Efficacy of Probiotic Tablets in the Reduction of Halitosis: A Randomised, Single Blind, Controlled Clinical Trial

Purpose: To evaluate the effect of a fresh-breath mild effervescent tablet on halitosis as an alternative to mouthwash.
Materials and Methods: Halitosis is the unpleasant and offensive odour emanating from the oral cavity (bad breath), which is linked to the presence of volatile sulphur compounds (VSCs). A randomised, single-blind, controlled clinical trial was conducted with 102 volunteers who had oral complaints (range 18–60 years). Breath samples were taken and analysed for the level of hydrogen sulphide (H2S), methyl mercaptan (CH3SH) and dimethyl sulphide (CH3SCH3). Sixty-one volunteers who met the halitosis criteria were enrolled and completed the clinical trial. Two groups were formed according to the test employed: the Immediate Effect Test (IET) (n = 31) and the Effective Duration Test (EDT) (n = 30). In the IET, subjects were divided into three subgroups: fresh-breath mild effervescent tablet (MT, n = 11), the fresh-breath lozenge tablet (LT, n = 10), and fresh-breath mouthwash (MW, n = 10). Halitosis was measured immediately after completely consuming the test tablet or gargling. In the EDT, subjects were also divided into three subgroups: fresh-breath mild effervescent tablet (MT, n = 10), probiotic powder (PP, n = 10) and probiotic tablet (PT, n = 10). Halitosis was measured at 0 h, 1 h, and 2 h after consuming the test substances.
Results: In the IET group, a statistically significant reduction in VSCs was obtained in all three subgroups compared with baseline (VSCs of MT group, p 0.01, VSCs of LT subgroup, p 0.05, VSCs of MT group, p 0.01). The fresh-breath mild effervescent tablet subgroup showed a statistically significantly greater reduction in VSCs compared to the fresh-breath lozenge subgroup (p 0.01). No statistically significant differences in VSC reduction were found between the fresh-breath mild effervescent tablet subgroup and the mouthwash group (p = 0.38). In the EDT group, the VSC level of the fresh-breath mild effervescent tablet group was still statistically significantly lower than the baseline 2 h after consumption (p 0.01). The two control groups which used commercial fresh-breath probiotic products did not show any statistically significant difference compared to baseline. The VSC level of these two groups gradually returned to the baseline level 2 h after consumption.
Conclusion: Fresh-breath mild effervescent tablets have shown promising potential as an alternative, effective, and potentially safe choice for fresh breath in comparison to mouthwash. Keywords: fresh breath, halitosis, natural extracts, probiotic, volatile sulphur compounds (VSCs)