The main cause of persistent bad breath is volatile sulfur compounds. Bacteria in the mouth form these compounds as a result of a mix of bacteria and food debris associated with poor gum and dental hygiene.

Current treatments for halitosis include mechanical cleaning (scale and tongue scraping) and chemical therapy (antibiotics, mouth rinses, and other agents). However, mechanical therapy is often uncomfortable even when performed by a dentist. In addition, although chemotherapy is generally effective in the short term, it is always associated with various side effects, including disruption of the normal microbiome of the oral cavity and staining of the tongue and teeth. Emerging evidence suggests that probiotic bacteria may offer a simpler alternative.

The number of participants in the studies was small, ranging from 23 to 68, with an age range of 19 to 70. Monitoring periods ranged from 2 to 12 weeks. Bad breath severity was determined by the levels of volatile sulfur compounds detected in the mouth or the OLP score, which measures breath odor at different distances from the mouth. Tongue coating scores (3 studies) and plaque index (3 studies) were also included in the analysis, because a dirty tongue and the accumulation of tartar between the teeth are often considered to be the main causes of bad breath.

Pooled data analysis showed that OLP scores were significantly lower in patients given probiotics compared to those not given probiotics in the comparison study, regardless of the length of the monitoring period.

A similar result was observed for the levels of volatile sulfur compounds detected, although these varied considerably in individual studies and the observed effects were relatively short-lived – up to 4 weeks, after which there was no significant difference.

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However, there were no significant differences in tongue coating score or plaque index between those given and those not given probiotics.

The researchers explain that probiotics can inhibit the breakdown of amino acids and proteins by anaerobic bacteria in the mouth, thus preventing the production of foul-smelling byproducts.

However, they note that caution should be exercised in interpreting their findings. The sample sizes of the included studies were small and some data were incomplete. These factors, detection methods, bacterial species, plus wide variation in clinical trial design and methodology, all weaken the findings.

According to the researchers, this systematic review and meta-analysis suggests that probiotics (eg, Lactobacillus salivarius, Lactobacillus reuteri, Streptococcus salivarius, and Weissella cibaria) may alleviate halitosis by reducing concentration levels of volatile sulfur compounds, but not significantly in the short term. effects on the underlying causes of bad breath, such as plaque and tongue coating.

However, higher quality randomized clinical trials are needed to verify the results and provide evidence for the effectiveness of probiotics in the management of halitosis in the future.

Reference:

  1. Efficacy of probiotics in the management of halitosis: a systematic review and meta-analysis – (https:bmjopen.bmj.com/content/bmjopen/12/12/e060753.full.pdf)

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