Halitosis - Emerging treatments

Lactobacillus salivarius WB21

Oil droplets containing Lactobacillus salivarius WB21 have been investigated to improve oral health and reduce halitosis. One study on oil droplets containing L salivarius WB21 found reduced intra-oral levels of periodontopathic bacteria, but this reduction may not correlate with changes in volatile sulfur compounds (VSCs).[57] In a randomised crossover trial, tablets containing L salivarius WB21 reduced the concentration of VSCs after 14 days, but there were no differences in organoleptic test scores between the probiotic and placebo periods.[58]

Streptococcus salivarius K12

The primary treatment for oral malodour is the reduction of bacterial populations by use of a variety of antimicrobial agents or mechanical devices. However, halitosis-related bacteria quickly repopulate the oral surfaces after treatment. Repopulating the tongue surface with Streptococcus salivarius K12, a benign commensal probiotic, may help to maintain improvements following chlorhexidine treatment.[59] In one study, children with halitosis treated with a combination of conventional oral hygiene, tongue scraping, chlorhexidine, and S salivarius K12 had significant and stable improvement in organoleptic test score at up to 3 months follow-up. Children treated with conventional oral hygiene, tongue scraping, and chlorhexidine (but no probiotic) also had improved organoleptic test scores, but it was not stable at follow-up.[60]

Lethal photosensitisation

The ability of laser irradiation in the presence of a photosensitising agent to induce lethal effect on oral bacteria is well documented. In one case series of 5 adolescents with halitosis, photodynamic therapy with methylene blue and red band laser irradiation resulted in a 31.8% reduction in VSCs.[61] In this era of increased incidence of antibiotic resistance, killing bacteria with laser or light energy in the presence of a photosensitising agent could prove to be a valuable treatment modality.[62]

Green tea

Many food products are claimed to be effective in controlling halitosis. The tea catechin epigallocatechin gallate (EGCg) has been found to suppress the mgl gene that encodes L-methionine-alpha-deamino-gamma-mercaptomethanelyase of the oral anaerobe Porphyromonas gingivalis. In addition, EGCg is bactericidal, and hence it may be a diet-derived means of reducing halitosis due to oral bacteria.[63] In one study, green tea powder temporarily reduced the concentration of VSCs in the exhaled air of 15 men with halitosis. However, no reduction was observed at 1, 2, and 3 hours after administration.[64] In a crossover trial of 54 adults with halitosis, sugar-free tablets containing green tea extract were significantly more effective than placebo at reducing VSCs immediately and 30 minutes after tablet consumption.[65]