Cochrane · intervention · CD006701
Mouthrinses for the treatment of halitosis
Cochrane Database of Systematic Reviews · 2008 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
16
current version
GRADE rated
0
No studies
0
Included studies
5
as reported
No studies 0 · 0%Ungraded 16 · 100%Very low 0 · 0%Low 0 · 0%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Adults over the age of 18 with a clinical or self-assessed diagnosis of halitosis, with no significant comorbidity or health condition that might lead to increased halitosis (e.g. diabetes); studies on participants with refractory and severe chronic periodontal diseases were excluded | Adults with halitosis recruited in Thailand, Israel, the Netherlands and Spain, and the USA; 16 to 30 participants per group; trials excluded participants with significant periodontal disease, extensive caries, chronic oral neglect or dentures; all but one trial excluded smokers (n=293) |
| Intervention | Mouthrinses available over the counter or prescribed by a clinician for the treatment of halitosis, administered over a minimum of 1 week (single-use mouthwashes excluded) | Essential oils (Listerine) (n=25); cetylpyridinium chloride + essential oils + chlorine dioxide + zinc (Breath Rx) (n=25); chlorine dioxide + zinc (Oxygene) (n=22); two-phase oil-water (0.05% cetylpyridinium chloride) (n=26); zinc chloride + sodium chlorite (TriOral); zinc chloride minus sodium chlorite (Breath Rx containing cetylpyridinium chloride); pericarp extract of Garcinia mangostana L (n=30); 0.05% chlorhexidine + 0.05% cetylpyridinium chloride + 0.14% zinc lactate (n=20) |
| Comparison | Placebo, or another mouthrinse (head-to-head) | Placebo; essential oils (Listerine) as active control; control containing neither zinc chloride nor sodium chlorite |
| Outcomes | Primary: self-expressed (perceived) and organoleptic (human nose) assessments of halitosis using a validated malodour intensity scale. Secondary: halitosis measured by halimeter, portable sulphide monitor or gas chromatography; peak and steady-state VSC levels. Adverse events | Organoleptic assessment of halitosis (n=185, 3 trials); halimeter-assessed volatile sulphur compounds/peak VSC (n=293, 5 trials); indirect surrogate salivary organoleptic scores (1 trial); adverse events (2 trials). No self-assessed halitosis and no gas-chromatography outcomes were reported |
| Study designs | Randomised controlled trials (RCTs) | Five parallel-group RCTs; 2 at low risk of bias, 3 at moderate risk of bias |
| Timing | Interventions administered over a minimum of 1 week, with no upper time limit | Intervention and assessment periods ranged from 2 to 6 weeks |
Search date: 2008-08. Databases: Cochrane Oral Health Group Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; EMBASE; CINAHL
Questions and results
Current version onlyEssential oils mouthrinse (Listerine) vs Placebo
Population: Adults over 18 years with a clinical or self-assessed diagnosis of halitosis, without significant comorbidity (e.g. diabetes) or refractory/severe chronic periodontal disease
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Halimeter-assessed volatile sulphur compounds (VSC) (mean change from baseline) 4 weeks | Borden 2002: mean change in halimeter-assessed VSC (ppb). Essential oils (Listerine): -43.22 at 2 weeks (48.54% reduction), -68.90 at 4 weeks (77.39% reduction); Placebo: -39.86 at 2 weeks (45.25%), -36.77 at 4 weeks… | 1 study | Ungraded |
Organoleptic assessment of halitosis (mean change from baseline) 4 weeks | Borden 2002: mean change in organoleptic score (scale 0 to 5). Essential oils (Listerine): 0.02 at 2 weeks, 0 at 4 weeks; Placebo: 0.23 at 2 weeks, 0.16 at 4 weeks. Listerine did not reduce organoleptic scores. No… | 1 study | Ungraded |
Cetylpyridinium chloride + essential oils + chlorine dioxide + zinc mouthrinse (Breath Rx) vs Placebo
Population: Adults over 18 years with a clinical or self-assessed diagnosis of halitosis, without significant comorbidity (e.g. diabetes) or refractory/severe chronic periodontal disease
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Halimeter-assessed volatile sulphur compounds (VSC) (mean change from baseline) 4 weeks | Borden 2002: mean change in halimeter-assessed VSC (ppb). Breath Rx: -66.84 at 2 weeks (67.65% reduction), -77.87 at 4 weeks (78.82% reduction); Placebo: -39.86 at 2 weeks, -36.77 at 4 weeks (41.75%). No between-group… | 1 study | Ungraded |
Organoleptic assessment of halitosis (mean change from baseline) 4 weeks | Borden 2002: mean change in organoleptic score (scale 0 to 5). Breath Rx (cetylpyridinium chloride + essential oils + chlorine dioxide + zinc): -0.52 at 2 weeks, -0.41 at 4 weeks; Placebo: 0.23 at 2 weeks, 0.16 at 4… | 1 study | Ungraded |
Adverse events 4 weeks | Borden 2002: 13 adverse events were reported in the trial, but the investigators concluded that none were likely to be related to product usage. | 1 study | Ungraded |
Chlorine dioxide + zinc mouthrinse (Oxygene) vs Placebo
Population: Adults over 18 years with a clinical or self-assessed diagnosis of halitosis, without significant comorbidity (e.g. diabetes) or refractory/severe chronic periodontal disease
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Halimeter-assessed volatile sulphur compounds (VSC) (mean change from baseline) 4 weeks | Borden 2002: mean change in halimeter-assessed VSC (ppb). Oxygene: -47.63 at 2 weeks (64.97% reduction), -53.28 at 4 weeks (72.67% reduction); Placebo: -39.86 at 2 weeks, -36.77 at 4 weeks (41.75%). No between-group… | 1 study | Ungraded |
Organoleptic assessment of halitosis (mean change from baseline) 4 weeks | Borden 2002: mean change in organoleptic score (scale 0 to 5). Oxygene (chlorine dioxide + zinc): 0 at 2 weeks, 0.06 at 4 weeks; Placebo: 0.23 at 2 weeks, 0.16 at 4 weeks. Oxygene did not appear to reduce organoleptic… | 1 study | Ungraded |
Two-phase oil-water mouthrinse (0.05% cetylpyridinium chloride) vs Essential oils mouthrinse (Listerine)
Population: Adults over 18 years with a clinical or self-assessed diagnosis of halitosis, without significant comorbidity (e.g. diabetes) or refractory/severe chronic periodontal disease
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Organoleptic assessment of halitosis 6 weeks | Kozlovsky 1996 (6-week parallel comparison): mean organoleptic score (scale 0 to 5). Two-phase oil-water (0.05% cetylpyridinium chloride): 2.14 (SD 0.88) at baseline to 0.42 (SD 0.55) at week 6 (about 80% reduction);… | 1 study · 50 participants | Ungraded |
Peak volatile sulphur compounds (VSC) 6 weeks | Kozlovsky 1996: peak VSC (ppb). Two-phase oil-water (0.05% cetylpyridinium chloride): 94 (SD 36) at baseline to 56 (SD 10) at week 6 (less than 40% reduction); Control essential oils (Listerine): 79 (SD 40) to 56 (SD… | 1 study · 50 participants | Ungraded |
Zinc chloride + sodium chlorite mouthrinse (TriOral) vs Control mouthrinse (containing neither zinc chloride nor sodium chlorite)
Population: Adults over 18 years with a clinical or self-assessed diagnosis of halitosis, without significant comorbidity (e.g. diabetes) or refractory/severe chronic periodontal disease
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Halimeter-assessed volatile sulphur compounds (VSC) 4 weeks | Codipilly 2004: precise data could not be extracted (results presented as graph plots). Reported VSC reductions from baseline for zinc chloride + sodium chlorite (TriOral): 55% (P < 0.01) at 2 weeks and 60% (P < 0.01)… | 1 study | Ungraded |
Organoleptic assessment (indirect surrogate salivary organoleptic score) 4 weeks | Codipilly 2004: only indirect surrogate salivary organoleptic scores were reported (not organoleptic breath scores); no accurate deductions could be made from the reported values. | 1 study | Ungraded |
Zinc chloride without sodium chlorite mouthrinse (Breath Rx containing cetylpyridinium chloride) vs Control mouthrinse (containing neither zinc chloride nor sodium chlorite)
Population: Adults over 18 years with a clinical or self-assessed diagnosis of halitosis, without significant comorbidity (e.g. diabetes) or refractory/severe chronic periodontal disease
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Halimeter-assessed volatile sulphur compounds (VSC) 4 weeks | Codipilly 2004: reported VSC reduction from baseline for zinc chloride minus sodium chlorite (Breath Rx containing cetylpyridinium chloride): 38% (P < 0.05) at 2 weeks, versus a control containing neither zinc chloride… | 1 study | Ungraded |
Pericarp extract of Garcinia mangostana L mouthrinse (herbal) vs Placebo
Population: Adults over 18 years with a clinical or self-assessed diagnosis of halitosis, without significant comorbidity (e.g. diabetes) or refractory/severe chronic periodontal disease
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Halimeter-assessed volatile sulphur compounds (VSC) 15 days | Rassameemasmaung 2007: halimeter-assessed VSC (ppb). Herbal (Garcinia mangostana L): 248.35 (SD 172.30) at baseline to 100.54 (SD 69.37) at day 15 (59.68% reduction, P < 0.05); Placebo: 237.45 (SD 114.15) to 176.83 (SD… | 1 study · 60 participants | Ungraded |
0.05% chlorhexidine + 0.05% cetylpyridinium chloride + 0.14% zinc lactate mouthrinse vs Placebo
Population: Adults over 18 years with a clinical or self-assessed diagnosis of halitosis, without significant comorbidity (e.g. diabetes) or refractory/severe chronic periodontal disease
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Organoleptic assessment of halitosis (mean change from baseline) 2 weeks | Winkel 2003 (2-week trial): mean change (SD) in organoleptic score (scale 0 to 5). 0.05% chlorhexidine + 0.05% cetylpyridinium chloride + 0.14% zinc lactate: -1.13 (1.1), baseline 2.8 (0.5) to 1.5 (1.0) at day 14, P <… | 1 study · 40 participants | Ungraded |
Adverse events (tongue and tooth staining) 2 weeks | Winkel 2003: significantly more tongue staining (P < 0.001) and tooth staining (P < 0.002) were noted with the chlorhexidine + cetylpyridinium chloride + zinc lactate mouthrinse than with placebo. | 1 study · 40 participants | Ungraded |
Peak volatile sulphur compounds (VSC) (mean change from baseline) 2 weeks | Winkel 2003: mean change (SD) in peak VSC (ppb). Mouthrinse: -120 (92), baseline 292 (141) to 172 (104) at day 14, P < 0.005; Placebo: 8 (145), baseline 352 (161) to 360 (254). The mouthrinse caused a significantly… | 1 study · 40 participants | Ungraded |
Mouthrinse (over-the-counter or clinician-prescribed; used at least 1 week) vs Placebo or another mouthrinse (head-to-head)
Population: Adults over 18 years with a clinical or self-assessed diagnosis of halitosis, without significant comorbidity (e.g. diabetes) or refractory/severe chronic periodontal disease
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Organoleptic (human nose) assessment of halitosis on a validated malodour intensity scale At least 1 week (protocol minimum; no upper limit) | no estimate extracted | NR | No studies |
Self-expressed (perceived) assessment of halitosis on a validated malodour intensity scale At least 1 week (protocol minimum; no upper limit) | no estimate extracted | NR | No studies |
Adverse events At least 1 week (protocol minimum; no upper limit) | no estimate extracted | NR | No studies |
Volatile sulphur compounds (VSC) measured by halimeter, portable sulphide monitor or gas chromatography (incl. peak and steady-state levels) At least 1 week (protocol minimum; no upper limit) | no estimate extracted | NR | No studies |