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 Table of Contents  
ORIGINAL ARTICLE
Year : 2023  |  Volume : 16  |  Issue : 1  |  Page : 67-70

Evaluation of efficacy of 0.1% of chlorine dioxide mouthwash against oral malodor – A pilot study


Department of Periodontics, KLE Academy of Higher Education and Research, KLE VK Institute of Dental Sciences, Belagavi, Karnataka, India

Date of Submission07-Jan-2022
Date of Acceptance28-Mar-2022
Date of Web Publication21-Jan-2023

Correspondence Address:
Dr. Shweta Shivayogi Hugar
Department of Periodontics, KLE Academy of Higher Education and Research, KLE VK Institute of Dental Science, Belagavi, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kleuhsj.kleuhsj_73_22

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  Abstract 


BACKGROUND: Oral malodor, also known as halitosis or bad breath can be defined as an offensive odor that emerges from the oral cavity and can be easily detected by others. The etiology of halitosis is multifactorial and can include several intra- and extraoral factors such as gingivitis, periodontitis, chronic sinusitis, nasal inflammation, diabetes mellitus, lung carcinoma, liver insufficiency, cirrhosis, uremia, trimethylaminuria, and postnasal drip. Chlorine dioxide associated with chlorite anion results in the oxidative consumption of amino acids such as cysteine and methionine, which are precursors of volatile sulfur compounds (VSC). Thus, it can reduce the concentrations of VSCs which help in the reduction of oral malodor. Due to the lesser availability of literature to prove the effectiveness of this chlorine dioxide formula, this study is conducted to evaluate the inhibiting effect of commercially available chlorine dioxide-containing mouthwash – FRESHCLOR to combat oral malodor in patients.
MATERIALS AND METHODS: The study was conducted among the patients reporting at the outpatient department of periodontics who visited with the chief complaint of bad breath and bleeding gums at KAHER'S VK Institute of Dental Sciences, Belagavi. Patients were selected according to inclusion criteria and divided into test and control groups. Post scaling Freshclor mouthwash was distributed to all test group participants. The organoleptic ratings for halitosis, gingival index (given by Loe H and Silness J, 1963), and plaque index (given by Loe H and Silness J, 1964) were recorded at baseline and 2 weeks for the group.
RESULTS: There was a statistically significant reduction in halitosis with a reduction of gingival and plaque indices at 2 weeks from baseline in the test group.
CONCLUSION: With the results, it can be concluded that chlorine dioxide-containing mouthwash – freshclor is effective in reducing halitosis.

Keywords: Chlorine dioxide, freshclor, halitosis, oral malodor


How to cite this article:
Brahmankar P, Hugar SS, Kumbhojkar VR, Shetti N. Evaluation of efficacy of 0.1% of chlorine dioxide mouthwash against oral malodor – A pilot study. Indian J Health Sci Biomed Res 2023;16:67-70

How to cite this URL:
Brahmankar P, Hugar SS, Kumbhojkar VR, Shetti N. Evaluation of efficacy of 0.1% of chlorine dioxide mouthwash against oral malodor – A pilot study. Indian J Health Sci Biomed Res [serial online] 2023 [cited 2023 Jan 28];16:67-70. Available from: https://www.ijournalhs.org/text.asp?2023/16/1/67/368340




  Introduction Top


Oral malodor is not considered as a life-threatening illness, but it deeply affects psychological and communication issues of patients. It is the third leading cause for patients to seek dental treatment after dental caries and periodontal disease (Loesche 2002). Various byproducts of bacterial metabolism such as amino acids, oral epithelial cells, and white blood cells result in oral malodor.[1] The extraoral causes for halitosis include nasal inflammation, liver and kidney disorders, and endocrine diseases such as diabetes mellitus. The oral malodor is well controlled by the toothpastes or mouth rinses containing antimicrobial agents.[2] Stabilized chlorine dioxide shows marked bactericidal activity against oral bacteria associated with gingivitis and periodontitis. The use of chlorine dioxide is associated with the presence of chlorite anion which results in oxidative consumption of amino acids such as cysteine and methionine which are the precursors of volatile sulpfur compounds (VSCs). Thus, clinical use of this mouth rinse can be helpful in combating oral malodor by causing a reduction in the concentration of VSCs.[3]

When a literature search was carried out, less studies were available which proved the effectiveness of chlorine dioxide formula in the treatment of oral malodor. Thus, this study was carried out with an aim to evaluate the inhibitory effect of commercially available chlorine dioxide-containing mouthwash – FRESHCLOR on oral malodor in patients.


  Materials and Methods Top


The present study is a pilot study conducted among the patients reporting at the outpatient department of periodontics who visited with the chief complaint of bad breath and bleeding gums at KAHER'S VK Institute of Dental Sciences, Belagavi. The duration of the study was 2 weeks. The participants were selected according to the inclusion criteria. Recording of the gingival index (given by Loe H and Silness J 1963) and plaque index (given by Loe H and Silness J 1964) was carried out at baseline and at 2 weeks intervals. Thorough full-mouth ultrasonic scaling and root planing were performed for all the participants. Distribution of mouthwash containing 0.1% chlorine dioxide was done and they were instructed to rinse thrice daily for 60 s after brushing for 2 weeks (according to the manufacturer's instruction). All the subjects were recalled after 2 weeks for re-evaluation of plaque and gingival index. Statistical analysis was carried out using Wilcoxon signed-rank test which was used for pre- and posttest comparison.



Ethical clearance

Research and Ethics committee, KLE VK institute of dental sciences, Belagavi, Reference number – 1411, Date – 12/02/2021.




  Results Top


[Table 1] shows the descriptive statistics of mean and standard deviation values of pre and posttest of organoleptic ratings [Graph 1] and [Graph 2] plaque index scores [Graph 3] and [Graph 4] and gingival index scores [Graph 5] and [Graph 6].
Table 1: Pre and posttest organoleptic ratings, gingival and plaque index scores

Click here to view



Normality test (Shapiro–Wilk test).

Since all the P values of Shapiro–Wilk test are < 0.05, it means that none of the data are normally distributed. Since, normal distribution was absent, nonparametric tests of significance were applied further.

Since all the “p”-values of Shapiro–Wilk Test are < 0.05, it means that NONE of the data are normally distributed. Since, normal distribution was absent; nonparametric tests of significance were applied further.

[Table 2] shows the mean and standard deviation values of pre- and posttest scores of organoleptic ratings, gingival and plaque index scores [Table 2]a, [Table 2]b, [Table 2]c.


Click here to view


There has been a reduction in the mean of organoleptic score from pre to post and this reduction is proven to be statistically significant as P < 0.05.

There has been a reduction in the mean of plaque score from pre to post and this reduction is proven to be statistically significant as P < 0.05.

There has been a reduction in the mean of gingival score from pre to post and this reduction is proven to be statistically significant as P < 0.05.


  Discussion Top


Halitosis/bad breath can be defined as an offensive odor that comes from the oral cavity and can be simply detected by others.[1] The causes of oral malodor include intra- and extraoral reasons such as caries, periodontitis, and respiratory and endocrine disorders. For years, chlorhexidine is considered as the gold standard in reducing plaque and gingivitis. However, less literature search is found on reducing oral malodor. Hence, this pilot study was conducted with 0.1% chlorine dioxide for 2 weeks in patients who had halitosis.

Chlorine dioxide is water soluble free radicle which is stable for a greater period of time. Chloride ion is an efficient antimicrobial agent against several bacterial species. While in the mouth, chlorine dioxide reacts with salivary amino acids such as pyruvate and methionine which act as a source of nutrition for odor-causing microflora. Therefore, chlorine dioxide shows an inhibitory effect against oral malodor by interrupting these bacteria. VSC have a close relation to the level of oral malodor present. Free chloride ions chemically react to oxidize odorous substances such as VSCs.[2]

In the present study, we found a statistically significant decline in pre- and postorganoleptic scores [Table 1]. This could be due to the reduction in VSCs and this is in accordance with the study conducted by Pham et al. in 2018.[1] There was also a significant reduction in gingival and plaque scores from pre to 2 weeks posttest with “P” < 0.005 [Table 2]b and [Table 2]c. This is in accordance with the studies conducted by Shinada et al. in 2010 and Srinivas T et al. in 2021 and Carrione E et al. in 2020.[4],[5],[6]

Limitations

  1. It is a short-term pilot study
  2. By comparing it with the control group better results can be obtained
  3. The study can be conducted with microbiologic parameters with a longer duration.



  Conclusion Top


Considering the limitations of our study, the findings suggest that chlorine dioxide is effective in reducing VSC and thus reduces oral malodor.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Pham TA, Nguyen NT. Efficacy of chlorine dioxide mouthwash in reducing oral malodor: A 2-week randomized, double-blind, crossover study. Clin Exp Dent Res 2018;4:206-15.  Back to cited text no. 1
    
2.
Peruzzo DC, Jandiroba PF, Nogueira Filho Gda R. Use of 0.1% chlorine dioxide to inhibit the formation of morning volatile sulphur compounds (VSC). Braz Oral Res 2007;21:70-4.  Back to cited text no. 2
    
3.
Siddeshappa ST, Bhatnagar S, Yeltiwar RK, Parvez H, Singh A, Banchhor S. Comparative evaluation of antiplaque and antigingivitis effects of an herbal and chlorine dioxide mouthwashes: A clinicomicrobiological study. Indian J Dent Res 2018;29:34-40.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Shinada K, Ueno M, Konishi C, Takehara S, Yokoyama S, Kawaguchi Y. A randomized double blind crossover placebo-controlled clinical trial to assess the effects of a mouthwash containing chlorine dioxide on oral malodor. Trials 2008;9:71.  Back to cited text no. 4
    
5.
Available from: http://freshclor.in/dental_proffesionals/. [Last accessed on 2021 May 19].  Back to cited text no. 5
    
6.
Insignares-Carrione E, Bolano Gomez B, Kalcker A. Chlorine dioxide in COVID-19: Hypothesis about the possible mechanism of molecular action in SARS-CoV-2. J Mol Genet Med 2020;14:468.  Back to cited text no. 6
    



 
 
    Tables

  [Table 1], [Table 2]



 

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