Written by Jessica Patella, ND. Children who supplemented for 2 weeks with a probiotic, in addition to ( brushing, flossing, tongue scraping and rinsing with chlorhexidine), had the greatest improvement in oral health and sustained that improvement for 3 months after discontinuing the probiotic. 

oral healthHalitosis is the medical term for “bad breath” that is detected by others. Ninety percent of malodor in the mouth comes from an imbalance in bacteria on the tongue, with the majority coming from the back of the tongue 1,2. Recent research has found that supplementing with probiotics after using proper oral hygiene can reduce the severity of halitosis over a longer period of time 1.

The research included children (6-9 years of age) with no signs of gingivitis, periodontal disease, or mouth breathing (because halitosis can be a side effect) but who had halitosis or bad breath. A total of 208 children with diagnosed halitosis were included in the study. The children were randomly assigned to one of four groups:

  • Group A: Brushing and flossing
  • Group B: Brushing, flossing and tongue scraping
  • Group C: Brushing, flossing, tongue scraping and chlorhexidine rinse
  • Group D: Brushing, flossing, tongue scraping, chlorhexidine rinse and probiotics

Children were advised to follow the above protocol twice a day for two weeks. The tongue scraper was to be used for 30 seconds. The chlorhexidine rinse was used for 30 seconds (5ml 0.12% chlorhexidine). The probiotic was administered on a lozenge to be sucked (>1 X 10^9 CFU of S. salivarius K12)1.

The organoleptic test is the gold standard for measuring bad breath and is measured on a scale of 0-5 (0=absence of odor, 5= severe/ overwhelming malodor). Organoleptic tests were carried out at 1 week and 3 months following interventions 1.

The results were as follows:

  • Group A: no change
  • Group B: no change
  • Group C: Statistically significance major to moderate improvement at the 1-week follow-up (p<0.001), but there was no change at the 3-month follow-up.
  • Group D: Statistically significant major to moderate improvement at both the 1-week and 3-month follow-ups (p<0.001).

Parental satisfaction was also recorded, with 79.59% satisfied with the outcome in Group C and 91.83% satisfied with the outcome in Group D 1. These results are likely explained by the fact that S. salivarius probiotic has been shown to suppress the growth of bacteria that is linked to halitosis 1,3.

In conclusion, probiotic supplementation showed the greatest improvement in halitosis, with results that were seen even after supplementation was discontinued for 3 months. Proper oral hygiene is important for removing microorganisms that cause halitosis, but additional interventions, such as chlorhexidine rinse showed greater improvement, but results were not long-term 1. Future research with a larger population was recommended by the researchers to confirm results 1.

Source: Jamali Z, et al. Impact of Chlorhexidine Pretreatment Followed by Probiotic Streptococcus salivarius Strain K12 on Halitosis in Children: A Randomised Controlled Clinical Trial. Oral health Prev Dent 2016;14:305-313.

Posted November 8, 2016.

Jessica Patella, ND, is a naturopathic physician specializing in nutrition and homeopathic medicine and offers a holistic approach to health.  She earned her ND from Southwest College of Naturopathic Medicine in Tempe, AZ, and is a member of the North Carolina Association of Naturopathic Physicians. Visit her website at  www.awarenesswellness.com.

References:

  1. Jamali Z, Aminabadi NA, Samiei M, Sighari Deljavan A, Shokravi M, Shirazi S. Impact of Chlorhexidine Pretreatment Followed by Probiotic Streptococcus salivarius Strain K12 on Halitosis in Children: A Randomised Controlled Clinical Trial. Oral Health Prev Dent. 2016;14(4):305-313.
  2. Akaji EA, Folaranmi N, Ashiwaju O. Halitosis: a review of the literature on its prevalence, impact and control. Oral Health Prev Dent. 2014;12(4):297-304.
  3. Kazor CE, Mitchell PM, Lee AM, et al. Diversity of bacterial populations on the tongue dorsa of patients with halitosis and healthy patients. J Clin Microbiol. 2003;41(2):558-563.