Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Trials
Published in: Trials 1/2010

Open Access 01-12-2010 | Research

Effects of a mouthwash with chlorine dioxide on oral malodor and salivary bacteria: a randomized placebo-controlled 7-day trial

Authors: Kayoko Shinada, Masayuki Ueno, Chisato Konishi, Sachiko Takehara, Sayaka Yokoyama, Takashi Zaitsu, Mari Ohnuki, Fredrick Allan Clive Wright, Yoko Kawaguchi

Published in: Trials | Issue 1/2010

Login to get access

Abstract

Background

Previous research has shown the oxidizing properties and microbiological efficacies of chlorine dioxide (ClO2). Its clinical efficacies on oral malodor have been evaluated and reported only in short duration trials, moreover, no clinical studies have investigated its microbiological efficacies on periodontal and malodorous bacteria. Thus, the aim of this study was to assess the inhibitory effects of a mouthwash containing ClO2 used for 7 days on morning oral malodor and on salivary periodontal and malodorous bacteria.

Methods/Design

A randomized, double blind, crossover, placebo-controlled trial was conducted among 15 healthy male volunteers, who were divided into 2 groups. Subjects were instructed to rinse with the experimental mouthwash containing ClO2 or the placebo mouthwash, without ClO2, twice per day for 7 days. After a one week washout period, each group then used the opposite mouthwash for 7 days. At baseline and after 7 days, oral malodor was evaluated with Organoleptic measurement (OM), and analyzed the concentrations of hydrogen sulfide (H2S), methyl mercaptan (CH3SH) and dimethyl sulfide ((CH3)2S), the main VSCs of human oral malodor, were assessed by gas chromatography (GC). Clinical outcome variables included plaque and gingival indices, and tongue coating index. The samples of saliva were microbiologically investigated. Quantitative and qualitative analyses were performed using the polymerase chain reaction-Invader method.

Results and Discussion

The baseline oral condition in healthy subjects in the 2 groups did not differ significantly. After rinsing with the mouthwash containing ClO2 for 7 days, morning bad breath decreased as measured by the OM and reduced the concentrations of H2S, CH3SH and (CH3)2S measured by GC, were found. Moreover ClO2 mouthwash used over a 7-day period appeared effective in reducing plaque, tongue coating accumulation and the counts of Fusobacterium nucleatum in saliva. Future research is needed to examine long-term effects, as well as effects on periodontal diseases and plaque accumulation in a well-defined sample of halitosis patients and broader population samples.

Trial registration

ClinicalTrials.gov NCT00748943
Literature
1.
Krespi YP, Shrime MG, Kacker A: The relationship between oral malodor and volatile sulfur compound-producing bacteria. Otolaryngol Head Neck Surg. 2006, 135: 671-676. 10.1016/j.otohns.2005.09.036.CrossRefPubMed
2.
Tonzetich J: Production and origin of oral malodor: a review of mechanisms and methods of analysis. J Periodontol. 1977, 48: 13-20.CrossRefPubMed
3.
Miyazaki H, Sakao S, Katoh Y, Takehara T: Correlation between volatile sulfur compounds and certain oral health measurements in the general population. J Periodontol. 1995, 66: 679-684.CrossRefPubMed
4.
Murata T, Yamaga T, Iida T, Miyazaki H, Yaegaki K: Classification and examination of halitosis. Int Dent J. 2002, 52 (Suppl 3): 181-186.CrossRefPubMed
5.
Yaegaki K, Sanada K: Volatile sulfur compounds in mouth air from clinically healthy subjects and patients with periodontal disease. J Periodontal Res. 1992, 27: 233-238. 10.1111/j.1600-0765.1992.tb01673.x.CrossRefPubMed
6.
Nakano Y, Yoshimura M, Koga T: Correlation between oral malodor and periodontal bacteria. Microbes Infect. 2002, 4: 679-683. 10.1016/S1286-4579(02)01586-1.CrossRefPubMed
7.
Persson S, Edlund MB, Claesson R, Carlsson J: The formulation of hydrogen sulfide and methyl mercaptan by oral bacteria. Oral Microbiol Immunol. 1990, 5: 195-201. 10.1111/j.1399-302X.1990.tb00645.x.CrossRefPubMed
8.
van Steenberghe D, Avontroodt P, Peeters W, Pauwels M, Coucke W, Lijnen A, Quirynen M: Effect of different mouthrinses on morning breath. J Periodontol. 2001, 72: 1183-1191. 10.1902/jop.2000.72.9.1183.CrossRefPubMed
9.
Pianotti R, Lachette S, Dills S: Desulfuration of cysteine and methionine by Fusobacterium nucleatum. J Dent Res. 1986, 65: 913-917.CrossRefPubMed
10.
Loesche WJ, Kazor C: Microbiology and treatment of halitosis. Periodontol 2000. 2002, 28: 256-279. 10.1034/j.1600-0757.2002.280111.x.CrossRefPubMed
11.
Roldán S, Winkel EG, Herrera D, Sanz M, van Winkelhoff AJ: The effects of a new mouthrinse containing chlorhexidine, cetylpyridium chloride and zinc lactate on the microflora of oral halitosis patients: a dual-centre, double-blind placebo-controlled study. J Clin Periodontol. 2003, 30: 427-434. 10.1034/j.1600-051X.2003.20004.x.CrossRefPubMed
12.
Bosy A, Kulkarni GV, Rosenberg M, McCulloch G: Relationship of oral malodor to periodontitis: evidence of independence in discrete subpopulations. J Periodontol. 1994, 65: 37-46.CrossRefPubMed
13.
De Boever EH, Loesche WJ: Assessing the contribution of anaerobic microflora of the tongue to oral malodor. J A D A. 1995, 126: 1384-1393.
14.
Gürgan CA, Zaim E, Bakirsoy I, Soykan E: Short-term side effects of 0.2% alcohol-free chlorhexidine mouthrinse used as an adjunct to non-surgical periodontal treatment: a double-blind clinical study. J Periodontol. 2006, 77: 370-384. 10.1902/jop.2006.050141.CrossRefPubMed
15.
Lorenz K, Bruhn G, Heumann C, Netuschil L, Brecx M, Hoffmann T: Effect of two new chlorhexidine mouthrinses on the development of dental plaque, gingivitis, and discolouration. A randomized, investigator-blind, placebo-controlled, 3-week experimental gingivitis study. J Clin Periodontol. 2006, 33: 561-567. 10.1111/j.1600-051X.2006.00946.x.CrossRefPubMed
16.
Lynch E, Sheerin A, Claxson AWD, Atherton MD, Rhodes CJ, Silwood CJL, Naughton DP, Grootveld M: Multicomponent spectroscopic investigations of salivary antioxidant consumption by an oral rinse preparation containing the stable free radical species chlorine dioxide (ClO2). Free Radical Res. 1997, 26: 209-234. 10.3109/10715769709097801.CrossRef
17.
Yates R, Moran J, Addy M, Mullan PJ, Wade WG, Newcombe R: The comparative effect of acidified sodium chlorite and chlorhexidine mouthrinses on plaque regrowth and salivary bacterial counts. J Clin Periodontol. 1997, 24: 603-609. 10.1111/j.1600-051X.1997.tb00236.x.CrossRefPubMed
18.
Frascella J, Gilbert R, Fernandez P: Odor reduction potential of a chlorine dioxide mouthrinse. J Clin Dent. 1998, 9: 39-42.PubMed
19.
Grootveld M, Silwood CJ, Gill D, Lynch E: Evidence for the microbicidal activity of a chlorine dioxide-containing oral rinse formulation in vivo. J Clin Dent. 2001, 12: 67-70.PubMed
20.
Shinada K, Ueno M, Konishi C, Takehara S, Yokoyama S, Kawaguchi Y: A randomized, double blind, crossover, placebo-controlled clinical trial to assess the effects of a mouthwash containing chlorine dioxide on oral malodor. Trials. 2008, 9: 71-10.1186/1745-6215-9-71.CrossRefPubMedPubMedCentral
21.
Silwood CJ, Grootveld M, Lynch E: A multifactorial investigation of the ability of oral health care products (OHCPs) to alleviate oral malodour. J Clin Periodontol. 2001, 28: 634-641. 10.1034/j.1600-051x.2001.028007634.x.CrossRefPubMed
22.
Frascella J, Gilbert RD, Fernandez P, Hendler J: Efficacy of a chlorine dioxide-containing mouthrinse in oral malodor. Comp Cont Educ Dent. 2000, 21: 241-248.
23.
Quirynen M, Avontroodt P, Soers C, Zhao H, Pauwels M, Coucke W, van Steenberghe D: The efficacy of amine fluoride/stannous fluoride in the suppression of morning breath odour. J Clin Periodontol. 2002, 29: 944-954. 10.1034/j.1600-051X.2002.291010.x.CrossRefPubMed
24.
Tonzetich J: Oral malodour: an indicator of health status and oral cleanliness. Int Dent J. 1978, 28: 309-319.PubMed
25.
Löe H, Silness J: Periodontal disease in pregnancy. I. Prevalence and severity. Acta Odontol Scand. 1963, 21: 533-551. 10.3109/00016356309011240.CrossRefPubMed
26.
Silness J, Löe H: Periodontal disease in pregnancy. II. Correlation between oral hygiene and periodontal condition. Acta Odontol Scand. 1964, 22: 121-135. 10.3109/00016356408993968.CrossRefPubMed
27.
Winkel EG, Roldán S, van Winkelhoff AJ, Herrera D, Sanz M: The clinical effects of a new mouthrinse containing chlorhexidine, cetylpyridinium chloride and zinc-lactate on oral halitosis. A dual-center, double-blind placebo-controlled study. J Clin Periodontol. 2003, 30: 300-306. 10.1034/j.1600-051X.2003.00342.x.CrossRefPubMed
28.
Gomez SM, Danser MM, Sipos PM, Rowshani B, Welden van der U, Weijden van der GA: Tongue coating and salivary bacterial counts in healthy/gingivitis subjects and periodontal patients. J Clin Periodontol. 2001, 28: 970-978. 10.1034/j.1600-051x.2001.028010970.x.CrossRef
29.
Tadokoro K, Yamaguchi T, Kawamura K, Shimizu H, Egashira T, Minabe M, Oguchi H: Rapid quantification of periodontitis-related bacteria using a novel modification of Invader PLUS technologies. Microbiological Research. 2010, 165: 43-49. 10.1016/j.micres.2008.06.001.CrossRefPubMed
30.
Rosenberg M, McCulloch CA: Measurement of oral malodor: current methods and future prospects. J Periodontol. 1992, 63: 776-782.CrossRefPubMed
31.
Sopapornamorn P, Ueno M, Vachirarojpisan T, Shinada K, Kawaguchi Y: Association between oral malodor and measurements obtained using a new sulfide monitor. J Dent. 2006, 34: 770-774. 10.1016/j.jdent.2006.02.004.CrossRefPubMed
32.
Sandham JA: The FDI two-digit system of designating teeth. Int Dent J. 1983, 33: 390-392.PubMed
33.
Oho T, Yoshida Y, Shimazaki Y, Yamashita Y, Koga T: Characteristics of patients complaining of halitosis and the usefulness of gas chromatography for diagnosing halitosis. Oral Surg Oral Med Oral Pathol Oral Radio Endod. 2001, 91: 531-534. 10.1067/moe.2001.112543.CrossRef
34.
Awano S, Gohara K, Kurihara E, Ansai T, Takehara T: The relationship between the presence of periodontopathogenic bacteria in saliva and halitosis. Int Dent J. 2002, 52 (Suppl 3): 212-216.CrossRefPubMed
35.
Gornitsky M, Paradis I, Randaverde G, Malo AM, Velly AM: A clinical and microbiological evaluation of denture cleansers for geriatric patients in long-term care institutions. J Can Dent Assoc. 2002, 68: 39-45.PubMed
36.
Mohammad AR, Giannini PJ, Preshaw PM, Alliger H: Clinical and microbiological efficacy of chlorine dioxide in the management of chronic atrophic candidiasis: an open study. Int Dent J. 2004, 54: 154-158.CrossRefPubMed
37.
Takayama M, Sugimoto H, Mizutani S, Tanno K: Bactericidal activities of chlorine dioxide. J Antibact Antifung Agents. 1995, 23: 401-406.
38.
Ashimoto A, Chen C, Bakker I, Slots J: Polymerase chain reaction detection of 8 putative periodontal pathogens in subgingival plaque of gingivitis and advanced periodontitis lesions. Oral Microbiol Immunol. 1996, 11: 266-273. 10.1111/j.1399-302X.1996.tb00180.x.CrossRefPubMed
39.
Tanaka M, Yamamoto Y, Kuboniwa M, Nonaka A, Nishida N, Maeda K, Kataoka K, Nagata H, Shizukuishi S: Contribution of periodontal pathogens on tongue dorsa analyzed with real-time PCR to oral malodor. Microbes Infect. 2004, 6: 1078-1083. 10.1016/j.micinf.2004.05.021.CrossRefPubMed
40.
Bolstad AI, Jensen HB, Bakken V: Taxonomy, biology, and periodontal aspects of Fusobacterium nucleatum. Clin Microbiol Rev. 1996, 9: 55-71.PubMedPubMedCentral
41.
Sharma A, Inagaki S, Sigurdson W, Kuramitsu HK: Synergy between Tannerella forsythensis and Fusobacterium nucleatum in biofilm formation. Oral Microbiol Immunol. 2005, 20: 39-42. 10.1111/j.1399-302X.2004.00175.x.CrossRefPubMed
42.
Bradshaw DI, Marsh PD, Watson GK, Allison C: Role of Fusobacterium nucleatum and coaggration in anaerobe survival in plantonic and biofilm oral microbial communities during aeration. Infect Immun. 1998, 66: 4729-4732.PubMedPubMedCentral
43.
Roldán S, Herrera D, O'Connor A, Gonzalez I, Sanz M: A combined therapeutic approach to manage oral halitosis: A 3-month prospective case series. J periodontal. 2005, 76: 1025-1033. 10.1902/jop.2005.76.6.1025.CrossRef
44.
Kurata H, Awano S, Yoshida A, Ansai T, Takehara T: The prevalence of periodontopathogenic bacteria in saliva is linked to periodontal health status and oral malodour. J Med Microbiol. 2008, 57: 636-642. 10.1099/jmm.0.47706-0.CrossRefPubMed
45.
Hakuta C, Mori C, Ueno M, Shinada K, Kawaguchi Y: Evaluation of an oral function promotion program for the independent elderly in Japan. Gerodontol. 2009, 26: 250-258. 10.1111/j.1741-2358.2008.00269.x.CrossRef
46.
Roldán S, Herrera D, Santa-Cruz I, O'Connor A, Gonzalez I, Sanz M: Comparative effects of different chlorhexidine mouth-rinse formulations on volatile sulfur compound and salivary bacterial counts. J Clin Periodontol. 2004, 31: 1128-1134. 10.1111/j.1600-051X.2004.00621.x.CrossRefPubMed
47.
Charles CH, Mostler KM, Bartels LL, Mankodi SM: Comparative antiplaque and antigingivitis effectiveness of a chlorhexidine and an essential oil mouthrinse: 6-month clinical trial. J Clin Periodontol. 2004, 31: 878-884. 10.1111/j.1600-051X.2004.00578.x.CrossRefPubMed
48.
Bolanowski SJ, Gescheider GA, Suttin SVW: Relationship between oral pain and ethanol concentration in mouthrinses. J Periodontal Res. 1995, 30: 192-197. 10.1111/j.1600-0765.1995.tb01273.x.CrossRefPubMed
49.
Young A, Jonski G, Rölla G: Inhibition of orally produced volatile sulfur compounds by zinc, chlorhexidine or cetylpyridium chloride - effect of concentration. Eur J Oral Sci. 2003, 111: 400-404. 10.1034/j.1600-0722.2003.00063.x.CrossRefPubMed
50.
Nogueira-Filho GR, Duarte PM, Toledo S, Tabchoury CP, Cury JA: Effect of triclosan dentifrices on mouth volatile sulfur compounds and dental plaque trypsin-like activity during experimental gingivitis development. J Clin Periodontol. 2002, 29: 1059-1064. 10.1034/j.1600-051X.2002.291202.x.CrossRefPubMed
51.
Roldán S, Herrera D, Sanz M: Biofilms and the tongue: therapeutical approaches for the control of halitosis. Clin Oral Invest. 2003, 7: 189-197. 10.1007/s00784-003-0214-7.CrossRef
52.
53.
Kimoto K, Hamada N, Ohno M, Furuya M, Kushida M, Usui S, Toda S, Kawamura K, Okudera H, Hirata Y, Umemoto T, Arakawa H: Study on the bactericidal effects of chlorine dioxide gas. Bull Kanagawa Dent College. 2004, 32: 77-82.
54.
Suarez FL, Furne JK, Springfield J, Levitt MD: Morning breath odor: influence of treatments on sulfur gases. J Dent Res. 2000, 79: 1773-1777. 10.1177/00220345000790100701.CrossRefPubMed
55.
Carvalho MD, Tabchoury CM, Cury JA, Toledo S, Nogueira-Filho GR: Impact of mouthrinses on morning bad breath in healthy subjects. J Clin Periodontol. 2004, 31: 85-90. 10.1111/j.0303-6979.2004.00452.x.CrossRefPubMed
56.
Faveri M, Hayacibara MF, Pupio GC, Cury JA, Tsuzuki CO, Hayacibara RM: A cross-over study on the effect of various therapeutic approaches to morning breath odour. J Clin Periodontol. 2006, 33: 555-560. 10.1111/j.1600-051X.2006.00955.x.CrossRefPubMed
Metadata
Title
Effects of a mouthwash with chlorine dioxide on oral malodor and salivary bacteria: a randomized placebo-controlled 7-day trial
Authors
Kayoko Shinada
Masayuki Ueno
Chisato Konishi
Sachiko Takehara
Sayaka Yokoyama
Takashi Zaitsu
Mari Ohnuki
Fredrick Allan Clive Wright
Yoko Kawaguchi
Publication date
01-12-2010
Publisher
BioMed Central
Published in
Trials / Issue 1/2010
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/1745-6215-11-14

Other articles of this Issue 1/2010

Trials 1/2010 Go to the issue

Study protocol

Efficacy of n-3 polyunsaturated fatty acids and feasibility of optimizing preventive strategies in patients at high cardiovascular risk: rationale, design and baseline characteristics of the Rischio and Prevenzione study, a large randomised trial in general practice

Study protocol

Study protocol for the evaluation of an Infant Simulator based program delivered in schools: a pragmatic cluster randomised controlled trial

Methodology

Assessing the potential for outcome reporting bias in a review: a tutorial

Research

Heterogeneity prevails: the state of clinical trial data management in Europe - results of a survey of ECRIN centres

Study protocol

NEWHINTS cluster randomised trial to evaluate the impact on neonatal mortality in rural Ghana of routine home visits to provide a package of essential newborn care interventions in the third trimester of pregnancy and the first week of life: trial protocol

Study protocol

The fitness for the Ageing Brain Study II (FABS II): protocol for a randomized controlled clinical trial evaluating the effect of physical activity on cognitive function in patients with Alzheimer's disease