Halitosis is a term that consists of any unpleasant odor emanating from the oral cavity, the source of which may be local or systemic. This alteration in mouth odor is the third major cause of the search for oral treatment. Anaerobic bacteria are identified as the main cause of halitosis.
Study/Year | aPDT | Tongue Scraper | Results/Estimated Effects | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
da Mota 2021 [44] | da Mota 2021 [5] |
| no numerical data provided | no numerical data provided | The authors reported no difference between groups ( | p | > 0.05, | n | = 30) | |||
do Vale 2020 [43] | do Vale 2020 [4] |
| 18.5 | 185.3 | The authors reported a reduced H | 2 | S concentration in favour of aPDT ( | p | = 0.003, | n | = 40) | |
| 218.2 | 39.0 | The authors reported a reduced H | 2 | S concentration in favour of aPDT ( | p | = 0.000, | n | = 40) |
Antimicrobial Photodynamic Therapy (aPDT) versus Tongue Scraper | ||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Population: patients diagnosed with halitosis Context: outpatient Intervention: aPDT Comparison: tongue scraper |
||||||||||||||||||||
Outcomes | Anticipated Absolute Effects * | (95% CI) | Relative Effect | (95% CI) | № of Participants | (Studies) | Certainty of the Evidence | (GRADE) | Comments | |||||||||||
Risk with Tongue Scraper | Risk with aPDT | |||||||||||||||||||
Romero 2021 [24] | Romero 2021 [1] |
| ||||||||||||||||||
Hydrogen Sulfide (H | 2 | 68.3 (±68.0) |
100.9 (±103.0) | S) (in ppb) Assessed immediately |
The mean H | 2 | S reduction was | 100.9 | ppb | MD | 20.05 points higher | (53.22 lower to 93.22 higher)Seems to have no difference between groups, but this results are imprecise (wide CI) MD −32.6 [95% CI −86.6 to 21.4]; | n | = 40; | p | = 0.24, very low-certainty evidence | ||||
- | 40 | (1 RCT) | ⨁◯◯◯ | VERY LOW | a,b | The evidence is very uncertain about the effect of aPDT on H2S reduction immediately and after 7 and 90 days of treatment. Additionally, 4 other studies seem to present a reduced H | 2 | S concentration in favour of aPDT. However, it was not possible to estimate the effect due to the lack of numerical data. |
| 126.8 (±126.0) | 123.1 (±126.0) | |||||||||
Hydrogen Sulfide (H | 2 | S) (in ppb) Assessed after 7 days |
The mean H | 2 | S reduction was | 123.1 | ppbSeems to have no difference between groups, but this results are imprecise (wide CI) | MD 3.7 | points higher | (67.6 lower to 75 higher) MD 3.7 [95% CI −67.6 to 75.0]; | n | = 40; | p | = 0.92, very low-certainty evidence | ||||||
- | 40 | (1 RCT) | ⨁◯◯◯ | VERY LOW | a,b |
| 152.5 (±176.8) | |||||||||||||
Hydrogen Sulfide (H | 2 | S) (in ppb) Assessed after 90 days |
The mean H126.5 (±167.0) | 2 | S reduction was | 126.5 | ppbSeems to have no difference between groups, but this results are imprecise (wide CI) MD 26.0 [95% CI −80.5 to 132.5]; | n | MD | 26 points higher | (80.5 lower = 40; | p | = 0.63 | |||||||
to 132.5 higher) | - | 40 | (1 RCT) |
⨁◯◯◯ VERY LOW | a,b | Alshahrani 2020 [41] | Alshahrani 2020 [3] |
| 42 (38) | 65 (11.9) | The authors reported a reduced H | 2 | S concentration in favour of aPDT ( | p | < 0.0001, | n | = 30) | |||
Adverse events during the study | see comments | see comments | Not estimable | 40 (1 RCT) |
⨁◯◯◯ VERY LOW | c,d | No adverse events were reported in the aPDT group, and some participants reported discomfort and gagging sensation in the control group (no numerical data provided) | Lopes 2015 [36] | Lopes 2015 [2] |
| 20 (20.2) | 53 (7.0) | The authors reported a reduced H | 2 | S concentration in favour of aPDT ( | p | = 0.008, | n | = 31) |
* The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RR: risk ratio. GRADE Working Group grades of evidence. High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: weauthors are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: ourthe confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect. Very low certainty: weauthors have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect. Explanations.a. Downgraded one level due to methodological limitation (incomplete outcome data). b. Downgraded two levels for imprecision: only one study, very small number of participants, wide confidence interval. c. Downgraded two levels due to methodological limitations (lack of information on allocation concealment and blinding of participants). d. Downgraded one level for imprecision: only one study, very small number of participants and no events.
Lopes et al. [36][2] found that aPDT was effective at achieving an immediate reduction in halitosis and therefore constitutes a treatment option for this condition that does not harm the papillae, as occurs in conventional treatment with a tongue scraper. However, the authors found that the application of 90 s per point at six points on the dorsum of the tongue caused certain discomfort among the patients and suggested further studies to test different energies. Do Vale et al. [43][4] conducted a study with patients who wore complete dentures. The authors concluded that aPDT seems to be effective at reducing H2S immediately after treatment and that this effect was maintained at the seventh day follow-up. Laban et al. [42][6] concluded that antimicrobial PDT seems to help in reducing H2S concentration and improving quality of life in elderly patients wearing dentures. There also a reduction in P. gingivalis that occurred only in the short-term follow-up. Da Mota et al. [44][5] concluded that aPDT using a red LED and 0.005% methylene blue caused an immediate reduction in halitosis, but the effect was not maintained after 7, 14, or 30 days. Additionally, they found no reduction in the number of bacteria investigated or the quantification of universal 16S rRNA. Romero et al. [24][1] reinforces 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 two- or three-fold smaller than baseline values. Future studies should include other oral hygiene behavior to achieve better results in the treatment of halitosis. Alshahrani [41][3] concludes that PDT along with tongue scraping showed immediate reduction in H2S and reduction in oral pathogens in adolescent patients undergoing fixed orthodontic treatment for 15 days.