Intervention Review

Mouthrinses for the treatment of halitosis

  1. Zbys Fedorowicz1,*,
  2. Hamad Aljufairi2,
  3. Mona Nasser3,
  4. Trent L Outhouse4,
  5. Vinícius Pedrazzi5

Editorial Group: Cochrane Oral Health Group

Published Online: 8 OCT 2008

Assessed as up-to-date: 10 AUG 2008

DOI: 10.1002/14651858.CD006701.pub2

How to Cite

Fedorowicz Z, Aljufairi H, Nasser M, Outhouse TL, Pedrazzi V. Mouthrinses for the treatment of halitosis. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD006701. DOI: 10.1002/14651858.CD006701.pub2.

Author Information

  1. 1

    Ministry of Health, Bahrain, UKCC (Bahrain Branch), Awali, Bahrain

  2. 2

    UKCC Bahrain Branch, UKCC Bahrain Branch, Manama, Bahrain

  3. 3

    Institute for Quality and Efficiency in Health care, Department of Health Information, Köln, Germany

  4. 4

    Awali, Bahrain

  5. 5

    Faculdade de Odontologia de Ribeirão Preto, Universidade de São Paulo, Departamento de Materiais Dentários e Prótese, Ribeirão Preto, São Paulo, Brazil

*Zbys Fedorowicz, UKCC (Bahrain Branch), Ministry of Health, Bahrain, Box 25438, Awali, Bahrain.

Publication History

  1. Publication Status: New
  2. Published Online: 8 OCT 2008




  1. Top of page
  2. Abstract
  3. Plain language summary
  4. アブストラクト
  5. 摘要


Halitosis is an unpleasant odour emanating from the oral cavity. Mouthwashes, which are commonly used for dealing with oral malodour, can be generally divided into those that neutralize and those that mask the odour.


To investigate the effects of mouthrinses in controlling halitosis.

Search methods

We searched the following databases: Cochrane Oral Health Group Trials Register (to August 2008); the Cochrane Central Register of Controlled Trials (The Cochrane Library 2008, Issue 3); MEDLINE (1950 to August 2008); EMBASE (1980 to August 2008); and CINAHL (1982 to August 2008). There were no language restrictions.

Selection criteria

Randomised controlled trials (RCTs) comparing mouthrinses to placebo in adults over the age of 18 with halitosis and without significant other comorbidities or health conditions.
The primary outcomes considered were self expressed and organoleptic (human nose) assessments of halitosis, and the secondary outcomes included assessment of halitosis as measured by a halimeter, portable sulphide monitor or by gas chromatography coupled with flame-photometric detection.

Data collection and analysis

Two independent review authors screened and extracted information from, and independently assessed the risk of bias in the included trials.

Main results

Five RCTs, involving 293 participants who were randomised to mouthrinses or placebo, were included in this review.
In view of the clinical heterogeneity between the trials, pooling of the results and meta-analysis of the extracted data was not feasible and therefore only a descriptive summary of the results of the included trials is provided.
0.05% chlorhexidine + 0.05% cetylpyridinium chloride + 0.14% zinc lactate mouthrinse significantly reduced the mean change (standard deviation (SD)) of organoleptic scores from baseline compared to placebo (-1.13 (1.1) P < 0.005 versus -0.2 (0.7)) and also caused a more significant reduction in the mean change (SD) in peak level of volatile sulphur compounds (VSC) (-120 (92) parts per billion (ppb) versus 8 (145) ppb in placebo). The chlorhexidine cetylpyridinium chloride zinc lactate mouthrinse showed significantly more tongue (P < 0.001) and tooth (P < 0.002) staining compared to placebo.

However, in view of the incomplete reporting of results in three of the trials and the sole use of the halimeter for assessment of VSC levels as outcomes in two further trials, caution should be exercised in interpreting these results.

Authors' conclusions

Mouthrinses containing antibacterial agents such as chlorhexidine and cetylpyridinium chloride may play an important role in reducing the levels of halitosis-producing bacteria on the tongue, and chlorine dioxide and zinc containing mouthrinses can be effective in neutralisation of odouriferous sulphur compounds.
Well designed randomised controlled trials with a larger sample size, a longer intervention and follow-up period are still needed.


Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. アブストラクト
  5. 摘要

Mouthrinses for the treatment of halitosis

Halitosis is an unpleasant odour that originates from the mouth and can be serious enough to cause personal embarrassment. Up to half of the population in the USA and between 50% and 60% of the population in France claim to suffer from bad breath. Accumulation of halitosis-causing bacteria and food residues at the back and in the furrows of the tongue which are then broken down into volatile sulphur compounds (VSC) and other volatile compounds are considered to be the major causes of bad breath.
A wide range of mouthrinses, which can neutralize or mask bad breath, are available over the counter.
This review, which included five trials (293 participants), found that there is some evidence that mouthrinses containing antibacterial agents such as chlorhexidine and cetylpyridinium chloride or those containing chlorine dioxide and zinc can to some extent reduce the unpleasant odour but the use of mouthrinses containing chlorhexidine resulted in noticeable but temporary staining of the tongue and teeth.
Future research should aim to provide reliable evidence for people to make informed decisions about whether these treatments are effective in reducing and eliminating halitosis.



  1. Top of page
  2. Abstract
  3. Plain language summary
  4. アブストラクト
  5. 摘要







Cochrane Oral Health Group Trials Register(2008年8月まで)、Cochrane Central Register of Controlled Trials(The Cochrane Library 2008年Issue 3まで)、MEDLINE(1950年から2008年8月まで)、EMBASE(1980年から2008年8月まで)、CINAHL(1982年から2008年8月まで)から検索した。これらに言語の制限は設けなかった。










監  訳: 加治佐 枝里子,佐々木 好幸,JCOHR,2009.2.20

実施組織: 厚生労働省委託事業によりMindsが実施した。

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  1. Top of page
  2. Abstract
  3. Plain language summary
  4. アブストラクト
  5. 摘要







我們檢索了以下數據庫:Cochrane Oral Health Group Trials Register (到2008年8月); the Cochrane Central Register of Controlled Trials (The Cochrane Library 2008, Issue 3); MEDLINE (1950年2008年8月); EMBASE (1980 年2008年8月); and CINAHL (1982 年2008年8月)。沒有語言限制。






本篇回顧有5個隨機對照試驗,包含293個參與者,被隨機分配到漱口水或安慰劑。有鑑於臨床試驗間的異質性,匯集這些結果和整合分析這些提取的數據是不可行的,因此,只能有一個描述歸納這些試驗包含結果,可以證明含有 0.05%chlorhexidine + 0.05%cetylpyridinium chloride + 0.14%zinc lactate成分的漱口水與安慰劑相比,大大地減少了感官評分的平均變化(標準差)(−1.13 (1.1) P < 0.005 versus −0.2 (0.7)) ,也造成了揮發性硫化物(VSC)在最高程度的平均變化有更多大幅度的削減(−120 (92) parts per billion (ppb) 比上安慰劑的8 (145) ppb)。含有chlorhexidine cetylpyridinium chloride zinc lactate的漱口水比安慰劑有顯著的舌頭(P<0.001)和牙(P<0.002)染色。然而,鑑於這三個試驗有不完整的報告結果,只有唯一一個試驗使用口臭檢測儀來評估VSC的程度,應該謹慎的解釋這些結果。


漱口水含有chlorhexidine和cetylpyridinium chloride這類抗菌成份,對於減少在舌頭上造成口臭的細菌扮演著重要的角色。含有chlorine dioxide 和zinc的漱口水可以有效地中和有氣味的硫化物。仍然需要有良好設計的隨機對照試驗,更大的樣本量,更長的介入和後續的觀察時間。



此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。


漱口水用於治療口臭:口臭是一種產生於口腔內的不愉快氣味,足以引起個人嚴重的尷尬。在美國有多達一半、在法國有50%60%的人聲稱為口臭而苦惱。造成口臭的細菌和食物殘渣在舌頭後方和溝隙裡累積,隨後分解成揮發性硫化物(VSC)和其他揮發性物質,被認為是造成口臭的主要原因。市面上不用處方就可以買到廣泛種類的漱口水,可以中和或掩蓋口臭。這篇回顧中包括了5個試驗(293人),發現有一些證據證明,含有抗菌成分如chlorhexidine和cetylpyridinium chloride或是chlorine dioxide和 zinc的漱口水,可以在一定程度上減少不愉快的氣味。不過,使用含有chlorhexidine的漱口水會導致明顯但臨時的舌頭和牙齒染色。未來的研究應該旨在提供可靠的證據證明,這些治療是否可以有效地減少和消除口臭,讓人們可以作出明智的選擇。