A combined therapeutic approach to manage oral halitosis: a 3-month prospective case series

J Periodontol. 2005 Jun;76(6):1025-33. doi: 10.1902/jop.2005.76.6.1025.


Background: Clinical research assessing different therapeutic protocols aimed at treating oral halitosis is scarce. The aim of this study was to evaluate the effects of a combined mechanical and pharmacological approach to treat oral halitosis on clinical and microbiological outcomes on patients followed for 3 months.

Methods: Nineteen subjects with oral malodor participated. At baseline, all subjects completed a questionnaire and carried out an examination including full-mouth organoleptic and volatile sulfur compound (VSC) levels and the Winkel tongue coating index. Standard periodontal outcome variables were assessed at six teeth. Standardized microbiological samples of subgingival plaque, unstimulated saliva, and tongue coating were obtained for culture analysis. The treatment protocol included supragingival prophylaxis; instructions in oral hygiene (toothbrushing, interproximal cleaning, and tongue scraping); and gargling with a mouthrinse containing chlorhexidine, cetylpiridinium chloride, and zinc lactate. The same outcome variables were registered 1 and 3 months after baseline.

Results: Statistically significant reductions in organoleptic scores (P <0.001), VSC levels (P <0.05), and tongue coating index (P <0.05) were observed after 1 and 3 months. Mean probing depth and plaque levels also demonstrated significant reductions after 3 months (P <0.05). Total anaerobic counts were significantly reduced at all three locations after 1 month (P <0.05), and in samples from tongue coating and subgingival plaque at 3 months (P <0.05). Aerobic counts were significantly reduced in saliva at 1 month (P <0.05), and the anaerobic/aerobic ratio significantly increased in the tongue samples. Among the selected pathogens evaluated, Porphyromonas gingivalis was the most affected of the three microflora evaluated.

Conclusions: The evaluated therapeutic approach demonstrated its efficacy in the management of oral halitosis, demonstrating statistically significant improvements in both organoleptic and VSC values at 1 and 3 months. The proposed clinical protocol significantly affected the microbial composition in tongue coating, saliva, and subgingival microflora.

Publication types

  • Evaluation Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Infective Agents, Local / therapeutic use*
  • Cetylpyridinium / therapeutic use*
  • Chlorhexidine / adverse effects
  • Chlorhexidine / therapeutic use*
  • Dental Plaque / microbiology
  • Epidemiologic Methods
  • Female
  • Halitosis / classification
  • Halitosis / microbiology
  • Halitosis / therapy*
  • Humans
  • Lactates / therapeutic use
  • Male
  • Middle Aged
  • Mouthwashes / therapeutic use
  • Saliva / microbiology
  • Sulfur / analysis
  • Tongue / microbiology
  • Treatment Outcome
  • Zinc / therapeutic use


  • Anti-Infective Agents, Local
  • Lactates
  • Mouthwashes
  • Sulfur
  • Cetylpyridinium
  • Zinc
  • Chlorhexidine