Clinical efficacy of photodynamic therapy on halitosis: a systematic review and meta-analysis.

Halitosis is a widespread health problem with complex factors, and therapeutic effects sometimes are unsatisfactory. Plenty of clinical trials have tried to prove the effectiveness of photodynamic therapy (PDT), but the results are indeterminate. This study aimed to evaluate the clinical efficacy of PDT on halitosis. We searched PubMed, Cochrane Library, Embase, Web of Science, and Scopus from inception to August 10, 2022, and only studies about the PDT on halitosis were included. The criteria for meta-analysis comprised randomized controlled trials (RCTs) comparing the treatment of PDT with tongue scraper (TS) immediately after the halitosis therapy and during a 7-, 14-, 30-, and 90-day follow-up. Eight eligible studies involving 345 patients were included in this study. It was shown that PDT (MD = - 34.49, 95% CI [- 66.34, - 2.64], P = 0.03) or PDT + TS (MD = - 67.72, 95% CI [- 101.17, - 34.28], P < 0.001) had better efficacy than TS on the H2S concentration reduction immediately after the halitosis therapy. No significant differences were observed in reducing the H2S among TS, PDT alone, and PDT + TS at the follow-up. Besides, no difference between PDT and TS was found in the reduction of CH3SCH3 and CH3SH. Based on the current evidence, PDT and PDT + TS demonstrate efficacy in the treatment of halitosis in the short term, and PDT was shown to be a beneficial and promising therapeutic method.

The Effect of Mechanical Tongue Cleaning on Oral Malodor and Tongue Coating.

BACKGROUND: Mechanical tongue cleaning is an important oral hygiene procedure; it is known that a significant cause of volatile sulfur compounds (VSCs), a major component of bad breath, is due to the bacteria coating the tongue. This study was conducted to identify the effect of mechanical tongue cleaning on reducing bad breath and tongue coating. METHODS: Various mechanical tongue-cleaning methods were studied, including removing tongue coating using a toothbrush, removing tongue coating using a tongue scraper, and removing tongue coating using a toothbrush and a tongue scraper together. The results were as follows. RESULTS: First, the organic bad breath measurement value after cleaning the tongue significantly decreased in the group using only the toothbrush, the group using only the tongue scraper, and the group using both the toothbrush and the tongue scraper. However, there was no difference between the groups. Second, after cleaning the tongue, the measured values of the tongue coating in the values of WTCI (Winkel's tongue coating index) and Qray view were significantly reduced in all three groups, and there was no difference between the groups. Third, the gas measurement value in the oral cavity using a machine significantly decreased only the H2S value of the group using the tongue scraper immediately after the mechanical tongue cleaning. CONCLUSIONS: From these results, it can be confirmed that mechanical tongue cleaning is effective at reducing bad breath and tongue coating. However, in this study, there was no difference in the reduction effect according to the tools (groups) used for mechanical tongue cleaning. It can therefore be seen that wiping accurately from the rear of the tongue to the front is more effective at reducing bad breath and tongue coating.

In vitro evaluation of the effects of Ultrasound Tongue Scraper on bacteria and biofilm formation.

AIM: Oral malodor is a common condition caused by some Gram-negative oral bacteria, among which are the 3 red complex bacteria (RCB). The present study investigated the effectiveness of the Ultrasound Tongue Scraper (UTS) to disrupt the structural morphology of the bacteria and their biofilm. METHODS: While developing over 72 hours, multispecies biofilms of RCB (Porphromonas gingivalis, Tryponema denticola, Tannerella forsythia) were treated every 24 hours with 1.6-MHz ultrasound waves generated with UTS. An untreated group served as controls. Confocal laser scanning microscopy was used to determine the biofilm thickness, biomass and live : dead cell ratio at each time point (24, 48 and 72 hours). Biofilm morphology and bacteria ultrastructure were viewed using scanning/transmission electron microscopy, respectively. Data were analyzed using ANOVA and Tukey tests. RESULTS: At each time point, the 3 variables were significantly lower in treated samples than the untreated. Significant biofilm disruption was observed in treated samples at each time period while the untreated had intact biofilm morphology. Cells in treated samples showed disrupted cell wall, cytoplasmic material, huge vacuoles and heterogeneity in electron density, while these cell organelles remained intact in untreated samples. CONCLUSION: The UTS has an inhibitory effect on RCB and could be useful for oral malodor management.

Effectiveness of Various Tongue Cleaning Aids in the Reduction of Tongue Coating and Bacterial Load: A Comparative Clinical Study.

AIM: To remove tongue biofilm and improve breath odor, specific instruments (tongue scrapers) or toothbrushes are used. MATERIALS AND METHODS: This study compared the effectiveness of a manual toothbrush that has a tongue scraper on the back of its head and two commercially available tongue scrapers in reducing the tongue coating and aerobic and anaerobic microbiota of the tongue dorsum. A randomized, negative controlled, double-blind, parallel design study for three different treatment interventions was conducted. RESULTS: All tongue cleaners showed a significant reduction in Winkle's tongue coating scores with significant values of reduction (p <0.001) of the anaerobic bacterial count with plastic and metal tongue scraper when compared to brush scrapper. CONCLUSION: There was an effective reduction of bacterial load on tongue dorsum with the use of tongue cleaners, with maximum load reduction by using plastic tongue cleaners. CLINICAL SIGNIFICANCE: The results of the present study may be helpful for the dentists while prescribing tongue cleaners to their patients in their clinical practice.

How to deal with morning bad breath: A randomized, crossover clinical trial.

CONTEXT: The absence of a protocol for the treatment of halitosis has led us to compare mouthrinses with mechanical oral hygiene procedures for treating morning breath by employing a hand-held sulfide monitor. AIMS: To compare the efficacy of five modalities of treatment for controlling morning halitosis in subjects with no dental or periodontal disease. SETTINGS AND DESIGN: This is a five-period, randomized, crossover clinical trial. MATERIALS AND METHODS: Twenty volunteers were randomly assigned to the trial. Testing involved the use of a conventional tongue scraper, a tongue scraper joined to the back of a toothbrush's head, two mouthrinses (0.05% cetylpyridinium chloride and 0.12% chlorhexidine digluconate) and a soft-bristled toothbrush and fluoride toothpaste for practicing oral hygiene. STATISTICAL ANALYSIS USED: Data analysis was performed using SPSS version 17 for Windows and NCSS 2007 software (P < 0.05). The products and the periods were compared with each other using the Friedman's test. When significant differences (P < 0.05) were determined, the products and periods were compared in pairs by using the Wilcoxon's test and by adjusting the original significance level (0.05) for multiple comparisons by using the Bonferroni's method. RESULTS: The toothbrush's tongue scraper was able to significantly reduce bad breath for up to 2 h. Chlorhexidine reduced bad breath only at the end of the second hour, an effect that lasted for 3 h. CONCLUSIONS: Mechanical tongue cleaning was able to immediately reduce bad breath for a short period, whereas chlorhexidine and mechanical oral hygiene reduced bad breath for longer periods, achieving the best results against morning breath.

Avaliação da utilização de limpador de língua na redução dos níveis de leveduras na cavidade bucal / Evaluation of the use of tongue scraper in the reduction of yeasts levels in the oral cavity

O controle dos níveis de leveduras do gênero Candida spp. na cavidade bucal é considerado medida importante na prevenção da candidose, principalmente em pacientes imunocomprometidos. A partir dos relatos de que a língua é o reservatório primário de leveduras do gênero Candida na cavidade bucal, o objetivo deste estudo foi avaliar os efeitos da utilizaçãode limpadores de língua nos níveis de leveduras da cavidade bucal. Enxágues bucais em solução fisiológica (PBS) de 100 voluntários foram coletados, semeados em ágar Sabouraud dextrose comcloranfenicol e incubados a 37 °C, por 24 horas. Trinta e cinco indivíduos (15 a 70 anos) positivos para leveduras foram incluídos no estudo, obtendo-se assim a contagem inicial de leveduras. Vinte e quatro horas após a contagem inicial, foram fornecidos limpadores de língua padronizados para estes indivíduos, que foram orientados quanto à sua utilização de acordo com as instruções do fabricante. Duas horas após a limpeza da língua, seguiu-se a segunda coleta (enxágue bucal) eos números ? inicial e final ? de unidades formadoras de colônia por mililitro foram comparados estatisticamente pelo teste de Mann Whitney (a = 5%). Observou-se que a primeira contagem (mediana = 820) foi significativamente maior do que a contagem após a utilização do limpadorde língua (mediana = 280) (p = 0,012). Concluiu-se que o uso do limpador de língua diminuiu de maneira significativa os níveis de leveduras na cavidade bucal.

The control of Candida levels in the oral cavity is considered an important step to prevent candidosis, mainly in immunocompromised patients. Considering the reports that the tongue is the primary reservoir of Candida in the oral cavity, the aim of this study was to evaluate the effects of the use of tongue scrapers in the oral levels of yeasts. Oral rinses in physiologic solution (PBS) from 100 volunteers were sampled, and plated on Sabouraud dextrose agar with chloramphenicol and incubated at 37 °C for 24 hours. Thirty-five individuals (15 to 70 years) positive to oral yeasts were included in the study, obtaining the initial count. Twenty-four hoursafter the initial count, standardized tongue scrapers were given to the individuals who were informed about their use according to manufacturer?s instruction. Two hours after tongue cleaning, thesecond sampling was accomplished (oral rinse) and the number of initial and final colony-forming units per milliliter were statistically compared by Mann-Whitney test (a = 5%). The first count (median = 820) was significantly higher in relation to the evaluation after the tongue scraper use (median = 280) (p = 0.012). From theses results, it could be concluded that the use of tongue scraper reduced significantly the levels of oral yeasts.

Effectiveness of a new toothbrush design versus a conventional tongue scraper in improving breath odor and reducing tongue microbiota

For centuries, specific instruments or regular toothbrushes have routinely been used to remove tongue biofilm and improve breath odor. Toothbrushes with a tongue scraper on the back of their head have recently been introduced to the market. The present study compared the effectiveness of a manual toothbrush with this new design, i.e., possessing a tongue scraper, and a commercial tongue scraper in improving breath odor and reducing the aerobic and anaerobic microbiota of tongue surface. The evaluations occurred at 4 moments, when the participants (n=30) had their halitosis quantified with a halimeter and scored according to a 4-point scoring system corresponding to different levels of intensity. Saliva was collected for counts of aerobic and anaerobic microorganisms. Data were analyzed statistically by Friedman's test (p<0.05). When differences were detected, the Wilcoxon test adjusted for Bonferroni correction was used for multiple comparisons (group to group). The results confirmed the importance of mechanical cleaning of the tongue, since this procedure provided an improvement in halitosis and reduction of aerobe and anaerobe counts. Regarding the evaluated methods, the toothbrush's tongue scraper and conventional tongue scraper had a similar performance in terms of breath improvement and reduction of tongue microbiota, and may be indicated as effective methods for tongue cleaning.