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Aim: To determine the effect of different cleaning methods and devices in reducing halitosis during active orthodontic treatment. Materials & Methods: 39 patients were randomly allocated into 4 groups. Group A: Using manual tooth brush and dental floss. Group B: Using electric tooth brush and dental floss. Group C: Using manual tooth brush with water jet device. Group D: Using electrical tooth brush and water jet device. each group were underwent clinical evaluation and oral malodor assessment Each participant was examined at baseline (T1) and after 4-6 weeks (T2) and then after 8-12 weeks (T3). Portable halimeter was used to evaluate the level of Volatile Sulphur compound for each participant at each time point. Oral malodor values were divided into five categories and classified as normal (1), weak (2), medium (3) strong (4), or very strong (5). Sample size: Sample size calculation has been done based on previous literature. The sample size was calculated as 39 participants. Results: No clinically significant differences were found between the four groups in the Volatile Sulphur Compound level (VSC). Also there was no clinically significant differences between females and males. Conclusion: Oral malodor could indicate a need to evaluate oral health and remind patients of the importance of maintaining ideal oral hygiene during fixed orthodontic treatment. When Comparing the efficacy of these four different methods of teeth cleaning on reducing VSC in patients with active orthodontic fixed appliances, results found that there are No significant difference between controlled group and the other groups. *Correspondence to: AlAnoud Mishal AlHarbi, Orthodontic Department, BDS, Riyadh Elm University, Kingdom of Saudi Arabia, E-mail: alanoud.m.alharbi@ student.riyadh.edu.sa Received: November 08, 2020; Accepted: November 16, 2020; Published: November 19, 2020 Introduction There is an increasing in number of patients who seeks orthodontic treatment in contemporary dental care to correct malocclusion and aesthetic dental problems that can cause negative physical, social and psychological effects. Nevertheless, after the placements of fixed orthodontic appliances, patients continue to deal with other struggles such as plaque accumulation leading to an increased risk of evolving gingivitis, white spot lesions and halitosis [1]. Dentofacial complex mainly affected by Orthodontic treatment. Therefore, it is broadly practiced branch of dentistry. A lot of people don’t brush teeth regularly after main meals. Because of that, there is food accumulation. According to previous studies there is a rapid decrease in oral hygiene compliance after the initial bonding, and the appliance helps plaque build-up and it is an obstruction to the hygiene practice like tooth brushing and flossing. This can even initiate gingivitis. Enamel decalcification may occur due to plaque build-up around the bracket base. Orthodontic patients are instructed to rinse two times a day with 20 mL of mouthwashes as an adjunct to brushing and flossing. Demineralization commonly follows fixed orthodontic treatment, if oral hygiene is not maintained. The reason for this is the bacteria’s acidic deposits in the plaque and it has negative effect on aesthetics [1]. Orthodontic treatments are usually done for children and adolescents, which can be challenging as they tend to have fewer skills and pay less attention to their oral health & hygiene. A lot of factors affects oral health including oral hygiene measures such as the frequency of brushing, the type of toothpaste used, and the method of brushing and additional measures such as the use of mouthwash and interdental floss or brush. Eating habits, the role of parents, the social situation and the education of the patient are also important. Accordingly, the important role of orthodontists is to instruct children and their parents how to take care of their oral health [2]. For patients with fixed orthodontic appliances it is hard to achieve good oral hygiene because the appliances can be an barrier to mechanical brushing – food can repeatedly get trapped around the brackets and under the arch wires after eating, and for patients whose treatment is lengthy it can be a challenge to preserve good oral health and avoid enamel demineralization, periodontal disease or halitosis. Atassi, et al. reported that after three months of orthodontic treatment beginning there is a statistically significant increase in stimulated salivary flow rate, buffer capacity and levels of lactobacilli, as well as increased bleeding on probing (BOP), a higher plaque index AlHarbi AM (2020) The efficacy of different methods of teeth cleaning on the levels of volatile sulfur compounds in patients with orthodontic fixed appliances Volume 5: 2-8 Oral Health Care, 2020 doi: 10.15761/OHC.1000196 (PI), a higher gingival index (GI), and an increase in probing pocket depth (PPD) [3]. There are several studies that evaluate the effects of orthodontic treatment on periodontal status.  The brackets and ligatures have a negative effect on natural cleaning by producing retention areas for plaques, making the mechanical cleaning of the teeth and gingiva by the tongue and lips more difficult, and increasing the viscosity of the saliva. Periodontal inflammation, hyperemia, hyperplasia, and demineralization of the teeth have been found as a consequence of failure of ensuring adequate oral hygiene. It has been stated that accumulation of plaque and the increase in bacterial count, and tongue coating noticeably are also involved in the formation of halitosis [1]. Lately, some investigators have reported that fixed orthodontic appliances can play a major role in increasing oral malodor, and that oral malodor should be regarded as one of prospective side effects of orthodontic treatments [4]. Human breath is composed of highly complex substances with numerous variable odors which can generate unpleasant situations like halitosis. Halitosis is a latin word which derived from halitus (breathed air) and the osis (pathologic alteration),and it is used to explain any offensive bad or unpleasant odor arising from the mouth air and breath. This undesirable condition is a common complaint for both genders and for all age groups. It creates social and psychological disadvantages for individuals, and these circumstances affect individual’s relation with other people [5]. Aim of the study To determine the effect of different cleaning methods and devices in reducing halitosis during active orthodontic treatment. Hypothesis Orthodontic treatment can interfere with halitosis and different malocclusions can help in accumulation of dental plaque. Definitions of halitosis Halitosis is the general term used to describe a foul odor emanating from the oral cavity, in which proteolysis, metabolic products of the desquamating cells and bacterial putrefaction are involved [6]. Halitosis is the general term used to describe any disagreeable odor in expired air, regardless of whether the odorous substances originate from oral or nonoral sources [7]. Halitosis is also termed as fetor ex ore or fetor oris. It is a foul or offensive odor emanating from the oral cavity [8] Unpleasant odor of the expired air whatever the origin may be. Oral malodor specifically refers to such odor originating from the oral cavity itself [9]. Halitosis, which means foul breath, might be interrelated to physiologic and/or pathologic reasons such as ear nosethroat diseases (chronic sinusitis, tonsillitis), gastrointestinal system diseases, diabetes mellitus, and acute rheumatic fever. Also, more frequently, halitosis can be related to intraoral factors, including especially gram-negative anaerobic microorganisms on the dental plaque, in the periodontal pockets, in saliva, and on the dorsum of the tongue. The volatile sulfur components (VSCs) consisting of hydrogen sulfide, dimethyl sulfide, and especially methyl mercaptan releasing through the proteolytic degradation of saliva, exfoliated epithelium, food debris, gingival crevicular fluid, plaque, postnasal drip, sulfurcontaining amino acids, and peptides in the blood by the anaerobic microorganisms found in the oral cavity are effective on the formation of halitosis. The levels of VSCs in the mouth are also affected by to the number and depth of periodontal pockets, the bleeding tendency of periodontal pockets, and the amount of coating on the tongue [10]. Etiology of halitosis Morning breath (physiologic halitosis) is caused by stagnation of saliva, entrapment of food particles, and presence of bacteria on the dorsum of the tongue due to the decrease in salivary movement during sleep [11]. Dental origin (intraoral)—75% of all cases Periodontal /peri-implant problem Tooth problem Soft-tissue problems