OBJECTIVES: The objectives of this review were to assess the effects of various interventions used to control halitosis due to oral diseases only. We excluded studies including patients with halitosis secondary to systemic disease and halitosis-masking interventions.

SEARCH METHODS: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 8 April 2019), the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 3) in the Cochrane Library (searched 8 April 2019), MEDLINE Ovid (1946 to 8 April 2019), and Embase Ovid (1980 to 8 April 2019). We also searched LILACS BIREME (1982 to 19 April 2019), the National Database of Indian Medical Journals (1985 to 19 April 2019), OpenGrey (1992 to 19 April 2019), and CINAHL EBSCO (1937 to 19 April 2019). The US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov (8 April 2019), the World Health Organization International Clinical Trials Registry Platform (8 April 2019), the ISRCTN Registry (19 April 2019), the Clinical Trials Registry - India (19 April 2019), were searched for ongoing trials. We also searched the cross-references of included studies and systematic reviews published on the topic. No restrictions were placed on the language or date of publication when searching the electronic databases.

SELECTION CRITERIA: We included randomised controlled trials (RCTs) which involved adults over the age of 16, and any intervention for managing halitosis compared to another or placebo, or no intervention. The active interventions or controls were administered over a minimum of one week and with no upper time limit. We excluded quasi-randomised trials, trials comparing the results for less than one week follow-up, and studies including advanced periodontitis.

DATA COLLECTION AND ANALYSIS: Two pairs of review authors independently selected trials, extracted data, and assessed risk of bias. We estimated mean differences (MDs) for continuous data, with 95% confidence intervals (CIs). We assessed the certainty of the evidence using the GRADE approach.

MAIN RESULTS: We included 44 trials in the review with 1809 participants comparing an intervention with a placebo or a control. The age of participants ranged from 17 to 77 years. Most of the trials reported on short-term follow-up (ranging from one week to four weeks). Only one trial reported long-term follow-up (three months). Three studies were at low overall risk of bias, 16 at high overall risk of bias, and the remaining 25 at unclear overall risk of bias. We compared different types of interventions which were categorised as mechanical debridement, chewing gums, systemic deodorising agents, topical agents, toothpastes, mouthrinse/mouthwash, tablets, and combination methods. Mechanical debridement: for mechanical tongue cleaning versus no tongue cleaning, the evidence was very uncertain for the outcome dentist-reported organoleptic test (OLT) scores (MD -0.20, 95% CI -0.34 to -0.07; 2 trials, 46 participants; very low-certainty evidence). No data were reported for patient-reported OLT score or adverse events. Chewing gums: for 0.6% eucalyptus chewing gum versus placebo chewing gum, the evidence was very uncertain for the outcome dentist-reported OLT scores (MD -0.10, 95% CI -0.31 to 0.11; 1 trial, 65 participants; very low-certainty evidence). No data were reported for patient-reported OLT score or adverse events. Systemic deodorising agents: for 1000 mg champignon versus placebo, the evidence was very uncertain for the outcome patient-reported visual analogue scale (VAS) scores (MD -1.07, 95% CI -14.51 to 12.37; 1 trial, 40 participants; very low-certainty evidence). No data were reported for dentist-reported OLT score or adverse events. Topical agents: for hinokitiol gel versus placebo gel, the evidence was very uncertain for the outcome dentist-reported OLT scores (MD -0.27, 95% CI -1.26 to 0.72; 1 trial, 18 participants; very low-certainty evidence). No data were reported for patient-reported OLT score or adverse events. Toothpastes: for 0.3% triclosan toothpaste versus control toothpaste, the evidence was very uncertain for the outcome dentist-reported OLT scores (MD -3.48, 95% CI -3.77 to -3.19; 1 trial, 81 participants; very low-certainty evidence). No data were reported for patient-reported OLT score or adverse events. Mouthrinse/mouthwash: for mouthwash containing chlorhexidine and zinc acetate versus placebo mouthwash, the evidence was very uncertain for the outcome dentist-reported OLT scores (MD -0.20, 95% CI -0.58 to 0.18; 1 trial, 44 participants; very low-certainty evidence). No data were reported for patient-reported OLT score or adverse events. Tablets: no data were reported on key outcomes for this comparison. Combination methods: for brushing plus cetylpyridium mouthwash versus brushing, the evidence was uncertain for the outcome dentist-reported OLT scores (MD -0.48, 95% CI -0.72 to -0.24; 1 trial, 70 participants; low-certainty evidence). No data were reported for patient-reported OLT score or adverse events.

MATERIALS AND METHODS: A cross-sectional comparative study was performed on subjects from multiple dental centres in Malaysia using a questionnaire covering sociodemographics, OHRQoL using the Malaysian Oral Health Impact Profile questionnaire, OHIP-14(M) and self-reported symptoms. Participants with severe CP were age-and gender-matched with periodontally healthy/mild periodontitis (HMP) participants based on inclusion and exclusion criteria. Full mouth periodontal examination was performed on participants. Outcome measures were OHIP-14(M) prevalence of impact and severity of impact scores.

RESULTS: One hundred and thirty (130) participants comprising 65 severe CP and 65 HMP participants were included in the study. Prevalence of impact on OHRQoL was significantly higher in the severe CP than HMP group, with an odds ratio of 3. Mean OHIP-14(M) score was significantly higher in the severe CP (18.26 ± 10.22) compared to HMP (11.28± 8.09) group. The dimensions of psychological discomfort and functional limitation, and factors such as 'discomfort due to food stuck' and 'felt shy' were impacted more in severe CP compared to HMP group (p < 0.05). When compared with the HMP group, generalised severe CP participants showed higher prevalence of impact on OHRQoL [OR=5] (p < 0.05) compared to localised severe CP [OR=2] (p = 0.05). Participants who had experienced self-reported symptoms had statistically significant impacts on OHRQoL.

METHODS: Subjects from dental and RA clinics were screened. Complete periodontal examinations were performed. Subjects were divided into 4 groups: RA-PD, RA, PD and healthy controls (HC). Questionnaires on characteristics and Malaysian versions of Oral Health Impact Profile (OHIP-14(M)) and Health Assessment Questionnaire (HAQ-DI)) were answered.

MATERIALS AND METHODS: A cross-sectional survey research design was employed in this study. Self-administered questionnaire of the validated "Graduating medical students' Knowledge and Attitudes Survey Regarding Infant's oral health care" were utilized to ascertain the baseline levels of knowledge and attitudes of graduating medical students' in Kulasekaram hospital. In this regard, a preliminary study with a convenience sample of 100 medical students was conducted so as to assess the knowledge of infant oral health care among graduating medical students in Kulasekaram. This study, while limited in sample size, benefits the general practitioners as target readers to assess the abnormalities in children at early stages of life.

RESULTS: The results of the study revealed that the mean percentage score overall was 65.7%. Only 3.2% of participants obtained a passing score of 80% or greater. Widespread knowledge deficits and poor attitudes among graduating medical students were noted in this study, particularly in the domain of pharmacological management of pain. Positive correlations were observed between the respondents' score and level of education. Further analysis revealed respondents had an inaccurate self-evaluation of their pain management knowledge.

METHODS: The Khadijah Rohani's Readability Formula (KRRF) and Suitability Assessment of Materials (SAM) instrument were used to assess the readability and suitability of the pamphlets respectively. All 23 Bahasa Malaysia pamphlets retrieved from the official portal of OHP on the 31st January 2019 were assessed for suitability. However, only five pamphlets were found to be eligible for readability assessment because the KRRF, the single formula available for Bahasa Malaysia text is applicable only for materials with 300 words or more. The readability is interpreted based on the level of formal education in Malaysia.

RESULTS: All pamphlets achieved superior suitability rating with a minimum and maximum score of 75% and 95% respectively. However, a few pamphlets did not fulfil SAM superior and adequate criteria for the following factors and were rated not suitable: did not include summary (73.9%), have few or no headers (4.3%), did not use captions to explain graphics (17.4%), and did not provide interactive learning (21.7%). Readability of the pamphlets eligible for assessment ranged from primary six to secondary three.

MATERIAL AND METHODS: In this prospective study, 20 IFPP (mean age 47.0; SD 12.9 years) and 28 ISOD (mean age 61.5; SD 9.1 years) patients received 2 mandibular implants. Metal ceramic nonsplinted fixed prostheses were provided in IFPP group, while in ISOD group, the mandibular overdentures were retained by nonsplinted attachments. Patients rated their oral health-related quality of life using OHIP-14 Malaysian version at baseline (T0), 2-3 months (T1) and 1 year (T2) postimplant treatment. Mean OHIP-14 for total and domain scores between groups and intervals was analysed using repeated-measures ANOVA and t-test. Mann-Whitney and Wilcoxon signed-rank tests were used for the comparison of mean score change and effect size, while the association between pre- and post-treatment scores was determined using multivariate linear regression modelling.

RESULTS: The total OHIP and domain scores before implant treatment were significantly higher (lower OHRQoL) in IFPP than in ISOD groups, except for physical pain where this domain showed similar impact in both groups. Postimplant scores between groups at T1 and T2 showed no significant difference. The mean score changes at T0-T1 and T0-T2 for total OHIP-14 and domains were significantly greater in IFPP except in the domains of physical pain and disability which showed no difference. Large effect size (ES) was observed for total OHIP-14 in IFPP while moderate in ISOD. Improved OHRQoL was dependent on the treatment group and pretreatment score.

METHODS: Databases including Medline, Embase and bibliographies were searched from inception to 1 April 2023. Randomized controlled trials (RCTs) with 7 days or longer duration of oil pulling with edible oils in comparison to chlorhexidine or other mouthwashes or oral hygiene practice concerning the parameters of plaque index scores (PI), gingival index scores (GI), modified gingival index scores (MGI) and bacteria counts were included. Cochrane's Risk of Bias (ROB) tool and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework were employed to determine the quality of evidence. Two authors independently conducted study selection and data extraction. Meta-analyses of the effect of oil pulling on the parameters were conducted using an inverse-variance random-effects model.

RESULTS: Twenty-five trials involving 1184 participants were included. Twenty-one trials comparing oil pulling (n = 535) to chlorhexidine (n = 286) and non-chlorhexidine intervention (n = 205) were pooled for meta-analysis. More than half of the trials (n = 17) involved participants with no reported oral health issues. The duration of intervention ranged from 7 to 45 days, with half of the trials using sesame oil. When compared to non-chlorhexidine mouthwash interventions, oil pulling clinically and significantly improved MGI scores (Standardized mean difference, SMD = -1.14; 95% confidence interval [CI]: -1.31, -0.97). Chlorhexidine was more effective in reducing the PI scores compared to oil pulling, with an SMD of 0.33 (95% CI: 0.17, 0.49). The overall quality of the body of evidence was very low.