Nasal breathing is the major route of air into the human organism and is responsible for filtering, heating, and humidifying the inhaled air for the protection of the airway. Mouth breathing can be defined as pathological and can be caused by many factors including upper airway obstruction, flaccid facial muscles, and harmful oral habits. Mouth breathing is mostly a combination of nasal and oral breathing and has a reported prevalence of more than 50% in the population. Contribution of mouth breathing is the evaporation of saliva which decreases its antibacterial and cleaning effect making way for a huge increase in halitosis.
A recent study published in PLOS ONE assessed the effectiveness of antimicrobial photodynamic therapy (aPDT) employing an annatto-based (20%) dye combined with blue LED for the treatment of halitosis in mouth-breathing children.
A total of 52 children, aged 6–12 years, diagnosed with mouth breathing and halitosis (score of >3 on portable breath meter) Breath Alert™ (Tanita Corporation®-Japan), were randomly divided into two groups (n=26). In Group 1, subjects used brushing, dental floss, and aPDT applied to the middle third of the dorsum of the tongue. In Group 2, subjects used brushing, dental floss, and a tongue scraper. Breath meter results before, immediately after treatment and, later on, at 7 days and 30 days following treatment were analyzed and compared. Normality in data was rejected with the Shapiro-Wilk test (p<0.05) and Wilcoxon and Mann-Whitney tests were used for statistical analysis.
The index for coated tongues was estimated. For this, the tongue was divided into 9 sections – the coded tongue among these areas was taken using a 3-point scale: 0 = absence of coated tongue; 1 = presence of coated tongue with papillae visible; 2 = presence of coated tongue with papillae not visible and thus, the sum of scores given to the regions was divided by 18 as this was the total number of regions studied. The result would then be multiplied by 100 to produce a coated tongue index between 0-100%.
A highly significant difference exists between the pre-treatment reading and all other readings (p<0.05) in both groups concerning the proposed treatment effects. Post-treatment readings were not significantly different from two follow-up readings, indicating the effect of treatment over time (p>0.05), while all post-treatment assessments showed between-group differences (p<0.0001, for all comparisons), demonstrating a higher effectiveness of aPDT. No correlation was observed with an initial reading for the presence of a coated tongue.
A statistically significant difference was found between pre-treatment readings and all other readings (p<0.05) in both groups, indicating the effectiveness of the treatment proposed. Between post-treatment readings and the two follow-up readings, no significant differences were found; treatment effect was therefore established over time (p>0.05). However, between-group differences were found in all post-treatment assessments (p<0.0001 for all comparisons) indicating better effectiveness with aPDT. No association was found between the initial reading and the presence of a coated tongue.
Antimicrobial photodynamic therapy using annatto and blue LED proved to be a viable therapeutic option for the treatment of halitosis in children with mouth breathing.
Reference: Bruno LH, Mandetta ARH, Sobral APT, et al. Assessment of photodynamic therapy with annatto and led for the treatment of halitosis in mouth-breathing children: Randomized controlled clinical trial. PLoS One. 2024;19(9):e0307957. doi:10.1371/journal.pone.0307957
