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Aim: To evaluate the long-term effects of a zinc acetate and chlorhexidine diacetate mouth rinse (Zn/CHX) on intra-oral halitosis., Materials and Methods: Forty-six adults with intra-oral halitosis were randomized into a 6-month, double-blind, placebo-controlled clinical study. The presence of intra-oral halitosis was evaluated at baseline, 3 and 6 months after treatment by assessment of organoleptic score (OLS) and by total volatile sulphur compounds (T-VSC), hydrogen sulphide (H 2 S) and methyl mercaptan (MM) concentrations in exhaled air., Results: A Zn/CHX mouth rinse provided significantly better control of intra-oral halitosis than a placebo mouth rinse. At 3 and 6 months, individuals rinsing with the Zn/CHX rinse presented with reductions of the OLS, T-VSC (p < .01, respectively), H 2 S (p < .001), and MM (p < .01) in subjects' exhaled air. At 6 months, 68.2% of individuals using the Zn/CHX rinse experienced a 1 or 2 category improvement in OLS compared with 19.1% of placebo-treated subjects. 91% of subjects in the Zn/CHX group were categorized as being effectively treated for intra-oral halitosis (i.e. H 2 S < 112 ppb), compared to 43% in the placebo group., Conclusion: Zn/CHX mouth rinse provides effective long-term efficacy against intra-oral halitosis, assessed both objectively and subjectively. With regular rinsing, the effect was sustained for 6 months., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Aim: To evaluate the effect of different mouth rinses 12 h after rinsing on genuine intra-oral halitosis., Materials and Methods: Twenty-four adults with halitosis were included in a double-blind, crossover, randomized clinical trial. Halitosis was evaluated 12 h after rinsing with placebo and five mouth rinse products containing zinc acetate and chlorhexidine diacetate; zinc lactate, chlorhexidine and cetylpyridinium chloride; zinc acetate and chlorhexidine diacetate with reduced amounts of mint and menthol; zinc chloride and essential oil; and chlorine dioxide using the organoleptic method and a gas chromatograph. Test periods were separated by 1 week., Results: Hydrogen sulphide (H2 S), methyl mercaptan (MM) and the organoleptic scores (OLS) were significantly reduced 12 h following rinsing with all substances compared to placebo (P < 0.05). H2 S was more effectively reduced after rinsing with zinc acetate and chlorhexidine diacetate and zinc acetate and chlorhexidine diacetate with reduced amounts of mint and menthol compared to rinsing with zinc chloride and essential oil (P < 0.05), and significantly lower values of MM were obtained after rinsing with zinc acetate and chlorhexidine diacetate compared to zinc lactate, chlorhexidine and cetylpyridinium chloride (P < 0.05). The percentage effectively treated individuals (H2 S (<112 ppb), MM (<26 ppb) and OLS score <2) varied from 58% percentage (zinc acetate and chlorhexidine diacetate) to 26% (zinc chloride and essential oil)., Conclusion: All treatments resulted in reduction in halitosis 12 h after rinsing compared to placebo. H2 S and MM were most effectively reduced by zinc acetate and chlorhexidine diacetate., (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: This study aims to assess the effects of rinsing with zinc- and chlorhexidine-containing mouth rinse with or without adjunct tongue scraping on volatile sulfur compounds (VSCs) in breath air, and the microbiota at the dorsum of the tongue., Material and Methods: A randomized single-masked controlled clinical trial with a cross-over study design over 14 days including 21 subjects was performed. Bacterial samples from the dorsum of the tongue were assayed by checkerboard DNA-DNA hybridization., Results: No halitosis (identified by VSC assessments) at day 14 was identified in 12/21 subjects with active rinse alone, in 10/21 with adjunct use of tongue scraper, in 1/21 for negative control rinse alone, and in 3/21 in the control and tongue scraping sequence. At day 14, significantly lower counts were identified only in the active rinse sequence (p < 0.001) for 15/78 species including, Fusobacterium sp., Porphyromonas gingivalis, Pseudomonas aeruginosa, Staphylococcus aureus, and Tannerella forsythia. A decrease in bacteria from baseline to day 14 was found in successfully treated subjects for 9/74 species including: P. gingivalis, Prevotella melaninogenica, S. aureus, and Treponema denticola. Baseline VSC scores were correlated with several bacterial species. The use of a tongue scraper combined with active rinse did not change the levels of VSC compared to rinsing alone., Conclusions: VSC scores were not associated with bacterial counts in samples taken from the dorsum of the tongue. The active rinse alone containing zinc and chlorhexidine had effects on intra-oral halitosis and reduced bacterial counts of species associated with malodor. Tongue scraping provided no beneficial effects on the microbiota studied., Clinical Relevance: Periodontally healthy subjects with intra-oral halitosis benefit from daily rinsing with zinc- and chlorhexidine-containing mouth rinse.

Objectives: To assess the effects on intra-oral halitosis by a mouth rinse containing zinc acetate (0.3%) and chlorhexidine diacetate (0.025%) with and without adjunct tongue scraping., Materials and Methods: Twenty-one subjects without a diagnosis of periodontitis were randomized in a cross-over clinical trial. Organoleptic scores (OLS) were assessed to define intra-oral halitosis by total volatile sulfur compound (T-VSC) measurements and by gas chromatography., Results: Twenty-one subjects with a mean age of 45.7 years (SD: ±13.3, range: 21-66). The OLS were significantly lower following active rinse combined with tongue scraping (p < 0.001) at all time points. Immediately after, at 30 min, and at day 14, the T-VSC values were lower in the active rinse sequence than in the negative rinse sequence (p < 0.001, p < 0.001 and p < 0.05, respectively). At 30 min and at day 14, the hydrogen sulfide (H(2)S) and methyl mercaptan (MM) values were lower in the active rinse sequence compared to the inactive rinse sequence (p < 0.001). The inactive rinse sequence with tongue scraping reduced T-VSC at 30 min (p < 0.001) but not at 14 days. Similar reductions in T-VSC, H(2)S and MM were found in the active rinse sequence with or without tongue scraping., Conclusion: The use of a tongue scraper did not provide additional benefits to the active mouth rinse, but reduced OLS and tongue coating index.

Objective: A controlled, clinical, double-blind study was conducted to assess the efficacy of a sugar-free chewing gum containing zinc acetate and magnolia bark extract (MBE) on oral volatile sulfur-containing compounds (VSC) versus a placebo sugar-free chewing gum for two hours., Methods: To participate in the study, subjects had to have at least 24 of their teeth, no report of oral and systemic diseases, and no removable dentures. All 168 eligible participants had to avoid any professional oral hygiene, refrain from taking medicine for two weeks, and not be menstruating. They were also instructed not to brush their teeth and tongue, smoke, drink alcohol, or eat onion, garlic, or licorice for the six-hour period before the visit and during the test. Moreover, to join the protocol, they had to show a VSC score of > or = 75 ppb at the baseline measurement. One-hundred and twenty-three subjects (67 men and 56 women, mean age 37) met the criteria at baseline and were entered into either the test or control group by assignment from a table of randomized numbers. The test chewing gum (2.23 g) contained zinc acetate 0.012% and magnolia bark extract 0.15% in weight; the control gum was equivalent without these active agents. The OralChroma device was utilized to evaluate total oral VSC. Their levels were recorded at baseline, after ten minutes of mastication, after one hour, and after two hours. Data were analyzed with SPSS software and the level of significance was set at alpha = 0.05., Results: One-hundred and twenty-three subjects completed the trial (62 in the control group and 61 in the test group); none reported problems linked to zinc acetate or magnolia bark extract. The mean percentage reductions from baseline at the end of the 10-minute chewing were 31.2% in the control group (p < 0.05) and 50.9% in the test group (p < 0.05). One hour later the reductions were 6.9% in the control group and 27.6% in the test group (p < 0.05); two hours later the reductions were 2.3% in the control group and 13.6% in the test group. The comparison of the two groups after baseline adjustment showed a statistically significant difference (p < 0.05) in VSC reductions between the test and control chewing gums at the end of the mastication period and after one hour., Conclusion: Chewing gum containing zinc acetate and magnoliabark extract can significantly reduce the oral VSC levels for more than one hour. Moreover, the test chewing gum reduces oral VSC significantly more than a control chewing gum.

Unlabelled: The anti-VSC (volatile sulphur compounds) effect of zinc is known to be associated with free zinc ions., Objective: To examine whether zinc salts with low stability constants were more suitable as sources of zinc in zinc lozenges than zinc salts with high stability constants. The former provide free zinc ions upon dissolution in water, whereas the latter provide few such ions., Design and Participants: Identical lozenges were produced which contained either zinc acetate, zinc gluconate (low stability constants), zinc citrate or amino-acid chelated zinc (extremely high stability constants). All the lozenges contained 0.1 per cent of zinc. A test panel of 10 volunteers used the different lozenges randomly. VSC were measured by GC., Results and Conclusion: The lozenge with the highest stability constant was as effective as those with very low stability constants. The anti-VSC effect was thus not related to this constant. These findings may be explained by the possibility that alternative ligands with stronger affinity for zinc than the original ligands in the lozenges may be present in the oral cavity. An in vitro experiment indicated that the sulphide ion (S2-) may be such a ligand.

Volatile sulphur compounds (VSC) produced in the oral cavity, are a major cause of oral malodour. Zinc (Zn) ions inhibit VSC formation. The objective of this study was to examine whether Zn salts with low stability constants were more suitable as sources of Zn in lozenges than salts with high stability constants. The former provide free Zn ions upon dissolution in water, whereas the latter provide almost no free Zn. Identical lozenges containing Zn-acetate and -gluconate, which have low stability constants, and Zn citrate and amino acid-chelated Zn, which have extremely high stability constants, were tested. All the lozenges contained 0.9% w/w Zn. Ten volunteers sucked the lozenges until dissolved, and oral VSC were measured by gas chromatography. Zn-acetate, -gluconate and -chelate had an impressive anti-VSC effect even 3 h after the lozenges were taken. Zn citrate had significantly less effect than the other lozenges except Zn acetate after 2 and 3 h. It was concluded that the anti-VSC effect was not related to the stability constants of the Zn compounds tested. Alternative ligands. with stronger affinity for Zn than the ligands in the lozenges, must be present in the oral cavity to explain these results. It is suggested that the sulphide ion may serve this function.

Oral malodor is mainly caused by the presence of volatile sulfur-containing compounds (VSC) produced by proteolytic periodontopathic bacteria in the oral cavity. Different solutions have been used as mouthrinses, trying to reduce malodor, and a large number is on the market. The aim of this study was to compare the effect of three commercially available mouthrinses with a simple inexpensive solution of zinc (zinc acetate 0.1%) on the production of VSC in vivo. Two of the solutions contained triclosan, one of them with fluoride and the other with sodium bicarbonate, and the third one contained herbal components. Seven healthy subjects rinsed with cysteine to induce production of VSC at baseline. After halitosis induction and VSC measurements, the subjects rinsed with the test solution, and mouth airVSC analyses were then performed by means of gas chromatography subsequent to repeated cysteine rinses after 30, 60, and 120 min. The data were calculated as percentage reduction of VSC from baseline. The percentage reduction of VSC decreased over time for all experimental groups. Zinc acetate had clearly the highest percentage reduction, starting from 95.68% at 30 min and with 69.27% after 2 h. The three other mouthrinses produced a VSC reduction of 23.92% 49.86% after 30 min, decreasing to 13.06%-37.09% after 2 h. One-way ANOVA (P = 0.05) was applied, and comparisons showed no differences between the commercially available solutions, but zinc acetate was significantly better than these. It may be concluded that some commercial mouthrinses are markedly less effective than a simple and cheap solution of zinc acetate.

Volatile sulfur-containing compounds (VSC) are known to constitute the major component of halitosis. Aqueous solutions of zinc salts have been shown to reduce the levels of VSC produced orally. The aim of the present study was to examine whether zinc could be made available in the oral cavity and inhibit VSC production when delivered by a chewing gum. VSC measurements were carried out on the 'morning breath' of 11 test subjects and re-examined after the use of test solutions containing 0.02% zinc chloride, 0.2% chlorhexidine, or water or the use of chewing gums containing 2 mg, 0.5 mg, or 0 mg zinc acetate. The results showed that similar amounts of zinc in mouthrinses or chewing gum had the same effect, with a reduction of the oral VSC of 45%. Chewing gum thus seems to be a viable alternative for delivering zinc to reduce VSC levels in the oral cavity.