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Tongue-Cleaning Methods: A Comparative Clinical Trial Employing a Toothbrush and a Tongue Scraper
Abstract
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.
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.
The baseline measurements were compared with those of the end of each week using the Dunn method (alpha = 0.01). The tongue scraper showed a 75% reduction in VSCs, while the toothbrush only achieved a 45% reduction in VSCs.
Although the tongue coating was removed by both methods, the tongue scraper performed better in reducing the production of volatile sulfur compounds.
... Há uma correlação direta entre saburra lingual e concentração de CSVs (Calil et al., 2009;Miyazaki et al., 1995). A remoção mecânica dessa saburra lingual é recomendada como cuidado caseiro para controle da halitose intraoral (Quirynen et al., 2004;Seeman et al., 2014), uma vez que reduz o substrato para a degradação pelas bactérias anaeróbias gram-negativas e, consequentemente, os níveis de CSVs orais (Calil et al., 2009;Pedrazzi et al., 2004;Quirynen et al., 2004;Seemann et al., 2001;Memon et al., 2023;Motta et al., 2024). Os raspadores linguais foram desenvolvidos para esta finalidade (Laleman et al., 2017;Zanotti et al., 2016) e são comercialmente disponíveis em diferentes desenhos, geralmente de plástico ou metal (Beekmans et al., 2016;Dwivedi et al., 2019;Singh et al., 2022;Timmesfeld et al., 2021). ...
... Os raspadores linguais foram desenvolvidos para esta finalidade (Laleman et al., 2017;Zanotti et al., 2016) e são comercialmente disponíveis em diferentes desenhos, geralmente de plástico ou metal (Beekmans et al., 2016;Dwivedi et al., 2019;Singh et al., 2022;Timmesfeld et al., 2021). As escovas dentais também podem ser usadas para limpeza da língua (Hughes & Mcnab, 2008), mas são menos efetivas que os raspadores linguais (De Geest et al., 2016;Pedrazzi et al., 2004;Seemann et al., 2001) porque geralmente provocam náuseas (Quirynen et al., 2004). ...
O objetivo deste trabalho foi comparar um raspador de língua obtido de garrafas de polietilenotereftalato (PET) com um modelo comercial (COM). Um desenho paralelo, controlado e randomizado foi usado. Dos 61 voluntários do Departamento de Odontologia da Universidade Federal de Sergipe, 30 atenderam aos critérios de inclusão e exclusão para distribuição aleatória em 2 grupos: PET (n=15) e COM (n=15). Na consulta inicial, o Índice de Saburra Lingual de Winkel (ISL-W) foi medido antes (T0) e imediatamente após (T1) remoção da saburra lingual realizada pelo profissional, que forneceu instruções para uso caseiro do raspador 2 vezes ao dia. Após 14 dias, o ISL-W foi mensurado em T0 e T1, com remoção da saburra feita pelo participante. Dos 30, 1 do grupo COM não retornou para consulta de 14 dias. Os dados obtidos em T0 e T1 foram submetidos ao teste t-Student pareado (α=0,05). As diferenças entre T0 e T1 foram transformadas em valores percentuais e analisadas com teste t de Student não pareado (α=0,05). Os dados de T0 das consultas inicial e após 14 dias foram submetidos ao teste t-Student pareado (α=0,05). Os resultados indicaram que os 2 raspadores reduziram significantemente o ISL-W (P<0,05), com percentuais de redução semelhantes: PET (34±36%) e COM (32±22%); houve redução significante do ISL-W após 14 dias de uso caseiro dos raspadores de língua (P<0,01). Concluiu-se que o raspador de língua PET foi capaz de remover a saburra lingual, com resultados semelhantes ao COM, reduzindo o ISL-W após 14 dias de uso caseiro.
... Possible explanations for the changes in GI and PI after bariatric surgery are the presence of tongue coating (Dupim Souza et al., 2013), dry mouth, and stick plaque accumulation, which could be due to the type of diet in the first month, which started with clear liquid, colored liquid, and semi-liquid that led to a decrease in chewing function and stimulated salivation (Nakagawa et al., 2017). According to multiple studies, the tongue coating is primarily responsible for halitosis of oral origin (Lee et al., 2003;Pedrazzi et al., 2004;Tsai et al., 2008). Furthermore, it is possible to notice a change in diet with a higher feeding frequency of small meals and soft foods (Schneider and Knieknecht, 1986) that adhere to the tooth surface throughout the day, together with a reduction in salivary flow, which could explain the increase in PI and GI in these individuals (Hague and Baechle, 2008;Marsicano et al., 2011;Marsicano et al., 2012;Maria de Souza et al., 2018). ...
Background
The association between sleeve gastrectomy and halitosis remains relatively unknown. Therefore, this study aimed to evaluate the effect of sleeve gastrectomy on halitosis and the oral bacterial species associated with halitosis in patients with obesity.
Methods
This was a prospective longitudinal cohort study that examined patients before and after sleeve gastrectomy and followed the patients at three time intervals (1, 3, and 6 months) after sleeve gastrectomy. Clinical periodontal measurements (plaque index [PI], gingival index [GI], and probing depth [PD]) were obtained. In addition, plaque samples were collected for quantification of the periodontopathogenic bacteria: Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, and Fusobacterium nucleatum using real-time quantitative polymerase chain reaction (qPCR). In addition, breath samples were collected to analyze the concentration of volatile sulfur compounds (VSCs), namely hydrogen sulfide (H2S), methyl mercaptan (CH3SH), and dimethyl sulfide (CH3SCH3), via portable gas chromatography (Oral Chroma™).
Results
Of the 43 patients initially included, 39 completed the study, with a mean age of 32.2 ± 10.4 years. For PI and GI repeated measurements one way analysis of variance showed a significant increase (p-value < 0.001 for both) one month after surgery, with mean values of 1.3 and 1.59, respectively, compared to the baseline. During the same period, the number of P. gingivalis increased, with a p-value = 0.04. Similarly, the levels of hydrogen sulfide (H2S) and methyl mercaptan (CH3SH) increased significantly in the first month after surgery (p-value = 0.02 and 0.01, respectively).
Conclusion
This study demonstrated that sleeve gastrectomy may lead to increased halitosis one month post-surgery, attributed to elevated and P. gingivalis counts, contributing to the development of gingivitis in obese patients who underwent sleeve gastrectomy. This emphasizes the importance of including oral health professionals in the multidisciplinary team for the management of patients undergoing bariatric surgery
... When the identified cause is the tongue coating, periodontitis or caries, the primary way to reduce intraoral halitosis is to eliminate the bacteria synthetizing the chemical compounds responsible for malodor [46,84] through a mechanical reduction of the microorganisms [18]. Patients must receive guidance about brushing their teeth, mechanical cleanliness of the tongue [84] and flossing or interdental cleaning devices such as interdental brushes [15,[85][86][87]. Even though oral hygiene practices are a daily issue, some people have a lack of proper knowledge about the correct execution and frequency of such practices [88]. ...
Objective: Halitosis is the offensive odor emanated by the oral and nasal cavities and perceived by the individual and/or by other people. Halitosis is a symptom that directly impacts on the social aspects of an individual’s life and may be a sign for a systemic disorder in some cases. Material and Methods: A search was conducted on the literature in order to gather the main aspects about halitosis and make a review about the main features necessary to the clinical practice when a professional deals with a patient with halitosis. Results: The information was summarized and discussed with a focus on what clinicians should be aware of when dealing with a patient with halitosis. Conclusion: Halitosis is a prevalent symptom that affects approximately 25% of the individuals. Its classification takes into consideration the origin of the compounds producing the malodor. The diagnosis must take into consideration the various etiological possibilities before defining the treatment. The treatment must be focused on the cause and since there is a wide range of possible causes, halitosis needs a multidisciplinary approach. KEYWORDS Dimethyl sulfide; Halitosis; Hydrogen sulfide; Odorants; Oral hygiene.
... Therefore it is not surprising that most of all fashion models clean the tongue. For this purpose they prefer the toothbrush, although tongue scrapers are superior (Pedrazzi et al. 2004). ...
Self-reliant oral health behavior exert great influence on the oral health of our society. The aim of the present study was to find out whether there is an occupation-related difference in the oral health behavior between dental students, students of other disciplines, and fashion models in German-speaking Switzerland. The survey comprised 19 questions which were asked using a web-based anonymous questionnaire. The investigation particularly inquired about employed auxiliaries and their application for an improvement of oral hygiene. In addition, the satisfaction with the own teeth and smile as well as the influence of the occupation or the study on oral hygiene were examined. Included in this evaluation were 204 dental students, 257 students of other disciplines, and 117 fashion models aged between 21 and 25 years. The evaluation reveals that the state of knowledge and the professional relationship affect the practice of oral hygiene, in particular among dental students. Fashion models, however, are most intensively concerned with body care and oral hygiene. Their attention is directed particularly to means supposed to improve the smile as well as to ensure fresh breath. Dental students and fashion models constitute a selected minority clearly demarcated from students of other disciplines regarding a higher awareness of self-reliant oral hygiene. The comparatively minor rating of oral health in a group of basically well-trained individuals suggests great need of educational work in the general population.
Aim: This study aimed to explore the dental students’ contemporary oral hygiene practices, their knowledge of oral care procedures, and determine the effect of dental education on eventual changes in the oral hygiene habits of the students of two different dental faculties. Methods: This study included 377 students in two dental faculties. Habits, knowledge, and attitudes regarding dental care were obtained from the questionnaire. Statistical analysis of the data was performed by applying the Chi-Square test. Results: The students at Ankara Medipol University (52.3%) had a significantly higher knowledge of the working principle of power toothbrushes (oscillating-rotating) (p
Background
To evaluate children’s and parents’ practice and attitude toward oral hygiene and their knowledge about oral hygiene.
Methods
This cross-sectional questionnaire-based study was conducted on randomly selected children who were seen in the Pediatric dentistry clinic in different Royal Medical Services hospitals. A modified questionnaire was used to gather information from the child or parents to gather the child’s demographic data and evaluate the children’s and parents’ practice and attitude toward oral hygiene, their knowledge about oral hygiene, information about the parent and family, and oral examination, the questionnaire questions' reliability and validity were assessed by test–retest and Cronbach's Alpha test.
Results
Three hundred seventy four patients were included, and the average age was 5.06 ± 3.58 SD years. Children’s and parents’ practice toward oral hygiene was inadequate where the majority (83.3%) brush their teeth occasionally, change their toothbrushes infrequently, apply toothpaste inappropriately, and less than half (47.2%) clean their tongue after teeth brushing. A significant number (73%) of candidates were aware that oral health has a significant role in their general health and can prevent dental problems. Participants agreed that maintaining a healthy mouth is an individual responsibility. The majority of participants came from large family size (the average family members 6.1 ± 1.7 SD) who live below the poverty line.
Conclusion
Our study demonstrated that awareness of oral health status in children below the age of 12 was poor. Although their oral knowledge was good their attitude and behavior were inadequate. These findings urge the need for expanded, well-organized, preventive educational programs that include school’s syllabus, house visits, and hospitals for parents and children alike.
In this study, we aimed to evaluate the halitosis and pain threshold of the peri-implant soft tissues in individuals rehabilitated with implant-supported prostheses. Forty-eight subjects were divided into four groups (n = 12) according to their prosthetic rehabilitation: single-tooth fixed prosthesis, multi-tooth fixed prosthesis, overdentures, and the Brånemark protocol. Halitosis was measured using a halimeter, whereas the pain threshold was measured using Von Frey monofilaments. Measurements were taken before (t0) and 30 days after (t1) placement of healing caps, and at the time of (t2) and 30 days after (t3) prosthetic placement. Halitosis data were analyzed using the chi-square test and Bonferroni correction (p < 0.05). Two-way ANOVA and Tukey’s test (p < 0.05) were used to analyze pain threshold data. We noted an association between halitosis and time for the Brånemark protocol [X2(6) = 18.471; p = 0.005] and overdenture groups [X2(6) = 17.732; p = 0.007], and between halitosis and type of prosthesis only at t0 [X2(6) = 12.894; p = 0.045]. The interaction between time and the type of prosthesis significantly interfered with the mean pain threshold values (p = 0.001). At most time points, the majority of participants in each group had clinically unacceptable halitosis. After 30 days of using the prostheses, the overdenture group had a lower pain threshold compared to the Brånemark protocol group.
Background
Tongue coating consists of oral bacteria, desquamated epithelium, blood cells, and food residues and is involved in periodontal disease, halitosis, and aspiration pneumonia. Recently, a tongue brush with sonic vibration was developed to clean the tongue. This comparative study examined the extent of tongue coating, its effects on the tongue, bacterial count particularly on the posterior dorsum of the tongue, and the degree of pain using a manual tongue brush and the newly developed sonic tongue brush.
Materials and methods
Patients’ extent of tongue coating and the quantity of bacteria were analysed before and after brushing with a sonic or manual nylon tongue brush. Moreover, the impressions of the dorsum linguae were obtained before and after brushing to establish models that were observed under a stereo microscope to evaluate tongue trauma. Pain caused during the use of these brushes was evaluated based on the numerical rating scale (NRS).
Results
The extent of tongue coating and number of bacteria decreased in both the sonic and manual nylon brush groups after tongue cleaning; however, no significant differences were noted. Tongue trauma evaluation revealed that the tongue surface was significantly scratched in the manual brush group compared with the sonic brush group. NRS-based pain evaluation revealed no significant differences.
Conclusions
The sonic brush was equally effective in removing tongue coating and bacteria compared with the manual brush. As the sonic brush does not cause tongue trauma, it may be considered a safe and effective cleaning tool of the tongue.
Background and aim: Toothbrushes can be contaminated with many pathogens from the same person, storage and adjacent brushes, which may cause recurrent infections in the mouth,
therefore this study aimed to evaluate the effectiveness of chlorhexidine 0,12% and white vinegar 5% in disinfecting toothbrushes selectively contaminated with the three most prevalent and pathogenic bacterial types.
Materials and Methods: The study sample included 90 toothbrushes that were divided into three main groups, each of which was contaminated with one of the germs (Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa), and each group was divided into three subgroups according to the disinfectant used (Chlorhexidine 0,12%, white vinegar 5%, tap water as a control sample), and the number of colonies after disinfection was calculated, then the data were analyzed using (Kruskal-Wallis, Mann-Whitney U) tests to study the significance of the differences between groups.
Results: Comparisons according to the Kruskal-Wallis test. Showed that there was a statistically significant difference in the number of colonies / ml between the control group and each of the disinfectant groups (p <0.001).no statistical difference was found between the chlorhexidine0,12% and white vinegar groups (p 0.05).
Conclusion: The study showed that chlorhexidine 0.12% and white vinegar 5% are effective against the tested bacteria and can be used as an antiseptic for toothbrushes.
key words: Chlorhexidine 0,,0%, white vinegar 5%,toothbrushes, disinfection, bacteria
Previous studies have established that hydrogen sulphide and mercaptans are the primary components of halitosis (bad breath). In the present investigation, we report a simple, rapid technique for measurement of halitosis-related sulphides. The technique is based on a portable instrument generally used for environmental safety applications. Seventy-five volunteers were measured using this technique, and the results (in peak ppb hydrogen sulphide equivalents) compared with organoleptic assessment by 7 judges. A highly significant overall correlation (r = 0.603; P less than 0.001) was obtained between these 2 methods. Moreover, in most cases, the organoleptic ratings of the individual judges correlated more highly with sulphide monitor values than with one another. The simplicity of the technique suggests its use in clinical studies as well as in diagnosis and treatment of patients with this complaint.
Forty-one subjects with bad breath were assessed for oral malodor and periodontal status on three occasions, at intervals of approximately one week. Oral malodor was assessed by measurement of peak and steady-state volatile sulphide levels with a portable sulphide monitor and by organoleptic measurement of whole-mouth, tongue dorsum, and interproximal dental odors by two independent judges. Reproducibility of measurements, assessed by paired t tests and Kappa testing, demonstrated no significant differences between any of the test results from the first and second appointments. Steady-state sulphide levels were the most reproducible of all tests. The ability of the tests to detect an expected reduction of malodor following a 0.2% chlorhexidine mouthrinse regimen was investigated by comparison of test values between the second and third appointments. Following the mouthrinsing treatment, 43% reductions of peak, 47% reductions of steady-state volatile sulphide levels, and 15-58% reductions in all other measurement categories were observed. The majority of the participants (22/41) had no pockets greater than 5 mm and exhibited both moderate gingival inflammation (Mean Gingival Index = 1.17) and moderate plaque accumulation (Mean Plaque Index = 1.84). Plaque Index and presence of pockets greater than 7 mm were weakly related to sulphide measurements. Whereas assessment of steady-state sulphide levels by the sulphide monitor does not constitute a direct measure of oral malodor, its relation to organoleptic measurement, superior reproducibility, objectivity, and sensitivity support the use of the sulphide monitor in clinical studies.
The capacity to form volatile sulfur compounds was tested in bacteria isolated from subgingival microbiotas and in a representative number of reference strains. A majority of the 75 tested oral bacterial species and 7 unnamed bacterial taxa formed significant amounts of hydrogen sulfide from L-cysteine. The most active bacteria were found in the genera Peptostreptococcus, Eubacterium, Selenomonas, Centipeda, Bacteroides and Fusobacterium. Methyl mercaptan from L-methionine was formed by some members of the genera Fusobacterium, Bacteroides, Porphyromonas and Eubacterium. When incubated in serum for 7 d, the most potent producers of hydrogen sulfide were Treponema denticola and the black-pigmented species, Bacteroides intermedius, Bacteroides loescheii, Porphyromonas endodontalis and Porphyromonas gingivalis. P. endodontalis and P. gingivalis also produced significant amounts of methyl mercaptan in serum. No other volatile sulfur compound was detected in serum or in the presence of L-cysteine and L-methionine. These findings significantly increase the list of oral bacteria known to produce volatile sulfur compounds.
Organoleptic studies indicate that the oral cavity is usually the principal source of physiologic malodor associated with the early morning halitosis. In all individuals, regardless of the age or health status of the oral tissues, the most intense oral malodor is exhibited after prolonged periods of reduced saliva flow and abstinence from food and liquid. This results from normal metabolic activity in the oral cavity and is accentuated in cases with poriodontal involvement. Physiologic oral malodor is transient in duration as it can be controlled to varying degrees in most individuals by oral hygiene measures, such as tooth brushing, dental prophylaxis, tongue scraping and rinsing with antiseptic mouth washes. Experimental evidence strongly suggests that putrefaction of sulphur containing proteinaceous substrates by predominantly gram negative oral microorganisms is the primary cause of oral malodor. Brushing studies indicate that both plaque and tongue are important sources of malodor with most of the odor emanating from the dorso posterior surface of the tongue. None of the gas chromatographic or mass spectrometric analyses have detected the presence of amines, indole, or skatole in the head space, mouth air, or breath vapor samples.
Measurement of oral malodor is complicated by a variety of parameters including complexity of gaseous molecular species, sampling difficulties, temporal variations, choice of suitable subject populations, and lack of agreement on reference standards. Since oral malodor is a perceived olfactory stimulus, direct sampling and assessment by human judges may be the most logical measurement approach. However, as with other psychophysical assessments, human malodor measurement by the human nose may vary widely among and between judges, and consequently cannot be confidently reproduced in other laboratories. Such shortcomings have led several investigators to propose quantitative approaches based on measurement of volatile sulfide compounds which are associated with oral malodor. Highly sensitive and discriminatory measurements of volatile sulfides can be made using gas chromatography although for rapid sampling of larger subject populations, portable sulfide monitors may be more appropriate. Future research in this field should consider: 1) improved and simplified instrumentation for more rapid through-put and reliability; 2) development and definition of reference standards for oral malodor assessment; 3) formulation of clinical studies with appropriately sized, well-defined patient populations; and 4) further development of within mouth, site-specific measurements.
Hydrogen sulfide is formed by the subgingival microbiotas of periodontal pockets. The capacity of these microbiotas to form various volatile sulfur compounds in human serum was studied. Bacterial samples from nine deep periodontal pockets were incubated for 7 days in human serum and the amounts of volatile sulfur compounds and the degradation of serum proteins were determined. Hydrogen sulfide was the predominant volatile sulfur compound, but also methyl mercaptan was formed in significant amounts. Only traces of dimethyl sulfide and dimethyl disulfide were detected. There was an extensive degradation of the serum proteins. In most of the reaction mixtures hydrogen sulfide reached highly toxic levels.
Research suggests that the tongue plays an important role in the production of oral malodor. To investigate the role of tongue surface characteristics and oral bacteria in halitosis development, the authors tested associations between odor measurements, volatile sulfur compound levels, periodontal parameters, tongue surface characteristics, presence of trypsinlike activity of organisms on the tongue and teeth and bacteriological parameters in 16 participants with complaints of oral malodor. The data indicate that the proteolytic, anaerobic flora residing on the tongue plays an essential role in the development of halitosis.