feenstra L, de Baat C. A review of the current literature on management of halitosis. Oral Dis. 2008;14:30–39.
    1. Scully C, Greenman J. Halitology (breath odour: aetiopathogenesis and management) Oral Dis. 2012;18:333–345. doi: 10.1111/j.1601-0825.2011.01890.x.
    1. Faveri M, Hayacibara MF, Pupio GC, Cury JA, Tsuzuki CO, Hayacibara RM. A cross-over study on the effect of various therapeutic approaches to morning breath odour. J Clin Periodontol. 2006;33:555–560. doi: 10.1111/j.1600-051X.2006.00955.x.
    1. Shinada K, Ueno M, Konishi C, Takehara S, Yokoyama S, Zaitsu T, et al. Effects of a mouthwash with chlorine dioxide on oral malodor and salivary bacteria: a randomized placebo-controlled 7-day trial. Trials. 2010;11:14. doi: 10.1186/1745-6215-11-14.
    1. Shinada K, Ueno M, Konishi C, Takehara S, Yokoyama S, Kawaguchi Y. A randomized double blind crossover placebo-controlled clinical trial to assess the effects of a mouthwash containing chlorine dioxide on oral malodor. Trials. 2008;9:71. doi: 10.1186/1745-6215-9-71.
    1. Outhouse TL, Al-Alawi R, Fedorowicz Z, Keenan JV. Tongue scraping for treating halitosis. Cochrane Database Syst Rev. 2006;2
    1. Van der Sleen MI, Slot DE, Van Trijffel E, Winkel EG, Van der Weijden GA. Effectiveness of mechanical tongue cleaning on breath odour and tongue coating: a systematic review. Int J Dent Hyg. 2010;8:258–268. doi: 10.1111/j.1601-5037.2010.00479.x.
    1. Pham TA, Ueno M, Shinada K, Kawaguchi Y. Factors affecting oral malodor in periodontitis and gingivitis patients. J Investig Clin Dent. 2012;3:284–290. doi: 10.1111/j.2041-1626.2012.00155.x.
    1. Donaldson AC, Riggio MP, Rolph HJ, Bagg J, Hodge PJ. Clinical examination of subjects with halitosis. Oral Dis. 2007;13:63–70. doi: 10.1111/j.1601-0825.2006.01248.x.
    1. Saad S, Greenman J, Shaw H. Comparative effects of various commercially available mouthrinse formulations on oral malodor. Oral Dis. 2011;17:180–186. doi: 10.1111/j.1601-0825.2010.01714.x.
    1. Ileri Keceli T, Gulmez D, Dolgun A, Tekcicek M. The relationship between tongue brushing and halitosis in children: a randomized controlled trial. Oral Dis. 2015;21:66–73. doi: 10.1111/odi.12210.
    1. Sopapornamorn P, Ueno M, Vachirarojpisan T, Shinada K, Kawaguchi Y. Association between oral malodor and measurements obtained using a new sulfide monitor. J Dent. 2006;34:770–774. doi: 10.1016/j.jdent.2006.02.004.
    1. Ueno M, Shinada K, Yanagisawa T, Mori C, Yokoyama S, Furukawa S, et al. Clinical oral malodor measurement with a portable sulfide monitor. Oral Dis. 2008;14:264–269. doi: 10.1111/j.1601-0825.2007.01374.x.
    1. Greene JC, Vermillion JR. The simplified oral hygiene index. J Am Dent Assoc. 1964;68:7–13. doi: 10.14219/jada.archive.1964.0034.
    1. Winkel EG, Roldan S, Van Winkelhoff AJ, Herrera D, Sanz M. Clinical effects of a new mouthrinse containing chlorhexidine, cetylpyridinium chloride and zinc-lactate on oral halitosis. A dual-center, double-blind placebo-controlled study. J Clin Periodontol. 2003;30:300–306. doi: 10.1034/j.1600-051X.2003.00342.x.
    1. Farrell S, Baker RA, Somogyi-Mann M, Witt JJ, Gerlach RW. Oral malodor reduction by a combination of chemotherapeutical and mechanical treatments. Clin Oral Investig. 2006;10:157–163. doi: 10.1007/s00784-006-0044-5.
    1. Bordas A, McNab R, Staples AM, Bowman J, Kanapka J, Bosma MP. Impact of different tongue cleaning methods on the bacterial load of the tongue dorsum. Arch Oral Biol. 2008;53(Suppl 1):S13–S18. doi: 10.1016/S0003-9969(08)70004-9.
    1. Wilhelm D, Himmelmann A, Axmann EM, Wilhelm KP. Clinical efficacy of a new tooth and tongue gel applied with a tongue cleaner in reducing oral halitosis. Quintessence Int. 2012;43:709–718.
    1. Calil CM, Lima PO, Bernardes CF, Groppo FC, Bado F, Marcondes FK. Influence of gender and menstrual cycle on volatile sulphur compounds production. Arch Oral Biol. 2008;53:1107–1112. doi: 10.1016/j.archoralbio.2008.06.008.
    1. Krespi YP, Shrime MG, Kacker A. The relationship between oral malodor and volatile sulfur compound-producing bacteria. Otolaryngol Head Neck Surg. 2006;135:671–676. doi: 10.1016/j.otohns.2005.09.036.
    1. Robinson E. A comparative evaluation of the scrub and bass methods of toothbrushing with flossing as an adjunct (in fifth and sixth graders) Am J Public Health. 1976;66:1078–1081. doi: 10.2105/AJPH.66.11.1078.
    1. Roldan S, Herrera D, Santa-Cruz I, O’Connor A, Gonzalez I, Sanz M. Comparative effects of different chlorhexidine mouth-rinse formulations on volatile sulphur compounds and salivary bacterial counts. J Clin Periodontol. 2004;31:1128–1134. doi: 10.1111/j.1600-051X.2004.00621.x.
    1. Peruzzo DC, Jandiroba PF. Nogueira Filho Gda R. Use of 0.1% chlorine dioxide to inhibit the formation of morning volatile sulphur compounds (VSC) Braz Oral Res. 2007;21:70–74. doi: 10.1590/S1806-83242007000100012.
    1. Blom T, Slot DE, Quirynen M, Van der Weijden GA. The effect of mouthrinses on oral malodor: a systematic review. Int J Dent Hyg. 2012;10:209–222.
    1. van Steenberghe D, Avontroodt P, Peeters W, Pauwels M, Coucke W, Lijnen A, et al. Effect of different mouthrinses on morning breath. J Periodontol. 2001;72:1183–1191. doi: 10.1902/jop.2000.72.9.1183.
    1. Morita M, Wang HL. Association between oral malodor and adult periodontitis: a review. J Clin Periodontol. 2001;28:813–819. doi: 10.1034/j.1600-051x.2001.028009813.x.
    1. Quirynen M, Avontroodt P, Soers C, Zhao H, Pauwels M, van Steenberghe D. Impact of tongue cleansers on microbial load and taste. J Clin Periodontol. 2004;31:506–510. doi: 10.1111/j.0303-6979.2004.00507.x.
    1. Seemann R, Passek G, Zimmer S, Roulet JF. The effect of an oral hygiene program on oral levels of volatile sulfur compounds (VSC) J Clin Dent. 2001;12:104–107.
    1. Cortelli JR, Barbosa MD, Westphal MA. Halitosis: a review of associated factors and therapeutic approach. Braz Oral Res. 2008;22(Suppl 1):44–54.

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner