A laboratory-formulated essential oil mouthwash led to greater reductions in halitosis, plaque, gum bleeding, and bacterial markers than placebo in a short-term randomized clinical trial involving patients with obesity and periodontitis.

Background and Clinical Need:

Halitosis affects up to half the population and is particularly common in patients with obesity and chronic inflammatory conditions, including periodontitis. While standard treatments such as chlorhexidine can reduce oral malodor, they often cause adverse effects. Researchers continue to seek safe, natural alternatives for these high-risk patients.

Study Methods:

This randomized, placebo-controlled clinical trial enrolled 45 adult patients with obesity (mean age, 43 years; mean BMI, 32 kg/m²), all of whom had chronic periodontitis and self-reported halitosis. Patients were randomly assigned in a 2:1 ratio to use either an essential oil mouthwash (n = 30) or placebo (distilled water, n = 15) for four weeks, in addition to standardized oral hygiene.

The essential oil rinse included lemon (Citrus limon), melissa (Melissa officinalis), grapefruit seed extract, sodium bicarbonate, vegetable glycerine, and distilled water. Halitosis was evaluated using both patient self-assessment and examiner scoring (on a 0–5 scale), and the BANA test was used to detect oral bacteria known to cause malodor.

Findings:

After 4 weeks, patients using the essential oil rinse had greater improvements than those using placebo:

• Plaque index: Decreased from 1.39 to 0.95 (32 percent reduction) vs. 1.33 to 1.21 (9 percent) in controls

• Gum bleeding: Decreased from 58 percent to 38 percent (34 percent) vs. 56 percent to 53 percent (6 percent)

• Self-rated halitosis: Improved from 3.4 to 2.1 (37 percent) vs. 3.2 to 2.9 (10 percent)

• Examiner-rated halitosis: Improved from 3.1 to 1.7 (46 percent) vs. 3.0 to 2.8 (8 percent)

• BANA positivity: Decreased from 77 percent to 38 percent (38 percent) vs. 68 percent to 65 percent (4 percent)

All participants adhered to the protocol, and no adverse effects were reported.

The findings suggest that essential oil mouthwashes could be a useful adjunctive therapy for patients with obesity and periodontitis who are seeking non-pharmacological approaches to reduce oral malodor and inflammation. Study investigator Gabriela Beresescu, DDS, noted that the essential oil rinse outperformed placebo in reducing not only plaque and gum inflammation, but also halitosis and microbial burden among patients.

Study limitations include its short 28-day duration, small sample size, single center, and the use of semi-objective halitosis measures. The researchers recommend larger, longer-term studies, including direct comparisons with chlorhexidine and studies in diverse patient populations. Further research should also address psychosocial benefits, as improved breath may enhance quality of life.

The researchers reported no conflicts of interest.

Source: Journal of Clinical Medicine