Hope for Halitosis

October 29, 2014 Written by JP    [Font too small?]

It’s estimated that approximately 30%-50% of the population is affected by chronic halitosis or oral malodor, the technical terms for ongoing bad breath. In most instances, the cause originates in the oral cavity. Improving dental hygiene is sometimes enough to remedy the situation. In practice, this means brushing at least twice-daily and flossing prior to retiring at night. However, if proper oral care is already in place, then odiferous foods and substances (alcoholic beverages, cruciferous vegetables, garlic and onions, tobacco, etc.) and/or other factors, including diabetes, gastro-esophageal reflux (GERD), medication side-effects and metabolic disorders may be involved. When in doubt, it’s best to identify the cause with the assistance of a health care professional as any underlying medical condition should be addressed and not masked.

If you’re in generally good health but your breath tells a different story, there are a number of natural remedies which can improve your immediate air space. Apart from flossing and brushing your teeth, studies report that brushing or scraping your tongue can minimize the odor caused by bacterial interactions. Likewise, swishing your mouth with antiseptic (essential oil containing) mouthwashes, green tea and sesame oil, also known as “oil pulling”, provide temporarily fresher breath. Having said that, green tea can discolor teeth and oil pulling isn’t very practical because it requires a daily commitment of 10-15 minutes of swishing prior to brushing.

As mentioned, gargling and swishing with green tea isn’t the best option because of staining. But, drinking green tea on a daily basis can still improve bad breath. When green tea makes contact with your tongue, it decreases the amount of volatile sulfur compounds (VSCs) which are implicated in halitosis. In addition, green tea may also reduce the severity of gingivitis or gum disease – yet another bad breath causing culprit. Chewing natural, sugar-free gum also improves oral malodor. However, instead of fruit flavored or mint gums, try cinnamon gum, as it has been clinically shown to have a similar effect as green tea without the staining probability. As an aside, if you prefer not to chew gum, I suggest cinnamon mints because they tend to maintain longer contact with your tongue – a primary site of VSCs. Personally, I opt for all-natural cinnamon mints which feature xylitol as a sweetening agent. A final option worth considering is a specially formulated probiotic lozenge containing a bacterial strain called Streptococcus salivarius K12. Preliminary evidence has demonstrated that this good bacteria may crowd out some of the unwelcome oral bacteria which contribute to halitosis and infections of mouth and throat.

Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!

To learn more about the studies referenced in today’s column, please click on the following links:

Study 1 – Toothbrushing Vs Toothbrushing + Tongue Cleaning In Reducing Halitosis (link)

Study 2 – Effectiveness of Mechanical Tongue Cleaning On Breath Odour (link)

Study 3 – Effect of An Essential Oil-Containing Mouth Rinse On VSC-Producing (link)

Study 4 – Effect of Oil Pulling On Halitosis & Microorganisms Causing Halitosis (link)

Study 5 – Effect of Green Tea Mouthwash On Oral Malodor(link)

Study 6 – Effect of Green Tea Extract On the Removal of Sulfur-Containing Oral (link)

Study 7 – Historical Study On Traditional Chinese Formulations & Crude Drugs ... (link)

Study 8 – Short-Term Germ-Killing Effect of Sugar-Sweetened Cinnamon Gum (link)

Study 9 – Antimicrobial Activity of Streptococcus Salivarius K12 On Bacteria (link)

Study 10 – A Preliminary Study of the Effect of Probiotic Streptococcus Salivarius (link)

Common Causes of Oral Malodor

Source: Oral Diseases (2012) 18, 333–345 (link)

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Posted in Alternative Therapies, Dental Health, Food and Drink

12 Comments & Updates to “Hope for Halitosis”

  1. JP Says:

    Update: More support for probiotic supplementation …


    Oral Surg Oral Med Oral Pathol Oral Radiol. 2014 Apr;117(4):462-70. doi: 10.1016/j.oooo.2013.12.400. Epub 2013 Dec 20.

    Lactobacillus salivarius WB21–containing tablets for the treatment of oral malodor: a double-blind, randomized, placebo-controlled crossover trial.

    OBJECTIVE: This study evaluated the effect of probiotic intervention using lactobacilli on oral malodor.

    STUDY DESIGN: We conducted a 14-day, double-blind, placebo-controlled, randomized crossover trial of tablets containing Lactobacillus salivarius WB21 (2.0 × 10(9) colony-forming units per day) or placebo taken orally by patients with oral malodor.

    RESULTS: Organoleptic test scores significantly decreased in both the probiotic and placebo periods compared with the respective baseline scores (P < .001 and P = .002), and no difference was detected between periods. In contrast, the concentration of volatile sulfur compounds (VSCs) (P = .019) and the average probing pocket depth (P = .001) decreased significantly in the probiotic period compared with the placebo period. Bacterial quantitative analysis found significantly lower levels of ubiquitous bacteria (P = .003) and Fusobacterium nucleatum (P = .020) in the probiotic period. CONCLUSIONS: These results indicated that daily oral consumption of tablets containing probiotic lactobacilli could help to control oral malodor and malodor-related factors. Be well! JP

  2. JP Says:

    Update: Oil pulling “works”, but it requires motivation to stick with it …


    J Clin Diagn Res. 2014 Nov;8(11):ZC18-21.

    Comparative efficacy of oil pulling and chlorhexidine on oral malodor: a randomized controlled trial.

    BACKGROUND: Oral malodor affects a large section of population. Traditional Indian folk remedy, oil pulling not only reduces it but can also bring down the cost of treatment.

    AIMS: To compare the efficacy of oil pulling and chlorhexidine in reducing oral malodor and microbes.

    MATERIALS AND METHODS: Three week randomized controlled trial was conducted among 60 students of three hostels of Maharani College of science and arts and commerce and Smt V.H.D.College of Home Science. The hostels were randomized into two intervention groups namely chlorhexidine group, sesame oil and one control (placebo) group. Twenty girls were selected from each hostel based on inclusion and exclusion criteria. Informed consent was obtained. The parameters recorded at the baseline (day 0) and post intervention on day 22 were plaque index (PI), gingival index (GI), objective (ORG1) and subjective (ORG2) organoleptic scores and anaerobic bacterial colony (ABC) count. Intra and inter group comparisons were made using Kruskal Wallis test, Wilcoxan sign rank test, ANOVA and student t-test.

    RESULTS: There was significant reduction (p<0.05) in the mean scores of all the parameters within sesame oil and chlorhexidine group. Among the groups significant difference was observed in objective and subjective organoleptic scores. Post hoc test showed significant difference (p<0.000) in mean organoleptic scores of sesame oil and placebo and chlorhexidine and placebo group. No significant difference (p<0.05) was observed between sesame oil and chlorhexidine group.

    CONCLUSION: Oil pulling with sesame oil is equally efficacious as chlorhexidine in reducing oral malodor and microbes causing it. It should be promoted as a preventive home care therapy.

    Be well!


  3. JP Says:

    Update 05/03/15:


    BMC Complement Altern Med. 2015 Mar 10;15(1):48.

    Green tea extract and its major constituent epigallocatechin-3-gallate inhibit growth and halitosis-related properties of Solobacterium moorei.

    BACKGROUND: Solobacterium moorei is a volatile sulfide compound (VSC)-producing Gram-positive anaerobic bacterium that has been associated with halitosis. The aim of this study was to investigate the effects of green tea extract and its major constituent epigallocatechin-3-gallate (EGCG) on growth and several halitosis-related properties of S. moorei.

    METHODS: A microplate dilution assay was used to determine the antibacterial activity of green tea extract and EGCG against S. moorei. Their effects on bacterial cell membrane integrity were investigated by transmission electron microscopy and a fluorescence-based permeability assay. Biofilm formation was quantified by crystal violet staining. Adhesion of FITC-labeled S. moorei to oral epithelial cells was monitored by fluorometry. The modulation of β-galactosidase gene expression in S. moorei was evaluated by quantitative RT-PCR.

    RESULTS: The green tea extract as well as EGCG inhibited the growth of S. moorei, with MIC values of 500 and 250 μg/ml, respectively. Transmission electron microscopy analysis and a permeabilization assay brought evidence that the bacterial cell membrane was the target of green tea polyphenols. Regarding the effects of green tea polyphenols on the S. moorei colonization properties, it was found that biofilm formation on EGCG-treated surfaces was significantly affected, and that green tea extract and EGCG can cause the eradication of pre-formed S. moorei biofilms. Moreover, both the green tea extract and EGCG were found to reduce the adherence of S. moorei to oral epithelial cells. The β-galactosidase activity of S. moorei, which plays a key role in VSC production, was dose-dependently inhibited by green tea polyphenols. In addition, EGCG at ½ MIC significantly decreased the β-galactosidase gene expression.

    CONCLUSION: Our study brought evidence to support that green tea polyphenols possess a number of properties that may contribute to reduce S. moorei-related halitosis. Therefore, these natural compounds may be of interest to be used to supplement oral healthcare products.

    Be well!


  4. JP Says:

    Update 06/16/15:


    Niger Med J. 2015 Mar-Apr;56(2):143-7.

    Effect of coconut oil in plaque related gingivitis – A preliminary report.

    BACKGROUND: Oil pulling or oil swishing therapy is a traditional procedure in which the practitioners rinse or swish oil in their mouth. It is supposed to cure oral and systemic diseases but the evidence is minimal. Oil pulling with sesame oil and sunflower oil was found to reduce plaque related gingivitis. Coconut oil is an easily available edible oil. It is unique because it contains predominantly medium chain fatty acids of which 45-50 percent is lauric acid. Lauric acid has proven anti inflammatory and antimicrobial effects. No studies have been done on the benefits of oil pulling using coconut oil to date. So a pilot study was planned to assess the effect of coconut oil pulling on plaque induced gingivitis.

    MATERIALS AND METHODS: The aim of the study was to evaluate the effect of coconut oil pulling/oil swishing on plaque formation and plaque induced gingivitis. A prospective interventional study was carried out. 60 age matched adolescent boys and girls in the age-group of 16-18 years with plaque induced gingivitis were included in the study and oil pulling was included in their oral hygiene routine. The study period was 30 days. Plaque and gingival indices of the subjects were assessed at baseline days 1,7,15 and 30. The data was analyzed using paired t test.

    RESULTS: A statistically significant decrease in the plaque and gingival indices was noticed from day 7 and the scores continued to decrease during the period of study.

    CONCLUSION: Oil pulling using coconut oil could be an effective adjuvant procedure in decreasing plaque formation and plaque induced gingivitis.

    Be well!


  5. JP Says:

    Update 07/13/15:


    J Adv Pharm Technol Res. 2015 Apr-Jun;6(2):43-7.

    The magic of magic bugs in oral cavity: Probiotics.

    The aim of this review is to present an update about the current status of probiotics in the field of dentistry. Oral infections are the most common forms of infections. It is necessary to understand the role of the ecology and microbiology of the oral cavity in better understanding of the pathogenesis of various oral diseases. The concept of bacteriotherapy has been an emerging field in dentistry. The use of health-beneficial micro-organisms to heal diseases or support immune function was first introduced in the beginning of the 20(th) century. Probiotics are dietary supplements containing potentially beneficial bacteria or yeasts and it has been found to be beneficial to the host health. In medicine, probiotics are used mainly in support therapy for gastro-intestinal diseases. In recent years, probiotics have been used as a treatment to promote oral health. This approach has shown promising results in the oral cavity with respect to control of chronic diseases such as dental caries, periodontitis, and recurring problems such as halitosis and candidal infections. Despite the immense potential of probiotics, data are still deficient on the probiotic action in the oral cavity, which further mandates randomized trials before any concrete clinical recommendations can be arrived.

    Be well!


  6. JP Says:

    Updated 10/27/15:


    Hua Xi Kou Qiang Yi Xue Za Zhi. 2015 Apr;33(2):166-8.

    [Anti-halitosis effect of sugar-free chewing gum].

    OBJECTIVE: To study the anti-halitosis effect of sugar-free chewing gum through their influence on odor induced by cysteine.

    METHODS: Ten volunteers were randomly divided into the treatment group and the untreated group; each group consisted of five volunteers. All volunteers consented to participate in a test in which breath odor was induced by cysteine. After the test, the treatment group chewed sugar-free chewing gum for 1 min, whereas the untreated group did not undergo any treatment. The effectiveness was determined by the percent reduction of H2S, CH3SH, and (CH3)2S response after the volunteers chewed gum for 1, 10, and 20 min.

    RESULTS: At 1, 10, and 20 min, H2S of the treatment group was reduced by 82.68%, 92.27%, 97.47%, respectively, CH3SH was reduced by 65.49%, 73.79%, and 82.89%, respectively, and (CH3)2S was reduced by 60.45%, 73.82%, and 59.72%, respectively. The differences between the two groups at different times were significant (P < 0.05). CONCLUSION: Chewing gum can effectively inhibit cysteine-induced odor. Be well! JP

  7. JP Says:

    Updated 06/13/16:

    Note: Gingivitis can contribute to oral malodor…


    J Dent (Shiraz). 2016 Jun;17(2):149-54.

    The Efficacy of Green Tea Chewing Gum on Gingival Inflammation.

    STATEMENT OF THE PROBLEM: According to previous studies, the components of green tea extracts can inhibit the growth of a wide range of gram-pos-itive and -negative bacterial species and might be useful in controlling oral infections.

    PURPOSE: The aim of this study was to determine the effect of green tea chewing gum on the rate of plaque and gingival inflammation in subjects with gingivitis.

    MATERIALS AND METHOD: In this double-blind randomize controlled clinical trial, 45 patients with generalized marginal gingivitis were selected and divided into two groups of green tea (23) and placebo (22) chewing gum. The patients chewed two gums for 15 minutes daily for three weeks. Sulcus bleeding index (SBI) and approximal plaque index (API) were studied at the baseline, 7 and 21 days later. Saliva sampling was conducted before and after 21 days for evaluation of IL-1β. The results were analyzed and compared by using repeated measures ANOVA, paired t test, and independent two-sample t test (α=0.05).

    RESULT: The results showed that chewing gum significantly affected the SBI and API (p< 0.001). Paired t test showed that the two groups were significantly different regarding the mean changes of SBI and API at different periods of 1-7, 1-21, and 7-21 (p< 0.001). Concerning IL-1β, the repeated measures ANOVA revealed that the effect of chewing gum was significant (p<0.001). Moreover, paired t-test represented no significant difference between the mean changes of IL-1β within 1-21 day (p= 0.086). CONCLUSION: The green tea chewing gum improved the SBI and API and effectively reduced the level of IL-1β. Be well! JP

  8. JP Says:


    J Contemp Dent Pract. 2016 Jan 1;17(1):38-41.

    The Effect of Coconut Oil pulling on Streptococcus mutans Count in Saliva in Comparison with Chlorhexidine Mouthwash.

    OBJECTIVES: Oil pulling is an age-old practice that has gained modern popularity in promoting oral and systemic health. The scientific verification for this practice is insufficient. Thus, this study evaluated the effect of coconut oil pulling on the count of Streptococcus mutans in saliva and to compare its efficacy with that of Chlorhexidine mouthwash: in vivo. The null hypothesis was that coconut oil pulling has no effect on the bacterial count in saliva.

    MATERIALS AND METHODS: A randomized controlled study was planned and 60 subjects were selected. The subjects were divided into three groups, Group A: Oil pulling, Group B: Chlorhexidine, and Group C: Distilled water. Group A subjects rinsed mouth with 10 ml of coconut oil for 10 minutes. Group B subjects rinsed mouth with 5 ml Chlorhexidine mouthwash for 1 minute and Group C with 5 ml distilled water for 1 minute in the morning before brushing. Saliva samples were collected and cultured on 1st day and after 2 weeks from all subjects. Colonies were counted to compare the efficacy of coconut oil and Chlorhexidine with distilled water.

    RESULTS: Statistically significant reduction in S. mutans count was seen in both the coconut oil pulling and Chlorhexidine group.

    CONCLUSION: Oil pulling can be explored as a safe and effective alternative to Chlorhexidine.

    CLINICAL SIGNIFICANCE: Edible oil-pulling therapy is natural, safe and has no side effects. Hence, it can be considered as a preventive therapy at home to maintain oral hygiene.

    Be well!


  9. JP Says:

    Updated 08/13/16:


    Open Dent J. 2016 May 11;10:166-73.

    Green Tea (Camellia Sinensis): Chemistry and Oral Health.

    Green tea is a widely consumed beverage worldwide. Numerous studies have suggested about the beneficial effects of green tea on oral conditions such as dental caries, periodontal diseases and halitosis. However, to date there have not been many review articles published that focus on beneficial effects of green tea on oral disease. The aim of this publication is to summarize the research conducted on the effects of green tea on oral cavity. Green tea might help reduce the bacterial activity in the oral cavity that in turn, can reduce the aforementioned oral afflictions. Furthermore, the antioxidant effect of the tea may reduce the chances of oral cancer. However, more clinical data is required to ascertain the possible benefits of green tea consumption on oral health.

    Be well!


  10. JP Says:

    Updated 04/10/17:


    J Clin Dent. 2016 Dec;27(4):110-113.

    Effect of Green Tea-Added Tablets on Volatile Sulfur-Containing Compounds in the Oral Cavity.

    OBJECTIVES: A controlled, clinical, double-blind, cross-over study was conducted to assess the efficacy of sugar-free tablets containing green tea extract on oral volatile sulfur-containing compounds (VSC) versus placebo tablets for 30 minutes.

    METHODS: To join the study, subjects had to have at least 24 teeth, no report of oral and systemic diseases, and no removable dentures. All eligible participants had to avoid professional oral hygiene and drugs for two weeks, to not be menstruating, to avoid brushing their teeth and tongue, to not smoke, to not consume alcohol, coffee or tea, nor onion, garlic, or licorice for six hours before the test. Moreover, they had to score a level of VSC ≥ 75 ppb at the basal measurement. Subjects were entered into their respective groups after a minimum 48-hour wash-out period. The test tablet (0.7 g) contained 0.05% green tea extract (equivalent of 1 mg polyphenols for three tablets); the control tablet was identical but without the active agent. The OralChroma2™ device was utilized to evaluate VSC in the oral air. The levels were recorded at baseline, after sucking three tablets in succession, and after 30 minutes. Data were analyzed with SPSS software and significance was set at α = 0.05.

    RESULTS: 54 subjects completed the trial (23 men, 31 women). None reported problems linked to green tea. The mean reductions in VSC level from baseline at the end of tablet sucking were 34% (p < 0.001) in the control and 55% (p < 0.001) in the test group; after 30 minutes, reductions were 7% in the control (p = NS) and 26% (p < 0.005) in the test group. The comparisons between the two groups after baseline adjustment showed a statistically significant difference in reductions both at the end of the sucking period (p < 0.01) and after 30 minutes (p < 0.01). CONCLUSIONS: Tablets containing green tea extract can statistically significantly reduce the oral VSC levels immediately, and after 30 minutes. Moreover, the test tablets reduced oral VSC significantly more than the control tablets. Be well! JP

  11. JP Says:

    Updated 07/29/17:


    J Periodontol. 2017 Jul 28:1-14.

    The Influence of a Bifidobacterium Animalis Probiotic on Gingival Health: a Randomized Controlled Clinical Trial.

    BACKGROUND: There is a growing interest for probiotics in periodontal therapy, however, until to date, most research is focused on lactobacilli probiotics. The aim of this study was to evaluate the effect of the 4-week usage of a Bifidobacterium animalis subsp. lactis DN-173010 supplemented yoghurt versus a placebo yoghurt, followed by a 5-day non-brushing period.

    METHODS: Individuals were included in this single-blind, randomized controlled study if probing depth was (PD) ≤ 3 mm and attachment loss ≤ 2 mm. After professional prophylaxis, they were randomized into two groups receiving a placebo or Bifidobacterium containing yoghurt for 28 days, followed by a 5-day non-brushing period. The outcome measures were plaque and gingival indices, bleeding on probing, probing depth, gingival crevicular fluid (GCF) volume, total amount and concentration of interleukin-1β in GCF. These were measured at baseline, after 28 days of the study product usage and subsequently after the 5 days of plaque accumulation.

    RESULTS: 51 patients were analyzed. No intergroup differences could be detected before and after the intake of the study products. However, after plaque accumulation, significant better results for all parameters could be seen in the probiotic group compared to the control group (p<0.001): lower plaque and gingivitis scores, less bleeding on probing, less increase in GCF volume and lower total interleukin-1β amount/ concentration.

    CONCLUSION: The use of a probiotic yoghurt supplemented with Bifidobacterium animalis can have a positive effect on plaque accumulation and gingival inflammatory parameters after refraining oral hygiene practices.

    Be well!


  12. JP Says:

    Updated 12/13/18:


    Dent Res J (Isfahan). 2018 Nov-Dec;15(6):379-384.

    Effect of Camellia sinensis plant on decreasing the level of halitosis: A systematic review.

    Tea is the second most consumed beverage. Polyphenolic catechins of green tea have a number of beneficial effects in oral cavity. This study aims to evaluate the clinical effects of green tea on halitosis through a systematic review of available literature. All available randomized, clinical trials – with a relevant subject that met the inclusion criteria – were included by searching PubMed, Cochrane, ProQuest, and Google Scholar, and Scopus databases. To score the selected articles, 27 items of CONSORT 2010 checklist were considered. Each article was reviewed by all the authors. Searching the PubMed database yielded 42 articles, 2 of which met the inclusion criteria. None of the 12 articles were obtained through Cochrane library, and 85 articles retrieved from ProQuest database met the inclusion criteria. Three hundred and five articles were obtained from Google Scholar, three of which fulfilled the inclusion criteria. Two articles were omitted because they were duplicated, and the rest were excluded. Searching the Scopus database yielded 270 articles, 2 of which met the inclusion criteria, but they were also duplicated. Finally, two studies were selected according to the inclusion criteria of the study. In both of the included articles, the early effect of green tea use was statistically significant in comparison with baseline. One of the studies showed the long-term effect of green tea mouthwash. Green tea can reduce halitosis through rinsing and antimicrobial effect.

    Be well!


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