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Halitosis - Management
Basis for recommendation
These recommendations are mainly based on expert opinion published in narrative reviews on halitosis or oral malodour [Rosenberg, 1996; Coventry et al, 2000; Loesche and Kazor, 2002; Messadi and Younai, 2003; Scully and Felix, 2005a; Porter and Scully, 2006; Lee et al, 2007; Hughes and McNab, 2008; Scully and Greenman, 2008; van den Broek et al, 2008]. Evidence is lacking for treatments of halitosis (such as mouthwashes, tongue scraping, toothpaste, and interdental aids).
General hygiene measures
Antibacterial mouthwashes and toothpaste
- The recommendation to offer antibacterial mouthwashes and/or toothpastes is based on expert opinion [Messadi and Younai, 2003; Porter and Scully, 2006; Scully and Greenman, 2008].
- Although acknowledging that certain mouthwashes can be useful in reducing levels of halitosis-producing bacteria (for example chlorhexidine or cetylpyridinium chloride mouthwashes), a Cochrane systematic review found poor evidence to support their use [Fedorowicz et al, 2008].
- CKS found a lack of good evidence for the various types of toothpastes (antibacterial and non-antibacterial) for the treatment of halitosis.
- Consequently, CKS is unable to recommend a specific mouthwash or toothpaste for the management of halitosis.
Tongue scraping
- A Cochrane systematic review found weak and unreliable evidence to support the use of tongue scraping for the management of halitosis [Outhouse et al, 2006].
- Given that the back of the tongue is regarded as a major oral source of halitosis, the recommendation to consider tongue scraping is based on expert opinion — particularly in people with halitosis who have good dental hygiene [Rosenberg, 1996; Messadi and Younai, 2003; Quirynen, 2003; Porter and Scully, 2006].
- Provided it is done gently and regularly, tongue scraping is regarded as not harmful, and may provide transient benefits in controlling halitosis [Porter and Scully, 2006].
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