Treatment of oral malodour. Medium‐term efficacy of mechanical and/or chemical agents: a systematic review

Focused question What is the effect of a dentifrice ( DF ), a mouthwash ( MW ), tongue cleaning ( TC ), or any combination of these as adjunct to toothbrushing on intra‐oral malodour and tongue coating as compared to toothbrushing alone in systemically healthy patients, when used for a minimum follow‐up period of 2 weeks? Material and Methods The MEDLINE ‐ P ub M ed, C ochrane‐ CENTRAL and EMBASE databases were searched up to A ugust 2014. Measurements of V olatile S ulphur C ompounds and organoleptic scores of oral malodour were selected as outcome variables. Data were extracted and a descriptive analysis was performed. Results Independent screening of 1054 unique papers resulted in 12 eligible clinical trials with a medium‐term (≥2 weeks) duration. The majority of studies provided a significant reduction in oral malodour when evaluating products with an active ingredient (incorporated into a DF or a MW ) used adjunctively to toothbrushing. The added value of tongue cleaning over a MW was evaluated in one study. Conclusion Due to very limited evidence, the potential effect of a specifically formulated dentifrice, a mouthwash or a tongue scraper for treating oral malodour is, in general, unclear. For mouthwashes containing the active ingredients chlorhexidine + cetylpyridinium chloride + zinc ( CHX  +  CPC  +  Z n) and zinc chloride + cetylpyridinium chloride (ZnCl +  CPC ) most evidence was available. The strength of a recommendation to use these products was graded to be ‘weak’.