Interventions for managing halitosis

Sumanth Kumbargere Nagraj, Prashanti Eachempati, Eswara Uma, Vijendra Pal Singh, Noorliza Mastura Ismail, Eby Varghese, Sumanth Kumbargere Nagraj, Prashanti Eachempati, Eswara Uma, Vijendra Pal Singh, Noorliza Mastura Ismail, Eby Varghese

Abstract

Background: Halitosis or bad breath is a symptom in which a noticeably unpleasant breath odour is present due to an underlying oral or systemic disease. 50% to 60% of the world population has experienced this problem which can lead to social stigma and loss of self-confidence. Multiple interventions have been tried to control halitosis ranging from mouthwashes and toothpastes to lasers. This new Cochrane Review incorporates Cochrane Reviews previously published on tongue scraping and mouthrinses for halitosis.

Objectives: The objectives of this review were to assess the effects of various interventions used to control halitosis due to oral diseases only. We excluded studies including patients with halitosis secondary to systemic disease and halitosis-masking interventions.

Search methods: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 8 April 2019), the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 3) in the Cochrane Library (searched 8 April 2019), MEDLINE Ovid (1946 to 8 April 2019), and Embase Ovid (1980 to 8 April 2019). We also searched LILACS BIREME (1982 to 19 April 2019), the National Database of Indian Medical Journals (1985 to 19 April 2019), OpenGrey (1992 to 19 April 2019), and CINAHL EBSCO (1937 to 19 April 2019). The US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov (8 April 2019), the World Health Organization International Clinical Trials Registry Platform (8 April 2019), the ISRCTN Registry (19 April 2019), the Clinical Trials Registry - India (19 April 2019), were searched for ongoing trials. We also searched the cross-references of included studies and systematic reviews published on the topic. No restrictions were placed on the language or date of publication when searching the electronic databases.

Selection criteria: We included randomised controlled trials (RCTs) which involved adults over the age of 16, and any intervention for managing halitosis compared to another or placebo, or no intervention. The active interventions or controls were administered over a minimum of one week and with no upper time limit. We excluded quasi-randomised trials, trials comparing the results for less than one week follow-up, and studies including advanced periodontitis.

Data collection and analysis: Two pairs of review authors independently selected trials, extracted data, and assessed risk of bias. We estimated mean differences (MDs) for continuous data, with 95% confidence intervals (CIs). We assessed the certainty of the evidence using the GRADE approach.

Main results: We included 44 trials in the review with 1809 participants comparing an intervention with a placebo or a control. The age of participants ranged from 17 to 77 years. Most of the trials reported on short-term follow-up (ranging from one week to four weeks). Only one trial reported long-term follow-up (three months). Three studies were at low overall risk of bias, 16 at high overall risk of bias, and the remaining 25 at unclear overall risk of bias. We compared different types of interventions which were categorised as mechanical debridement, chewing gums, systemic deodorising agents, topical agents, toothpastes, mouthrinse/mouthwash, tablets, and combination methods. Mechanical debridement: for mechanical tongue cleaning versus no tongue cleaning, the evidence was very uncertain for the outcome dentist-reported organoleptic test (OLT) scores (MD -0.20, 95% CI -0.34 to -0.07; 2 trials, 46 participants; very low-certainty evidence). No data were reported for patient-reported OLT score or adverse events. Chewing gums: for 0.6% eucalyptus chewing gum versus placebo chewing gum, the evidence was very uncertain for the outcome dentist-reported OLT scores (MD -0.10, 95% CI -0.31 to 0.11; 1 trial, 65 participants; very low-certainty evidence). No data were reported for patient-reported OLT score or adverse events. Systemic deodorising agents: for 1000 mg champignon versus placebo, the evidence was very uncertain for the outcome patient-reported visual analogue scale (VAS) scores (MD -1.07, 95% CI -14.51 to 12.37; 1 trial, 40 participants; very low-certainty evidence). No data were reported for dentist-reported OLT score or adverse events. Topical agents: for hinokitiol gel versus placebo gel, the evidence was very uncertain for the outcome dentist-reported OLT scores (MD -0.27, 95% CI -1.26 to 0.72; 1 trial, 18 participants; very low-certainty evidence). No data were reported for patient-reported OLT score or adverse events. Toothpastes: for 0.3% triclosan toothpaste versus control toothpaste, the evidence was very uncertain for the outcome dentist-reported OLT scores (MD -3.48, 95% CI -3.77 to -3.19; 1 trial, 81 participants; very low-certainty evidence). No data were reported for patient-reported OLT score or adverse events. Mouthrinse/mouthwash: for mouthwash containing chlorhexidine and zinc acetate versus placebo mouthwash, the evidence was very uncertain for the outcome dentist-reported OLT scores (MD -0.20, 95% CI -0.58 to 0.18; 1 trial, 44 participants; very low-certainty evidence). No data were reported for patient-reported OLT score or adverse events. Tablets: no data were reported on key outcomes for this comparison. Combination methods: for brushing plus cetylpyridium mouthwash versus brushing, the evidence was uncertain for the outcome dentist-reported OLT scores (MD -0.48, 95% CI -0.72 to -0.24; 1 trial, 70 participants; low-certainty evidence). No data were reported for patient-reported OLT score or adverse events.

Authors' conclusions: We found low- to very low-certainty evidence to support the effectiveness of interventions for managing halitosis compared to placebo or control for the OLT and patient-reported outcomes tested. We were unable to draw any conclusions regarding the superiority of any intervention or concentration. Well-planned RCTs need to be conducted by standardising the interventions and concentrations.

Conflict of interest statement

There are no financial conflicts of interest and all the review authors (Sumanth Kumbargere Nagraj, Prashanti Eachempati, Eswara Uma, Vijendra Pal Singh, Noorliza Mastura Ismail, and Eby Varghese) declare that they do not have any associations with any parties who may have vested interests in the results of this Cochrane Review.

Copyright © 2019 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Figures

1
1
Study flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1. Analysis
1.1. Analysis
Comparison 1 SRP + air polishing versus SRP, Outcome 1 VSC.
2.1. Analysis
2.1. Analysis
Comparison 2 SRP + laser versus SRP, Outcome 1 VSC.
3.1. Analysis
3.1. Analysis
Comparison 3 Mechanical tongue cleaning versus no tongue cleaning, Outcome 1 VSC.
3.2. Analysis
3.2. Analysis
Comparison 3 Mechanical tongue cleaning versus no tongue cleaning, Outcome 2 Dentist‐reported OLT score.
4.1. Analysis
4.1. Analysis
Comparison 4 0.6% eucalyptus chewing gum versus 0.4% eucalyptus chewing gum, Outcome 1 Dentist‐reported OLT score.
4.2. Analysis
4.2. Analysis
Comparison 4 0.6% eucalyptus chewing gum versus 0.4% eucalyptus chewing gum, Outcome 2 VSC.
5.1. Analysis
5.1. Analysis
Comparison 5 0.6% eucalyptus chewing gum versus placebo chewing gum, Outcome 1 Dentist‐reported OLT score.
5.2. Analysis
5.2. Analysis
Comparison 5 0.6% eucalyptus chewing gum versus placebo chewing gum, Outcome 2 VSC.
6.1. Analysis
6.1. Analysis
Comparison 6 Pycnogenol chewing gum versus placebo chewing gum, Outcome 1 VSC (hydrogen sulphide).
6.2. Analysis
6.2. Analysis
Comparison 6 Pycnogenol chewing gum versus placebo chewing gum, Outcome 2 VSC (methyl mercaptan).
6.3. Analysis
6.3. Analysis
Comparison 6 Pycnogenol chewing gum versus placebo chewing gum, Outcome 3 VSC (methyl sulphide).
7.1. Analysis
7.1. Analysis
Comparison 7 1000 mg champignon versus placebo, Outcome 1 Patient‐reported VAS.
7.2. Analysis
7.2. Analysis
Comparison 7 1000 mg champignon versus placebo, Outcome 2 Patient's relative‐reported VAS.
8.1. Analysis
8.1. Analysis
Comparison 8 1000 mg champignon extract versus 50 mg champignon extract, Outcome 1 Patient‐reported VAS.
8.2. Analysis
8.2. Analysis
Comparison 8 1000 mg champignon extract versus 50 mg champignon extract, Outcome 2 Patient's relative‐reported VAS.
9.1. Analysis
9.1. Analysis
Comparison 9 Hinokitiol gel versus placebo gel, Outcome 1 Dentist‐reported OLT score.
9.2. Analysis
9.2. Analysis
Comparison 9 Hinokitiol gel versus placebo gel, Outcome 2 VSC (methyl mercaptan).
9.3. Analysis
9.3. Analysis
Comparison 9 Hinokitiol gel versus placebo gel, Outcome 3 VSC (hydrogen sulphide).
10.1. Analysis
10.1. Analysis
Comparison 10 G32 versus chlorhexidine gel, Outcome 1 VSC.
11.1. Analysis
11.1. Analysis
Comparison 11 Triclosan + PVM/MA toothpaste versus control toothpaste, Outcome 1 Dentist‐reported breath odour score.
12.1. Analysis
12.1. Analysis
Comparison 12 Zinc toothpaste versus placebo toothpaste, Outcome 1 Dentist‐reported OLT score.
12.2. Analysis
12.2. Analysis
Comparison 12 Zinc toothpaste versus placebo toothpaste, Outcome 2 VSC.
13.1. Analysis
13.1. Analysis
Comparison 13 Sodium bicarbonate toothpaste versus control toothpaste, Outcome 1 VSC.
14.1. Analysis
14.1. Analysis
Comparison 14 Dual zinc + arginine dentifrice versus control dentifrice, Outcome 1 OLT hedonic ratings.
15.1. Analysis
15.1. Analysis
Comparison 15 Halita versus placebo mouthwash, Outcome 1 Dentist‐reported OLT score.
15.2. Analysis
15.2. Analysis
Comparison 15 Halita versus placebo mouthwash, Outcome 2 VSC.
16.1. Analysis
16.1. Analysis
Comparison 16 Chlorhexidine + zinc acetate mouthwash versus placebo mouthwash, Outcome 1 Dentist‐reported OLT score.
17.1. Analysis
17.1. Analysis
Comparison 17 Cetylperidinium chloride mouthwash versus placebo, Outcome 1 Dentist‐reported OLT score.
17.2. Analysis
17.2. Analysis
Comparison 17 Cetylperidinium chloride mouthwash versus placebo, Outcome 2 VSC.
18.1. Analysis
18.1. Analysis
Comparison 18 Essential oil mouthwash versus placebo mouthwash, Outcome 1 Dentist‐reported OLT score.
18.2. Analysis
18.2. Analysis
Comparison 18 Essential oil mouthwash versus placebo mouthwash, Outcome 2 VSC.
19.1. Analysis
19.1. Analysis
Comparison 19 Chlorine dioxide + zinc mouthwash versus placebo mouthwash, Outcome 1 Dentist‐reported OLT score.
19.2. Analysis
19.2. Analysis
Comparison 19 Chlorine dioxide + zinc mouthwash versus placebo mouthwash, Outcome 2 VSC.
20.1. Analysis
20.1. Analysis
Comparison 20 Chlorine dioxide mouthwash versus placebo, Outcome 1 Dentist‐reported OLT score.
21.1. Analysis
21.1. Analysis
Comparison 21 Herbal mouthwash versus placebo mouthwash, Outcome 1 VSC.
22.1. Analysis
22.1. Analysis
Comparison 22 Benzethonium chloride mouthwash versus placebo mouthwash, Outcome 1 VSC (methyl mercaptan).
22.2. Analysis
22.2. Analysis
Comparison 22 Benzethonium chloride mouthwash versus placebo mouthwash, Outcome 2 VSC (hydrogen sulphide).
22.3. Analysis
22.3. Analysis
Comparison 22 Benzethonium chloride mouthwash versus placebo mouthwash, Outcome 3 VSC (dimethyl sulphide).
23.1. Analysis
23.1. Analysis
Comparison 23 Green tea mouthwash versus placebo mouthwash, Outcome 1 VSC.
24.1. Analysis
24.1. Analysis
Comparison 24 Lemongrass mouthwash versus placebo mouthwash, Outcome 1 VSC.
25.1. Analysis
25.1. Analysis
Comparison 25 Cetylpyridinium chloride mouthwash versus chlorine dioxide + zinc mouthwash, Outcome 1 Dentist‐reported OLT score.
25.2. Analysis
25.2. Analysis
Comparison 25 Cetylpyridinium chloride mouthwash versus chlorine dioxide + zinc mouthwash, Outcome 2 VSC.
26.1. Analysis
26.1. Analysis
Comparison 26 Halita mouthrinse versus Perio‐plus, Outcome 1 Dentist‐reported OLT score.
26.2. Analysis
26.2. Analysis
Comparison 26 Halita mouthrinse versus Perio‐plus, Outcome 2 VSC.
27.1. Analysis
27.1. Analysis
Comparison 27 Oil water 2‐phase mouthwash versus control mouthwash, Outcome 1 VSC.
28.1. Analysis
28.1. Analysis
Comparison 28 Triphala and Ela decoction versus chlorhexidine mouthwash, Outcome 1 Dentist‐reported OLT score.
29.1. Analysis
29.1. Analysis
Comparison 29 Miswak mouthwash versus chlorhexidine mouthwash, Outcome 1 Dentist‐reported OLT score.
29.2. Analysis
29.2. Analysis
Comparison 29 Miswak mouthwash versus chlorhexidine mouthwash, Outcome 2 VSC.
29.3. Analysis
29.3. Analysis
Comparison 29 Miswak mouthwash versus chlorhexidine mouthwash, Outcome 3 Patient self‐assessment score.
30.1. Analysis
30.1. Analysis
Comparison 30 Chlorine dioxide mouthrinse versus chlorhexidine mouthwash, Outcome 1 VSC (hydrogen sulphide).
30.2. Analysis
30.2. Analysis
Comparison 30 Chlorine dioxide mouthrinse versus chlorhexidine mouthwash, Outcome 2 VSC (methyl mercaptan).
30.3. Analysis
30.3. Analysis
Comparison 30 Chlorine dioxide mouthrinse versus chlorhexidine mouthwash, Outcome 3 VSC (methyl sulphide).
31.1. Analysis
31.1. Analysis
Comparison 31 Protease cysteine + actinidine versus placebo tablets, Outcome 1 VSC.
32.1. Analysis
32.1. Analysis
Comparison 32 Miswak stick versus chlorhexidine mouthwash, Outcome 1 Dentist‐reported OLT score.
32.2. Analysis
32.2. Analysis
Comparison 32 Miswak stick versus chlorhexidine mouthwash, Outcome 2 VSC.
32.3. Analysis
32.3. Analysis
Comparison 32 Miswak stick versus chlorhexidine mouthwash, Outcome 3 Patient self‐assessment score.
33.1. Analysis
33.1. Analysis
Comparison 33 Brushing + mouthwash versus brushing + tongue cleaning, Outcome 1 VSC.
34.1. Analysis
34.1. Analysis
Comparison 34 Brushing + cetylpyridium mouthwash versus brushing, Outcome 1 Dentist‐reported OLT score.
34.2. Analysis
34.2. Analysis
Comparison 34 Brushing + cetylpyridium mouthwash versus brushing, Outcome 2 VSC.
35.1. Analysis
35.1. Analysis
Comparison 35 Turkish gall oral rinse versus brushing alone, Outcome 1 Dentist‐reported OLT score.
35.2. Analysis
35.2. Analysis
Comparison 35 Turkish gall oral rinse versus brushing alone, Outcome 2 VSC.
36.1. Analysis
36.1. Analysis
Comparison 36 Laser + povidone iodine versus SRP, Outcome 1 Dentist‐reported OLT score.
36.2. Analysis
36.2. Analysis
Comparison 36 Laser + povidone iodine versus SRP, Outcome 2 VSC.

References

References to studies included in this review Acar 2019 {published data only}

    1. Acar B, Berker E, Tan C, Ilarslan YD, Tekcicek M, Tezcan I. Effects of oral prophylaxis including tongue cleaning on halitosis and gingival inflammation in gingivitis patients ‐ a randomized controlled clinical trial. Clinical Oral Investigations 2019;23(4):1829‐36.
Ademovski 2012 {published data only}
    1. Ademovski SE, Lingström P, Winkel E, Tangerman A, Persson GR, Renvert S. Comparison of different treatment modalities for oral halitosis. Acta Odontologica Scandinavica 2012;70(3):224‐33.
    1. Ademovski SE, Persson GR, Winkel E, Tangerman A, Lingström P, Renvert S. The short‐term treatment effects on the microbiota at the dorsum of the tongue in intra‐oral halitosis patients ‐ a randomized clinical trial. Clinical Oral Investigations 2013;17(2):463‐73.
Ademovski 2017 {published data only}
    1. Ademovski SE, Mårtensson C, Persson GR, Renvert S. The long‐term effect of a zinc acetate and chlorhexidine diacetate containing mouthrinse on intra‐oral halitosis ‐ a randomized clinical trial. Journal of Clinical Periodontology 2017;44(10):1010‐9.
An 2011 {published data only}
    1. An Yb, He L, Meng Hx, Liu Tt, Yan Fh. Effect of oral rinse with Turkish gall on the clinical periodontal parameters and halitosis. Beijing Da Xue Xue Bao Yi Xue Ban [Journal of Peking University (Health Sciences)] 2011;43(1):22‐5.
Asokan 2011 {published data only}
    1. Asokan S, Kumar RS, Emmadi P, Raghuraman R, Sivakumar N. Effect of oil pulling on halitosis and microorganisms causing halitosis: a randomized controlled pilot trial. Journal of Indian Society of Pedodontics and Preventive Dentistry 2011;29(2):90‐4.
Aung 2015 {published data only}
    1. Aung EE, Ueno M, Zaitsu T, Furukawa S, Kawaguchi Y. Effectiveness of three oral hygiene regimens on oral malodor reduction: a randomised clinical trial. Trials 2015;16:31.
    1. NCT02113137. Oral hygiene procedures on reduction of oral malodor [Effects of various oral hygiene procedures on the reduction of oral malodor in periodontally healthy patients]. (first received 14 April 2014).
Barak 2012 {published data only}
    1. Barak S, Katz J. The effect of Breezy candy on halitosis: a double‐blind,controlled, and randomized study. Quintessence International 2012;43(4):313‐7.
Borden 2002 {published data only}
    1. Borden LC, Chaves ES, Bowman JP, Fath BM, Hollar GL. The effect of four mouthrinses on oral malodor. Compendium of Continuing Education in Dentistry 2002;23(6):531‐6.
Caygur 2017 {published data only}
    1. Caygur A, Albaba MR, Berberoglu A, Yilmaz HG. Efficacy of glycine powder air‐polishing combined with scaling and root planing in the treatment of periodontitis and halitosis: a randomised clinical study. Journal of International Medical Research 2017;45(3):1168‐74.
Dadamio 2013 {published data only}
    1. Dadamio J, Tournout M, Teughels W, Dekeyser C, Coucke W, Quirynen M. Efficacy of different mouthrinse formulations in reducing oral malodour: a randomized clinical trial. Journal of Clinical Periodontology 2013;40(5):505‐13.
Feres 2015 {published data only}
    1. Feres M, Figueiredo LC, Faveri M, Guerra MC, Mateo LR, Stewart B, et al. The efficacy of two oral hygiene regimens in reducing oral malodour: a randomised clinical trial. International Dental Journal 2015;65(6):292‐302.
Garcia 2014 {published data only}
    1. Garcia MT, Silveira JO, Gargioni Filho A, Cortelli JR, Costa FO, Aquino DR, et al. Pre‐ and post‐treatment comparative levels of VSC, subgingival total bacterial load and gingival bleeding [Níveis comparativos pré‐ e pós‐tratamento de CSV, carga bacteriana total subgengival e sangramento gengival]. Periodontia 2014;24(1):24‐9.
Hu 2005 {published data only}
    1. Hu D, Zhang YP, Petrone M, Volpe AR, DeVizio W, Proskin HM. Clinical effectiveness of a triclosan/copolymer/sodium‐fluoride dentifrice in controlling oral malodour: a three‐week clinical trial. Compendium of Continuing Education in Dentistry 2003;24(9 Suppl):34‐41.
    1. Hu D, Zhang YP, Petrone M, Volpe AR, Devizio W, Giniger M. Clinical effectiveness of a triclosan/copolymer/sodium fluoride dentifrice in controlling oral malodor: a 3‐week clinical trial. Oral Disease 2005;11(Suppl 1):51‐3.
Hu 2018 {published data only}
    1. Hu D, Zhang X, Zhong Y, Mateo LR, Dibart S, Delgado E. A clinical investigation of the efficacy of a dual zinc + arginine dentifrice for controlling oral malodor. Journal of Clinical Dentistry 2018;29(Spec No A):A41‐5. [PUBMED: 30620870]
Iha 2013 {published data only}
    1. Iha K, Suzuki N, Yoneda M, Takeshita T, Hirofuji T. Effect of mouth cleaning with hinokitiol‐containing gel on oral malodor: a randomized, open‐label pilot study. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology 2013;116(4):433‐9.
Iwamura 2016 {published data only}
    1. ISRCTN67671859. Assessment of oral malodour and tonsil bacteria after gargling of throat with an antiseptic [Assessment of oral malodour and tonsillar microbiota after gargling in oropharynx with benzethonium chloride]. (first received 12 August 2015).
    1. Iwamura Y, Hayashi J, Sato T, Sato S, Murakami T, Fujimura T, et al. Assessment of oral malodor and tonsillar microbiota after gargling with benzethonium chloride. Journal of Oral Science 2016;58(1):83‐91.
Kara 2008 {published data only}
    1. Kara C, Demir T, Orbak R, Tezel A. Effect of Nd: YAG laser irradiation on the treatment of oral malodour associated with chronic periodontitis. International Dental Journal 2008;58(3):151‐8.
Kozlovsky 1996 {published data only}
    1. Kozlovsky A, Goldberg S, Natour I, Rogatky‐Gat A, Gelernter I, Rosenberg M. Efficacy of a 2‐phase oil: water mouthrinse in controlling oral malodor, gingivitis, and plaque. Journal of Periodontology 1996;67(6):577‐82.
Lee 2018 {published data only}
    1. Lee S, Suprono M, Stephens J, Withers S, Li Y. Efficacy of stabilized chlorine dioxide‐based unflavored mouthwash in reducing oral malodor: an 8‐week randomized controlled study. American Journal of Dentistry 2018;31(6):309‐12.
Lomax 2017 {published data only}
    1. Lomax A, Patel S, Wang N, Kakar K, Kakar A, Bosma ML. A randomized controlled trial evaluating the efficacy of a 67% sodium bicarbonate toothpaste on gingivitis. International Journal of Dental Hygiene 2017;15(4):e35‐e41.
López Jornet 2003 {published data only}
    1. López Jornet P, Henarejas Hernández JL, Saura Pérez M, Camacho Alonso F. Pilot study to assess effectiveness of different mouthwashes for the treatment of oral halitosis. [Efectos de los diferentes colutorios para el tratamiento de la halitosis oral]. Avances en Odontoestomatología 2003;19(6):275‐82.
Mamgain 2016 {published data only}
    1. Mamgain P, Kandwal A, Mamgain RK. Comparative evaluation of Triphala and Ela decoction with 0.2% chlorhexidine as mouthwash in the treatment of plaque‐induced gingivitis and halitosis: a randomised controlled clinical trial. Journal of Evidence‐Based Complementary and Alternative Medicine 2017;22(3):468‐72.
Marchetti 2015 {published data only}
    1. Marchetti E, Tecco S, Santonico M, Vernile C, Ciciarelli D, Tarantino E, et al. Multi‐sensor approach for the monitoring of halitosis treatment via Lactobacillus brevis (CD2)‐containing lozenges ‐ a randomized, double‐blind placebo‐controlled clinical trial. Sensors (Basel, Switzerland) 2015;15(8):19583‐96.
Nakano 2017 {published data only}
    1. Nakano M, Wakabayashi H, Sugahara H, Odamaki T, Yamauchi K, Abe F, et al. Effects of lactoferrin and lactoperoxidase‐containing food on the oral microbiota of older individuals. Microbiology and Immunology 2017;61(10):416‐26. [PUBMED: 28881387]
Navada 2008 {published data only}
    1. Navada R, Kumari H, Le S, Zhang J. Oral malodor reduction from a zinc‐containing toothpaste. Journal of Clinical Dentistry 2008;19(2):69‐73.
NCT02628938 {unpublished data only}
    1. NCT02628938. Effect of miswak and miswak extract on oral malodor. (first received 11 December 2015).
Niles 1999 {published data only}
    1. Niles HP, Vazquez J, Rustogi KN, Williams M, Gaffar A, Proskin HM. The clinical effectiveness of a dentifrice containing triclosan and a copolymer for providing long‐term control of breath odor measured chromatographically. Journal of Clinical Dentistry 1999;10(4):135‐8.
Nishihira 2017 {published data only}
    1. Nishihira J, Nishimura M, Tanaka A, Yamaguchi A, Taira T. Effects of 4‐week continuous ingestion of champignon extract on halitosis and body and fecal odor. Journal of Traditional and Complementary Medicine 2015;7(1):110‐6.
Nogueira‐Filho 2002 {published data only}
    1. Nogueira‐Filho GR, Duarte PM, Toledo S, Tabchoury CP, Cury JA. Effect of triclosan dentifrices on mouth volatile sulphur compounds and dental plaque trypsin‐like activity during experimental gingivitis development. Journal of Clinical Periodontology 2002;29(12):1059‐64.
Nohno 2012 {published data only}
    1. Nohno K, Yamaga T, Kaneko N, Miyazaki H. Tablets containing a cysteine protease, actinidine, reduce oral malodor: a crossover study. Journal of Breath Research 2012;6(1):017107.
Patil 2017 {published data only}
    1. CTRI/2012/05/002695. G32 (Ayurvedic drug) ‐ an affordable alternative to chlorhexidine in treating bad breath [Evaluation of the efficacy of G32 (commercially available Ayurvedic preparation) in reducing halitosis as compared to chlorhexidine]. (first received 25 May 2012).
    1. Patil S, Acharya S, Hathiwala S, Singhal DK, Srinivasan SR, Khatri S. Evaluation of the efficacy of G32 (commercially available Ayurvedic preparation) in reducing halitosis ‐ a randomized controlled trial. Journal of Clinical and Diagnostic Research 2017;11(9):ZC79‐ZC83.
Payne 2011 {published data only}
    1. Payne D, Gordon JJ, Nisbet S, Karwal R, Bosma ML. A randomised clinical trial to assess control of oral malodour by a novel dentifrice containing 0.1% w/w o‐cymen‐5‐ol, 0.6% w/w zinc chloride. International Dental Journal 2011;61 Suppl 3:60‐6.
Rassameemasmaung 2007 {published data only}
    1. Rassameemasmaung S, Sirikulsathean A, Amornchat C, Hirunrat K, Rojanapanthu P, Gritsanapan W. Effects of herbal mouthwash containing the pericarp extract of Garcinia mangostana L on halitosis, plaque and papillary bleeding index. Journal of the International Academy of Periodontology 2007;9(1):19‐25.
Rassameemasmaung 2012 {published data only}
    1. NCT00932347. Effect of mouthwash containing camellia sinensis extracts on oral malodor [Effect of mouthwash containing camellia sinensis extracts on oral malodor, plaque and papillary bleeding indices in gingivitis patients]. (first received 3 July 2009).
    1. Rassameemasmaung S, Phusudsawang P, Sangalungkarn V. Effect of green tea mouthwash on oral malodor. ISRN Preventive Medicine 2012;2013:975148. [DOI: 10.5402/2013/975148]
Satthanakul 2014 {published data only}
    1. Satthanakul P, Taweechaisupapong S, Paphangkorakit J, Pesee M, Timabut P, Khunkitti W. Antimicrobial effect of lemongrass oil against oral malodour micro‐organisms and the pilot study of safety and efficacy of lemongrass mouthrinse on oral malodour. Journal of Applied Microbiology 2015;118(1):11‐7.
Suzuki 2014 {published data only}
    1. Suzuki N, Yoneda M, Tanabe K, Fujimoto A, Iha K, Seno K, et al. Lactobacillus salivarius WB21‐containing tablets for the treatment of oral malodor: a double‐blind, randomized, placebo‐controlled crossover trial. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology 2014;117(4):462‐70.
    1. Suzuki N, Yoneda M, Tanabe K, Fujimoto A, Iha K, Seno K, et al. Lactobacillus salivarius WB21‐containing tablets for the treatment of oral malodor: a double‐blind, randomized, placebo‐controlled crossover trial ‐ reply to letter. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology 2014;118(4):506.
Talebian 2009 {published data only}
    1. Talebian A, Doosti M, Tazhibi M, Iranpoor R, Namazi G, Khonakdar A. Comparative effects of selected mouthwashes on halitosis using sulphide monitoring devise [sic]. Journal of Islamic Dental Association of Iran 2009;20(4):335‐42.
Tanaka 2010 {published data only}
    1. Tanaka M, Toe M, Nagata H, Ojima M, Kuboniwa M, Shimizu K, et al. Effect of eucalyptus‐extract chewing gum on oral malodor: a double‐masked, randomized trial. Journal of Periodontology 2010;81(11):1564‐71.
Wang 2017 {published data only}
    1. Wang J, He L. Effect of mechanical self‐cleaning of tongue coating on malodor in halitosis patients originating from tongue coating. Beijing Da Xue Xue Bao YiXue Ban [Journal of Peking University (Health Sciences)] 2017;49(2):344‐8.
Watanabe 2018 {published data only}
    1. UMIN000018305. Effects of Pycnogenol chewing gum on oral malodor, gingivitis and plaque formation. (first received 14 July 2015).
    1. Watanabe Hiramine H, Toyama T, Hamada N. Effects of French pine bark extract chewing gum on oral malodor and salivary bacteria. Journal of Nutritional Science and Vitaminology 2018;64(3):185‐91.
Wigger‐Alberti 2010 {published data only}
    1. NCT01747226. Effect of mouth rinses in oral malodor (MR2012) [Masking and therapeutic effect of different mouth rinses in patients with oral malodor]. (first received 11 December 2012).
    1. Wigger‐Alberti W, Gysen K, Axmann EM, Wilhelm KP. Efficacy of a new mouthrinse formulation on the reduction of oral malodour in vivo. A randomized, double‐blind, placebo‐controlled, 3 week clinical study. Journal of Breath Research 2010;4(1):017102.
Wilhelm 2012 {published data only}
    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 International 2012;43(8):709‐18.
Winkel 2003 {published data only}
    1. Roldán S, Winkel EG, Herrera D, Sanz M, Winkelhoff AJ. The effects of a new mouthrinse containing chlorhexidine, cetylpyridinium chloride and zinc lactate on the microflora of oral halitosis patients: a dual‐centre, double‐blind placebo‐controlled study. Journal of Clinical Periodontology 2003;30(5):427‐34.
    1. Winkel EG, Roldán S, 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. Journal of Clinical Periodontology 2003;30(4):300‐6.
Wirthlin 2011 {published data only}
    1. NCT00867035. Bad breath response to tongue scraper and rinses [Bad breath response to tongue scraper and rinses, a double‐blind, randomized, parallel group clinical trial]. (first received 23 March 2009).
    1. Wirthlin MR, Im T, Ellis RR, Hoover CI. Effect of tongue scraper and rinses on bad breath, a double‐blind, randomized, parallel group clinical trial. Journal of the Western Society of Periodontology/Periodontal Abstracts 2011;59(3):67‐73.
References to studies excluded from this review Ademovski 2016 {published data only}
    1. Erovic Ademovski S, Lingström P, Renvert S. The effect of different mouth rinse products on intra‐oral halitosis. International Journal of Dental Hygiene 2016;14(2):117‐23.
Alqumber 2014 {published data only}
    1. Alqumber MA, Arafa KA. Site‐specific mouth rinsing can improve oral odor by altering bacterial counts. Blind crossover clinical study. Saudi Medical Journal 2014;35(11):1412‐6.
Badanjak 2016 {published data only}
    1. Badanjak SM, Boyd LD, Perry KR, LaSpina LM, Rothman AT, Byrne L. Efficacy of sodium chlorite + zinc gluconate on volatile sulfur compound halitosis: a randomized, double‐blind, placebo‐controlled pilot study. Canadian Journal of Dental Hygiene 2016;50(3):116‐25.
Betsy 2014 {published data only}
    1. Betsy J, Prasanth CS, Baiju KV, Prasanthila J, Subhash N. Efficacy of antimicrobial photodynamic therapy in the management of chronic periodontitis: a randomized controlled clinical trial. Journal of Clinical Periodontology 2014;41(6):573‐81. [PUBMED: 24617449]
    1. Betsy J, Prasanth CS, Baiju KV, Presanthila J, Subhash N. Patients' perceptions of antimicrobial photodynamic therapy in the management of chronic periodontitis. Photodiagnosis and Photodynamic Therapy 2016;14:84‐90.
Bordas 2008 {published data only}
    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. Archives of Oral Biology 2008;53 Suppl 1:S13‐8.
Boulware 1984 {published data only}
    1. Boulware RT, Southard GL. Sanguinarine in the control of volatile sulfur compounds in the mouth: a comparative study. Compendium of Continuing Education in Dentistry 1984;Suppl 5:S61‐4.
Brunette 1998 {published data only}
    1. Brunette DM, Proskin HM, Nelson BJ. The effects of dentifrice systems on oral malodor. Journal of Clinical Dentistry 1998;9(3):76‐82.
Carvalho 2004 {published data only}
    1. Carvalho MD, Tabchoury CM, Cury JA, Toledo S, Nogueira‐Filho GR. Impact of mouthrinses on morning bad breath in healthy subjects. Journal of Clinical Periodontology 2004;31(2):85‐90.
Chen 2010 {published data only}
    1. Chen X, He T, Sun L, Zhang Y, Feng X. A randomized cross‐over clinical trial to evaluate the effect of a 0.454% stannous fluoride dentifrice on the reduction of oral malodor. American Journal of Dentistry 2010;23(3):175‐8.
Codipilly 2004 {published data only}
    1. Codipilly DP, Kaufman HW, Kleinberg I. Use of a novel group of oral malodor measurements to evaluate an anti‐oral malodor mouthrinse (TriOralTM) in humans. Journal of Clinical Dentistry 2004;15(4):98‐104.
Conceição 2008 {published data only}
    1. Conceição MD, Marocchio LS, Tárzia O. Evaluation of a new mouthwash on caseous formation. Revista Brasileira de Otorrinolaringologia [Brazilian Journal of Otorhinolaryngology] 2008;74(1):61‐7.
Dereci 2016 {published data only}
    1. Dereci Ö, Hatipoğlu M, Sindel A, Tozoğlu S, Üstün K. The efficacy of Er,Cr:YSGG laser supported periodontal therapy on the reduction of periodontal disease related oral malodor: a randomized clinical study. Head and Face Medicine 2016;12(1):20.
DRKS00005334 {published data only}
    1. DRKS00005334. Double‐blind, controlled, randomised, three‐fold cross‐over study to investigate the efficacy of two different mouthwashes in patients with intra‐oral halitosis. (first received 17 October 2013).
EUCTR 2007‐003756‐11 {published data only}
    1. EUCTR 2007‐003756‐11. Treatment for GUT‐caused halitosis with with E. coli strain Nissle 1917. (first received 17 June 2008).
Farrell 2006 {published data only}
    1. Farrell S, Baker RA, Somogyi‐Mann M, Witt JJ, Gerlach RW. Oral malodor reduction by a combination of chemotherapeutical and mechanical treatments. Clinical Oral Investigations 2006;10(2):157‐63.
Farrell 2007 {published data only}
    1. Farrell S, Barker ML, Gerlach RW. Overnight malodor effect with a 0.454% stabilized stannous fluoride sodium hexametaphosphate dentifrice. Compendium of Continuing Education in Dentistry 2007;28(12):658‐61.
Farrell 2008 {published data only}
    1. Farrell S, Barker ML, Walanski A, Gerlach RW. Short‐term effects of a combination product night‐time therapeutic regimen on breath malodor. Journal of Contemporary Dental Practice 2008;9(6):1‐8.
Faveri 2006 {published data only}
    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. Journal of Clinical Periodontology 2006;33(8):555‐60.
Feng 2010 {published data only}
    1. Feng X, Chen X, Cheng R, Sun L, Zhang Y, He T. Breath malodor reduction with use of a stannous‐containing sodium fluoride dentifrice: a meta‐analysis of four randomized and controlled clinical trials. American Journal of Dentistry 2010;23 Spec No B:27B‐31B.
Fine 2005 {published data only}
    1. Fine DH, Furgang D, Sinatra K, Charles C, McGuire A, Kumar LD. In vivo antimicrobial effectiveness of an essential oil‐containing mouthrinse 12 h after a single use and 14 days' use. Journal of Clinical Periodontology 2005;32(4):335‐40.
Frascella 1998 {published data only}
    1. Frascella J, Gilbert R, Fernandez P. Odor reduction potential of a chlorine dioxide mouthrinse. Journal of Clinical Dentistry 1998;9(2):39‐42.
Frascella 2000 {published data only}
    1. Frascella J, Gilbert RD, Fernandez P, Hendler J. Efficacy of a chlorine dioxide‐containing mouthrinse in oral malodor. Compendium of Continuing Education in Dentistry 2000;21(3):241‐4.
Gerlach 1998 {published data only}
    1. Gerlach RW, Hyde JD, Poore CL, Stevens DP, Witt JJ. Breath effects of three marketed dentifrices: a comparative study evaluating single and cumulative use. Journal of Clinical Dentistry 1998;9(4):83‐8.
Greenstein 1997 {published data only}
    1. Greenstein RB, Goldberg S, Marku‐Cohen S, Sterer N, Rosenberg M. Reduction of oral malodor by oxidizing lozenges. Journal of Periodontology 1997;68(12):1176‐81.
Haas 2007 {published data only}
    1. Haas AN, Silveira EM, Rösing CK. Effect of tongue cleansing on morning oral malodour in periodontally healthy individuals. Oral Health & Preventive Dentistry 2007;5(2):89‐94. [PUBMED: 17722433]
Hu 2013 {published data only}
    1. Hu D, Li X, Yin W, DeVizio W, Mateo LR, Dibart S, et al. Clinical investigation of oral malodor during long‐term use of arginine‐containing dentifrices. American Journal of Dentistry 2013;26(6):329‐34.
Katsinelos 2007 {published data only}
    1. Katsinelos P, Tziomalos K, Chatzimavroudis G, Vasiliadis T, Katsinelos T, Pilpilidis I, et al. Eradication therapy in Helicobacter pylori‐positive patients with halitosis: long‐term outcome. Medical Principles and Practice 2007;16(2):119‐23.
Keller 2012 {published data only}
    1. Keller MK, Bardow A, Jensdottir T, Lykkeaa J, Twetman S. Effect of chewing gums containing the probiotic bacterium Lactobacillus reuteri on oral malodour. Acta Odontologica Scandinavica 2012;70(3):246‐50.
Leal 2019 {published data only}
    1. Leal MB, Goes JS, Dellovo AG, Sao Mateus CR, Macedo GO. Effect of polyethylene terephthalate tongue scraper on oral levels of volatile sulfur compounds: a randomized clinical trial. Brazilian Dental Science 2019;22(1):31‐8.
Lodhia 2008 {published data only}
    1. Lodhia P, Yaegaki K, Khakbaznejad A, Imai T, Sato T, Tanaka T, et al. Effect of green tea on volatile sulfur compounds in mouth air. Journal of Nutritional Science and Vitaminology 2008;54(1):89‐94. [PUBMED: 18388413]
Malhotra 2011a {published data only}
    1. Malhotra R, Grover V, Kapoor A, Saxena D. Comparison of the effectiveness of a commercially available herbal mouthrinse with chlorhexidine gluconate at the clinical and patient level. Journal of Indian Society of Periodontology 2011;15(4):349‐52.
Mendes 2016 {published data only}
    1. Mendes L, Coimbra J, Pereira AL, Resende M, Pinto MG. Comparative effect of a new mouthrinse containing chlorhexidine, triclosan and zinc on volatile sulphur compounds: a randomized, crossover, double‐blind study. International Journal of Dental Hygiene 2016;14(3):202‐8.
Moreno 2005 {published data only}
    1. Moreno T, Haas AN, Castro GD, Winter R, Oppermann RV, Rosing CK. Treatment of aggressive periodontitis and alterations on volatile sulfur compounds. Revista Odonto Ciência – Faculdade de Odontologia 2005;20(49):217‐21.
Mousquer 2017 {published data only}
    1. Mousquer CR, Thomé BB, Iserhard WB, Callegari‐Jacques SM, Bona AD, Venturini AP, et al. Inulin and Streptococcus salivarius reduce halitosis associated with tongue coating: a randomized clinical trial. Gastroenterology 2017;152(5 Suppl 1):S815.
Nakano 2016 {published data only}
    1. Nakano M, Shimizu E, Wakabayashi H, Yamauchi K, Abe F. A randomized, double‐blind, crossover, placebo‐controlled clinical trial to assess effects of the single ingestion of a tablet containing lactoferrin, lactoperoxidase, and glucose oxidase on oral malodor. BMC Oral Health 2016;16:37. [PUBMED: 27001471]
NCT00250289 {published data only}
    1. NCT00250289. Prevention of oral malodor with an oral sticker containing herbal formula [Invivo study of the efficacy of an innovative herbal formula and delivery system on oral malodor]. (first received 8 November 2005).
NCT00655772 {published data only}
    1. NCT00655772. A clinical trial to assess the effects of a mouthwash containing chlorine dioxide on oral malodor [A randomized, double blind, crossover, placebo‐controlled clinical trial to assess the effects of a mouthwash containing chlorine dioxide on oral malodor]. (first received 10 April 2008).
NCT00748943 {published data only}
    1. NCT00748943. Clinical and microbiological effects of a mouthwash containing chlorine dioxide [The clinical effects of a mouthwash containing chlorine dioxide on oral malodor and salivary periodontal and malodorous bacteria using for 7 days]. (first received 9 September 2008).
NCT00875927 {published data only}
    1. NCT00875927. Effects of Breezy candy on halitosis [Breezy candy halitosis study]. (first received 6 April 2009).
NCT02194621 {published data only}
    1. NCT02194621. Clinical investigation to examine toothpaste effect on oral bacteria [A randomized, single center, three cell, double blind and parallel groups clinical study conducted in Newark, NJ to evaluate the antibacterial effects of two toothpastes containing 0.3% Triclosan/2% copolymer/0.243% sodium fluoride in a silica base as compared to a control regular fluoride toothpaste on oral bacteria 12 hours after 13 days product use]. (first received 18 July 2014).
NCT02789436 {published data only}
    1. NCT02789436. Effect of probiotic lozenges on halitosis in patients with chronic periodontitis [Effect of probiotic Lactobacillus reuteri‐containing lozenges (Prodentis) on halitosis in patients with chronic periodontitis]. (first received 3 June 2016).
NCT03346460 {published data only}
    1. NCT03346460. Effect of photodymamic therapy with urucum and LED in the reduction of halitosis [Effect of photodymamic therapy with urucum and LED in the reduction of halitosis: a clinical and microbiological trial]. (first received 17 November 2017).
NCT03591484 {published data only}
    1. NCT03591484. Treatment of halitosis with photodynamic therapy in older patients [Treatment of halitosis with photodynamic therapy in older patients: protocol for a randomized, controlled trial]. (first received 19 July 2018).
NCT03656419 {published data only}
    1. NCT03656419. Photodynamic therapy with red leds in microorganisms related to halitosis [Action of antimicrobial photodynamic therapy with red leds in microorganisms related to halitose: clinical controlled and randomized trial]. (first received 3 September 2018).
Newby 2008 {published data only}
    1. Newby EE, Hickling JM, Hughes FJ, Proskin HM, Bosma MP. Control of oral malodour by dentifrices measured by gas chromatography. Archives of Oral Biology 2008;53 Suppl 1:S19‐25.
NL3100 (NTR3240) {published data only}
    1. NL3100 (NTR3240). The effect of chemotherapeutic agents and mechanical tongue cleaning on morning bad breath. (first received 17 January 2012).
Pedrazzi 2004 {published data only}
    1. Pedrazzi V, Sato S, Mattos Mda G, Lara EH, Panzeri H. Tongue‐cleaning methods: a comparative clinical trial employing a toothbrush and a tongue scraper. Journal of Periodontology 2004;75(7):1009‐12.
Penala 2016 {published data only}
    1. Penala S, Kalakonda B, Pathakota KR, Jayakumar A, Koppolu P, Bolla VL, et al. Efficacy of local use of probiotics as an adjunct to scaling and root planing in chronic periodontitis and halitosis: a randomized controlled trial. Journal of Research in Pharmacy Practice 2016;5(2):86‐93.
Peruzzo 2007 {published data only}
    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). Brazilian Oral Research 2007;21(1):70‐4.
Peruzzo 2008 {published data only}
    1. Peruzzo DC, Salvador SL, Sallum AW, Nogueira‐Filho Gda R. Flavoring agents present in a dentifrice can modify volatile sulphur compounds (VSCs) formation in morning bad breath. Brazilian Oral Research 2008;22(3):252‐7.
Pitts 1981 {published data only}
    1. Pitts G, Pianotti R, Feary TW, McGuiness J, Masurat T. The in vivo effects of an antiseptic mouthwash on odor‐producing microorganisms. Journal of Dental Research 1981;60(11):1891‐6. [PUBMED: 6945328]
Polat 2008 {published data only}
    1. Polat HB, Ozdemir H, Ay S. Effect of different mouthrinses on third molar surgery‐related oral malodor. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics 2008;105(3):e1‐8.
Porciani 2012 {published data only}
    1. Porciani PF, Franciosi G, Grandini S. Effect of zinc and magnolia tablets on oral VSC. IADR, 2013 Continental European Division Meeting (Florence, Italy): 583.
    1. Porciani PF, Grandini S. The effect of zinc acetate and magnolia bark extract added to chewing gum on volatile sulfur‐containing compounds in the oral cavity. Journal of Clinical Dentistry 2012;23(3):76‐9. [PUBMED: 23210417]
Quirynen 2002 {published data only}
    1. Quirynen M, Avontroodt P, Soers C, Zhao H, Pauwels M, Coucke W, et al. The efficacy of amine fluoride/stannous fluoride in the suppression of morning breath odour. Journal of Clinical Periodontology 2002;29(10):944‐54.
Quirynen 2004 {published data only}
    1. Quirynen M, Avontroodt P, Soers C, Zhao H, Pauwels M, Steenberghe D. Impact of tongue cleansers on microbial load and taste. Journal of Clinical Periodontology 2004;31(7):506‐10.
Quirynen 2005 {published data only}
    1. Quirynen M, Zhao H, Soers C, Dekeyser C, Pauwels M, Coucke W, et al. The impact of periodontal therapy and the adjunctive effect of antiseptics on breath odor‐related outcome variables: a double‐blind randomized study. Journal of Periodontology 2005;76(5):705‐12.
Reingewirtz 1999 {published data only}
    1. Reingewirtz Y, Girault O, Reingewirtz N, Senger B, Tenenbaum H. Mechanical effects and volatile sulfur compound‐reducing effects of chewing gums: comparison between test and base gums and a control group. Quintessence International 1999;30(5):319‐23.
Roldán 2004 {published data only}
    1. Roldán S, Herrera D, Santa‐Cruz I, O'Connor A, González I, Sanz M. Comparative effects of different chlorhexidine mouth‐rinse formulations on volatile sulphur compounds and salivary bacterial counts. Journal of Clinical Periodontology 2004;31(12):1128–34.
Rolla 2002 {published data only}
    1. Rolla G, Jonski G, Young A. The significance of the source of zinc and its anti‐VSC effect. International Dental Journal 2002;52 Suppl 3:233‐5.
Rosenberg 1992 {published data only}
    1. Rosenberg M, Gelernter I, Barki M, Bar‐Ness R. Day‐long reduction of oral malodor by a two‐phase oil:water mouthrinse as compared to chlorhexidine and placebo rinses. Journal of Periodontology 1992;63(1):39‐43.
Rosing 2009 {published data only}
    1. Rosing CK, Gomes SC, Bassani DG, Oppermann RV. Effect of chewing gums on the production of volatile sulfur compounds (VSC) in vivo. Acta Odontologica Latinoamericana 2009;22(1):11‐4. [PUBMED: 19601490]
Saad 2011 {published data only}
    1. Saad S, Greenman J, Shaw H. Comparative effects of various commercially available mouthrinse formulations on oral malodor. Oral Diseases 2011;17(2):180‐6.
Saad 2016 {published data only}
    1. ISRCTN38199132. Breath freshening effects of mechanical removal of tongue biofilm [Clinical study on the breath freshening effects of mechanical removal of tongue biofilm used with oral formulations]. (first received 14 December 2015).
    1. Saad S, Gomez‐Pereira P, Hewett K, Horstman P, Patel J, Greenman J. Daily reduction of oral malodor with the use of a sonic tongue brush combined with an antibacterial tongue spray in a randomized cross‐over clinical investigation. Journal of Breath Research 2016;10(1):016013. [PUBMED: 26869586]
Schmidt 1978 {published data only}
    1. Schmidt NF, Tarbet WJ. The effect of oral rinses on organoleptic mouth odor ratings and levels of volatile sulfur compounds. Oral Surgery, Oral Medicine, and Oral Pathology 1978;45(6):876‐83.
Seemann 2001 {published data only}
    1. Seemann R, Kison A, Bizhang M, Zimmer S. Effectiveness of mechanical tongue cleaning on oral levels of volatile sulfur compounds. Journal of the American Dental Association 2001;132(9):1263‐7.
Seemann 2001a {published data only}
    1. Seemann R, Passek G, Zimmer S, Roulet JF. The effect of an oral hygiene program on oral levels of volatile sulfur compounds (VSC). Journal of Clinical Dentistry 2001;12(4):104‐7.
Sharma 1999 {published data only}
    1. Sharma NC, Galustians HJ, Qaquish J, Galustians A, Rustogi KN, Petrone ME, et al. The clinical effectiveness of a dentifrice containing triclosan and a copolymer for controlling breath odor measured organoleptically twelve hours after toothbrushing. Journal of Clinical Dentistry 1999;10(4):131‐4.
Sharma 2007 {published data only}
    1. Sharma NC, Galustians HJ, Qaqish J, Galustians A, Rustogi K, Petrone ME, et al. Clinical effectiveness of a dentifrice containing triclosan and a copolymer for controlling breath odor. American Journal of Dentistry 2007;20(2):79‐82.
Sheikh 2016 {published data only}
    1. Sheikh FS, Iyer RR. The effect of oil pulling with rice bran oil, sesame oil, and chlorhexidine mouth rinsing on halitosis among pregnant women: a comparative interventional study. Indian Journal of Dental Research 2016;27(5):508‐12.
Shin 2011 {published data only}
    1. Shin K, Yaegaki K, Murata T, Ii H, Tanaka T, Aoyama I, et al. Effects of a composition containing lactoferrin and lactoperoxidase on oral malodor and salivary bacteria: a randomized, double‐blind, crossover, placebo‐controlled clinical trial. Clinical Oral Investigations 2011;15(4):485‐93.
Shinada 2008 {published data only}
    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. [PUBMED: 19068114]
Shinada 2010 {published data only}
    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.
Silveira 2014 {published data only}
    1. Silveira JO. Effect of Full‐Mouth Disinfection and Quadrant Root Scraping and Smoothing Techniques on Halitosis in Individuals with Advanced Chronic Periodontitis: a Randomized Controlled Trial [Efeito das Técnicas de Full‐Mouth Disinfection e Raspagem e Alisamento Radicular por Quadrante na Halitose em Indivíduos com Periodontite Crônica Avançada: Ensaio Clínico Randomizado Controlado] [Masters thesis]. Minas Gerais (Brazil): Federal University of Minas Gerais, 2014.
Silveria 2017 {published data only}
    1. NCT02368678. Study of halitosis in patients with advanced chronic periodontitis (HACP) [Effect of full mouth disinfection and scaling root planing per quadrant in halitosis in patients with advanced chronic periodontitis: randomized clinical controlled trial]. (first received 23 February 2015).
    1. Silveira JO, Costa FO, Oliveira PAD, Dutra BC, Cortelli SC, Cortelli JR, et al. Effect of non‐surgical periodontal treatment by full‐mouth disinfection or scaling and root planing per quadrant in halitosis‐a randomized controlled clinical trial. Clinical Oral Investigations 2017;21(5):1545‐52.
Soares 2015 {published data only}
    1. Soares LG, Jonski G, Tinoco EM, Young A. Short‐term effect of strontium‐ and zinc‐containing toothpastes and mouthrinses on volatile sulphur compounds in morning breath: a randomized, double‐blind, cross‐over clinical study. European Journal of Oral Sciences 2015;123(2):72‐9.
Soares 2015a {published data only}
    1. G Soares L, Castagna L, C Weyne S, G Silva D, EV Falabella M, MB Tinoco E. Effectiveness of full‐ and partial‐mouth disinfection on halitosis in periodontal patients. Journal of Oral Science 2015;57(1):1‐6. [PUBMED: 25807902]
Sreenivasan 2003 {published data only}
    1. Sreenivasan P. The effects of a triclosan/copolymer dentifrice on oral bacteria including those producing hydrogen sulfide. European Journal of Oral Sciences 2003;111(3):223‐7.
Sreenivasan 2004 {published data only}
    1. Sreenivasan PK, Gittins E. The effects of a chlorhexidine mouthrinse on culturable microorganisms of the tongue and saliva. Microbiological Research 2004;159(4):365‐70.
Steenberghe 2001 {published data only}
    1. Steenberghe D, Avontroodt P, Peeters W, Pauwels M, Coucke W, Lijnen A, et al. Effect of different mouthrinses on morning breath. Journal of Periodontology 2001;72(9):1183‐91.
Sterer 2008 {published data only}
    1. Sterer N, Nuas S, Mizrahi B, Goldenberg C, Weiss EI, Domb A, et al. Oral malodor reduction by a palatal muco‐adhesive tablet containing herbal formulation. Journal of Dentistry 2008;36(7):535‐9.
Sterer 2013 {published data only}
    1. Sterer N, Ovadia O, Weiss EI, Perez Davidi M. Day‐long reduction of oral malodor by a palatal muco‐adhesive tablet containing herbal formulation. Journal of Breath Research 2013;7(2):026004.
Tamaki 2007 {published data only}
    1. Tamaki K, Tamaki T, Yamazaki T. Studies on the deodorization by mushroom (Agaricus bisporus) extract of garlic extract‐induced oral malodor. Journal of Nutritional Science and Vitaminology (Tokyo) 2007;53(3):277‐86.
Thaweboon 2011 {published data only}
    1. Thaweboon S, Thaweboon B. Effect of an essential oil‐containing mouthrinse on VSC‐producing bacteria on the tongue. Southeast Asian Journal of Tropical Medicine and Public Health 2011;42(2):456‐62.
Thrane 2010 {published data only}
    1. Thrane P, Jonski G, Young A, Rolla G. Beating bad breath with zinc and chlorhexidine. Dental Practice 2010;48(11):14‐6.
Tian 2013 {published data only}
    1. Tian M, Hanley AB, Dodds MW, Yaegaki K. Chewing gum containing allyl isothiocyanate from mustard seed extract is effective in reducing volatile sulfur compounds responsible for oral malodor. American Journal of Dentistry 2013;26(4):180‐4.
Tolentino 2011 {published data only}
    1. Tolentino Ede S, Chinellato LE, Tarzia O. Saliva and tongue coating pH before and after use of mouthwashes and relationship with parameters of halitosis. Journal of Applied Oral Science 2011;19(2):90‐4.
Troccaz 2011 {published data only}
    1. Troccaz M, Haefliger OP, Cayeux I, Beccucci S, Jeckelmann N, Barra J, et al. Effects of flavoured mouthrinses on morning breath odour: a sensory, analytical and microbial evaluation. Flavour and Fragrance Journal 2011;26(2):90‐7.
Uchida 1973 {published data only}
    1. Uchida Y, Ishii Y, Kusunoki M, Murai S, Kinoshita S, Yashima T, et al. Investigation on the effect of 'Flagyl' in fetor ex ore by means of the double blind test. Journal of Japanese Society of Oral and Maxillofacial Surgery 1973;19(3):309‐22.
UMIN000002145 {published data only}
    1. UMIN000002145. Randomized controlled trial on an effect of preparation of botanical extract on physiological halitosis. (first received 1 August 2009).
UMIN000002713 {published data only}
    1. UMIN000002713. Randomized cross‐over trial on an effect of quercus salicina extract chewing gum on genuine halitosis. (first received 1 December 2009).
Van der Sluijs 2018 {published data only}
    1. Sluijs E, Weijden GA, Hennequin‐Hoenderdos NL, Slot DE. The effect of a tooth/tongue gel and mouthwash regimen on morning oral malodour: a 3‐week single‐blind randomized clinical trial. International Journal of Dental Hygiene 2018;16(1):92‐102.
Wåler 1997 {published data only}
    1. Wåler SM. The effect of some metal ions on volatile sulfur‐containing compounds originating from the oral cavity. Acta Odontologica Scandinavica 1997;55(4):261‐4.
Wang 2015 {published data only}
    1. Wang SC. Thirty‐seven cases of bad breath due to periodontitis treated with therapy of integrated traditional Chinese and Western medicine. He Nan Zhong Yi [Henan Traditional Chinese Medicine] 2015;35(9):2251‐2.
Wessel 2017 {published data only}
    1. Wessel SW, Mei HC, Slomp AM, Belt‐Gritter B, Dodds MWJ, Busscher HJ. Self‐perceived mouth feel and physico‐chemical surface effects after chewing gums containing sorbitol and Magnolia bark extract. European Journal of Oral Sciences 2017;125(5):379‐84.
Wild 2001 {published data only}
    1. Wild JE, Nelson BJ, Hubbard ME, Bowman JP. Oral malodor control afforded through the use of sodium bicarbonate‐containing chewing gum. Compendium of Continuing Education in Dentistry 2001;22(7A):43‐6.
Wilhelm 2010 {published data only}
    1. Wilhelm D, Gysen K, Himmelmann A, Krause C, Wilhelm KP. Short‐term effect of a new mouthrinse formulation on oral malodour after single use in vivo: a comparative, randomized, single‐blind, parallel‐group clinical study. Journal of Breath Research 2010;4(3):036002.
Wilhelm 2013 {published data only}
    1. Wilhelm D, Himmelmann A, Krause C, Wilhelm KP. Short term clinical efficacy of new meridol HALITOSIS tooth & tongue gel in combination with a tongue cleaner to reduce oral malodor. Journal of Clinical Dentistry 2013;24(1):12‐9.
Yaegaki 1992 {published data only}
    1. Yaegaki K, Sanada K. Effects of a two‐phase oil‐water mouthwash on halitosis. Clinical Preventive Dentistry 1992;14(1):5‐9.
Yoshimatsu 2006 {published data only}
    1. Yoshimatsu D, Sugimura S, Ioka T, Kometani T, Yamaga T, Miyazaki H. Effect of protease tablet on reduction of tongue coating. Oral Diseases 2005;11(Suppl 1):112 (Abs No P20).
    1. Yoshimatsu D, Sugimura S, Ioka T, Shiraishi K, Kometani T, Yamaga T, et al. Effect of protease tablet on reduction of tongue coating. Journal of Dental Health 2006;56:37‐41.
Yoshimatsu 2007 {published data only}
    1. Yoshimatsu D, Sugimura S, Ioka T, Shiraishi K, Kometani T, Yamaga T. Reduction of volatile sulfur compounds in mouth air by protease tablet. Journal of Dental Health 2007;57:22‐7.
References to studies awaiting assessment Cuihua 2009 {published data only}
    1. Cuihua X. Observation on the efficacy of integrated traditional Chinese and Western medicine in treating halitosis caused by periodontitis. Chinese Medical Innovation 2009;15:35.
Dongling 2017 {published data only}
    1. Dongling M. Clinical effect of integrated traditional Chinese and Western medicine on halitosis caused by periodontitis. Chinese Health Care Nutrition 2017;31:285‐6.
Gupta 2016 {published data only}
    1. Gupta A, Bhowate R, Srivastava R, Sunilkumar, Devasthale SV, Sastry JLN. Clinical evaluation of Babool neem toothpaste in oral hygiene and dental care. International Journal of Pharmaceutical Research 2016;8(2):57‐64.
Liang 2013 {published data only}
    1. Yulin L. Observation on the efficacy of combined treatment of traditional Chinese medicine and Western medicine for halitosis caused by periodontitis. Chinese Journal of Trauma and Disability Medicine 2013;5:247‐8.
Niles 2003 {published data only}
    1. Niles HP, Hunter CM, Vazquez J, Williams MI, Cummins D. Clinical comparison of Colgate Total Advanced Fresh vs a commercially available fluoride breath‐freshening toothpaste in reducing breath odor overnight: a multiple‐use study. Compendium of Continuing Education in Dentistry 2003;24(9):29‐33.
Rostoka 2012 {published data only}
    1. Rostoka D, Kroica J, Iriste V, Reinis A, Kuznetsova V, Teibe U. Treatment of halitosis with mouth rinsing agents containing essential oils. Stomatologiia 2012;91(3):27‐34.
Shimei 2014 {published data only}
    1. Shimei S. Clinical observation of Banxia Xiexin decoction in treating Helicobacter pylori related halitosis. Inner Mongolia Medical Journal 2014;33(31):33‐4.
Vazquez 2003 {published data only}
    1. Vazquez J, Pilch S, Williams MI, Cummins D. Clinical efficacy of Colgate Total Advanced Fresh and a commercially available breath‐freshening dentifrice in reducing mouth‐odor‐causing bacteria. Compendium of Continuing Education in Dentistry 2003;24(9):20‐4.
References to ongoing studies CTRI/2014/04/004519 {published data only}
    1. CTRI/2014/04/004519. Effect of test chewing gums on bad breath and oral micro‐organisms [Effect of test chewing gums on oral malodour and oral pathogens]. (first received 2 April 2014).
CTRI/2018/05/014049 {published data only}
    1. CTRI/2018/05/014049. Effect of a new herbal toothpaste on gum disease, bad breath and debris on the tooth surfaces [Effect of novel herbal dentifrice in control of plaque, gingivitis and halitosis ‐ randomized controlled trial]. (first received 22 May 2018).
CTRI/2018/06/014686 {published data only}
    1. CTRI/2018/06/014686. Ability of a polyherbal formulation to treat gum imflammation and bad breath over a period of three months [Effectiveness of a polyherbal formulation to treat gingivitis over a period of three months: a randomized trial]. (first received 29 June 2018).
DRKS00010618 {published data only}
    1. DRKS00010618. Clinical evaluation of the efficacy of Shur breath (Sylphar) in the reduction of bad breath. (first received 10 June 2016).
IRCT201105136466N1 {published data only}
    1. IRCT201105136466N1. The effect of persica (herbal oral rinse) on halitosis [The effect of persica (herbal oral rinse) on halitosis in patient visiting Shiraz dental school‐2011]. (first received 5 November 2011).
IRCT2014121520314N1 {published and unpublished data}
    1. IRCT2014121520314N1. Comparison of efficacy of Halita mouthrinse with chlorhexidine mouthrinse in reducing oral malodor in patients with oral malodor [Clinical trial of comparison of efficacy of Halita mouthrinse with chlorhexidine mouthrinse in reducing oral malodor in patients with halitosis in 7‐day consumption]. (first received 23 February 2015).
IRCT2015030921395N1 {published data only}
    1. IRCT2015030921395N1. Effect of Pistacia atlantica subsp. mutica oleo‐gum resin, Punica granatum var. pleniflora flowers and Eugenia on halitosis [Preparation and clinical trial of toothpaste contained Pistacia atlantica subsp. mutica oleo‐gum resin, Punica granatum var. pleniflora flowers and Eugenia caryophyllata buds for halitosis]. (first received 30 August 2016).
IRCT2016012026122N1 {published and unpublished data}
    1. IRCT2016012026122N1. Comparison of the effectiveness of mouthwashes containing green tea on the severity of halitosis in patients with halitosis. (first received 25 February 2016).
ISRCTN67671859 {published data only}
    1. ISRCTN67671859. Assessment of oral malodour and tonsil bacteria after gargling of throat with an antiseptic [Assessment of oral malodour and tonsillar microbiota after gargling in oropharynx with benzethonium chloride]. (first received 19 August 2015).
ISRCTN74655176 {published data only}
    1. ISRCTN74655176. The safety and efficacy of an herbal chlorhexidine gel on bad breath caused by oral bacteria [A double‐bind placebo controlled study to determine the effectiveness of a new oral gel for halitosis]. (first received 24 October 2017).
ISRCTN75902618 {published data only}
    1. ISRCTN75902618. Efficacy of 0.1% chlorine dioxide mouthwash in reducing oral malodour [Efficacy of 0.1% chlorine dioxide mouthwash in reducing oral malodour ‐ a 2‐week randomized double‐blind cross‐over study]. (first received 15 March 2018).
NCT02794766 {published data only}
    1. NCT02794766. Inulin and S salivarius reduce halitosis [Inulin and Streptococcus salivarius reduce halitosis associated with tongue coating: a randomized clinical trial]. (first received 9 June 2016).
NCT03031756 {published data only}
    1. NCT03031756. Efficacy of Glycine powder air‐polishing combined with scaling and root planing in the treatment of periodontitis and halitosis. (first received 26 January 2017).
NCT03053882 {published data only}
    1. NCT03053882. Efficacy of peppermint and green tea in malodor [Comparative study of the effects of green tea and peppermint herbal mouthwash on halitosis]. (first received 15 February 2017).
NCT03160573 {published data only}
    1. NCT03160560. Controlling oral malodor by ClōSYS® oral rinse [Efficacy of ClōSYS® oral rinse products in human subjects in controlling oral malodor]. (first received 19 May 2017).
    1. NCT03160573. Controlling oral malodor by ClōSYS oral rinse [Efficacy of ClōSYS oral rinse products in human subjects in controlling oral malodor]. (first received 19 May 2017).
NCT03468595 {published data only}
    1. NCT03468595. Clinical evaluation of some local antimicrobial agents' adjunctive effects on periodontal parameters and halitosis. (first received 16 March 2018).
TCTR20151109001 {published data only}
    1. TCTR20151109001. Effectiveness of alcohol‐free fluoride and essential oils containing mouthrinse in controlling dental plaque, gingivitis and halitosis in pregnancy: RCT (Alcohol‐free EO mouthwash for controlling gingivitis and halitosis in pregnancy). (first received 8 November 2015).
UMIN000023832 {published data only}
    1. UMIN000023832. Crossover test for reducing oral malodor by the chewing gums containing Myrsine seguinii extracts. (first received 30 August 2016).
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