Is there a role for
alternative therapies in controlling intra-oral
halitosis? Treatments other than tongue cleaning and anti-
halitosis products containing
zinc, chlorhexidine and
cetylpyridinium chloride were considered as
alternative therapies. Four databases were searched (PubMed, EMBASE, Web of Science and The Cochrane Library). Inclusion criteria were: examination of alternative
halitosis therapies, study population with oral malodour, a (negative or positive) control group and evaluation of breath odour via organoleptic and/or instrumental assessment. Data were extracted for descriptive analysis. The screening of 7656 titles led to the inclusion of 26 articles. Analysis showed heterogeneity concerning the population of interest (from
cysteine-induced to genuine
halitosis), the examined treatment and the reported outcomes. This made a meta-analysis impossible.
Essential oils,
fluoride-containing products and herbal substances were the most studied. Results varied enormously and none of the active ingredients had an unambiguously positive effect on the malodour. The risk of bias was assessed as high in all articles. Given the fact that little evidence was found for each of the investigated treatments, it could be concluded that there is currently insufficient evidence that
alternative therapies are of added value in the treatment of
halitosis.Clinical relevanceScientific rationale:
Halitosis is a common problem causing social isolation. Out of embarrassment, patients search the internet, leading to many questions about alternative solutions (e.g. oil pulling, herbs). This is the first systematic review on these
alternative therapies.Principal findings: Results varied among studies. Some promising results were found for
fluoride-containing
toothpastes and probiotics. For other products (such as herbal and antibacterial products and
essential oils) results were inconsistent. Long-term follow-up studies on these products are scarce. Moreover, the quality of the studies was poor.Practical implications:No clear evidence was found to support a certain alternative anti-
halitosis therapy.