Bad Breath Response to Tongue Scraper and Mouthrinses

Objective: Randomized, double-blinded, active control, parallel group equivalence, clinical trial using 0.12% chlorhexidine gluconate (CHX, Peridex) or 0.1% stabilized chlorine dioxide (ClO₂, CloSYS) mouthrinses as adjuncts to tongue scraping. The hypothesis was that there would be no difference in length or strength of action between the two. Methods: Proposal approved by institutional review committee; registered at www.clinicaltrials.gov. Individuals at UCSF Medical Center concerned about bad breath (halitosis) were invited for professional breath screening. We screened 47 people using organoleptic (OLT) Rosenberg scale 0 to 5. Twenty-two with score of 2 or more were allocated by random numbers table: 9 to CHX, 13 to ClO₂. Medical history review, clinical exam for dental caries, periodontal diseases, oral pathology, PlI, GI, and probing pocket depth were conducted. Tongue coating sample from dorsum taken for culture and enumeration of H₂S-producing colonies. Mouth air (0.5ml) was measured by portable gas chromatogram (OralChroma). All subjects were healthy, non-smokers, having oral (tongue-related) physiological halitosis. Mouthrinses were dispensed in double-blind manner. OLT scores compared to baseline by Mann-Whitney test at 1, 2, 4 hours after single use of plastic tongue scraper and assigned rinse; and 1 week after use two times a day. Groups were compared to each other at each time point. VSCs H₂S, methyl mercaptan concentrations were compared by t-tests. Results: Primary outcome: ClO₂ group had statistically significant (all P0.001) reductions of OLT scores compared to baseline at 1, 2, 4hr, and 1wk. CHX group had significant reductions at 1hr (P0.001), 2hr (P0.01), 4hr (P0.01), 1wk (P0.05). No differences between groups were found at any time. Secondary outcome: VSC measures were reduced but had large variances and did not differ from baseline. H₂S-producing colonies were reduced: ClO₂ 55.8% to 32.0%; CHX 46.6% to 27.8%. Conclusion: Mouthrinses were equivalent.