Impact of different oral hygiene aids for the reduction of morning bad breath among dental students: a crossover clinical trial

BACKGROUND AND AIMS: To assess and compare the effects of different oral hygiene procedures on the reduction of morning bad breath, plaque and gingival status in healthy subjects. METHODS: A four step cross-over trial was performed on 32 study subjects. They were allocated into four groups: Group I: tooth brushing; Group II: tooth brushing and tongue scraping; Group III: tooth brushing and mouth washing; and Group IV: tooth brushing, tongue scraping and use of mouthwash. A washout interval of 7 days was employed. At the beginning and at the end of all intervention periods, breath score was measured by hand held sulfide monitor (Breath Alert) at four time intervals. The Plaque and Gingival status was evaluated using Plaque and Gingival Index. RESULTS: The highest reduction in mean breath score (2.12±0.65), plaque score (0.75±0.47) and gingival score (0.67±0.41) were found in the Group IV followed by Group II and Group III. A significant positive correlation was observed between plaque scores and gingival scores before intervention (r=0.443; p value<0.001) and after intervention (r=0.846; p value<0.001). CONCLUSION: The study findings suggest that mechanical aids in conjunction with chemical regimens are considered as the most effective method for reducing the morning bad breath in healthy subjects and should be incorporated in daily oral hygiene practices.