Utilization of Chlorine Dioxide Solution to Prevent Halitosis Due to

Coated Tongue

Suci Erawati, Mangatas H. P., Laras P.

Faculty of Dentistry, Universitas Prima Indonesia, Indonesia

Keywords: Halitosis, Coated Tongue, Chlorine dioxide.

Abstract: Halitosis is a characteristic of unpleasant odors arising from the oral cavity and causing disruption in one's

life. The source of halitosis can come from the oral cavity (intra oral) or from outside the mouth (extra oral).

One of the causes of intra-oral is coated tongue which is a condition where the surface of the tongue in white

or other colored which is a pile of debris, food debris, and microorganisms attached to the dorsum surface of

the tongue. Chlorine dioxide is a powerful oxidizing agent and is effective for killing bacteria. This research

was an experimental method with pre and post test with control group design using 30 female subjects with

complaints of halitosis. The results showed that after gargling for 10 days, found 76.7% subjects without

coated tongue and 100% mild halitosis subjects became normal.

1 INTRODUCTION

Halitosis or in other terms feor ex ore, bad or foul

breath is a characteristic of unpleasant odors arising

from the oral cavity. The cause of halitosis can come

from inside the oral cavity and from outside the oral

cavity. The cause of the oral cavity is usually due to

poor oral hygiene care, deep caries, periodontal

disease, oral cavity infection, dry mouth, smoking,

mucosal ulceration, pericoronitis, food scraps in the

mouth and Coated Tongue.10.19.20. The main

component of gas compounds in halitosis is Volatile

sulfur compounds (VSCs). Halitosis is one of the bad

breath disorders that has a negative impact on a

person's life, including causing poor communication,

low self-esteem, shame, difficulty interacting

socially, disturbing people around (Alsheri, 2016;

Ashwath, 2014).

One of the conditions that can be found in almost

everyone is the condition of coated tongue 3. In the

initial research conducted at Ujung Berung Health

Center in Bandung in 2016 showed that the condition

of coated tongue is the most common oral lesions

found in all grosups 4. Coated Tongue is one of the

factors important thing that can cause halitosis. The

dominant development in anaerobic microbes

associated with coated tongue has been considered as

an ideal microenvironment to produce foul-smelling

compounds. Therefore the relationship between

Coated Tongue and halitosis was assessed and

evaluated through patients who visited the clinic with

complaints of halitosis consisting of 51% due to

Coated Tongue, 17% gingivitis, 15% periodontitis

and 17% combination.

The results of a 2017 study showed that students

with coated tongue were 2.75 times more likely to

have halitosis compared to those who did not have a

coated tongue. The relationship between Coated

Tongue and halitosis complaints has also been

observed in populations in Thailand (Casemiro, 2008;

Aydin, 2014).

Most people today need a fast and efficient way to

reduce halitosis to be more confident. There are many

ways to deal with halitosis, one way is to use

mouthwash. Mouthwash containing essential oils,

triclosan, cetylpridinium chloride, and Chlorine

Dioxide (CIO2) has clearly proven effective in

reducing bad breath. The use of mouthwash is a

simple effort to overcome halitosis. In Indonesia, the

market offers a variety of brands with different active

ingredients than mouthwash (Poetry et al,2018;

Aydin, 2014; Erawati, 2014; Sun Choi, 2020; Turnip,

2020; Wijaya, 2019).

Chlorine Dioxide is a powerful and effective

oxidizing agent to kill bacteria, viruses, and fungi in

an acidic environment. At low concentrations CIO2

is effective in reducing VSC which causes bad breath.

This can inhibit the growth of microorganisms by

disrupting the transportation of nutrients throughout

the cell membrane. CIO2 oxidatively activates

salivary biomolecules including pyruvate

methionine, trimethylarine, tyrosain 'and glycine so

254

Erawati, S., H. P., M. and P., L.

Utilization of Chlorine Dioxide Solution to Prevent Halitosis Due to Coated Tongue.

DOI: 10.5220/0010329802540258

In Proceedings of the International Conference on Health Informatics, Medical, Biological Engineering, and Pharmaceutical (HIMBEP 2020), pages 254-258

ISBN: 978-989-758-500-5

as to direct its anti-microbial effects (Poetry et al,

2018; Sun Choi, 2020; Chen, 2016; Dwirassa, 2016;

Nazir, 2017).

2 METHOD

This research has been completed with the approval

of the Health Research Ethics Commission (KEPK)

of Prima Indonesia University No: 002 / KEPK /

UNPRI / III / 2019. This type of research is an

experimental study using a pretest and post test

design approach that is by measuring or observing

before and after the treatment is given. The

population in this study was 90 mothers with a large

sample of 30 people obtained using the proportion

research formula. The tools used are as follows: Sheet

sheet of subject selection form, Breathon II

measuring instrument, gloves / hand scoon, mask,

flashlight, tissue, stationery. The ingredients used are

chlorindioxide mouthwash, distilled water / mineral

water, anti-septic soap.

Figure 1: Scheme of research process

The research stage was to conduct screening to

determine the subject by means of examination in

accordance with inclusion and exclusion criteria.

Each subject agrees, the subject can sign the Informed

Consent. Then the coated tongue and halitosis scores

were measured in the subjects before being treated

(first day). Clinical examination of the tongue to

measure the score for the coated tongue on the surface

of the tongue by sticking out the tongue. Then

proceed with the examination of the VSC gas score

which causes bad breath (halitosis) using the

Breathon II device, the next day (second to ten days)

the subject is given mouthwash (CIO2) and must be

used for ten consecutive days with a dose of 10 ml

liters. twice a day, morning after breakfast and night

brushing. There are no specific rules in the use of the

method of brushing teeth or the toothpaste used.

Subjects rinsed for one to two minutes, on day five

and day ten subjects had to follow the instructions of

the investigator to measure the coated tongue and

halitosis scores to determine the difference before and

after using chlorine dioxide mouthwash.

3 RESULTS

The distribution of sample characteristics based on

age can be seen in full in Table 1.

Table 1. Distribution of sample characteristics by age

Age N Percentage

(Years) (%)

30-33 3 10,0

34-37 0 0,0

38-41 7 23,3

42-45 9 30,0

46-49 6 20,0

50 5 16,7

Total 30 100,0

Based on the results of the study, on the first day,

20 samples (66.7%) had coated tongue with thick

membranes. Meanwhile, 10 samples with thin-coated

coated tongue (33.3%). On the fifth day, there were 8

people (26.7%) who experienced coated tongue with

thick membranes while 17 people (56.7%) had thin-

coated coated tangue (16.7%) and 5 people (16.7%)

were absent. samples with thick coated tongue (0%).

The thin membrane of 7 people (23.33%) and no

membrane 23 people (76.67%) is seen in Table 2.

Distribution of samples with mild halitosis on the

first day 28 people (93.3%) moderate halitosis 2

people (6.7%) on the fifth day, 30 people did not

experience halitosis (100%) and on the tenth day of

the entire sample, 30 people did not experience

halitosis (100%) this is shown in Table 3.

Utilization of Chlorine Dioxide Solution to Prevent Halitosis Due to Coated Tongue

255

Table 2: Distribution of samples experiencing coated

tongue on the first fifth to tenth

Days

Coated Tongue

Membrane

Thin

membrane

Thick

membrane

n % N % n %

0,0

33,3

56,7

23,3

66,7

26,7

0,0

Table 3. The distribution of sample frequencies

experiencing normal, mild and moderate halitosis

Days Halitosis

Normal Light Medium

N % n % n %

1 0 0,00 28 93,3 2 6,7

5 30 100,00 0 0,00 0 0,00

10 30 100,00 0 0,00 0 0,00

The average halitosis score of the sample after

rinsing with CIO2 solution on the first day was 163,

77 + 54,957, on the fifth day there was a decrease in

the halitosis score in the sample to 59, 80 + 27.95, and

on the tenth day the average halitosis score in the

sample decreasing to 36.17 + 12,152 can be seen in

Table 4.

Table 4. Average halitosis scores of samples on the first,

fifth, and tenth days.

Gargle treatment

Solution (C IO2)

X + SD

Day 1 163, 77 +54,9573

Day 5 59, 80 + 27,95

Day 10 36,17 + 12,152

The difference in the mean halitosis scores of the

samples after rinsing with CIO2 solution on the fifth

day was 93.97 + 27.862, while the average difference

in halitosis scores after rinsing CIO2 solution on the

tenth day was 127.60 + 42,805. The results of

statistical tests showed that there was a significant

difference between day five and day ten p = 0.00 (p

<0.05). Can be seen in table 5.

Table 5. The difference in the average halitosis difference

of samples after rinsing with CIO2 solution on the fifth and

tenth day (n = 30).

Difference in average

halitosis scores

X + SD P

5 93,97+ 27,862 0,000

Day 10 127,60+42,805

4 DISCUSSIONS

Oral disease affects humans in almost all over the

world, including Indonesia, and almost reaches 50%

of the total adult population. One condition that can

be found in almost everyone is coated tongue. One of

the important factors that can cause halitosis. The

dominant development in anaerobic microbes

associated with coated tongue is considered to be the

ideal microenvironment to produce foul smelling

compounds (Poetry et al, 2018; Nazir et al, 2017).

The results showed that before rinsing with

chlorine dioxide, twenty out of thirty had thick-filmed

coated tongue (66.7%) and twenty-eight out of thirty

respondents had mild halitosis (93.3%). After rinsing

with mouthwash containing (CIO2) for ten

consecutive days (posttest), twenty-three out of thirty

respondents on coated tongue had no membranes

(76.7%) and overall normal halitosis (100%). The

results showed that the average coated tongue score

index on the first day was 1.67 ± 0.479, the fifth day

was 1.10 ± 0.662 and on the tenth day was 0.23 ±

0.430 which indicated that there was a significant

difference in the mean coated score. tongue, namely

with a p value of 0.000 (<0.05) (Poetry et al, 2018;

Nazir et al, 2017; Pangesti, 2014).

Likewise with the results of research on halitosis,

it was found that respondents on the first day were in

the halitosis parameter based on a mild VSC gas score

of 110-239 ppb and moderate halitosis of 351 pbb and

277 pbb with mean values of 163.77 ± 54.957.

Halitosis on the fifth day of all respondents was in the

halitosis parameter based on the normal VSC gas

score, namely 13-18 pbb with a mean of 59.80 ±

27.095 as well as halitosis on the tenth day with a

mean of 59.80 ± 27.095 as well as halitosis on the

tenth day where the overall the respondent is in the

parameter. Halitosis based on the normal VSC gas

score is 19-82 pbb with a mean of 36.17 ± 12.152.

From these data it can also be concluded that the use

of CIO2 mouthwash in dealing with coated tongue is

more effective on the tenth (pottest) day, this

statement is in line with the research conducted by

Shinada et al., (2010) which was conducted on 15

healthy adult men aged 19- 83 years of age proven to

be effective in eliminating bad breath (halitosis),

plaque and coated tongue on the seventh day of

mouthwash (pottest) use (Nazir et al, 2017; Pangesti,

2014; Sun Choi, 2020).

From the results of the study it can be concluded

that the decrease in the coated tongue score also has

an impact on the decrease in the halitosis score, which

is significant, which can be seen in the bar graph in

the image. In line with the results of research from

HIMBEP 2020 - International Conference on Health Informatics, Medical, Biological Engineering, and Pharmaceutical

256

Lawande (2013) that there is a relationship between

coated tongue and halitosis. Likewise, the results of

research conducted by Jui-Wei-Ma, et al., (2017) also

stated the same results that there was a correlation

between Coated Tongue and halitosis (Pangesti,

2014; Sun Choi, 2020; Jui, 2017).

5 DISCUSSIONS

 There was a significant effect on the use of

chlorine dioxide mouthwash on the conditions

of coated tongue causing halitosis in

respondents (p value = 0.000 <0.05).

 The average index score for coated tongue on

day 1, day 5 and day 10 was 1.67 + 0.662; 0.23

+ 0.430, which indicates that there is a

significant difference of p 0.000 (<0.05) on the

average index score of coated tongue among

respondents.

 Average halitosis parameters based on VSC

gas on day 1 163,77+ 54,957, day 5 (59,80+

27,095), and day 10 (36,17+ 12,152) which

indicated that there was a significant difference

p 0,000 (<0.05) on the average halitosis

parameter based on the VSC gas score of the

respondent.

 The use of chlorine dioxide mouthwash on day

5 was effective, but the reduction in coated

tongue and halitosis scores on day 10 was much

more effective than on day 5.

6 SUGGESTION

 It is recommended that the public carry out

maintenance of oral hygiene, especially the

tongue regularly such as brushing teeth,

brushing the tongue and rinsing with a

mouthwash solution, and it is also

recommended to routinely have their teeth and

mouth checked by the dentist to create a clean

and healthy oral cavity condition so as to avoid

coated tongue and bad breath.

 It is recommended that the public use chlorine

dioxide mouthwash to reduce coated tongue

and halitosis in the oral cavity in order to

increase self-confidence when communicating

with others.

 Use of mouthwash must follow the rules and

regulations recommended by dentists, dental

nurses or other health professionals.

Mouthwash only as a complement or addition

to carrying out oral health care only. Not for

continuous treatment because it can kill normal

flora in the oral cavity.

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