Use Of A Novel Group Of Oral Malodor Measurements To Evaluate An Anti-Oral Malodor Mouthrinse (Trioral) In Humans
OBJECTIVE: This study compared the ability of a test mouthwash containing zinc chloride and sodium chlorite (TriOral) to reduce intrinsic oral malodor, to that of two other mouthrinses, one with zinc chloride only and the other with no zinc chloride/no sodium chlorite, using a novel group of oral malodor parameter measurements. METHODOLOGY: Forty-eight subjects completed the study; 16 in the test group, 17 in the zinc only group, and 15 in the no zinc chloride/no sodium chlorite group. At baseline and after two and four weeks, parameters assessed were 1) malodorants in the headspace of and in solution in resting whole saliva determined organoleptically, 2) breath volatile sulfur compounds (VSC) measured with a sulfide monitor (Halimeter), 3) fresh and incubated saliva oxidation-reduction potential (E(h)) measured with a platinum electrode, and 4) level of saliva indolic compounds (IC), indole and skatole, determined colorimetrically with Kovac’s reagent. The VSC, E(h), and IC data for the three mouthrinses were analyzed statistically by repeated measures ANOVA between groups, and by 2-way ANOVA within groups. Corresponding organoleptic data were analyzed by Kruskal-Wallis and Friedman non-parametric tests. RESULTS: Organoleptic, VSC, and E(h) evaluations clearly showed the zinc chloride/sodium chlorite test mouthrinse to be more effective than the other two rinses. In all cases, the level of significance was P < .001 between the test mouthrinse and its no zinc chloride/no sodium chlorite control; between test mouthrinse and the zinc chloride only product, significance was P < .05, P <.001, and P <.01 for the organoleptic, VSC, and E(h) tests, respectively. Noteworthy was the observation that the mean organoleptic saliva headspace score with the test mouthrinse was reduced to zero, and VSC levels fell below 50 ppb S by the end of the study, a level where the breath is usually non-odorous. The test mouthwash also appeared more effective in reducing the salivary IC levels, but the results did not reach significance at P < .05 unless IC levels were amplified in the saliva by incubation overnight at 37 degrees C. Correlations between the various procedures were highly significant, achieving in almost all cases a probability level of P < .001. CONCLUSION: The results supported the conclusion that the zinc chloride plus sodium chlorite mouthrinse (TriOral) is more effective in reducing oral malodor than a zinc chloride alone mouthrinse, and even more effective than its no zinc chloride/no sodium chlorite mouthrinse control. The methods used in this study were consistent with one another, and highly effective in measuring various parameters that characterize oral malodor.
This well-designed study provides important insight into how and why certain mouthrinses work better than others. The oral parameters measured in this study provide excellent comparative data. Based on this study, the TriOral mouthrinse (now called SmartMouth) was significantly better than the zinc chloride product alone and both zinc-containing products were better than the control mouthrinse. As dentists and dental hygienists, we need to make recommendations for the control of oral malodor which avoid mouthwashes that merely mask bad breath for a short time, but rather make recommendations for treatment and home-use mouthrinses to provide therapeutic effects that control it. Most patients benefit from a periodontal cleaning and replacement of defective restorations, which are areas where gram-negative bacteria can colonize to contribute to oral malodor. Also, the evidence is very clear that zinc salts in mouthrinses have an inhibitory effect on VSCs and consistently help in the control of oral malodor. One problem with zinc ions is they are very astringent, and by using sodium chlorite—that astringency can be reduced while retaining effectiveness against oral malodor. The authors concluded that the additional benefit of the sodium chlorite in SmartMouth is the favoring of greater and more durable reduction in the malodor. Use of SmartMouth provided more than just masking odor, but an actual reduction in the causes of bad breath for longer periods of time.
Howard E. Strassler, DMD