Daily use of chlorine dioxide effectively treats halitosis: A meta-analysis of randomised controlled trials.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of randomized controlled trials
PubMed 36634129 · doi:10.1371/journal.pone.0280377
What was done
A systematic review and meta-analysis of databases (MEDLINE, Embase, Scopus, Web of Science, and CENTRAL through October 14, 2021) was performed. Investigators included randomized controlled trials evaluating chlorine dioxide mouthwash compared to placebo or other mouthwashes in adults with halitosis. Primary outcomes were changes from baseline in organoleptic test scores (OLS) and volatile sulfur compound (VSC) levels at the last available follow-up.
What was found
Ten articles met inclusion criteria for qualitative synthesis, and 7 RCTs with 234 patients were included in the meta-analysis. Chlorine dioxide significantly improved 1-day OLS compared to placebo (mean difference [MD]: -0.82; 95% CI: [-1.04, -0.60]; I² = 0%, p = 0.67), 1-week OLS (MD: -0.24; 95% CI: [-0.41, -0.07]; I² = 0%, p = 0.52), and 1-day H2S levels (standardized mean difference [SMD]: -1.81; 95% CI: [-2.52, -1.10]; I² = 73.4%, p = 0.02).
Why it matters
This review aggregates randomized trial evidence showing that chlorine dioxide mouthwash provides short-term reductions in organoleptic breath odor scores and hydrogen sulfide levels.
Limits
The total sample size was small across the included RCTs (234 patients in 7 trials). Reported follow-up durations were very short (1 day to 1 week), outcome reporting lacked longer-term data, and substantial heterogeneity was present for the 1-day hydrogen sulfide outcome (I² = 73.4%).
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