Effect of Metronidazole on Halitosis of 2 to 10-Year-Old Children

Abstract

Background:Regarding the fact that halitosis has social and personal aspects which can lead to social embarrassment and consequently low self-esteem and self-confidence in subjects suffering from the problem, especially children, its proper treatment is an important issue.Objectives:The aim of this study was to evaluate the effect of metronidazole as a nonspecific antimicrobial agent in the treatment of halitosis in children.Materials and Methods:In this study, 2-10 years old children with oral halitosis were enrolled. Children without H. pylori infection and parasitic infection were randomized in two interventional and control groups. Metronidazole was given 5mg/kg/day for one week. Information regarding the demographic characteristics of studied population and halitosis (duration and time of day with more halitosis and its severity) before and after intervention was recorded using a questionnaireResults:77 children with halitosis were studied in two interventional (40 children) and control (37 children) groups. There was no significant difference between two groups before intervention. After intervention, halitosis improvement rate - according to the reports of mothers of studied children - was higher significantly in intervention group (P < 0.05). Conclusions:The results support the effectiveness of metronidazole in the treatment of halitosis. Moreover, it supports recent findings regarding the participation of specific bacteria specially unculturable ones in the pathogenesis of the disease.

Aetiology, diagnosis and management of halitosis – a narrative review

“…They mainly increase saliva production so that more soluble sulphur components are retained for a short time (Sterer & Rubinstein, 2006). In cases of refractory halitosis, a 5-7 day treatment with metronidazole at a dose of 600-1000mg/day is used to reduce tongue microbiota and odour (Scully & Greenman, 2012;Sayedi et al, 2015). Treatment with a metronidazole rinse also positively changes patients' periodontal status and breath odour.…”

Halitosis: prevalence and association with oral etiological factors in children and adolescents

“…Ninety percent of cases of halitosis are caused by disorders of the oral cavity [10][11][12][13][14][15][16]23]. Halitosis of an oral origin is associated with poor oral hygiene, dental caries, coated tongue and oral carcinoma in the adult population [23], but these associations have been studied little in children and adolescents [7].…”

“…The presence of dental caries, independently of the number of affected teeth, was associated with halitosis in the present sample. Previous studies report that this condition is a risk factor for halitosis due to the exposure of necrotic dental tissue in the oral environment [10,[12][13][14][15].…”

“…Based on the present findings, the prevalence of halitosis in the sample analyzed was lower than that reported in previous studies involving children and adults, but the associated oral factors were the same: bacterial plaque, coated tongue (variables related to dental hygiene), dental caries and abnormal salivary flow. Therefore, as oral etiological factors are the cause of 90% of all cases of halitosis [15] and deficient hygiene is strongly associated with a positive diagnosis, therapeutic approaches should be centered on the reduction in the total load of oral microorganisms through educational and prevention strategies that address the mechanical removal of biofilm with an adequate toothbrush, the daily use of dental floss and tongue cleaning [15,23,25,29].…”

“…Studies have demonstrated that 90% of cases of halitosis in adults and children are directly associated with oral conditions, such as coated tongue, deficient oral hygiene, salivary alterations, periodontal disease, dental caries, etc [10][11][12][13][14][15][16]. Respiratory and otolaryngological disorders, such as acute tonsillitis, postnasal drip and sinusitis, account for 8% of the diagnoses of halitosis and metabolic syndromes as well as kidney, liver, endocrinological and gastrointestinal disorders account for 2%.…”