 |
||||||||||||||||||||||
 |
 |
 |
 |
|
 |
|
 |
|
 |
 |
||||||||||||
|
||||||||||||||||||||||
 |
 |
||||||
|
Tongue Cleaning Methods: A Comparative Clinical Trial Employing a Toothbrush and a Tongue Scraper
J Peridontal July 2004 Background: It is estimated that approximately 85% of all halitosis cases have their origin within the mouth; of these, 50% are caused by tongue residues. Previous studies have established that hydrogen sulfide and mercaptans are the primary components of halitosis. Thus, tongue cleaning gains importance as a means of halitosis management. Methods: This investigation compared the efficacy of two mechanical methods for tongue cleaning through a handheld sulfide monitor. This crossover trial was carried out with 10 healthy subjects, 20 to 50 years old. Before the baseline measurement of the volatile sulfur compounds (VSCs), the subjects were instructed to refrain from any tongue cleaning method for 48 hours. The 10 participants were then placed in one of two groups (five each): 1) first week: tongue scraper, second week: soft-bristle toothbrush; 2) first week: toothbrush, second week: tongue scraper, with a 48-hour wash-out period between each week. Results: The baseline measurements were compared with those of the end of each week using the Dunn method (a = 0.01). The tongue scraper showed a 75% reduction in VSCs, while the toothbrush only achieved a 45% reduction in VSCs. Conclusion: Although the tongue coating was removed by both methods, the tongue scraper performed better in reducing the production of volatile sulfur compounds. J PeriodontoI2004;75:10091012. KEY WORDS Halitosis/etiology; halitosis/prevention and control; hydrogen sulfide/analysis; tongue; toothbrushing. * University of Sao Paulo, Faculty of Dentistry, Department of Dental Materials and Prosthesis, Ribeirao Preto, Sao Paulo, Brazil. University of Sao Paulo, Faculty of Pharmaceutical Sciences, Department of Pharmaceutical Sciences, Ribeirao Preto. The most common concept concerning individual health is the harmony of one's physical, mental, and social well-being. The simple absence of disease is not accepted as an indication of health. Besides embarrassment, shyness, and occasional difficulties in communicating in a foreign language in which one is not fully conversant, halitosis has been cited as an obstacle in personal relationships. Furthermore, it may signal the presence of disease. Previous studies have established that hydrogen sulfide and mercaptans are the primary components of halitosis. 1 ,2 According to Tommasi, halitosis can appear through two main mechanisms: 1) the odor substances released from the mouth and respiratory path by the passage of normal breath; and 2) the elimination of the already affected breath during hemathosis (deriving from odors eliminated by the lungs). 3 One mistaken concept blames the stomach for most halitosis cases. It is safe to say that only through gastric eructation (belching) will there be the elimination of aggressive breath from the stomach, since in resting conditions, the cardia zone is contracted and the sphincter pressure prevents reflux.4,5 Halitosis, also called fetor ex ore or fetor oris, is the offensive or unpleasant odor eliminated from the oral cavity. Much has been said regarding the etiology of halitosis: retention of odorous meal particles between the teeth; tongue coating; gingivitis; acute necrotic ulcerative gingivitis; periodontosis; dehydration after physical activity; caries; badly finished, cleaned, or adapted prosthesis; premenstrual periods; smoker's breath; surgical healing or tooth extraction wounds; intestinal dyspepsia; esophagus reflux; and sinusitis and rhinosinusitis. The etiology of bad breath is usually (85% to 90%) an oral cavity phenomenon. The nose is responsible for 5% to 10%, followed by the tonsils (3%), with less than 1 % of the etiology originating below the tonsils. The overgrowth of proteolytic, anaerobic bacteria on the tongue's surface has been reported as a halitosis etiologic factor. Other major etiologies in the production of halitosis are periodontal diseases, which may be treated by improving oral hygiene habits. The simple removal of the tongue coating (a bio-film deposit over the tongue dorsum) with adequate instruments may contribute considerably to reducing mouth-originated halitosis. The aim of this clinical investigation was to compare the efficacy of a polystyrene tongue scraper to a soft bristle toothbrush in removing the tongue-dorsum coating, with the intention of reducing mouth-originated halitosis. For measurement purposes, a handheld sulfide monitor was employed. MATERIALS AND METHODS This crossover study was approved by the Ethical Committee. Fifty-two dental students or employees of the dental school were initially screened. Exclusion criteria included: periodontal disease; gastric conditions; presence of tonsils; smokers; or presence of hard or soft oral tissue lesions. We attempted to identify individuals with similar health conditions and eating habits. The study population consisted of 10 healthy subjects (both genders; age range 20 to 50 years) all of whom signed informed consent statements. Oral VSC values were measured using a handheld sulfide monitor. r Before the initial baseline VSC measurement, the subjects were instructed to refrain from any tongue-cleaning method for a 48-hour period. These volunteers were tested in the morning and asked to refrain from other oral hygiene activities as well, such as drinking, smoking, and eating, particularly candies since the flavors can mask the breath and induce a false-positive result. The 10 individuals were randomized into two groups of five each: group 1) first week: polystyrene tongue scraper,§ second week: nylon soft-bristle toothbrush;1I group 2) first week: soft-bristle toothbrush, second week: polystyrene tongue scraper, with a 48-hour wash-out period between the weeks. The volunteers were instructed to use the cleaners after each meal and in the morning for 3 minutes, from the dorsum - posterior to the dorsum -anterior region of the tongue, according to the directions of the tongue scraper manufacturer. The handheld sulfide monitor was employed according to the manufacturer's directions. The equipment is set to zero by shaking it 4 to 5 times, to eliminate any residual odors from its previous use. When the monitor is turned on, it emits a beep; when a second beep is heard the volunteer blows into the airflow passage. We changed this procedure for hygiene reasons, using a disposable 6 mm x 80 mm straw which was discarded after use. In a previous pilot study (unpublished data) there was no alteration in the effectiveness of the equipment using the straw. After a third beep, the breath odor level is measured by a graphic displaying one of the following values: 1) odorless, normal; 2) light odor, normal; 3) moderate odor, bad breath - perceptible; or 4) strong odor, bad breath - perceptible. If no number appears, there is a reading error and the procedure must be repeated after cleaning the air opening with a dry cloth and shaking the monitor. RESULTS We achieved highly satisfactory results with both tongue dorsum coating removal methods, confirmed by the averages of volatile sulfur compound indexes (VSCIs) at the initial (I) and final (F) periods (Table 1) (75% reduction with the scraper and 40% with the toothbrush). The results of the statistical analysis (non-parametric statistics, Dunn method)22 were significant at the 0.1 % level in five of the paired samples. Only the two initial YSCls were not significant for both the soft-bristle toothbrush and the tongue scraper. This is important, since it reveals there was the randomization of the distribution of methods, although 100% of the subjects presented an index of 4 after refraining from any tongue-cleaning method for a 48-hour period (time zero) (Table 2). A simple questionnaire was filled out by each of the volunteers, evaluating the two tools. There were complaints of nausea with the toothbrush (60%; four subjects from group 1 and two from group 2), and of tongue mucous traumatism (10%; one subject from group 1 when using the toothbrush), but under clinical examination, slight injury was observed due to the removal of some filiform papillae. All volunteers were receptive to using the tongue scraper. DISCUSSION Furred tongue constitutes the major cause of mouth originated halitosis and does not receive adequate attention from medical and dental health professionals. This pathological status is characterized by deposits of desquamated epithelial cells, leukocytes, microorganisms (fungus and bacteria), and food residues among filiform papillae, giving the tongue a pale appearance (or brownish-yellow in smokers). The reason for the tongue coating is esophageal antiperistalsis, a condition in which the cardia does not prevent small waves of muscular.The proteolytic activity of microorganisms in the oral cavity contributes to the volatile sulfur compounds found in malodorous mouth air. The metabolites include many compounds, such as hydrogen sulfide, methyl mercaptan, dimethyl sulfide, indole, skatole, and volatile fatty acids and polyamines. Dorsal tongue cleaning is not a common habit among Brazilians, at least with a tongue scraper. We agree with Figueiredo et al. that the measurement of halitosis by multiple judges is embarrassing and includes subjectivity and reproducibility problems. Furthermore, Rosenberg et al. showed that a simple sulfide monitor could be used to measure the concentration of YCS in air expelled from the mouth with a significant positive correlation between YCS and organoleptic ratings The monitor in the current study was a valid alternative to measuring halitosis by judges, as shown by the results (Tables 1 and 2). This is a simple, quick, and easy-to-use reproducible technique for measuring breath-related sulfides. Moreover, the equipment avoids risk of pulmonary infections, since it is designed for personal use, although we adapted it for research purposes using a disposable straw. In the present study, both the tongue scraper and soft-bristle toothbrush proved efficient in removing the tongue coating, although the tongue scraper had a higher efficacy (35% fewer volatile sulfur compounds emitted). CONCLUSION In summary, both tongue-coating removal methods evaluated were efficient, but the tongue scraper was noticeably superior. The importance of tongue coating in the etiology of halitosis was corroborated by use of a handheld sulfide monitor, which proved to be feasible, quick, and easy to use. |
|
||||
 |
||||||
|
 |
| Fresh breath tips, contests and giveaways, oral care product discounts and more! Sign up now to get Dr. Bill's latest bad breath treatment advice in our newsletter. |
|
| Privacy Policy |
Security Notice |
Ordering Policy |
Return Policy |
BRx News |
Corporate Website |
Contact Us
|
About
BreathRX Breakthrough |
Professional
Testimonials |
Brush |
Scrape |
Rinse
|
Refresh |
Meet
Dr. Bill |
Register
|
Home
© 2005 Discus Dental, All Rights Reserved. |
|