Oral hygiene associated with antimicrobial photodynamic therapy or lingual scraper in the reduction of halitosis after 90 days follow up: A randomized, controlled, single-blinded trial.
BACKGROUND
Although antimicrobial photodynamic therapy (aPDT) can reduce halitosis immediately after application, it returns after a week. This probably occurs because bacteria residing in the oral cavity may recolonize the dorsum of the tongue.


OBJECTIVE
Verify if modification of oral hygiene behavior associated with aPDT or lingual scraper can reduce halitosis after a 90-day follow-up.


METHODS
Forty adults with positive halitosis were randomized in G1 (n = 20) -aPDT + oral hygiene behavior (OHB) or G2 (n = 20)- lingual scraper + OHB. G1 group were submitted to 0.005 % methylene blue in the middle and posterior third of the tongue, with pre-irradiation of 1 min. Irradiations were performed with red laser diode (λ =660 nm), 100 mW, 318 J/cm2, 3537 mW/cm2, 9 J per point at 6 points. In the G2 group, the tongue was scraped 10 times on the right side and on the left side with a tongue scraper. All patients were instructed on OHB at baseline, 7 and 90 days (guidance on the use of dental floss and the Bass technique for brushing). Halitosis was evaluated by gas chromatography (OralChroma®). Values ​​> 112 ppb for Hydrogen sulfide (H2S) gas was considered positive halitosis. Methylmercaptanes and dimethylsulfide were also measured. The gas measures were assessed at baseline, immediately, and at 7 and 90 days. Paired t-test was used for the statistical analysis. For comparison between groups, the t-test was used. Values of p < 0.05 were considered statistically significant.


RESULTS
There was no difference between groups immediately after treatment (p = .1532) after 7 days (p = 0.9312) and 90 days (p = 0.6642). For the aPDT group, there was a decrease in hydrogen sulfide ​​immediately after treatment (p = 0.0001), after 7 days, values remained 3-fold smaller (p = 0.0088) and 2-fold smaller after 90 days (p = 0.0270). For the scraper group, there was a decrease immediately after treatment (p = 0.0001), the values remains 2-fold smaller ​​(p = 0.0003) after 7 days and 3 months (p = 0.0001).


CONCLUSION
The oral hygiene behavior associated with aPDT or tongue scraper was not able to reduce halitosis after 90-day follow-up. Despite halitosis remaining ​​ higher than 112 ppb in all follow-up periods, the mean values remain 2 or 3 fold smaller than baseline values. Future studies should include other oral hygiene behavior to achieve better results in the treatment of halitosis.
['Romero|Sergio Santos|SS|', 'do Vale|Katia Llanos|KL|', 'Remolina|Vanessa Gomes|VG|', 'Silva|Thayná Gomes|TG|', 'Schalch|Tânia Oppido|TO|', 'Ramalho|Karen Muller|KM|', 'Negreiros|Renata Matalon|RM|', 'Ando|Ellen Sayuri|ES|', 'Mayer|Marcia Pinto Alves|MPA|', 'Mesquita Ferrari|Raquel Agnelli|RA|', 'Motta|Lara Jansiski|LJ|', 'Fernandes|Kristianne Porta Santos|KPS|', 'Bussadori|Sandra Kalil|SK|', 'Horliana|Anna Carolina Ratto Tempestini|ACRT|']
D000328:Adult D000890:Anti-Infective Agents D006209:Halitosis D006801:Humans D009910:Oral Hygiene D010778:Photochemotherapy D017319:Photosensitizing Agents D014059:Tongue
Photodynamic therapy Scraper Halitosis Oral hygiene behavior