Efficacy of probiotics : Clinical and microbial parameters of halitosis

Background & aim. Halitosis is defined as an offensive breath odour of whatever source and therefore may affect a person's social interactions. Intra-oral halitosis is a result of bacterial activity. Therefore, probiotics may offer an appropriate and biological solution as a part of the therapy of intra-oral halitosis. The aim of this systematic review was to study the effect of the administration of probiotics alone or as an adjunct to other treatments on the level of halitosis as measured by volatile sulphur compound (VSC) levels, organoleptic scores (ORG) or hydrogen sulphide, methyl mercaptan and dimethyl sulphide levels. In addition, the effect of probiotic usage on oral microbial composition was summarised. Methods. The MEDLINE-PubMed and Embase databases were searched up to September 2017 with language restricted to English. Eligible papers were selected according to pre-set criteria; the data was extracted and analysed descriptively. Results. The search resulted in 1104 original research articles and a final six were selected as being eligible including 129 subjects. These studies used different detection methods and combinations thereof to measure halitosis. Five studies were randomised placebo-controlled clinical trials of which two studies reported a significant reduction in ORG between probiotic and placebo groups, and two studies on the basis of total VSC levels. The two studies reporting a significant improvement in ORG did not find an improvement in total VSC levels. Three studies included a microbiological assessment. In these three studies, the probiotic strain was detected at the end of the treatment period, but no detailed data was reported on the abundance of the strain before and after the treatment period. Conclusions. Probiotics may be beneficial in treating intra-oral halitosis. However, due to limited data and the heterogeneity of the studies, the efficacy of probiotics remains unclear. Studies with more subjects and standardised protocols need to be designed.