Microbiology and treatment of halitosis

Periodontol 2000. 2002;28:256-79. doi: 10.1034/j.1600-0757.2002.280111.x.


The prevalence of oral malodor is probably high in the United States, although precise epidemiological data are missing. The many thousands of individuals who experience oral malodor from the overgrowth of proteolytic, anaerobic bacteria on their tongue surfaces can be successfully treated by a regimen that includes tongue brushing, toothbrushing and possibly the usage of mouthrinses containing various agents. Several candidate mouthrinses containing essential oils (Listerine), ZnCl2, or an oil, water and cetylpyridum chloride mouthrinse have reduced the organoleptic scores of individuals with moderate levels of oral malodor in the absence of tongue brushing. Very few long-term data beyond 6 weeks of usage are available. Anecdotal evidence suggests that other agents such as chlorine dioxide may be helpful. These mouthrinses should be marketed as oral deodorants that are analogous in purpose to the usage of deodorant soaps to control and/or eliminate body malodors. In this way the mouthrinse could be considered as a cosmetic by the FDA, provided that there are data on the safety of the various ingredients in the mouthrinse. Mouthrinses containing zinc ions are able to reduce the levels of volatile sulfur compounds by converting these volatile compounds to non-volatile, and therefore, non-malodorous zinc sulfides, and this mode of action would appear to support a cosmetic claim.

Publication types

  • Research Support, U.S. Gov't, P.H.S.
  • Review

MeSH terms

  • Bacteria, Anaerobic / metabolism
  • Cosmetics
  • Dietary Proteins / adverse effects
  • Halitosis / etiology
  • Halitosis / microbiology*
  • Halitosis / therapy*
  • Humans
  • Mouthwashes / therapeutic use*
  • Oral Hygiene
  • Sulfur Compounds / metabolism
  • Sulfur-Reducing Bacteria / metabolism
  • Tongue / microbiology
  • United States
  • United States Food and Drug Administration


  • Cosmetics
  • Dietary Proteins
  • Mouthwashes
  • Sulfur Compounds