Effect of different treatment methods for reducing morning halitosis

Objectives: The aim of this study was to compare the chemical effect of antimicrobial agents in mouthrinses and mechanical effect of tongue scrapers along with toothbrushing and dentifrice for conventional oral hygiene, measured by a handheld sulphide monitor BreathAlert™. Methods: Twenty healthy volunteers, from 18 to 50 years-old, were randomly allocated into a five period cross-over trial. They were tested a conventional tongue scraper (Kolbe®), a tongue scraper coupled at the back of a toothbrush's head (Johnson's Professional Extreme®), two mouthwashes: 0,05% cetylpyridinium chloride (Oral-B®) and 0,12% chlorhexidine digluconate (PerioTherapy®); and a soft-bristle toothbrush (Johnson's Professional Extreme®) with fluoride toothpaste (Contente®) as a positive control. All volunteers were asked to refrain from any kind of oral hygiene for a 20-hours period for baseline scores. Each product was used at once, followed by a one-week washout period. The breath was measured before, immediately after and after 1, 2 and 3 hours after the procedure. Data were submitted to statistical analysis using Wilcoxon and Friedman tests. Results: Immediately after the products use, only the toothbrush's tongue scraper was able to significantly reduce the breath (p=0.0031) and its effect lasted for up to two hours. Chlorhexidine reduced the breath only at the final of the second hour (p=0.004) and lasted for three hours, while oral hygiene with toothbrush and toothpaste was effective in reducing breath in the first hour (p=0.002) and lasted for up to three hours. Conclusions: The mechanical cleaning of the tongue is able to immediately reduce the breath, but with relatively short duration of its effect, while chlorhexidine and the association of mechanical with chemical agents in oral hygiene can reduce the breath for longer periods, achieving the best results against morning halitosis.