Cochrane · intervention · CD012213
Interventions for managing halitosis
Kumbargere Nagraj, S, Eachempati, P, Uma, E, et al. · Cochrane Database of Systematic Reviews · 2019 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
102
current version
GRADE rated
26
No studies
15
Included studies
44
as reported
No studies 15 · 14.7%Ungraded 61 · 59.8%Very low 24 · 23.5%Low 2 · 2%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 | Adolescents and adults over the age of 16 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) of oral origin; excluding induced or physiological halitosis (e.g. morning breath), non-oral halitosis, and refractory or severe chronic periodontitis (clinical attachment level 5 mm or more) | Participants aged 17 to 77 years with halitosis, from 44 trials (1809 participants); 32 trials included both genders, 4 only males, 1 only females, 7 did not report gender |
| Intervention | Any intervention for the management of halitosis (mechanical methods, e.g. tongue cleaners and toothbrushes; chemical methods, e.g. mouthwashes/mouthrinses and toothpastes; and combinations), administered over a minimum of one week with no upper time limit | Mechanical debridement (n=4); Chewing gum/lozenges (n=4); Systemic deodorising agent (n=1); Topical agents (n=2); Toothpaste (n=7); Mouthrinse/mouthwash (n=17); Tablets (n=3); Combination methods (n=7) |
| Comparison | Another intervention; placebo; or no intervention | Placebo (n=17); Control or no intervention (n=13); Another active intervention (n=14) |
| Outcomes | Primary: self-expressed (perceived) and organoleptic (human nose) assessment of halitosis using a validated malodour intensity scale. Secondary: self-assessment (including quality of life); halitosis measured by halimeter, portable sulphide monitor or gas chromatography; peak and steady-state volatile sulphur compound levels; adverse events | Organoleptic test (OLT) scores (n=39); Volatile sulphur compound (VSC) levels (n=36); Visual analogue scale (VAS) scores (n=2); Quality of life (n=0); Adverse events (n=7) |
| Study designs | Randomised controlled trials | Randomised controlled trials (36 parallel-arm; 8 cross-over) (n=44) |
| Timing | Active interventions or controls administered over a minimum of one week with no upper time limit; single-use mouthwashes excluded | Follow-up ranged from 7 days to 3 months (1 to 2 weeks most commonly reported) |
Search date: 2019-04. Databases: Cochrane Oral Health's Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE Ovid; Embase Ovid; LILACS BIREME; National Database of Indian Medical Journals; OpenGrey; CINAHL EBSCO; US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov; World…
Questions and results
Show all 2 versionsScaling and root planing (SRP) plus glycine powder air polishing vs Scaling and root planing (SRP) alone
Population: Adolescents and adults aged over 16 years with clinical or self-assessed halitosis of oral origin; excluding induced or physiological halitosis, non-oral halitosis, and severe chronic periodontitis (clinical attachment level 5 mm or more)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Volatile sulphur compounds (VSC), halimeter 30 days | MD -3.87 [-17.93, 10.19] | 1 study · 60 participants | Ungraded |
SRP plus subgingival laser irradiation vs SRP alone
Population: Adolescents and adults aged over 16 years with clinical or self-assessed halitosis of oral origin; excluding induced or physiological halitosis, non-oral halitosis, and severe chronic periodontitis (clinical attachment level 5 mm or more)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Volatile sulphur compounds (VSC) 4 weeks | MD -3.3 [-9.38, 2.78] | 1 study · 40 participants | Ungraded |
Mechanical tongue cleaning (tongue scraper) vs No tongue cleaning
Population: Adolescents and adults aged over 16 years with clinical or self-assessed halitosis of oral origin; excluding induced or physiological halitosis, non-oral halitosis, and severe chronic periodontitis (clinical attachment level 5 mm or more)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Patient-reported OLT score mean 2 weeks | Patient-reported OLT score assessed with patient's perception: listed in the Summary of findings table but no data reported. No data were reported for patient-reported OLT score. | 0 studies | No studies |
Quality of life | Quality of life was a prespecified secondary outcome. None of the 44 included studies in the review (across all comparisons) reported quality-of-life data (review-wide evidence gap). | 0 studies | No studies |
Adverse events mean 2 weeks | Adverse events: listed in the Summary of findings table but no data reported. No data were reported for adverse events. | 0 studies | No studies |
Dentist-reported organoleptic test (OLT) score (scale 0 to 5) mean 2 weeks | MD -0.2 [-0.34, -0.07] | 2 studies · 46 participants | Very low Downgraded: risk of bias, imprecision |
Volatile sulphur compounds (VSC) 1 week | MD -7.69 [-47.08, 31.69] | 2 studies · 46 participants | Ungraded |
0.6% eucalyptus chewing gum vs 0.4% eucalyptus chewing gum
Population: Adolescents and adults aged over 16 years with clinical or self-assessed halitosis of oral origin; excluding induced or physiological halitosis, non-oral halitosis, and severe chronic periodontitis (clinical attachment level 5 mm or more)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Dentist-reported organoleptic test (OLT) score (scale 0 to 5) mean 4 weeks | MD -0.1 [-0.37, 0.17] | 1 study · 64 participants | Very low Downgraded: risk of bias, imprecision |
Volatile sulphur compounds (VSC) 4 weeks | MD 0.0 [-0.21, 0.21] | 1 study · 64 participants | Ungraded |
0.6% eucalyptus chewing gum vs Placebo chewing gum
Population: Adolescents and adults aged over 16 years with clinical or self-assessed halitosis of oral origin; excluding induced or physiological halitosis, non-oral halitosis, and severe chronic periodontitis (clinical attachment level 5 mm or more)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Patient-reported OLT score mean 4 weeks | Patient-reported OLT score: listed in the Summary of findings table but no data reported. No data were reported for patient-reported OLT score. | 0 studies | No studies |
Dentist-reported organoleptic test (OLT) score (scale 0 to 5) mean 4 weeks | MD -0.1 [-0.31, 0.11] | 1 study · 65 participants | Very low Downgraded: risk of bias, imprecision |
Volatile sulphur compounds (VSC) 4 weeks | MD 0.0 [-0.21, 0.21] | 1 study · 65 participants | Ungraded |
Adverse events mean 4 weeks | Adverse events: listed in the Summary of findings table but no data reported. No data were reported for adverse events. | 0 studies | No studies |
Pycnogenol chewing gum vs Placebo chewing gum
Population: Adolescents and adults aged over 16 years with clinical or self-assessed halitosis of oral origin; excluding induced or physiological halitosis, non-oral halitosis, and severe chronic periodontitis (clinical attachment level 5 mm or more)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
VSC: hydrogen sulphide 4 weeks | MD -114.9 [-206.59, -23.21] | 1 study · 21 participants | Ungraded |
VSC: methyl mercaptan 4 weeks | MD -8.4 [-24.95, 8.15] | 1 study · 21 participants | Ungraded |
VSC: methyl sulphide 4 weeks | MD -4.7 [-27.01, 17.61] | 1 study · 21 participants | Ungraded |
1000 mg champignon extract vs Placebo
Population: Adolescents and adults aged over 16 years with clinical or self-assessed halitosis of oral origin; excluding induced or physiological halitosis, non-oral halitosis, and severe chronic periodontitis (clinical attachment level 5 mm or more)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adverse events mean 2 weeks | Adverse events: listed in the Summary of findings table but no data reported. No data were reported for adverse events. | 0 studies | No studies |
Dentist-reported OLT score mean 2 weeks | Dentist-reported OLT score: listed in the Summary of findings table but no data reported. No data were reported for dentist-reported OLT score. | 0 studies | No studies |
Patient's family member-reported VAS score (scale 0 to 100) 2 weeks | MD -1.74 [-15.52, 12.04] | 1 study · 40 participants | Ungraded |
Patient-reported visual analogue scale (VAS) score (scale 0 to 100) mean 2 weeks | MD -1.07 [-14.51, 12.37] | 1 study · 40 participants | Very low Downgraded: risk of bias, imprecision |
1000 mg champignon extract vs 50 mg champignon extract
Population: Adolescents and adults aged over 16 years with clinical or self-assessed halitosis of oral origin; excluding induced or physiological halitosis, non-oral halitosis, and severe chronic periodontitis (clinical attachment level 5 mm or more)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Patient-reported visual analogue scale (VAS) score (scale 0 to 100) mean 2 weeks | MD -5.32 [-18.14, 7.5] | 1 study · 40 participants | Very low Downgraded: risk of bias, imprecision |
Patient's family member-reported VAS score (scale 0 to 100) 2 weeks | MD -0.61 [-15.58, 14.36] | 1 study · 40 participants | Ungraded |
Hinokitiol gel vs Placebo gel
Population: Adolescents and adults aged over 16 years with clinical or self-assessed halitosis of oral origin; excluding induced or physiological halitosis, non-oral halitosis, and severe chronic periodontitis (clinical attachment level 5 mm or more)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
VSC: methyl mercaptan 28 days | MD -1.64 [-5.77, 2.49] | 1 study · 18 participants | Ungraded |
Patient-reported OLT score mean 4 weeks | Patient-reported OLT score: listed in the Summary of findings table but no data reported. No data were reported for patient-reported OLT score. | 0 studies | No studies |
Dentist-reported organoleptic test (OLT) score (scale 0 to 5) mean 4 weeks | MD -0.27 [-1.26, 0.72] | 1 study · 18 participants | Very low Downgraded: risk of bias, imprecision |
Adverse events mean 4 weeks | Adverse events: listed in the Summary of findings table but no data reported. No data were reported for adverse events. | 0 studies | No studies |
VSC: hydrogen sulphide 28 days | MD -2.13 [-5.33, 1.08] | 1 study · 18 participants | Ungraded |
Topical G32 (ayurvedic preparation) vs Chlorhexidine digluconate 1% gel
Population: Adolescents and adults aged over 16 years with clinical or self-assessed halitosis of oral origin; excluding induced or physiological halitosis, non-oral halitosis, and severe chronic periodontitis (clinical attachment level 5 mm or more)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Volatile sulphur compounds (VSC) 1 week | MD 0.05 [-0.28, 0.38] | 1 study · 40 participants | Ungraded |
Adverse events 1 week | Patil 2017 reported burning mucosa and drying of mouth in a few subjects using the control drug (chlorhexidine) and no adverse effects were reported in the intervention group (G32 tablets). | 1 study · 40 participants | Ungraded |
0.3% triclosan + PVM/MA + sodium fluoride toothpaste vs Sodium fluoride (control) toothpaste
Population: Adolescents and adults aged over 16 years with clinical or self-assessed halitosis of oral origin; excluding induced or physiological halitosis, non-oral halitosis, and severe chronic periodontitis (clinical attachment level 5 mm or more)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Patient-reported OLT score mean 1 week | Patient-reported OLT score: listed in the Summary of findings table but no data reported. No data were reported for patient-reported OLT score. | 0 studies | No studies |
Dentist-reported breath odour (OLT) score (scale 1 to 9 hedonic) mean 1 week | MD -3.48 [-3.77, -3.19] | 1 study · 81 participants | Very low Downgraded: risk of bias, imprecision |
Adverse events mean 1 week | Adverse events: listed in the Summary of findings table but no data reported. No data were reported for adverse events. | 0 studies | No studies |
0.2% zinc sulphate toothpaste vs Placebo toothpaste (without zinc)
Population: Adolescents and adults aged over 16 years with clinical or self-assessed halitosis of oral origin; excluding induced or physiological halitosis, non-oral halitosis, and severe chronic periodontitis (clinical attachment level 5 mm or more)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Volatile sulphur compounds (VSC) 4 weeks | MD -11.3 [-20.45, -2.15] | 1 study · 188 participants | Ungraded |
Dentist-reported organoleptic test (OLT) score (scale 0 to 5) mean 4 weeks | MD -1.31 [-1.39, -1.23] | 1 study · 187 participants | Very low Downgraded: risk of bias, imprecision |
Sodium bicarbonate toothpaste vs Control toothpaste (without sodium bicarbonate)
Population: Adolescents and adults aged over 16 years with clinical or self-assessed halitosis of oral origin; excluding induced or physiological halitosis, non-oral halitosis, and severe chronic periodontitis (clinical attachment level 5 mm or more)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Volatile sulphur compounds (VSC) 6 weeks | MD 105.8 [-16.2, 227.8] | 1 study · 148 participants | Ungraded |
Adverse events 6 weeks | Adverse events reported by Lomax 2017 were not related to the interventions. | 1 study · 148 participants | Ungraded |
Dual zinc + arginine dentifrice vs Control (regular fluoride) dentifrice
Population: Adolescents and adults aged over 16 years with clinical or self-assessed halitosis of oral origin; excluding induced or physiological halitosis, non-oral halitosis, and severe chronic periodontitis (clinical attachment level 5 mm or more)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Dentist-reported OLT hedonic rating (scale 1 to 9) mean 3 weeks | MD -2.0 [-2.19, -1.81] | 1 study · 80 participants | Very low Downgraded: risk of bias, imprecision |
Halita mouthwash (chlorhexidine 0.05% + cetylpyridinium chloride 0.05% + zinc lactate 0.14%) vs Placebo mouthwash
Population: Adolescents and adults aged over 16 years with clinical or self-assessed halitosis of oral origin; excluding induced or physiological halitosis, non-oral halitosis, and severe chronic periodontitis (clinical attachment level 5 mm or more)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adverse events mean 2 weeks | Adverse events (Table 6). Risk with placebo mouthwash: None reported. Risk with halita mouthwash: tongue staining was seen in patients who gargled, rather than rinsed. 40 participants (1 RCT). Certainty: VERY LOW. | 1 study · 40 participants | Very low Downgraded: risk of bias, imprecision |
Dentist-reported organoleptic test (OLT) score (scale 0 to 5) mean 2 weeks | MD -1.0 [-1.65, -0.35] | 1 study · 40 participants | Very low Downgraded: risk of bias, imprecision |
Volatile sulphur compounds (VSC), halimeter 2 weeks | MD -188.0 [-308.29, -67.71] | 1 study · 40 participants | Ungraded |
Chlorhexidine + zinc acetate mouthwash vs Placebo mouthwash
Population: Adolescents and adults aged over 16 years with clinical or self-assessed halitosis of oral origin; excluding induced or physiological halitosis, non-oral halitosis, and severe chronic periodontitis (clinical attachment level 5 mm or more)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Patient-reported OLT score mean 3 months | Patient-reported OLT score: listed in the Summary of findings table but no data reported. No data were reported for patient-reported OLT score. | 0 studies | No studies |
Adverse events mean 3 months | Adverse events: listed in the Summary of findings table but no data reported. No data were reported for adverse events. | 0 studies | No studies |
Dentist-reported organoleptic test (OLT) score (scale 0 to 5) mean 3 months | MD -0.2 [-0.58, 0.18] | 1 study · 44 participants | Very low Downgraded: risk of bias, imprecision |
Cetylpyridinium chloride mouthwash vs Placebo mouthwash
Population: Adolescents and adults aged over 16 years with clinical or self-assessed halitosis of oral origin; excluding induced or physiological halitosis, non-oral halitosis, and severe chronic periodontitis (clinical attachment level 5 mm or more)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Volatile sulphur compounds (VSC), halimeter 2 weeks | MD -20.04 [-37.71, -2.37] | 1 study · 47 participants | Ungraded |
Dentist-reported organoleptic test (OLT) score (scale 0 to 5) mean 2 weeks | MD -0.5 [-0.83, -0.17] | 1 study · 47 participants | Very low Downgraded: risk of bias, imprecision |
Adverse events 2 weeks | Adverse events reported by Borden 2002 were not related to the interventions. | 1 study · 47 participants | Ungraded |
Essential oil mouthwash vs Placebo mouthwash
Population: Adolescents and adults aged over 16 years with clinical or self-assessed halitosis of oral origin; excluding induced or physiological halitosis, non-oral halitosis, and severe chronic periodontitis (clinical attachment level 5 mm or more)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Dentist-reported organoleptic test (OLT) score (scale 0 to 5) mean 2 weeks | MD -0.09 [-0.47, 0.29] | 1 study · 45 participants | Very low Downgraded: risk of bias, imprecision |
Volatile sulphur compounds (VSC), halimeter 2 weeks | MD -5.13 [-32.94, 22.68] | 1 study · 45 participants | Ungraded |
Adverse events 2 weeks | Adverse events reported by Borden 2002 were not related to the interventions. | 1 study · 45 participants | Ungraded |
Chlorine dioxide + zinc mouthwash vs Placebo mouthwash
Population: Adolescents and adults aged over 16 years with clinical or self-assessed halitosis of oral origin; excluding induced or physiological halitosis, non-oral halitosis, and severe chronic periodontitis (clinical attachment level 5 mm or more)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Dentist-reported organoleptic test (OLT) score (scale 0 to 5) mean 2 weeks | MD -0.17 [-0.59, 0.25] | 1 study · 41 participants | Very low Downgraded: risk of bias, imprecision |
Adverse events 2 weeks | Adverse events reported by Borden 2002 were not related to the interventions. | 1 study · 41 participants | Ungraded |
Volatile sulphur compounds (VSC), halimeter 2 weeks | MD -20.53 [-38.52, -2.54] | 1 study · 41 participants | Ungraded |
0.1% chlorine dioxide mouthwash vs Placebo mouthwash
Population: Adolescents and adults aged over 16 years with clinical or self-assessed halitosis of oral origin; excluding induced or physiological halitosis, non-oral halitosis, and severe chronic periodontitis (clinical attachment level 5 mm or more)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Dentist-reported organoleptic test (OLT) score (scale 0 to 5) mean 3 weeks | MD -0.61 [-0.73, -0.49] | 1 study · 47 participants | Low Downgraded: imprecision |
Herbal mouthwash vs Placebo mouthwash
Population: Adolescents and adults aged over 16 years with clinical or self-assessed halitosis of oral origin; excluding induced or physiological halitosis, non-oral halitosis, and severe chronic periodontitis (clinical attachment level 5 mm or more)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Volatile sulphur compounds (VSC) 15 days | MD -70.29 [-121.01, -19.57] | 1 study · 60 participants | Ungraded |
Benzethonium chloride mouthwash vs Placebo mouthwash
Population: Adolescents and adults aged over 16 years with clinical or self-assessed halitosis of oral origin; excluding induced or physiological halitosis, non-oral halitosis, and severe chronic periodontitis (clinical attachment level 5 mm or more)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
VSC: methyl mercaptan 9 days | MD 7.2 [-24.92, 39.32] | 1 study · 20 participants | Ungraded |
VSC: hydrogen sulphide 9 days | MD -125.1 [-286.32, 36.12] | 1 study · 20 participants | Ungraded |
VSC: dimethyl sulphide 9 days | MD -0.03 [-0.63, 0.57] | 1 study · 20 participants | Ungraded |
Green tea mouthwash vs Placebo mouthwash
Population: Adolescents and adults aged over 16 years with clinical or self-assessed halitosis of oral origin; excluding induced or physiological halitosis, non-oral halitosis, and severe chronic periodontitis (clinical attachment level 5 mm or more)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Volatile sulphur compounds (VSC), halimeter 28 days | MD -57.39 [-184.63, 69.85] | 1 study · 60 participants | Ungraded |
Lemongrass oil mouthwash vs Placebo mouthwash
Population: Adolescents and adults aged over 16 years with clinical or self-assessed halitosis of oral origin; excluding induced or physiological halitosis, non-oral halitosis, and severe chronic periodontitis (clinical attachment level 5 mm or more)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Volatile sulphur compounds (VSC), halimeter 8 days | MD -26.66 [-43.39, -9.93] | 1 study · 20 participants | Ungraded |
Cetylpyridinium chloride mouthwash vs Chlorhexidine + zinc mouthwash
Population: Adolescents and adults aged over 16 years with clinical or self-assessed halitosis of oral origin; excluding induced or physiological halitosis, non-oral halitosis, and severe chronic periodontitis (clinical attachment level 5 mm or more)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adverse events 2 weeks | Adverse events reported by Borden 2002 were not related to the interventions. | 1 study · 44 participants | Ungraded |
Dentist-reported organoleptic test (OLT) score (scale 0 to 5) mean 2 weeks | MD -0.33 [-0.72, 0.06] | 1 study · 44 participants | Very low Downgraded: risk of bias, imprecision |
Volatile sulphur compounds (VSC) 2 weeks | MD 0.49 [-8.68, 9.66] | 1 study · 44 participants | Ungraded |
Halita mouthrinse vs Perio-plus mouthrinse
Population: Adolescents and adults aged over 16 years with clinical or self-assessed halitosis of oral origin; excluding induced or physiological halitosis, non-oral halitosis, and severe chronic periodontitis (clinical attachment level 5 mm or more)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adverse events mean 8 days | Adverse events (Table 12). Risk with Perio-plus mouthrinse: 1 patient reported unpleasant feeling after the use of the product; there were no severe adverse events reported. Risk with halita mouthrinse: 1 patient… | 1 study · 36 participants | Very low Downgraded: risk of bias, imprecision |
Volatile sulphur compounds (VSC), portable gas chromatograph 8 days | MD -25.0 [-64.21, 14.21] | 1 study · 36 participants | Ungraded |
Dentist-reported organoleptic test (OLT) score (scale 0 to 5) mean 8 days | MD -0.2 [-0.86, 0.46] | 1 study · 36 participants | Very low Downgraded: risk of bias, imprecision |
Oil water two-phase mouthwash (with cetylpyridinium chloride) vs Control mouthwash
Population: Adolescents and adults aged over 16 years with clinical or self-assessed halitosis of oral origin; excluding induced or physiological halitosis, non-oral halitosis, and severe chronic periodontitis (clinical attachment level 5 mm or more)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Volatile sulphur compounds (VSC), sulphide monitor 1 week | MD -11.0 [-25.26, 3.26] | 1 study · 50 participants | Ungraded |
Triphala and Ela decoction mouthwash vs Chlorhexidine mouthwash
Population: Adolescents and adults aged over 16 years with clinical or self-assessed halitosis of oral origin; excluding induced or physiological halitosis, non-oral halitosis, and severe chronic periodontitis (clinical attachment level 5 mm or more)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Dentist-reported organoleptic test (OLT) score (scale 0 to 5) mean 2 weeks | MD 0.2 [0.09, 0.31] | 1 study · 60 participants | Very low Downgraded: risk of bias, imprecision |
Miswak (Salvadora persica) mouthwash vs Chlorhexidine mouthwash
Population: Adolescents and adults aged over 16 years with clinical or self-assessed halitosis of oral origin; excluding induced or physiological halitosis, non-oral halitosis, and severe chronic periodontitis (clinical attachment level 5 mm or more)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Patient self-assessment VAS (scale 0 to 10) mean 1 week | MD -0.18 [-1.59, 1.23] | 1 study · 21 participants | Very low Downgraded: risk of bias, imprecision |
Dentist-reported organoleptic test (OLT) score (scale 0 to 5) mean 1 week | MD 0.01 [-0.95, 0.97] | 1 study · 21 participants | Very low Downgraded: risk of bias, imprecision |
Volatile sulphur compounds (VSC) 1 week | MD -0.2 [-1.03, 0.63] | 1 study · 21 participants | Ungraded |
Chlorine dioxide mouthrinse (with tongue scraping) vs Chlorhexidine mouthwash (with tongue scraping)
Population: Adolescents and adults aged over 16 years with clinical or self-assessed halitosis of oral origin; excluding induced or physiological halitosis, non-oral halitosis, and severe chronic periodontitis (clinical attachment level 5 mm or more)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
VSC: third component 1 week | MD 22.8 [-33.18, 78.78] | 1 study · 22 participants | Ungraded |
VSC: methyl mercaptan 1 week | MD 7.63 [-1.7, 16.96] | 1 study · 22 participants | Ungraded |
Adverse events 1 week | Wirthlin 2011 reported altered taste sensation as the adverse event. OLT scores could not be included in the analysis as the group-wise data were not given. | 1 study · 22 participants | Ungraded |
VSC: hydrogen sulphide 1 week | MD -11.0 [-31.61, 9.61] | 1 study · 22 participants | Ungraded |
Protease cysteine + actinidine tablets vs Placebo tablets
Population: Adolescents and adults aged over 16 years with clinical or self-assessed halitosis of oral origin; excluding induced or physiological halitosis, non-oral halitosis, and severe chronic periodontitis (clinical attachment level 5 mm or more)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Volatile sulphur compounds (VSC), OralChroma 1 week | MD -45.8 [-258.38, 166.78] | 1 study · 14 participants | Ungraded |
Miswak (Salvadora persica) stick vs Chlorhexidine mouthwash
Population: Adolescents and adults aged over 16 years with clinical or self-assessed halitosis of oral origin; excluding induced or physiological halitosis, non-oral halitosis, and severe chronic periodontitis (clinical attachment level 5 mm or more)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Volatile sulphur compounds (VSC) 1 week | MD -0.77 [-1.19, -0.35] | 1 study · 24 participants | Ungraded |
Patient self-assessment VAS (scale 0 to 10) mean 1 week | MD -0.26 [-1.16, 0.64] | 1 study · 24 participants | Very low Downgraded: risk of bias, imprecision |
Dentist-reported organoleptic test (OLT) score (scale 0 to 5) mean 1 week | MD -0.55 [-1.33, 0.23] | 1 study · 24 participants | Very low Downgraded: risk of bias, imprecision |
Toothbrushing + chlorine dioxide mouthwash vs Toothbrushing + tongue cleaning
Population: Adolescents and adults aged over 16 years with clinical or self-assessed halitosis of oral origin; excluding induced or physiological halitosis, non-oral halitosis, and severe chronic periodontitis (clinical attachment level 5 mm or more)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Volatile sulphur compounds (VSC), sulphide monitor 4 weeks | MD -81.87 [-140.12, -23.62] | 1 study · 30 participants | Ungraded |
Toothbrushing + 0.075% cetylpyridinium chloride mouthwash vs Toothbrushing
Population: Adolescents and adults aged over 16 years with clinical or self-assessed halitosis of oral origin; excluding induced or physiological halitosis, non-oral halitosis, and severe chronic periodontitis (clinical attachment level 5 mm or more)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Patient-reported OLT score mean 3 weeks | Patient-reported OLT score: listed in the Summary of findings table but no data reported. No data were reported for patient-reported OLT score. | 0 studies | No studies |
Volatile sulphur compounds (VSC), halimeter 3 weeks | MD -8.04 [-15.87, -0.21] | 1 study · 70 participants | Ungraded |
Dentist-reported organoleptic test (OLT) score (scale 0 to 5) mean 3 weeks | MD -0.48 [-0.72, -0.24] | 1 study · 70 participants | Low Downgraded: imprecision |
Adverse events mean 3 weeks | Adverse events: listed in the Summary of findings table but no data reported. No data were reported for adverse events. | 0 studies | No studies |
Toothbrushing + Turkish gall oral rinse vs Toothbrushing
Population: Adolescents and adults aged over 16 years with clinical or self-assessed halitosis of oral origin; excluding induced or physiological halitosis, non-oral halitosis, and severe chronic periodontitis (clinical attachment level 5 mm or more)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Volatile sulphur compounds (VSC), halimeter 2 weeks | MD -211.47 [-503.58, 80.64] | 1 study · 66 participants | Ungraded |
Dentist-reported organoleptic test (OLT) score (scale 0 to 5) 2 weeks | MD -0.1 [-0.5, 0.3] | 1 study · 66 participants | Ungraded |
Subgingival laser irradiation + povidone-iodine vs SRP alone
Population: Adolescents and adults aged over 16 years with clinical or self-assessed halitosis of oral origin; excluding induced or physiological halitosis, non-oral halitosis, and severe chronic periodontitis (clinical attachment level 5 mm or more)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Volatile sulphur compounds (VSC) 4 weeks | MD 70.0 [63.88, 76.12] | 1 study · 40 participants | Ungraded |
Dentist-reported organoleptic test (OLT) score (scale 0 to 5) mean 4 weeks | MD 0.49 [0.3, 0.68] | 1 study · 40 participants | Very low Downgraded: risk of bias, imprecision |
Abrasive candy; abrasive candy + 2% propolis; abrasive candy + 0.5% zinc gluconate vs Abrasive candy + 1% propolis + 0.25% zinc
Population: Adolescents and adults aged over 16 years with clinical or self-assessed halitosis of oral origin; excluding induced or physiological halitosis, non-oral halitosis, and severe chronic periodontitis (clinical attachment level 5 mm or more)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Volatile sulphur compounds (VSC), halimeter | Barak 2012 (5-arm RCT) compared abrasive candy, abrasive candy with propolis and abrasive candy with zinc gluconate versus abrasive candy with propolis and zinc; VSC measured by halimeter. We could not use the results… | 1 study | Ungraded |
Lactobacillus brevis CD2 lozenges vs Placebo lozenges
Population: Adolescents and adults aged over 16 years with clinical or self-assessed halitosis of oral origin; excluding induced or physiological halitosis, non-oral halitosis, and severe chronic periodontitis (clinical attachment level 5 mm or more)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
OLT, VSC and breath print scores | Marchetti 2015 (2-arm RCT) compared Lactobacillus brevis CD2 lozenges versus placebo lozenges (OLT, VSC and breath print). The study did not report any usable data and hence could not be included in the meta-analysis. | 1 study | Ungraded |
Zinc chloride + sodium fluoride dentifrice vs Control dentifrice (sodium fluoride)
Population: Adolescents and adults aged over 16 years with clinical or self-assessed halitosis of oral origin; excluding induced or physiological halitosis, non-oral halitosis, and severe chronic periodontitis (clinical attachment level 5 mm or more)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Volatile sulphur compounds (VSC), gas chromatography | Payne 2011 (cross-over RCT) compared ZnCl + NaF dentifrice versus control NaF dentifrice; VSC by gas chromatography. The trial reported the adjusted mean VSC scores in a graph and hence we could not use the data in the… | 1 study | Ungraded |
Adverse events | Payne 2011 reported 19 non-oral and 12 oral adverse effects. The oral effects were tingling sensation in lips, dry mouth or sore gums. | 1 study | Ungraded |
0.3% triclosan + PVM/MA + sodium fluoride toothpaste vs Placebo toothpaste
Population: Adolescents and adults aged over 16 years with clinical or self-assessed halitosis of oral origin; excluding induced or physiological halitosis, non-oral halitosis, and severe chronic periodontitis (clinical attachment level 5 mm or more)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Volatile sulphur compounds (VSC), gas chromatography | Niles 1999 (cross-over trial) compared 0.3% triclosan + 2.0% PVM/MA + 0.243% NaF toothpaste versus placebo toothpaste; VSC by gas chromatograph. We could not use the results in the meta-analysis as there was no… | 1 study | Ungraded |
Triclosan dentifrices (Crest Complete A; Signal Global A; Colgate Total A; experimental 0.3% triclosan formulation) vs Negative control dentifrice
Population: Adolescents and adults aged over 16 years with clinical or self-assessed halitosis of oral origin; excluding induced or physiological halitosis, non-oral halitosis, and severe chronic periodontitis (clinical attachment level 5 mm or more)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Volatile sulphur compounds (VSC), halimeter | Nogueira-Filho 2002 (5-arm trial) compared three commercial 0.3% triclosan dentifrices and an experimental formulation versus a negative control dentifrice; VSC by halimeter. We could not use the results in the… | 1 study | Ungraded |
Triclosan mouthwash (with and without alcohol); zinc lactate + chlorhexidine + cetylpyridinium mouthwash vs Placebo mouthwash
Population: Adolescents and adults aged over 16 years with clinical or self-assessed halitosis of oral origin; excluding induced or physiological halitosis, non-oral halitosis, and severe chronic periodontitis (clinical attachment level 5 mm or more)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Volatile sulphur compounds (VSC) and OLT scores | Lopez Jornet 2003 (4-arm RCT) compared triclosan mouthwash with and without alcohol and a zinc lactate + chlorhexidine + cetylpyridinium mouthwash versus placebo mouthwash (VSC by halimeter and OLT). We could not… | 1 study | Ungraded |
Essential oil mouthwash vs Placebo mouthwash
Population: Adolescents and adults aged over 16 years with clinical or self-assessed halitosis of oral origin; excluding induced or physiological halitosis, non-oral halitosis, and severe chronic periodontitis (clinical attachment level 5 mm or more)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Volatile sulphur compounds (VSC), halimeter | Garcia 2014 (2-arm RCT) compared essential oil mouthwash versus placebo mouthwash (VSC by halimeter). We could not include the results in the meta-analysis because of the missing SD and P value. | 1 study | Ungraded |
Cinnamon herbal mouthwash; Nanosil (hydrogen peroxide) mouthwash; Irsha mouthwash vs Water (negative control) and zinc solution (positive control)
Population: Adolescents and adults aged over 16 years with clinical or self-assessed halitosis of oral origin; excluding induced or physiological halitosis, non-oral halitosis, and severe chronic periodontitis (clinical attachment level 5 mm or more)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Volatile sulphur compounds (VSC), halimeter | Talebian 2009 (cross-over study) tested cinnamon herbal, Nanosil and Irsha mouthwashes versus water (negative control) and zinc solution (positive control); VSC by halimeter. We could not include the results in the… | 1 study | Ungraded |
Sesame oil vs Chlorhexidine 0.2% mouthwash
Population: Adolescents and adults aged over 16 years with clinical or self-assessed halitosis of oral origin; excluding induced or physiological halitosis, non-oral halitosis, and severe chronic periodontitis (clinical attachment level 5 mm or more)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
OLT score and patient self-assessment (BANA test) | Asokan 2011 (2-arm trial) compared sesame oil versus chlorhexidine 0.2% mouthwash (OLT and BANA test). We could not include the results in the meta-analysis because they did not report post-intervention OLT score and P… | 1 study | Ungraded |
Lactobacillus beta lactoperoxidase (LPO) tablets vs Placebo tablets
Population: Adolescents and adults aged over 16 years with clinical or self-assessed halitosis of oral origin; excluding induced or physiological halitosis, non-oral halitosis, and severe chronic periodontitis (clinical attachment level 5 mm or more)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Volatile sulphur compounds (VSC), OralChroma | Nakano 2017 (2-arm trial) compared Lactobacillus beta LPO tablets versus placebo tablets (VSC by OralChroma). The trial did not report any usable data and hence could not be included in the analysis. | 1 study | Ungraded |
Lactobacillus salivarius WB21 tablets vs Placebo tablets
Population: Adolescents and adults aged over 16 years with clinical or self-assessed halitosis of oral origin; excluding induced or physiological halitosis, non-oral halitosis, and severe chronic periodontitis (clinical attachment level 5 mm or more)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
OLT scores and VSC scores (gas chromatography) | Suzuki 2014 (cross-over RCT) compared Lactobacillus salivarius WB21 tablets versus placebo tablets (OLT and VSC by gas chromatography). The trial did not give usable data and we could not extract data from the graph. | 1 study | Ungraded |
Active rinse (zinc acetate + chlorhexidine + sodium fluoride), with or without tongue scraping vs Negative control rinse, with or without tongue scraping
Population: Adolescents and adults aged over 16 years with clinical or self-assessed halitosis of oral origin; excluding induced or physiological halitosis, non-oral halitosis, and severe chronic periodontitis (clinical attachment level 5 mm or more)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
OLT and VSC scores (OralChroma and halimeter) | Ademovski 2012 (4-arm cross-over trial) compared an active rinse (with/without tongue scraping) versus a negative control rinse (with/without tongue scraping); OLT and VSC. The authors did not report the correlation… | 1 study | Ungraded |
Toothbrushing + tongue cleaning with a tooth-and-tongue gel (amine/stannous fluoride + zinc lactate) vs Toothbrushing with reference toothpaste (with or without tongue cleaning)
Population: Adolescents and adults aged over 16 years with clinical or self-assessed halitosis of oral origin; excluding induced or physiological halitosis, non-oral halitosis, and severe chronic periodontitis (clinical attachment level 5 mm or more)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
OLT, VSC and patient satisfaction scores | Wilhelm 2012 (3-arm cross-over trial) compared toothbrushing with a reference toothpaste, with reference toothpaste plus tongue cleaning, and toothbrushing plus tongue cleaning with a tooth-and-tongue gel (OLT, VSC,… | 1 study | Ungraded |
Mouthwash (amine/stannous fluoride; or chlorhexidine + cetylpyridinium + zinc) vs Chlorhexidine mouthwash or tap water
Population: Adolescents and adults aged over 16 years with clinical or self-assessed halitosis of oral origin; excluding induced or physiological halitosis, non-oral halitosis, and severe chronic periodontitis (clinical attachment level 5 mm or more)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
OLT and VSC scores 7 days | Wigger-Alberti 2010 mouthwash data (ASF; CHX + CPC + Zn; CHX; tap water) were calculated from a graph (Additional Table 1) but not included, as the report did not give details of sample size per group. | 1 study | Ungraded |