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Complementary and Alternative Medicine - Cam

Search Health Information    Halitosis (Holistic)

Halitosis (Holistic)

About This Condition

Fresh breath can lead to more enjoyable interactions with others. According to research or other evidence, the following self-care steps may be helpful.
  • Control the sulfur

    Routinely use a toothpaste or mouthwash containing zinc compounds or stabilized chlorine dioxide to help break down odor-causing sulfur chemicals

  • Keep an eye on hygiene

    Brush and floss regularly to keep your teeth free of food particles that can lead to halitosis

  • Scrub the tongue

    Brush your tongue or use a commercial tongue scraper regularly to remove odor-causing agents and keep bacteria in check

  • Get a dental checkup

    Visit your dentist to find out if problems associated with oral health are contributing to your halitosis

About

About This Condition

Halitosis is the technical term for bad breath, a condition estimated to affect 50 to 65% of the population.1

Up to 90% of cases are thought to originate from sources in the mouth, including poor oral hygiene, periodontal disease , coating on the tongue, impacted food, faulty dental restorations, and throat infections.2 , 3 , 4 The remaining 10% are due to systemic disorders, such as peptic ulcer (when associated with infection),5 , 6 lung infections (bad breath can be the first sign in some cases),7 liver or kidney disease,8 , 9 diabetes mellitus , cancer,10 or even a person’s imagination (healthy individuals sometimes complain of bad breath that cannot be smelled by anyone else and is not linked to any clinical disorder).11

In most cases, bad breath in the mouth can be traced to sulfur gases produced by bacteria in the mouth.12 , 13 Factors that support the growth of these bacteria will predispose a person to halitosis. Examples include accumulation of food within pockets around the teeth,14 among the bumps at the back of the tongue,15 or in small pockets in the tonsils; sloughed cells from the mouth; and diminished saliva flow. Mucus in the throat or sinuses can also serve as a breeding ground for bacteria. Conditions are most favorable for odor production during the night and between meals.16

Although bad breath primarily represents a source of embarrassment or annoyance, research has shown that the sulfur gases most responsible for halitosis (hydrogen sulfide and methyl mercaptan) are also potentially damaging to the tissues in the mouth, and can lead to periodontitis (inflammation of the gums and ligaments supporting the teeth).17 , 18 As periodontal disease progresses, so may the halitosis, as bacteria accumulate in the pockets that form next to the teeth.

Healthy Lifestyle Tips

Home oral hygiene is probably the most effective way to reduce accumulations of debris and bacteria that lead to halitosis. This includes regular tooth brushing and flossing, and/or the use of mechanical irrigators to remove accumulations of food after eating. Brushing the tongue or using a commercial tongue scraper, especially over the bumpiest region of the tongue, may help remove the odor-causing agents as well as lower the overall bacteria count in the mouth.

Because of the role of gum disease in halitosis, regular dental care is recommended to prevent or treat gum disease. Treatment for a person with periodontal pockets might include scaling of the teeth to remove tartar.19

A reduced saliva flow increases the concentration of bacteria in the mouth and worsens bad breath.20 One of the most common causes of dry mouth is medication, such as antihistamines, some antidepressants, and diuretics; however, chronic mouth breathing, radiation therapy, dehydration, and various diseases can also contribute.21 Measures that help increase saliva production (e.g., chewing sugarless gum and drinking adequate water) may improve halitosis associated with poor saliva flow. Avoiding alcohol (ironically found in many commercial mouthwashes) may also help, because alcohol is drying to the mouth.

Access by oral bacteria to sulfur-containing amino acids will enhance the production of sulfur gases that are responsible for bad breath. This effect was demonstrated in a study in which concentrations of these sulfur gases in the mouth were increased after subjects used a mouth rinse containing the amino acid cysteine .22 Cleaning the mouth after eating sulfur-rich foods, such as dairy, fish, and meat, may help remove the food sources for these bacteria.

Supplements

What Are Star Ratings?

Our proprietary “Star-Rating” system was developed to help you easily understand the amount of scientific support behind each supplement in relation to a specific health condition. While there is no way to predict whether a vitamin, mineral, or herb will successfully treat or prevent associated health conditions, our unique ratings tell you how well these supplements are understood by some in the medical community, and whether studies have found them to be effective for other people.

For over a decade, our team has combed through thousands of research articles published in reputable journals. To help you make educated decisions, and to better understand controversial or confusing supplements, our medical experts have digested the science into these three easy-to-follow ratings. We hope this provides you with a helpful resource to make informed decisions towards your health and well-being.

3 Stars Reliable and relatively consistent scientific data showing a substantial health benefit.

2 Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.

1 Star For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support.

Supplement Why
2 Stars
Coenzyme Q10 (Gingivitis)
50 to 60 mg daily
Learn More

Nutritional supplements recommended by some doctors for prevention and treatment of periodontitis include vitamin C (people with periodontitis are often found to be deficient),23 vitamin E , selenium , zinc, coenzyme Q10 , and folic acid .24 Folic acid has also been shown to reduce the severity of gingivitis when taken as a mouthwash.25

2 Stars
Folic Acid (Gingivitis)
Use 5 ml twice per day of a 0.1% solution
Learn More

Nutritional supplements recommended by some doctors for prevention and treatment of periodontitis include vitamin C (people with periodontitis are often found to be deficient),26 vitamin E , selenium , zinc, coenzyme Q10 , and folic acid .27 Folic acid has also been shown to reduce the severity of gingivitis when taken as a mouthwash.28

2 Stars
Probiotics
Refer to label instructions
Learn More
In a preliminary trial, treatment with a probiotic preparation significantly improved halitosis by about 33%. The preparation used in the study was a tablet containing Lactobacillus salivarius strain WB21 and 280 mg of xylitol. One tablet was taken 3 times per day for 2 to 4 weeks.29 In a double-blind trial, use of a probiotic-containing chewing gum twice a day for 2 weeks significantly improved halitosis in people with self-reported bad morning breath. The gum used in this study contained 100 million colony-forming units each of Lactobacillus reuteri DSM 17938 and L. reuteri ATCC PTA 5289 per piece.30
2 Stars
Zinc Chloride
Regularly use a mouthrinse or toothpaste containing zinc
Learn More

Preliminary research has also demonstrated the ability of zinc to reduce the concentration of volatile sulfur compounds in the mouth. One study found that the addition of zinc to a baking soda toothpaste lessened halitosis by lowering the levels of these compounds.31 A mouthrinse containing zinc chloride was seen in another study to neutralize the damaging effect of methyl mercaptan on periodontal tissue in the mouth.32 , 33

1 Star
Blood Root
800 IU daily
Learn More

The potent effects of some commercial mouthwashes may be due to the inclusion of thymol (from thyme ) and eukalyptol (from eucalyptus )—volatile oils that have proven activity against bacteria. One report showed bacterial counts plummet in as little as 30 seconds following a mouthrinse with the commercial mouthwash Listerine™, which contains thymol and eukalyptol.34 Thymol alone has been shown in research to inhibit the growth of bacteria found in the mouth.35 , 36 Because of their antibacterial properties, other volatile oils made from tea tree ,37 clove, caraway , peppermint , and sage ,38 as well as the herbs myrrh 39 and bloodroot ,40 might be considered in a mouthwash or toothpaste. Due to potential allergic reactions and potential side effects if some of these oils are swallowed, it is best to consult with a qualified healthcare professional before pursuing self-treatment with volatile oils that are not in approved over-the-counter products for halitosis.

1 Star
Caraway
Refer to label instructions
Learn More

The potent effects of some commercial mouthwashes may be due to the inclusion of thymol (from thyme ) and eukalyptol (from eucalyptus )—volatile oils that have proven activity against bacteria. One report showed bacterial counts plummet in as little as 30 seconds following a mouthrinse with the commercial mouthwash Listerine™, which contains thymol and eukalyptol.41 Thymol alone has been shown in research to inhibit the growth of bacteria found in the mouth.42 , 43 Because of their antibacterial properties, other volatile oils made from tea tree ,44 clove, caraway , peppermint , and sage ,45 as well as the herbs myrrh 46 and bloodroot ,47 might be considered in a mouthwash or toothpaste. Due to potential allergic reactions and potential side effects if some of these oils are swallowed, it is best to consult with a qualified healthcare professional before pursuing self-treatment with volatile oils that are not in approved over-the-counter products for halitosis.

1 Star
Clove Oil
Use a mouthrinse or toothpaste containing zinc regularly
Learn More

The potent effects of some commercial mouthwashes may be due to the inclusion of thymol (from thyme ) and eukalyptol (from eucalyptus )—volatile oils that have proven activity against bacteria. One report showed bacterial counts plummet in as little as 30 seconds following a mouthrinse with the commercial mouthwash Listerine™, which contains thymol and eukalyptol.48 Thymol alone has been shown in research to inhibit the growth of bacteria found in the mouth.49 , 50 Because of their antibacterial properties, other volatile oils made from tea tree ,51 clove, caraway , peppermint , and sage ,52 as well as the herbs myrrh 53 and bloodroot ,54 might be considered in a mouthwash or toothpaste. Due to potential allergic reactions and potential side effects if some of these oils are swallowed, it is best to consult with a qualified healthcare professional before pursuing self-treatment with volatile oils that are not in approved over-the-counter products for halitosis.

1 Star
Eucalyptus
Refer to label instructions
Learn More

Caution: Do not use eucalyptus oil internally without supervision by a healthcare professional. As little as 3.5 ml of the oil taken internally has proven fatal.

The potent effects of some commercial mouthwashes may be due to the inclusion of thymol (from thyme ) and eukalyptol (from eucalyptus )—volatile oils that have proven activity against bacteria. One report showed bacterial counts plummet in as little as 30 seconds following a mouthrinse with the commercial mouthwash Listerine, which contains thymol and eukalyptol.55 Thymol alone has been shown in research to inhibit the growth of bacteria found in the mouth.56 , 57 Because of their antibacterial properties, other volatile oils made from tea tree ,58 clove, caraway , peppermint , and sage ,59 as well as the herbs myrrh 60 and bloodroot ,61 might be considered in a mouthwash or toothpaste. Due to potential allergic reactions and potential side effects if some of these oils are swallowed, it is best to consult with a qualified healthcare professional before pursuing self-treatment with volatile oils that are not in approved over-the-counter products for halitosis.
1 Star
Myrrh
Refer to label instructions
Learn More

The potent effects of some commercial mouthwashes may be due to the inclusion of thymol (from thyme ) and eukalyptol (from eucalyptus )—volatile oils that have proven activity against bacteria. One report showed bacterial counts plummet in as little as 30 seconds following a mouthrinse with the commercial mouthwash Listerine™, which contains thymol and eukalyptol.62 Thymol alone has been shown in research to inhibit the growth of bacteria found in the mouth.63 , 64 Because of their antibacterial properties, other volatile oils made from tea tree ,65 clove, caraway , peppermint , and sage ,66 as well as the herbs myrrh 67 and bloodroot ,68 might be considered in a mouthwash or toothpaste. Due to potential allergic reactions and potential side effects if some of these oils are swallowed, it is best to consult with a qualified healthcare professional before pursuing self-treatment with volatile oils that are not in approved over-the-counter products for halitosis.

1 Star
Peppermint
0.5 to 8 grams daily
Learn More

The potent effects of some commercial mouthwashes may be due to the inclusion of thymol (from thyme ) and eukalyptol (from eucalyptus )—volatile oils that have proven activity against bacteria. One report showed bacterial counts plummet in as little as 30 seconds following a mouthrinse with the commercial mouthwash Listerine™, which contains thymol and eukalyptol.69 Thymol alone has been shown in research to inhibit the growth of bacteria found in the mouth.70 , 71 Because of their antibacterial properties, other volatile oils made from tea tree ,72 clove, caraway , peppermint , and sage ,73 as well as the herbs myrrh 74 and bloodroot ,75 might be considered in a mouthwash or toothpaste. Due to potential allergic reactions and potential side effects if some of these oils are swallowed, it is best to consult with a qualified healthcare professional before pursuing self-treatment with volatile oils that are not in approved over-the-counter products for halitosis.

1 Star
Sage
Consult a qualified healthcare practitioner
Learn More

The potent effects of some commercial mouthwashes may be due to the inclusion of thymol (from thyme ) and eukalyptol (from eucalyptus )—volatile oils that have proven activity against bacteria. One report showed bacterial counts plummet in as little as 30 seconds following a mouthrinse with the commercial mouthwash Listerine™, which contains thymol and eukalyptol.76 Thymol alone has been shown in research to inhibit the growth of bacteria found in the mouth.77 , 78 Because of their antibacterial properties, other volatile oils made from tea tree ,79 clove, caraway , peppermint , and sage ,80 as well as the herbs myrrh 81 and bloodroot ,82 might be considered in a mouthwash or toothpaste. Due to potential allergic reactions and potential side effects if some of these oils are swallowed, it is best to consult with a qualified healthcare professional before pursuing self-treatment with volatile oils that are not in approved over-the-counter products for halitosis.

1 Star
Selenium (Gingivitis)
Spray a lotion containing 3.7% citronella in a slow-release formula every morning for six days per week
Learn More

Nutritional supplements recommended by some doctors for prevention and treatment of periodontitis include vitamin C (people with periodontitis are often found to be deficient),83 vitamin E , selenium , zinc, coenzyme Q10 , and folic acid .84 Folic acid has also been shown to reduce the severity of gingivitis when taken as a mouthwash.85

1 Star
Tea Tree
Refer to label instructions
Learn More

The potent effects of some commercial mouthwashes may be due to the inclusion of thymol (from thyme ) and eukalyptol (from eucalyptus )—volatile oils that have proven activity against bacteria. One report showed bacterial counts plummet in as little as 30 seconds following a mouthrinse with the commercial mouthwash Listerine™, which contains thymol and eukalyptol.86 Thymol alone has been shown in research to inhibit the growth of bacteria found in the mouth.87 , 88 Because of their antibacterial properties, other volatile oils made from tea tree ,89 clove, caraway , peppermint , and sage ,90 as well as the herbs myrrh 91 and bloodroot ,92 might be considered in a mouthwash or toothpaste. Due to potential allergic reactions and potential side effects if some of these oils are swallowed, it is best to consult with a qualified healthcare professional before pursuing self-treatment with volatile oils that are not in approved over-the-counter products for halitosis.

1 Star
Thyme
Refer to label instructions
Learn More

The potent effects of some commercial mouthwashes may be due to the inclusion of thymol (from thyme ) and eukalyptol (from eucalyptus )—volatile oils that have proven activity against bacteria. One report showed bacterial counts plummet in as little as 30 seconds following a mouthrinse with the commercial mouthwash Listerine™, which contains thymol and eukalyptol.93 Thymol alone has been shown in research to inhibit the growth of bacteria found in the mouth.94 , 95 Because of their antibacterial properties, other volatile oils made from tea tree ,96 clove, caraway , peppermint , and sage ,97 as well as the herbs myrrh 98 and bloodroot ,99 might be considered in a mouthwash or toothpaste. Due to potential allergic reactions and potential side effects if some of these oils are swallowed, it is best to consult with a qualified healthcare professional before pursuing self-treatment with volatile oils that are not in approved over-the-counter products for halitosis.

1 Star
Vitamin E
Refer to label instructions
Learn More

Nutritional supplements recommended by some doctors for prevention and treatment of periodontitis include vitamin C (people with periodontitis are often found to be deficient),100 vitamin E , selenium , zinc, coenzyme Q10 , and folic acid .101 Folic acid has also been shown to reduce the severity of gingivitis when taken as a mouthwash.102

References

1. Bollen CM, Rompen EH, Demanez JP. Halitosis: a multidisciplinary problem. Rev Med Liege 1999;54:32–6 [in French].

2. Meningaud JP, Bado F, Favre E, et al. Halitosis in 1999. Rev Stomatol Chir Maxillofac 1999;100:240–4.

3. Spielman AI, Bivona P, Rifkin BR. Halitosis. A common oral problem. NY State Dent J 1996;62:36–42.

4. Touyz LZ. Oral malodor—a review. J Can Dent Assoc 1993;59:607–10.

5. Tiomny E, Arber N, Moshkowitz M, et al. Halitosis and Helicobacter pylori. A possible link? J Clin Gastroenterol 1992;15:236–7.

6. Ierardi E, Amoruso A, La Notte T, et al. Halitosis and Helicobacter pylori: a possible relationship. Dig Dis Sci 1998;43:2733–7.

7. Lorber B. “Bad breath”: presenting manifestation of anaerobic pulmonary infection. Am Rev Respir Dis 1975;112:875–7.

8. Touyz LZ. Oral malodor—a review. J Can Dent Assoc 1993;59:607–10.

9. Durham TM, Malloy T, Hodges ED. Halitosis: knowing when “bad breath” signals systems disease. Geriatrics 1993;48:55–9.

10. Spielman AI, Bivona P, Rifkin BR. Halitosis. A common oral problem. NY State Dent J 1996;62:36–42.

11. Iwakura M, Yasuno Y, Shimura M, Sakamoto S. Clinical characteristics of halitosis: differences in two patient groups with primary and secondary complaints of halitosis. J Dent Res 1994;73:1568–74.

12. Reiss M, Reiss G. Bad breath—etiological, diagnostic and therapeutic problems. Wien Med Wochenshchr 2000;150:98–100 [in German].

13. Tonzetich J. Production and origin of oral malodor: a review of mechanisms and methods of analysis. J Periodontol 1977;48:13–20.

14. Kleinberg I, Westbay G. Salivary and metabolic factors involved in oral malodor formation. J Periodontol 1992;63:768–75 [review].

15. Reiss M, Reiss G. Bad breath—etiological, diagnostic and therapeutic problems. Wien Med Wochenshchr 2000;150:98–100 [in German].

16. Waler SM. Bad breath from the oral cavity. Tidsskr Nor Laegeforen 1997;117:1618–21 [in Norwegian].

17. Ratcliff PA, Johnson PW. The relationship between oral malodor, gingivitis, and periodontitis. A review. J Periodontol 1999;7:485–9.

18. Waler SM. Bad breath from the oral cavity. Tidsskr Nor Laegeforen 1997;117:1618–21 [in Norwegian].

19. Bollen CM, Rompen EH, Demanez JP. Halitosis: a multidisciplinary problem. Rev Med Liege 1999;54:32–6 [in French].

20. Tonzetich J. Production and origin of oral malodor: a review of mechanisms and methods of analysis. J Periodontol 1977;48:13–20.

21. Astor FC, Hanft KL, Ciocon JO. Xerostomia: a prevalent condition in the elderly. Ear Nose Throat J 1999;78:476–9.

22. Waler SM. On the transformation of sulfur-containing amino acids and peptides to volatile sulfur compounds (VSC) in the human mouth. Eur J Oral Sci 1997;105:534–7.

23. Vaananen MK, Markkanen HA, Tuovinen VJ, et al. Periodontal health related to plasma ascorbic acid. Proc Finn Dent Soc 1993;89:51–9.

24. Murray M, Pizzorno J. Encyclopedia of Natural Medicine, rev2d ed. Rocklin, CA: Prima Publishing, 1998, 722–9.

25. Pack AR. Folate mouthwash: effects on established gingivitis in periodontal patients. J Clin Periodontol 1984;11:619–28.

26. Vaananen MK, Markkanen HA, Tuovinen VJ, et al. Periodontal health related to plasma ascorbic acid. Proc Finn Dent Soc 1993;89:51–9.

27. Murray M, Pizzorno J. Encyclopedia of Natural Medicine, rev2d ed. Rocklin, CA: Prima Publishing, 1998, 722–9.

28. Pack AR. Folate mouthwash: effects on established gingivitis in periodontal patients. J Clin Periodontol 1984;11:619–28.

29. Iwamoto T, Suzuki N, Tanabe K, et al. Effects of probiotic Lactobacillus salivarius WB21 on halitosis and oral health: an open-label pilot trial. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;110:201–8.

30. Keller MK, Bardow A, Jensdottir T, Lykkeaa J, Twetman S. Effect of chewing gums containing the probiotic bacterium Lactobacillus reuteri on oral malodour. Acta Odontol Scand 2012;70:246–50.

31. Brunette DM, Proskin HM, Nelson BJ. The effects of dentifrice systems on oral malodor. J Clin Dent 1998;9:76–82.

32. Ng W, Tonzetich J. Effect of hydrogen sulfide and methyl mercaptan on the permeability of oral mucosa. J Dent Res 1984;63:994–7.

33. Waler SM. The effect of some metal ions on volatile sulfur-containing compounds originating from the oral cavity. Acta Odontol Scand 1997;55:261–4.

34. Kato T, Iijima H, Ishihara K, et al. Antibacterial effects of Listerine on oral bacteria. Bull Tokyo Dent Coll 1990;31:301–7.

35. Cosentino S, Tuberoso CI, Pisano B, et al. In-vitro antimicrobial activity and chemical composition of Sardinian Thymus essential oils. Lett Appl Microbiol 1999;29:130–5.

36. Petersson LG, Edwardsson S, Arends J. Antimicrobial effect of a dental varnish, in vitro. Swed Dent J 1992;16:183–9.

37. Cox SD, Mann CM, Markham JL, et al. The mode of antimicrobial action of the essential oil of Melaleuca alternifolia (tea tree oil). J Appl Microbiol 2000;88:170–5.

38. Serfaty R, Itic J. Comparative trial with natural herbal mouthwash versus chlorhexidine in gingivitis. J Clin Dent 1988;1:A34–7.

39. Dolara P, Corte B, Ghelardini C, et al. Local anaesthetic, antibacterial and antifungal properties of sesquiterpenes from myrrh. Planta Med 2000;66:356–8.

40. Hannah JJ, Johnson JD, Kuftinec MM. Long-term clinical evaluation of toothpaste and oral rinse containing sanguinaria extract in controlling plaque, gingival inflammation, and sulcular bleeding during orthodontic treatment. Am J Orthod Dentofacial Orthop 1989;96:199–207.

41. Kato T, Iijima H, Ishihara K, et al. Antibacterial effects of Listerine on oral bacteria. Bull Tokyo Dent Coll 1990;31:301–7.

42. Cosentino S, Tuberoso CI, Pisano B, et al. In-vitro antimicrobial activity and chemical composition of Sardinian Thymus essential oils. Lett Appl Microbiol 1999;29:130–5.

43. Petersson LG, Edwardsson S, Arends J. Antimicrobial effect of a dental varnish, in vitro. Swed Dent J 1992;16:183–9.

44. Cox SD, Mann CM, Markham JL, et al. The mode of antimicrobial action of the essential oil of Melaleuca alternifolia (tea tree oil). J Appl Microbiol 2000;88:170–5.

45. Serfaty R, Itic J. Comparative trial with natural herbal mouthwash versus chlorhexidine in gingivitis. J Clin Dent 1988;1:A34–7.

46. Dolara P, Corte B, Ghelardini C, et al. Local anaesthetic, antibacterial and antifungal properties of sesquiterpenes from myrrh. Planta Med 2000;66:356–8.

47. Hannah JJ, Johnson JD, Kuftinec MM. Long-term clinical evaluation of toothpaste and oral rinse containing sanguinaria extract in controlling plaque, gingival inflammation, and sulcular bleeding during orthodontic treatment. Am J Orthod Dentofacial Orthop 1989;96:199–207.

48. Kato T, Iijima H, Ishihara K, et al. Antibacterial effects of Listerine on oral bacteria. Bull Tokyo Dent Coll 1990;31:301–7.

49. Cosentino S, Tuberoso CI, Pisano B, et al. In-vitro antimicrobial activity and chemical composition of Sardinian Thymus essential oils. Lett Appl Microbiol 1999;29:130–5.

50. Petersson LG, Edwardsson S, Arends J. Antimicrobial effect of a dental varnish, in vitro. Swed Dent J 1992;16:183–9.

51. Cox SD, Mann CM, Markham JL, et al. The mode of antimicrobial action of the essential oil of Melaleuca alternifolia (tea tree oil). J Appl Microbiol 2000;88:170–5.

52. Serfaty R, Itic J. Comparative trial with natural herbal mouthwash versus chlorhexidine in gingivitis. J Clin Dent 1988;1:A34–7.

53. Dolara P, Corte B, Ghelardini C, et al. Local anaesthetic, antibacterial and antifungal properties of sesquiterpenes from myrrh. Planta Med 2000;66:356–8.

54. Hannah JJ, Johnson JD, Kuftinec MM. Long-term clinical evaluation of toothpaste and oral rinse containing sanguinaria extract in controlling plaque, gingival inflammation, and sulcular bleeding during orthodontic treatment. Am J Orthod Dentofacial Orthop 1989;96:199–207.

55. Kato T, Iijima H, Ishihara K, et al. Antibacterial effects of Listerine on oral bacteria. Bull Tokyo Dent Coll 1990;31:301–7.

56. Cosentino S, Tuberoso CI, Pisano B, et al. In-vitro antimicrobial activity and chemical composition of Sardinian Thymus essential oils. Lett Appl Microbiol 1999;29:130–5.

57. Petersson LG, Edwardsson S, Arends J. Antimicrobial effect of a dental varnish, in vitro. Swed Dent J 1992;16:183–9.

58. Cox SD, Mann CM, Markham JL, et al. The mode of antimicrobial action of the essential oil of Melaleuca alternifolia (tea tree oil). J Appl Microbiol 2000;88:170–5.

59. Serfaty R, Itic J. Comparative trial with natural herbal mouthwash versus chlorhexidine in gingivitis. J Clin Dent 1988;1:A34–7.

60. Dolara P, Corte B, Ghelardini C, et al. Local anaesthetic, antibacterial and antifungal properties of sesquiterpenes from myrrh. Planta Med 2000;66:356–8.

61. Hannah JJ, Johnson JD, Kuftinec MM. Long-term clinical evaluation of toothpaste and oral rinse containing sanguinaria extract in controlling plaque, gingival inflammation, and sulcular bleeding during orthodontic treatment. Am J Orthod Dentofacial Orthop 1989;96:199–207.

62. Kato T, Iijima H, Ishihara K, et al. Antibacterial effects of Listerine on oral bacteria. Bull Tokyo Dent Coll 1990;31:301–7.

63. Cosentino S, Tuberoso CI, Pisano B, et al. In-vitro antimicrobial activity and chemical composition of Sardinian Thymus essential oils. Lett Appl Microbiol 1999;29:130–5.

64. Petersson LG, Edwardsson S, Arends J. Antimicrobial effect of a dental varnish, in vitro. Swed Dent J 1992;16:183–9.

65. Cox SD, Mann CM, Markham JL, et al. The mode of antimicrobial action of the essential oil of Melaleuca alternifolia (tea tree oil). J Appl Microbiol 2000;88:170–5.

66. Serfaty R, Itic J. Comparative trial with natural herbal mouthwash versus chlorhexidine in gingivitis. J Clin Dent 1988;1:A34–7.

67. Dolara P, Corte B, Ghelardini C, et al. Local anaesthetic, antibacterial and antifungal properties of sesquiterpenes from myrrh. Planta Med 2000;66:356–8.

68. Hannah JJ, Johnson JD, Kuftinec MM. Long-term clinical evaluation of toothpaste and oral rinse containing sanguinaria extract in controlling plaque, gingival inflammation, and sulcular bleeding during orthodontic treatment. Am J Orthod Dentofacial Orthop 1989;96:199–207.

69. Kato T, Iijima H, Ishihara K, et al. Antibacterial effects of Listerine on oral bacteria. Bull Tokyo Dent Coll 1990;31:301–7.

70. Cosentino S, Tuberoso CI, Pisano B, et al. In-vitro antimicrobial activity and chemical composition of Sardinian Thymus essential oils. Lett Appl Microbiol 1999;29:130–5.

71. Petersson LG, Edwardsson S, Arends J. Antimicrobial effect of a dental varnish, in vitro. Swed Dent J 1992;16:183–9.

72. Cox SD, Mann CM, Markham JL, et al. The mode of antimicrobial action of the essential oil of Melaleuca alternifolia (tea tree oil). J Appl Microbiol 2000;88:170–5.

73. Serfaty R, Itic J. Comparative trial with natural herbal mouthwash versus chlorhexidine in gingivitis. J Clin Dent 1988;1:A34–7.

74. Dolara P, Corte B, Ghelardini C, et al. Local anaesthetic, antibacterial and antifungal properties of sesquiterpenes from myrrh. Planta Med 2000;66:356–8.

75. Hannah JJ, Johnson JD, Kuftinec MM. Long-term clinical evaluation of toothpaste and oral rinse containing sanguinaria extract in controlling plaque, gingival inflammation, and sulcular bleeding during orthodontic treatment. Am J Orthod Dentofacial Orthop 1989;96:199–207.

76. Kato T, Iijima H, Ishihara K, et al. Antibacterial effects of Listerine on oral bacteria. Bull Tokyo Dent Coll 1990;31:301–7.

77. Cosentino S, Tuberoso CI, Pisano B, et al. In-vitro antimicrobial activity and chemical composition of Sardinian Thymus essential oils. Lett Appl Microbiol 1999;29:130–5.

78. Petersson LG, Edwardsson S, Arends J. Antimicrobial effect of a dental varnish, in vitro. Swed Dent J 1992;16:183–9.

79. Cox SD, Mann CM, Markham JL, et al. The mode of antimicrobial action of the essential oil of Melaleuca alternifolia (tea tree oil). J Appl Microbiol 2000;88:170–5.

80. Serfaty R, Itic J. Comparative trial with natural herbal mouthwash versus chlorhexidine in gingivitis. J Clin Dent 1988;1:A34–7.

81. Dolara P, Corte B, Ghelardini C, et al. Local anaesthetic, antibacterial and antifungal properties of sesquiterpenes from myrrh. Planta Med 2000;66:356–8.

82. Hannah JJ, Johnson JD, Kuftinec MM. Long-term clinical evaluation of toothpaste and oral rinse containing sanguinaria extract in controlling plaque, gingival inflammation, and sulcular bleeding during orthodontic treatment. Am J Orthod Dentofacial Orthop 1989;96:199–207.

83. Vaananen MK, Markkanen HA, Tuovinen VJ, et al. Periodontal health related to plasma ascorbic acid. Proc Finn Dent Soc 1993;89:51–9.

84. Murray M, Pizzorno J. Encyclopedia of Natural Medicine, rev2d ed. Rocklin, CA: Prima Publishing, 1998, 722–9.

85. Pack AR. Folate mouthwash: effects on established gingivitis in periodontal patients. J Clin Periodontol 1984;11:619–28.

86. Kato T, Iijima H, Ishihara K, et al. Antibacterial effects of Listerine on oral bacteria. Bull Tokyo Dent Coll 1990;31:301–7.

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