A new technique for tongue brushing and halitosis reduction: the X technique

Abstract The tongue is one of the primary sources of halitosis. The manual or mechanical removal of biofilm is known to decrease oral malodor. Objective: To evaluate a new tongue hygiene technique hereby referred to as "the X technique" and its effects on both halitosis and the number of microorganisms based on microbiological parameters and diagnostic features of the breath. Material and Methods: The study included thirty patients divided into a control group (patients without systematized guidelines of lingual hygiene, but who performed the mechanical cleaning of tongue dorsum, each in its own way), the 3R group (instructed to perform the movements of the X technique for 3 repetitions at each brushing), and the 6R group (instructed to perform 6 repetitions of the technique at each brushing). After two weeks, a new data collection was performed. Results: Patients in the 6R group presented the lowest score on the organoleptic assessment scale at the second consultation, followed by the 3R group and the controls. Regarding the self-perception of breath by the method of Visual Analog Scale (VAS), the control group did not perceive improvements in oral malodor; the results of the 3R group and the 6R group were similar. Conclusion: These results indicate that the X technique improves both measurements and perceptions of halitosis. Microbiological analyses revealed greatest reduction in the 6R group. The findings show that the X technique reduces both organoleptic scores and the number of bacterial colonies, and improves users' perceptions of their breath.

In vitro effects of Melaleuca alternifolia essential oil on growth and production of volatile sulphur compounds by oral bacteria

ABSTRACT Objective Halitosis can be caused by microorganisms that produce volatile sulphur compounds (VSCs), which colonize the surface of the tongue and subgingival sites. Studies have reported that the use of natural products can reduce the bacterial load and, consequently, the development of halitosis. The aim of this study was to evaluate the antimicrobial activity of the essential oil of Melaleuca alternifolia on the growth and volatile sulphur compound (VSC) production of oral bacteria compared with chlorhexidine. Material and Methods The effects of these substances were evaluated by the Minimum Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (MBC) in planktonic cultures of Porphyromonas gingivalis and Porphyromonas endodontalis. In addition, gas chromatography analyses were performed to measure the concentration of VSCs from bacterial cultures and to characterize M. alternifolia oil components. Results The MIC and MBC values were as follows: M. alternifolia - P. gingivalis (MIC and MBC=0.007%), P. endodontalis (MIC and MBC=0.007%=0.5%); chlorhexidine - P. gingivalis and P. endodontalis (MIC and MBC=1.5 mg/mL). M. alternifolia significantly reduced the growth and production of hydrogen sulfide (H2S) by P. gingivalis (p<0.05, ANOVA-Dunnet) and the H2S and methyl mercaptan (CH3SH) levels of P. endodontalis (p<0.05, ANOVA-Dunnet). Chlorhexidine reduced the growth of both microorganisms without altering the production of VSC in P. endodontalis. For P. gingivalis, the production of H2S and CH3SH decreased (p<0.05, ANOVA-Dunnet). Conclusion M. alternifolia can reduce bacterial growth and VSCs production and could be used as an alternative to chlorhexidine.

Effects of 4% Hypertonic Saline Solution Mouthwash on Oral Health of Elders in Long Term Care Facilities

PURPOSE: This study was done to examine the effects of 4% hypertonic saline solution mouthwash and tooth brushing education on the oral health of elders living in long term care facilities. METHODS: In this quasi-experimental study, the participants were assigned to a 2% experimental group (n=20), a 4% experimental group (n=20), and a control group (n=20). Data were analyzed using ANOVA, repeated measures ANOVA, Fisher exact test, Chi-square test, Kruskal-Wallis test and multiple response analysis with the SAS program. RESULTS: Regular tooth brushing and use of 4% hypertonic saline solution mouthwash by elders provided better oral health by decreasing xerostomia, oral tongue plaque, halitosis, and the number of oral bacteria. CONCLUSION: The results indicate that regular tooth brushing with continuous 4% hypertonic saline solution mouth washing education promotes oral health for elders in long term care facilities, thus the dental care described in this study is recommended for elders in long term facilities.

Effects of the medicinal plants Curcuma zedoaria and Camellia sinensis on halitosis control

Volatile sulphur compounds (VSC) are the gases mainly responsible for halitosis (bad breath). The aim of this research was to evaluate the effects of medicinal plants on halitosis control. Two commonly used plants were tested: Curcuma zedoaria and Camellia sinensis (green tea). These plants were prepared as an aqueous solution and used as mouthwashes, compared with a standard mouthwash of 0.12% chlorhexidine gluconate and a placebo (water). The experiment was conducted with 30 volunteers from the School of Dentistry of São Jose dos Campos, Univ. Estadual Paulista - UNESP, SP, Brazil. Each volunteer tested the four mouthwashes. The Cysteine Challenge Method, modified for this study, was used for initial breath standardization. Four breath assessments were conducted after volunteers rinsed orally with acetylcysteine: one before the test mouthwash was used; the second, one minute after its use; a third 90 minutes later; and the last 180 minutes later. The results showed that chlorhexidine gluconate lowered VSC production immediately, and that this effect lasted up to 3 hours, while the tested plants had immediate inhibitory effects but no residual inhibitory effects on VSC. We concluded that Curcuma zedoaria and Camellia sinensis, prepared as infusions and used as mouthwashes, did not have a residual neutralizing effect on VSC.

Effects of A-solution on Halitosis and Oral Status in Preoperative NPO Patients

PURPOSE: The aim of this study was to explore the effects of A-solution on halitosis and oral status in preoperative NPO patients. METHODS: A nonequivalent control group, non-synchronized pretest-posttest design was used in this study. The participants in this study were 66 patients who were admitted for gynecologic surgery. The experimental treatment was to give oral gargling with A-solution, blended essential oils and diluted with distilled water. To identify the experimental treatment effects, halitosis, salivary pH, and oral status were measured by a portable halitosis detector, visual analogue scale, Bromo Thymol Blue (BTB), Bromo Cresol Purple (BCP) test paper and oral assessment guide. Data were analyzed using chi2-test, t-test with PASW 18.0 version. RESULTS: Participants were homogeneous before experimental treatment. Objective halitosis in the experimental group, measured by a portable halitosis detector (t= -8.34, p<.001) was significantly lower than the control group. Subjective halitosis was significantly lower in the experimental group (t= -9.29, p<.001). Salivary pH was significantly different between two groups (t=8.81, p<.001). Oral status was significantly better in the experimental group (t= -13.31, p<.001). CONCLUSION: These findings indicate that oral gargling using A-solution is effective in reducing patient halitosis, and improving oral status.

Avaliação clínica de um dentifrício à base de dióxido de cloro na redução dos compostos sulfurados voláteis / Clinical assessment of a toothpaste based chlorine dioxide in the reduction of volatile sulfur compounds

A halitose é, na maioria das vezes, um problema originado na cavidade oral e tem como principal contribuinte os compostos sulfurados voláteis (CSV), que são formados a partir da quebra de aminoácidos por bactérias orais. 0 objetivo desse estudo foi avaliar a capacidade de um novo dentifrício contendo dióxido de cloro em reduzir os níveis de CSV. Esse estudo consistiu de uma avaliação duplo-cega, randomizada, placebo-controlada e cruzada, de dez voluntários saudáveis, onde a halitose foi induzida através do bochecho de cis-teína e três dentifrícios foram utilizados na forma de solução para bochecho, um teste à base de dióxido de cloro, placebo e digluconato de clorexidina a 0,12%. Para a aferição dos níveis de CSV foi utilizado um halímetro. No período pós-bochecho, a taxa de redução do dentifrício teste foi superior ao placebo e inferior à clorexidina. Já nos períodos após uma, duas e três horas, a taxa de redução do dentifrício teste foi similar à clorexidina, sendo ambas superiores estatisticamente ao placebo, concluindo-se que o dentifrício teste foi capaz de reduzir os níveis de CSV quando comparado ao placebo, se comportando de forma similar à solução de clorexidina a 0,12% após uma, duas e três horas ao bochecho.

Halitosis: revisión, estudio y prevención de la microflora asociada / Halitosis: review, study and prevention of the associated microflora

Existen muchas personas que presentan halitosis o mal aliento, encontrándose casi un tercio de la población en esta situación. Suetiología puede relacionarse con enfermedades sistémicas, psicológicas, la acción de medicamentos administrados, pero fundamentalmente a la actividad de las bacterias orales en especial bacilos gran negativos anaerobios (pigmentados), localizadospreferentemente en el dorso de la lengua. Consideramos que una buena higiene influye favorablemente en su eliminación. Existen diferentes métodos de limpieza: cepillo, enjuagatorios, utilización de limpia lenguas. El propósito de este trabajo consistió enuna revisión de este tema y en profundizar en el conocimiento de la colonización de los microorganismos de la cavidad oral, productores de compuestos sulfurados volátiles. Estudiamos la diferencia cuantitativa de microorganismos (UFC-unidad formadora de colonias) presentes en el dorso de lengua antes y después del uso de limpia lenguas.

There are many persons who experience halitosis or bad breath. Nearly a third part of the population has got this situation. It can be due to different causes, among them the administration of certain medicines, but essentially the most usually cause is theoral bacterial activity of gram negative rods (brown to black colonies on blood agar) that are on the tongue dorsum. We consider that a good hygiene can eliminate the bad breath. There are different cleaning methods: brushing, mouthrinses and tongue scrapins. The purpose of this study was a review of the halitosis and also consisted to get better in the knowledge of oralmicroorganisms that produce volatile sulfur compounds. We studied the difference (UFC-unit colony form) of the microflora of the tongue dorsum, before and after the use of the tongue dorsum scrapins.

Causas e sintomas da halitose: estudo do conhecimento entre pacientes do curso de odontologia / Causes and symptoms of halitosis: a study of knowledge among patients of the dentistry course

Introdução: O estudo avalia o conhecimento sobre causas e sintomas da halitose de pacientes da Clínica de Odontologia do Curso de Graduação do Centro Universitário de Araraquara - UNIARA, bem como analisa a eficiência de folheto educativo na mudança de comportamento quanto à prevenção do mau hálito. Métodos: Para isso, um questionário pré-codificado, composto por questões sobre o tema foi aplicado em 2 momentos: antes e após 30 dias da realização do experimento. A amostra foi composta por 30 pacientes, divididos em 2 grupos: GA ? controle (respondeu ao questionário); GB ? respondeu ao questionário e recebeu o folheto para leitura e novamente respondeu ao questionário, passados 30 dias da aplicação do folheto. Os grupos foram comparados por meio da coleta dos dados e análise descritiva da distribuição de frequências. Resultados: Os resultados mostraram que, de maneira geral, o conhecimento sobre halitose se mostrou controverso em alguns aspectos, principalmente, em relação às causas e formas de prevenção; não foi observada melhora no conhecimento sobre halitose para o grupo que recebeu o folheto. Conclusão: Tanto os profissionais quanto a população devem ser mais bem orientados em relação aos fatores fisiológicos e patológicos da halitose para atuarem na prevenção de seus efeitos individuais e sociais

Introduction: This study aims to evaluate the knowledge about the causes and symptoms of halitosis of patients in the clinic of Dentistry of the University Center of Araraquara - UNIARA and analyze the effectiveness of an educational booklet on behavior change in relation to preventing bad breath. Methods: For that, a pre-coded questionnaire, was applied in two phases: before and after 30 days of the study. The sample consisted of 30 patients divided into two groups: GA - control group (only answered the questionnaire); GB - answers questionnaire and received the booklet to read and answer the questionnaire again, after 30 days of booklet application. The groups were compared by means of data collection and descriptive analysis using distributions of frequency. Results: The results showed that, in general, knowledge about halitosis by the studied population was controversial in some respects, especially with regard to the causes and prevention methods; no improvement was observed about halitosis for the group who received the booklet compared with the control group. Conclusion: It may be concluded that professionals and the population must be better focused on the physiological and pathological halitosis, so that they may act to prevent individual and social effects

Autopercepção da halitose / Halitosis auto-perception

Objective: the aim of this study was to assess the self-perception of halitosis and to identify predisposing factors to the disease in individuals seeking dental treatment at public and private services in Recife (Pernambuco), Brazil. Materials and Methods - This cross-sectional study was carried out in Recife (Pernambuco/Brazil), which is divided into six geographical districts for health assistance. Public and private services units were randomly selected and questionnaires were used to collectdata from the service users. Results - The sample consisted of 416 randomly selected individuals aged 14-91 years old, of whom 74% were female and 26% male. The mean age was 37.49 years. The study found that 6.97% of subjects reported having bad breath and 39.9% moderate halitosis. There was no difference between genders and type of care (public/private) regarding the halitosis auto-perception. Despite the existence of risk factors for halitosis such as low consumption of water,smoking, alcohol use, and poor hygiene practices, the studied individuals reported no self-awareness.Conclusions - Therefore it is important to check the self-perception of halitosis and spread the knowledge about the disease and its etiology, because identification of the disease’s risk factors is important for its prevention and treatment.

Objetivo: o objetivo deste estudo foi o de verificar a autopercepção de halitose bem como identificar a presença de fatores predisponentes à doença em indivíduos que procuram tratamento odontológico nos serviços públicos e privados do Recife(PE) - Brasil. Material e Métodos - Foi realizado estudo transversal em Recife (Pernambuco/Brasil), que obedece à divisão geográfica dos seis Distritos Sanitários da cidade, sendo selecionados, aleatoriamente, os serviços públicos e privados para visitação e aplicação de questionário. Resultados - A amostra foi constituída de 416 indivíduos selecionados aleatoriamente, com idade entre 14-91 anos.. A idade média foi de 37,49 anos, sendo 74% do sexo feminino e 26% do sexo masculino. 6,97% dos indivíduos revelaram ter mau hálito, e 39,9% halitose moderada. Não houve diferença entre sexo e local de atendimento (público/privado) em relação à autopercepção do mau hálito. Apesar da existência de fatores de risco para a halitose como o baixo consumo de água, fumo, álcool, má higiene oral, os indivíduos da amostra não relataram a autopercepção. Conclusões - Assim, é importante verificar a autopercepção da halitose bem como socializar o conhecimento sobre as formas da doença e etiologia, porque a identificação da presença de fatores de risco para o desenvolvimento da doença aumenta, consideravelmente,a prevenção e tratamento.

Avaliação da aceitação de pacientes em relação ao uso de antissépticos orais e estudo do pH das diferentes soluções / Evaluation of patients' acceptance of mouthwashes use and pH study of different solutions

O objetivo deste estudo foi avaliar o pH de diferentes antissépticos orais e as opiniões dos pacientes em relação ao enxaguante utilizado. Cinquenta pacientes realizaram bochechos com cinco diferentes soluções – clorito de cetilpiridínio associado ao cloreto de sódio, triclosan, solução enzimática, óleo essencial e água destilada.Os pacientes foram submetidos a um exame clínico, bochecho específico e aplicação do questionário. Pôde-se observar que as quatro marcas comerciais de soluções para bochecho testadas apresentaram pH ácido e que houve diferença entre as medidas entre os pHmetros analógico e digital. Os enxaguantes de maior aceitação foram o dióxido de cloro e solução enzimática.

Avaliação do pH da saliva e da saburra lingual antes e após a utilização de soluções enxaguantes orais / Evaluation of saliva and tongue coat pH before and after use of mouthwashes

O objetivo deste estudo foi avaliar o pH da saliva e da saburra lingual em pacientes com saúde oral íntegra e halitose fisiológica através de um pHmetro analógico e de fitas indicadoras de pH, antes e imediatamente após utilização de diferentes enxaguantes orais e 30 minutos após o bochecho, assim como relacionar as possíveis alterações do pH a parâmetros de halitose, através de revisão da literatura. Foram avaliados 50 pacientes, com bochechos de 5 soluções – clorito de sódio associado ao cloreto de cetilpiridínio, Triclosan, solução enzimática, óleo essencial e água destilada. Os enxaguantes contendo Triclosan e óleo essencial aumentaram o pH da saliva imediatamente após o bochecho e a solução enzimática diminuiu o pH da saliva e da saburra lingual.

Halitosis: a review of basic principles

Halitosis, also known as bad breath or oral malodor, is the general term used to describe any disagreeable odor in expired air, regardless of whether the odorous substances originate from oral or non-oral sources. Bad breath can be detrimental to one’s self-image and confidence, causing social, emotional and psychological anxiety. This paper provides a comprehensive review of the historical background, prevalence, social aspects and pathological causes of halitosis as well as the dental professional’s responsibility.

Flavoring agents present in a dentifrice can modify volatile sulphur compounds (VSCs) formation in morning bad breath

This study aimed to evaluate the effects of a flavor-containing dentifrice on the formation of volatile sulphur compounds (VSCs) in morning bad breath. A two-step, blinded, crossover, randomized study was carried out in 50 dental students with a healthy periodontium divided into two experimental groups: flavor-containing dentifrice (test) and non-flavor-containing dentifrice (control). The volunteers received the designated dentifrice and a new toothbrush for a 3 X/day brushing regimen for 2 periods of 30 days. A seven-day washout interval was used between the periods. The assessed parameters were: plaque index (PI), gingival index (GI), organoleptic breath scores (ORG), VSC levels (as measured by a portable sulphide monitor) before (H1) and after (H2) cleaning of the tongue, tongue coating (TC) wet weight and BANA test from TC samples. The intra-group analysis showed a decrease in ORG, from 3 to 2, after 30 days for the test group (p < 0.05). The inter-group analysis showed lower values in ORG, H1 and H2 for the test group (p < 0.05). There was no difference between the amount of TC between groups and the presence of flavor also did not interfere in the BANA results between groups (p > 0.05). These findings suggest that a flavor-containing dentifrice seems to prevent VSCs formation in morning bad breath regardless of the amount of TC in periodontally healthy subjects.

Use of 0.1 percent chlorine dioxide to inhibit the formation of morning volatile sulphur compounds (VSC)

The aim of this study was to evaluate the VSC-inhibiting effect of a commercially available mouthrinse (0.1 percent chlorine dioxide) when compared to its placebo. A 2-step double blind, crossover, randomised study was conducted with 14 dental students with healthy periodontium, who refrained from any mechanical plaque and tongue coating control during two 4-day experimental periods. The subjects were instructed to rinse 3 times daily with the assigned product during each period. A 7-day washout interval was established. VSCs levels were measured by a sulphide monitor at the beginning (baseline) and at the end of each experimental period. Statistical analyses were performed using Wilcoxon's and Mann-Whitney's non-parametric tests. At baseline, intragroup analysis revealed that VSCs levels did not differ between groups (p > 0.05); at day 5, the use of the chlorine dioxide mouthrinse did not change the baseline VSCs scores in the control group (p > 0.05), while a 2-fold increase was observed with the use of the placebo mouthrinse (p < 0.05). Intergroup analysis showed a significant difference between the VSCs levels of the test and control groups (40.2 ± 30.72 and 82.3 ± 75.63 ppb, p < 0.001) at day 5. Within the limits of this study, the findings suggest that a mouthrinse containing chlorine dioxide can maintain VSCs at lower levels in the morning breath.

O objetivo do presente estudo foi avaliar o efeito inibitório do enxaguatório de dióxido de cloro a 0,1 por cento sobre a formação dos CSVs, quando comparados a um placebo. Um estudo randomizado, cruzado, duplo cego foi conduzido com 14 estudantes de odontologia apresentando saúde periodontal, os quais se abstiveram dos hábitos de escovação dentária e limpeza da língua durante dois períodos experimentais de 4 dias. Os voluntários foram orientados a utilizar o enxaguatório designado 3 vezes ao dia conforme indicado no rótulo. Um intervalo de 7 dias foi estabelecido entre os períodos experimentais. No início ("baseline") e no final de cada período experimental, os níveis de CSVs foram medidos com o uso do monitor de sulfetos. Análise estatística foi realizada utilizando-se os testes não-paramétricos de Wilcoxon e Mann-Whitney. No "baseline", uma análise intragrupo revelou que os níveis de CSVs não diferiram entre os grupos (p > 0.05); no dia 5, o uso do dióxido de cloro não promoveu mudanças significativas nos níveis de CSVs em relação ao "baseline" no grupo controle (p > 0,05), entretanto os níveis de CSVs duplicaram com a utilização enxaguatório placebo (p < 0,05). Uma análise entre os grupos teste e controle revelou diferença significante para os níveis de CSVs (40,2 ± 30,72 e 82,3 ± 75,63 ppb, p < 0,001) no dia 5. Dentro dos limites deste estudo, os achados sugerem que o uso de enxaguatórios contendo dióxido de cloro pode promover a manutenção de baixos níveis de CSVs no hálito matinal.

Cerco ao mau hálito / Laying siege to foul-smelling breth

Brasileira desenvolve protocolo de tratamento para prevenção, controle e tratamento de halitose crônica. Programa abrange treinamento de CDs e uso de equipamentos especiais. Um destes dispositivos é capaz de medir a intensidade do mau hálito