title: Impact of Chlorhexidine Pretreatment Followed by Probiotic Streptococcus salivarius Strain K12 on Halitosis in Children: A Randomised Controlled Clinical Trial. Effect of administration of Streptococcus salivarius K12 on the occurrence of streptococcal pharyngo-tonsillitis, scarlet fever and acute otitis media in 3 years old children. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials Efficacy of local use of probiotics as an adjunct to scaling and root planing in chronic periodontitis and halitosis: A randomized controlled trial Multi-Sensor Approach for the Monitoring of Halitosis Treatment via Lactobacillus brevis (CD2)—Containing Lozenges—A Randomized, Double-Blind Placebo-Controlled Clinical Trial Effect of different mouthrinses on morning breath. Comparison of ninhydrin method of detecting amine compounds with other methods of halitosis detection. Effect of chewing gums containing the probiotic bacterium Lactobacillus reuteri on oral malodour Lactobacillus salivarius WB21--containing tablets for the treatment of oral malodor: a double-blind, randomized, placebo-controlled crossover trial. Effects of probiotic Lactobacillus salivarius WB21 on halitosis and oral health: an open-label pilot trial.
abstract: PURPOSE The aim of this study was to examine the effect of chlorhexidine disinfection , as a chemical method of oral hygiene practice , and subsequent use of probiotics on  halitosis in children . The effects of mechanical and chemical oral hygiene practice methods on the severity of halitosis were also assessed . MATERIAL S AND METHODS 208 children with organoleptic test ( OLT ) scores of 2 or more were r and omly assigned to four groups : A : conventional oral hygiene practice s ( COH ) including toothbrushing and flossing ; B : COH + tongue scraping ( TS ) ; C : COH + TS + chlorhexidine ; D : COH + TS + chlorhexidine + probiotics . OLT was performed at 1-week and 3-month follow-ups . RESULTS A significant and stable number of participants showed major and moderate levels of improvement in OLT scores in group D ( p < 0.001 ) . The improvement of OLT scores in group C was also significant ( p < 0.001 ) , but not stable over the follow-ups ( p = 0.44 ) . Neither significant nor stable improvements in the OLT scores were detected in groups A and B through follow-ups ( p > 0.05 ) . CONCLUSION Probiotic therapy following oral disinfection with chlorhexidine may reduce the severity of halitosis over longer periods OBJECTIVE Streptococcus salivarius K12 ( BLIS K12 ) is a probiotic strain strongly antagonistic to the growth of Streptococcus pyogenes , the most important bacterial cause of pharyngeal infections in humans . Shown to colonize the oral cavity and to be safe for human use , BLIS K12 has previously been reported to reduce pharyngo-tonsillitis episodes in children or adults known to have experienced recurrent streptococcal infection . The present study was focussed upon evaluating the role of BLIS K12 in the control of streptococcal disease and acute otitis media in children attending the first year of kindergarten . PATIENTS AND METHODS By r and omization , 222 enrolled children attending the first year of kindergarten were divided into a  treated group ( N = 111 ) receiving for 6 months a daily treatment with BLIS K12 ( Bactoblis ® ) and a control group ( N = 111 ) who were monitored as untreated controls . During the 6 months of treatment and 3 months of follow-up , the children were evaluated for treatment tolerance , and for episodes of streptococcal pharyngo-tonsillitis , scarlet fever and acute otitis media . RESULTS During the 6-month trial ( N = 111 per group ) the incidence of streptococcal pharyngo-tonsillitis , scarlet fever and acute otitis media was approximately 16 % , 9 % and 44 % respectively in the treated group and 48 % , 4 % and 80 % in the control group . During the 3-months follow-up ( N = 29 per group ) the corresponding rates of infection were 15 % , 0 % and 12 % in the treated group and 26 % , 6 % and 36 % in the controls . No apparent side effects were detected in the treated group either during treatment or follow-up . All of the enrolled children completed the study . CONCLUSIONS The daily administration of BLIS K12 to children attending their first year of kindergarten was associated with a significant reduction in episodes of streptococcal pharyngitis and acute otitis media . No protection against scarlet fever was detected Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Objective : Periodontitis is known to have multifactorial etiology , involving interplay between environmental , host and microbial factors . The current treatment approaches are aim ed at reducing the pathogenic microorganisms . Administration of beneficial bacteria ( probiotics ) has emerged as a promising concept in the prevention and treatment of periodontitis . Thus , the aim of the present study is to evaluate the efficacy of the local use of probiotics as an adjunct to scaling and root planing ( SRP ) in the treatment of patients with chronic periodontitis and halitosis . Methods : This is a r and omized , placebo-controlled , double-blinded trial involving 32 systemically healthy chronic periodontitis patients . After SRP , the subjects were r and omly assigned into the test and control groups . Test group ( SRP + probiotics ) received subgingival delivery of probiotics and probiotic mouthwash , and control group ( SRP + placebo ) received subgingival delivery of placebo and placebo mouthwash for 15 days . Plaque index ( PI ) , modified gingival index ( MGI ) , and bleeding index ( BI ) were assessed at baseline , 1 and 3 months thereafter , whereas probing depth ( PD ) and clinical attachment level were assessed at baseline and after 3 months . Microbial assessment using N-benzoyl-DL-arginine-naphthylamide ( BANA ) and halitosis assessment using organoleptic scores ( ORG ) was done at baseline , 1 and 3 months . Findings : All the clinical and microbiological parameters were significantly reduced in both groups at the end of the study . Inter-group comparison of PD reduction ( PDR ) and clinical attachment gain ( CAG ) revealed no statistical significance except for PDR in moderate pockets for the test group . Test group has shown statistically significant improvement in PI , MGI , and BI at 3 months compared to control group . Inter-group comparison revealed a significant reduction in BANA in test group at 1 month . ORG were significantly reduced in test group when compared to control group . Conclusion : Within the limitations of the study , the present investigation showed that the adjunctive use of probiotics offers clinical benefit in terms of pocket depth reduction in moderate pockets and reduced oral malodor parameters The aim of this r and omized clinical trial was to evaluate whether a recently described multi-sensor approach called BIONOTE ® is accurate enough to verify the efficacy of treatment of patients with halitosis . A treatment with Lactobacillus brevis (CD2)–containing lozenges , compared with placebo was tested . The BIONOTE ® was compared with traditional techniques used to detect halitosis : OralChroma ™ and two calibrated odor judges enrolled for the organoleptic assessment s. Twenty patients ( 10 treated and 10 placebo ) , suffering from active phase halitosis were included in the study . Treatment consisted of Lactobacillus brevis (CD2)—containing lozenges or placebo , 4 tablets/day for 14 days . t0 was before the beginning of the study ; t1 was day 7 and t2 was day 14 . The effectiveness of treatment was assessed through : ( 1 ) Rosenberg score ; ( 2 ) Winkel tongue coating index ( WTCI ) anterior and posterior ; ( 2 ) OralChroma ™ ; ( 3 ) the new developed multi-sensor approach , called BIONOTE ® ( test technique ) . Only the WTCI anterior revealed statistically significant changes between t0 and t2 data ( p = 0.014 ) in the treated group . Except for the WTCI anterior , all diagnostic methods revealed the lack of effectiveness for halitosis of a 14-days treatment with Lactobacillus brevis (CD2)–containing lozenges . The BIONOTE ® multisensor system seems accurate in addition to OralChroma ™ to assess the initial condition of halitosis and its mitigation during treatment BACKGROUND Morning breath odor is an often-encountered complaint . This double-blind , crossover , r and omized study aim ed to examine the bad breath-inhibiting effect of 3 commercially available mouthrinses on morning halitosis during an experimental period of 12 days without mechanical plaque control . METHODS Twelve medical students with a healthy periodontium refrained from all means of mechanical plaque control during 3 experimental periods of 12 days ( with intervening washout periods of at least 3 weeks ) . A professional oral cleaning preceded each period . During each experimental period , as the only oral hygiene measure allowed , the students rinsed twice a day with one of the following formulations in a r and omized order : CHX-Alc ( a 0.2 % chlorhexidine [ CHX ] solution ) ; CHX-NaF ( CHX 0.12 % plus sodium fluoride 0.05 % ) ; or CHX-CPC-Zn ( CHX 0.05 % plus cetylpyridinium chloride 0.05 % plus zinc lactate 0.14 % ) . After 12 days , morning breath was scored via volatile sulfur compound ( VSC ) level measurements of the mouth air and organoleptic ratings of the mouth air , the expired air , and a scraping of the tongue coating . At the 12-day visit , a question naire ( subjective ratings ) was completed and sample s taken from both the tongue coating and the saliva for anaerobic and aerobic culturing and vitality staining . The de novo supragingival plaque formation was also recorded . All parameters were correlated with the baseline registration s. RESULTS Although oral hygiene during the 3 experimental periods was limited to oral rinses , bad breath parameters systematic ally improved , with the exception of a slight increase in VSC levels while using CHX-Alc , a finding which was associated with the direct influence of the CHX on the sulfide monitor . The oral microbial load after the use of CHX-NaF remained unchanged , while for the CHX-Alc and CHX-CPC-Zn , significant reductions in both aerobic and anaerobic colony forming units (CFU)/ml were noticed in comparison with baseline data for both tongue coating and saliva sample s. The composition of microflora , on the other h and , did not reveal significant changes . The supragingival plaque formation was inhibited , in descending order , by CHX-Alc , CHX-CPC-Zn , and CHX-NaF. The subjective scores for the rinses indicated a higher appreciation for CHX-CPC-Alc and CHX-NaF because of a better taste and fewer side effects . CONCLUSIONS The results of this study demonstrate that morning halitosis can be successfully reduced via daily use of mouthrinses . CHX-Alc and CHX-CPC-Zn mouthrinses result in a significant reduction of the microbial load of tongue and saliva OBJECTIVES Halitosis is a result of overactivity of Gram-negative bacteria for which protein amino acids are the major source of energy . Therefore , statistical correlation between concentrations of volatile sulphur compounds ( VSCs ) and low-molecular-weight amines should be expected . MATERIAL S AND METHODS Eighty-four patients suffering from halitosis and 40 healthy volunteers aged 20 - 62 years ( average 39.7 ) participated in the study . In all subjects low-molecular-weight amines were evaluated by the ninhydrin method .  Patients with halitosis were r and omized into treatment groups . Zinc tablets , tablets and mouthwash containing chlorhexidine or lyophilized lactic acid-forming bacteria were used . RESULTS Analysis showed that the level of amines was highest in subjects with halitosis ( 0.39 , s.d . + /- 0.06 , P < 0.001 ) and correlated significantly with results of VSC measurement and organoleptic scores ( P < 0.001 ) . Reduction of amine levels after treatment was statistically significant ( P < 0.001 ) . Three months following treatment the amine levels began to increase ( 0.37 , s.d . + /- 0.05 ) . The amine levels in healthy controls were lower ( 0.29 , s.d . + /- 0.07 ) and remained at a stable level . CONCLUSION The salivary amine levels significantly correlated with VSC levels and organoleptic scores . Therefore , the ninhydrin method of detecting salivary amines may be an alternative or additional method of diagnosing halitosis . This method may also be used to evaluate treatment efficacy Abstract Objective . To evaluate the effect of chewing gums containing probiotic bacteria on  oral malodour .  The null hypothesis was that no difference would be displayed compared with placebo gums . Material s and methods . Twenty-five healthy young adults with self-reported malodorous morning breath completed this r and omized double-blind placebo-controlled cross-over trial . The design included run-in and wash-out periods interspersed by two intervention periods of 14 days each . The subjects were instructed to chew one gum in the morning and one in the evening containing either two strains of probiotic lactobacilli ( L. reuteri DSM 17938 and L. reuteri ATCC PTA 5289 ) or placebo . The outcome measures were ( i ) organoleptic scores ( 0–5 ) by a certified test panel , ( ii ) concentration of volatile sulphur compounds ( VSC ) measured with a Halimeter and ( iii ) concentration of VSC after a cysteine rinse . Registration s were made at baseline and after each intervention period . Differences between the groups were assessed by non-parametric paired statistics and chi-square test . Results . The median organoleptic score was similar ( score 2 ) in both groups at baseline . After 14 days of treatment , the organoleptic scores were significantly lower in the probiotic group compared with the placebo group ( p < 0.05 ) . Assessment s of the VSC levels displayed no significant differences between the groups , either before or after rinsing with L-cysteine . No adverse effects were registered . Conclusion . The results demonstrated that probiotic chewing gums may have some beneficial effect on oral malodour assessed by organoleptic scores . The results indicate that the probiotic gum may affect bacteria that produce malodourous compounds other than VSCs OBJECTIVE This study evaluated the effect of probiotic intervention using lactobacilli on  oral malodor . STUDY DESIGN We conducted a 14-day , double-blind , placebo-controlled , r and omized crossover trial of tablets containing Lactobacillus salivarius WB21 ( 2.0 × 10(9 ) colony-forming units per day ) or placebo taken orally by patients with oral malodor .  RESULTS Organoleptic test scores significantly decreased in both the probiotic and placebo periods compared with the respective baseline scores ( P < .001 and P = .002 ) , and no difference was detected between periods . In contrast , the concentration of volatile sulfur compounds ( VSCs ) ( P = .019 ) and the average probing pocket depth ( P = .001 ) decreased significantly in the probiotic period compared with the placebo period . Bacterial quantitative analysis found significantly lower levels of ubiquitous bacteria ( P = .003 ) and Fusobacterium nucleatum ( P = .020 ) in the probiotic period . CONCLUSIONS These results indicated that daily oral consumption of tablets containing probiotic lactobacilli could help to control oral malodor and malodor-related factors OBJECTIVE The objective of this study was to evaluate whether oral administration of lactobacilli alters the degree of halitosis and clinical conditions associated with halitosis . STUDY DESIGN Twenty patients with genuine halitosis were given 2.0 x 10(9)Lactobacillus salivarius WB21 and xylitol in tablet form daily .  Oral malodor and clinical parameters were evaluated at the same time of day for each patient after 2 and 4 weeks . RESULTS All 20 patients were positive for L. salivarius DNA in their saliva at 2 weeks , although 12 patients were negative for this organism at baseline . Oral malodor parameters significantly decreased at 2 weeks in the subjects with physiologic halitosis . The scores of an organoleptic test and bleeding on probing significantly decreased at 4 weeks in the subjects with oral pathologic halitosis . CONCLUSIONS Oral administration of probiotic lactobacilli primarily improved physiologic halitosis and also showed beneficial effects on bleeding on probing from the periodontal pocket
target: Current evidence is supportive of recommending probiotics for the management of halitosis .
  Based on this review , transient ( average of 2 weeks ) dosing with probiotics ( mainly Lactobacillus strains ) has a moderate effect on halitosis regarding OLT scores , but we could not confirm the effects of probiotics on the VSC reduction .
background: Although several studies have evaluated the inhibitory effect of  probiotics  on  halitosis  , findings are inconsistent .
  This systematic review and meta- analysis of r and omized clinical trials ( RCT ) was conducted to summarize the evidence on the effect of  probiotics on halitosis .