title: How to deal with morning bad breath: A randomized, crossover clinical trial.
abstract: BACKGROUND
  The absence of a protocol for the treatment of halitosis has led us to compare mouthrinses with mechanical oral hygiene procedures for treating morning breath by employing a hand-held sulfide monitor.
  
  
  OBJECTIVE
  To compare the efficacy of five modalities of treatment for controlling morning halitosis in subjects with no dental or periodontal disease.
  
  
  METHODS
  This is a five-period, randomized, crossover clinical trial.
  
  
  METHODS
  Twenty volunteers were randomly assigned to the trial. Testing involved the use of a conventional tongue scraper, a tongue scraper joined to the back of a toothbrush's head, two mouthrinses (0.05% cetylpyridinium chloride and 0.12% chlorhexidine digluconate) and a soft-bristled toothbrush and fluoride toothpaste for practicing oral hygiene.
  
  
  METHODS
  Data analysis was performed using SPSS version 17 for Windows and NCSS 2007 software (P < 0.05). The products and the periods were compared with each other using the Friedman's test. When significant differences (P < 0.05) were determined, the products and periods were compared in pairs by using the Wilcoxon's test and by adjusting the original significance level (0.05) for multiple comparisons by using the Bonferroni's method.
  
  
  RESULTS
  The toothbrush's tongue scraper was able to significantly reduce bad breath for up to 2 h. Chlorhexidine reduced bad breath only at the end of the second hour, an effect that lasted for 3 h.
  
  
  CONCLUSIONS
  Mechanical tongue cleaning was able to immediately reduce bad breath for a short period, whereas chlorhexidine and mechanical oral hygiene reduced bad breath for longer periods, achieving the best results against morning breath.
authors.affiliation: Department of Dental Materials and Prosthodontics, Faculty of Dentistry of Ribeirão Preto, University of São Paulo - USP, Ribeirão Preto, Brazil.
authors.forename: Jeronimo M
authors.initials: JM
authors.lastname: Oliveira-Neto
authors.affiliation: Department of Dental Materials and Prosthodontics, Faculty of Dentistry of Ribeirão Preto, University of São Paulo - USP, Ribeirão Preto, Brazil.
authors.forename: Sandra
authors.initials: S
authors.lastname: Sato
authors.affiliation: Department of Dental Materials and Prosthodontics, Faculty of Dentistry of Ribeirão Preto, University of São Paulo - USP, Ribeirão Preto, Brazil.
authors.forename: Vinícius
authors.initials: V
authors.lastname: Pedrazzi
keywords: Halitosis; mouthwashes; sulfide monitor; tongue scraper