Some Evidence Shows that Certain Mouthrinses Can Reduce Halitosis: A critical summary of Fedorowicz Z, Aljufairi H, Nasser M, Outhouse TL, Pedrazzi V. Mouthrinses for the treatment of halitosis. Cochrane Database Syst Rev 2008;(4):CD006701.

Abstract

Systematic review conclusion. Mouthrinses containing antibacterial agents (chlorhexidine and cetylpyridinium chloride) or those containing chlorine dioxide and zinc can reduce halitosis to some extent.Critical summary assessment. Although antibacterial mouthrinses can reduce halitosis, the extent of effectiveness is uncertain owing to incomplete reporting, possible study bias and variation in patients' characteristics and assessment methods.Evidence quality rating. Limited. Systematic review conclusion. Mouthrinses containing antibacterial agents (chlorhexidine and cetylpyridinium chloride) or those containing chlorine dioxide and zinc can reduce halitosis to some extent. Critical summary assessment. Although antibacterial mouthrinses can reduce halitosis, the extent of effectiveness is uncertain owing to incomplete reporting, possible study bias and variation in patients' characteristics and assessment methods. Evidence quality rating. Limited. Are mouthrinses effective in controlling halitosis in patients older than 18 years who have a clinical or self-assessed diagnosis of halitosis without other significant comorbidity? The authors searched five electronic databases to August 2008 with no language restrictions. They included randomized controlled trials (RCTs) of a minimum of one week's duration in which investigators compared mouthrinses with placebo in adults older than 18 years who had halitosis and no significant comorbidities or other health conditions. The primary outcomes were self-expressed and organoleptic (human nose) assessments of halitosis. The secondary outcomes were assessments of halitosis as measured by a clinical instrument (Halimeter, Interscan, Chatsworth, Calif.), a portable sulfide monitor or gas chromatography coupled with flame-photometric detection. Two independent reviewers screened the studies, extracted information and independently assessed the risk of bias in the included trials. The researchers included five RCTs involving 293 participants. Investigators in three of these studies reported organoleptic and Halimeter outcomes; those in one study reported a secondary (Halimeter) outcome only; and investigators in one study reported an indirect salivary organoleptic outcome and a secondary (Halimeter) outcome. Investigators in three studies (two with organoleptic outcomes) reported incomplete results. Researchers in two studies used a placebo only for comparison; those in two studies used other mouthrinses only; and those in one study used a placebo and other mouthrinses. Use of mouthrinses containing essential oils only or those with various antibacterial agents (cetylpyridinium chloride, chlorhexidine, chlorine dioxide plus zinc, zinc chloride) resulted in significant reductions in scores for volatile sulfur compound (VSC), a commonly measured oral malodorant. Use of a mouthrinse based on an herbal extract (Garcinia mangostana) also resulted in significantly reduced VSC scores. Mouthrinses containing cetylpyridinium chloride, chlorhexidine or both were effective in reducing organoleptic scores in three studies; essential oil–based mouthrinses were less effective (two studies). In one study, the VSC measures did not coincide with the organoleptic measures. Use of a mouthrinse containing chlorhexidine, cetylpyridinium chloride, and zinc lactate resulted in significantly more tongue (P < .001) and tooth (P < .002) staining compared with staining with placebo use. Owing to heterogeneity between the trials, pooling of results and meta-analysis were not feasible. Mouthrinses 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, and chlorine dioxide and zinc-containing mouthrinses can be effective in neutralizing odoriferous sulfur compounds. Well-designed RCTs with larger sample sizes and longer intervention and follow-up periods are needed.