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Title Mouthrinses with Chemotherapeutic Agents are Effective Treatments For Halitosis
Clinical Question In adult patients with halitosis, does the addition of mouthrinses containing chemotherapeutic agents reduce the severity of halitosis as compared to patients not given the addition of chemotherapeutic agents into their oral health routine?
Clinical Bottom Line Mouthrinses containing chlorhexidine, cetylpyridinium chloride or chlorine dioxide and zinc are effective treatment options for patients with halitosis. Halitosis producing bacteria count such as Fusobacterium nucleatum may be reduced and VSCs neutralized. (See Comments on the CAT below)
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 18843727Fedorowicz/2008293 patients from 5 RCTsSystematic Review
Key resultsMouthrinses containing antibacterial agents such as chlorhexidine and cetylpyridinium chloride may play an important role in reducing the levels of halitosis-producing bacteria on the tongue (-1.13 (1.1) P < 0.005 versus -0.2 (0.7)), and chlorine dioxide and zinc containing mouthrinses can be effective in neutralisation of volitile sulphur compounds (VSC) (-120 (92) parts per billion (ppb) versus 8 (145) ppb in placebo).
#2) 20152022Shinada/201015 male patientsRandomized, placebo-controlled, double-blind, crossover trial
Key resultsAfter rinsing with the mouthwash containing ClO2 for 7 days, morning bad breath decreased as measured by organoleptic measurement and reduced the concentrations of H2S, CH3SH and (CH3)2S measured by GC, were found. ClO2 mouthwash used over a 7-day period appeared effective in reducing plaque, tongue coating accumulation and the counts of Fusobacterium nucleatum in saliva.
Evidence Search ("Halitosis"[Mesh]) AND "Mouthwashes"[Mesh] ...view in PubMed
Comments on
The Evidence
The evidence available to answer this PICO questions fell into the category Systematic Review and Controlled Crossover Trial. The Cochrane systematic review by Fedorowicz, et al. included randomized controlled trials up to August 2008. The Shinada, et al. study was published after August 2008 and thus included in this CAT. As a double blind RCT with 100% completion without any clear competing interests, the level of evidence is high.
Applicability Treatment of halitosis with mouthrinse is a feasible treatment option for adult patients with concerns about oral malodor in any practice setting.
Specialty/Discipline (Public Health) (General Dentistry) (Dental Hygiene)
Keywords Halitosis, mouthrinse, mouthwash
ID# 708
Date of submission: 09/16/2010spacer Revised: 04/16/2012
E-mail nakashiman@livemail.uthscsa.edu
Author Nicole Nakashima
Co-author(s) e-mail
Faculty mentor/Co-author Karen Troendle, DDS
Faculty mentor/Co-author e-mail TROENDLE@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
Comments and Evidence-Based Updates on the CAT
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by Jeremiah Whetman, Erin Wyrick (San Antonio, Texas) on 08/08/2013
We conducted a PubMed search on this topic in August 2013 and found a more recent systematic review (Blom 2012, PubMed # 22429551 ). In this systematic review, the authors agreed with the claims of the effectiveness of chlorihexidene and cetyl pyridium chloride as treatment of halitosis. The new systematic review broadened the inclusion criteria to include 12 studies in the analysis. However, it should be noted that overall, there is limited evidence that mouth rinses with chemotherapeutic agents are effective treatments for halitosis.

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