Effect of strict oral hygiene on self-rated halitosis and quality of life in patients with periodontitis: a secondary randomized controlled trial analysis
Clinical Snapshot
PICO Framework
| P — Population | 24 adults with periodontitis (mean age 47.2 years, balanced sex distribution) |
| I — Intervention | Strict oral hygiene phase for 45 days with personalized instructions |
| C — Comparator | No intervention group receiving no guidance during the same period |
| O — Outcomes | Self-reported halitosis, quality of life (HALT score), bleeding on probing (BOP), visible plaque index (VPI) |
Bottom Line
This small randomized trial suggests that intensive oral hygiene education can meaningfully reduce self-reported halitosis and improve quality of life in periodontitis patients within 45 days. The intervention group showed a 50% reduction in halitosis complaints and significant improvements in quality of life scores, with an impressive number needed to treat of 2. However, the study's very small sample size (n=24) and short follow-up period limit confidence in the findings. While the results support what clinicians already know about oral hygiene benefits, the specific focus on halitosis outcomes provides useful evidence for patient counselling. The intervention is low-cost and low-risk, making it easily implementable in Australian dental practice. Larger, longer-term studies are needed to confirm these promising preliminary findings.
Key Findings
P Value: p = 0.034 for halitosis reduction, p < 0.05 for QoL improvements
Effect Size: 11.9-point reduction in HALT score
Primary Outcome: Self-reported halitosis reduced from 100% to 50% in intervention group vs 91.6% in control
Nnt Or Sensitivity: NNT = 2 (based on 50% absolute risk reduction in halitosis)
Confidence Interval: 95% CI: -19.40 to -4.36
Clinical Application
Highly feasible - oral hygiene education is standard periodontal care Aligns with RACGP guidelines for periodontal management; no PBS implications as intervention is educational Adult patients with periodontitis experiencing halitosis concerns
Abstract
This single-blind, randomized clinical trial evaluated the impact of a strict oral hygiene (OH) phase on self-reported halitosis and quality of life (QoL) in patients with periodontitis. This study reports a secondary analysis of a single-blind randomized controlled trial (parallel, 1:1), registered at RBR-5jmx32v. The study included 24 individuals diagnosed with periodontitis who were randomly assigned to the intervention group (IG; n = 12) and the no-intervention group (NIG; n = 12). After receiving personalized OH instructions, the IG participants followed a rigorous OH phase for 45 days, whereas the NIG participants received no guidance during this period. The halitosis-associated QoL test (HALT) was administered at baseline and after 45 days. Data were analyzed using t-tests, chi-square tests, and multilevel linear regression, with significance set at p < 0.05. The average age of the study participants was 47.2 years, with a balanced sex distribution and no differences in income or education. Self-reported halitosis decreased from 100% to 50% in the IG after 45 days, whereas it remained at 91.6% in the NIG (p = 0.034). The IG also showed a mean HALT score reduction of 11.9 points (-11.88; 95% CI: -19.40 to -4.36), with significant improvements in social impact and self-esteem (p < 0.05). Clinically, BOP (p < 0.001) and VPI (p = 0.03) improved significantly in the IG, with no significant changes in NIG. This exploratory trial demonstrates that implementing a strict OH phase in patients with periodontitis may help reduce self-reported halitosis, improve HALT scores, and improve clinical outcomes, supporting its role as an adjunctive strategy in periodontal care.
References
- 1.Costa, B. F. B., Alves, V. F., Cassiano, L. S., Nascimento, G. G., Paiva, V. M. S., Silva, L. V. L. E., & Aquino, S. G. (2026). Effect of strict oral hygiene on self-rated halitosis and quality of life in patients with periodontitis: a secondary randomized controlled trial analysis. Brazilian Oral Research, 40, 021. https://doi.org/10.1590/1807-3107bor-2026.vol40.021
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