TONGUE Studies have shown that when combining

TONGUE HYGIENE 3 Tongue Cleaning and Oral HygieneIt is said that diet is an important factor when it comes to oral health. This is especially true when it comes to the development of bad breath. “Between 10% -30% of all Americanssuffer from bad breath on a regular basis (Duwaji, 2009).” Despite efforts to resolve bad breath,also coined as Halitosis in 1874, many seem to fail regardless of how much they brush their teeth(Duwaji, 2009). Halitosis can be considered a kind of social disability when it is experienced forprolonged periods of time (Duwaji, 2009).” Although halitosis is sometimes difficult to get ridof, there is a method that has been proven to work. Studies have shown that when combining theuse of tooth brushing incorporated with tongue scraping to physically remove bacterial flora anddental plaque from the dorsum of the tongue, one can significantly reduce bad breath (Matsui, etal.

, 2014). Tongue cleaning is an essential part of oral hygiene, by using the combined method oftongue cleaning and tooth brushing one can reduce bacteria on the teeth and tongue, halt badbreath, and promote a healthy oral environment for teeth to flourish in (Matsui, et al., 2014). Thepurpose of this paper is to explore the research conducted by professionals and examine theirliterature peer-reviews regarding the effectiveness of reducing or curing halitosis in healthy andunhealthy oral cavities. Review of Literature Bacteria adhere to places in the oral cavity where food can be retained (Dentech, inc.,2013). These places include the gum line, tongue, tooth spacing, pits, and fissures. As thebacteria decompose the retained food toxic substances, plaque and tartar (advanced formation ofplaque) cause bad breath, gum inflammation, and dental caries (Dentech, inc.

, 2013). Dentalplaque is a biofilm that is formed by colonizing bacteria that try to attach themselves to thesmooth superficial portion of the oral cavity they are considered a highly complex organization TONGUE HYGIENE 4 of bacteria consisting of dense loads of microorganisms embedded in an intermicrobial matrix(Winnier, Rupesh, Nayak, Reddy, & Prasad Rao, 2013). More than 500 bacterial species colonizethe superficial part of the oral cavity with the tongue having the highest load of bacterial inrelations to other oral tissue and contributes to the largest number of bacteria found in the oralcavity (Winnier, et al.

, 2013). More than 100 microorganisms can be attached to a singleepithelial cell of the tongue and when shredded the debris can contribute to the plaque formationon the teeth producing cavities when undisturbed for prolong periods of time (Winnier, et al.,2013). Therefore, if bacteria formation on the dorsum of the tongue can be reduced it cansubsequently, help reduce the formation of plaque on the teeth, as well as, reduce halitosis(Winnier, et al., 2013). A study was conducted on eighteen adult patients with untreated moderate to severeperiodontitis who also had some degree of tongue coating (Laleman, Koop, Teughels, Dekeyser,Quirynen, 2017). Patients were divided and randomly instructed to use either a toothbrush or atongue scraper to clean the tongue (Laleman, et al., 2017).

The amount of coating, the microbialload of saliva, and the tongues dorsum were observed at a baseline for two weeks (Laleman, etal., 2017). The results after two weeks showed that the use of either a toothbrush or tonguescraper, did not influence the amount of coating, or the microbiological sum, nor the saliva(Laleman, et al., 2017).

Furthermore, patients experienced no noticeable changes to in breathodor nor taste sensation following the two weeks of tongue cleaning (Laleman, et al., 2017).However, there was significantly less coating on the surface of the tongue and patients felt theirtongues seemed much cleaner at the end of the study (Laleman, et al.

, 2017). The study deducedthat tongue cleaning does not have any influence on bacteria present in saliva or on the dorsumof the tongue in regard to a patient that has periodontitis (Laleman, et al., 2017).

TONGUE HYGIENE 5 In contrast, a different study was conducted using 45 male students. The selection criteriawere based on several factors, one condition included students must be within the age range of 9-12 years old where dental caries are most common (Winnier, et al., 2013). Subjects must also beable to adhere to twice a day brushing routine and have at least four restored, decayed and/ormissing teeth (Winnier, et al.

, 2013). The subjects were then blindly separated into three groupsof 15 (Winnier, et al., 2013). A baseline reading was taken at the start and compared with resultsfrom day 10 and 21 (Winnier, et al., 2013). The first group was given a mental tongue scraper touse in conjunction with tooth brushing (Winnier, et al., 2013).

Instructions for the first groupincluded scraping the dorsum of tongue twice a day (morning and night), spitting out theadditional saliva, rising the scraper and repeating the steps five additional times (Winnier, et al.,2013). The second group was constituted the tongue-brushing group and were given a soft multi-tufted nylon toothbrush with a mini-head (Winnier, et al., 2013). They were instructed to brushthe dorsum of the tongue twice daily as well as, to firmly rub the toothbrush onto the deepestposterior part of the dorsum of the tongue to the apex of the tongue, rinse, and repeat the stepsthree additional times.

The final group continued with their normal routine of brushing their teethtwice a day (Winnier, et al., 2013). The findings from the study proved that tongue cleaning waseffective at reducing both the risks of caries and bad breath when unitizing the combined methodof either tongue brushing or tongue scraping with regular tooth brushing twice a day (Winnier, etal., 2013).

In addition, it was noted that tongue scraping produced a higher statistical reductionof plaque on the dorsum of the tongue in comparison to tongue brushing at the end of day 10 and21 (Winnier, et al., 2013). Another study, compared clinical trials conducted on people that were generally in goodhealth (Sleen Slot, Trijffel, Winkle, and Weijden, 2010). The study examined the effectiveness of TONGUE HYGIENE 6 reducing halitosis using mechanical tongue cleaning versus non-mechanical tongue cleaning onsubjects older than seventeen years old (Sleen, et al., 2010).

The aim was to assess if tonguecleaning along with tooth brushing could cure halitosis (Sleen, et al., 2010). The principles forthe trails selected included randomized controlled clinical trials and controlled clinical trials(Sleen, et al., 2010). Subjects observed in the trails were then divided into two groups; anintervention group using toothbrushes or tongue scrapers to clean the dorsum of the tongueversus a control group that only brushed their teeth (Sleen, et al., 2010). The results from the fivetrials (three randomized and two controlled) noted that mechanical tongue cleaning wasdefinitely effective against halitosis; however, it only reduced, but did not eliminate, volatilesulfur-containing compounds (which are anaerobic-bacteria that cause a rotten egg smell whenexpelling sulfur compounds) in people with chronic halitosis (Sleen, et al.

, 2010). The results of the three studies may conflict somewhat, however, each study gives acomprehensive understanding of the effectiveness of tongue cleaning on various degrees of oralhealth. The sum of the information provided supports that tongue cleaning can reduce plaque,bad breath, and create a healthier oral cavity. Although for patients with periodontist did notexperience a reduction in bad breath, they did experience the feeling of a cleaner tongue. Thissuggests that people are better off incorporating tongue cleaning into their daily regime than notincorporating it. TONGUE HYGIENE 7 ReferenceDentech, inc.; (2013). “oral hygiene products and method” in patent application approval process.

Pediatrics Week Retrieved from https://search.proquest.com/docview/1321143130?accountid=89121Duwaji, O.

S. (2014). The bacterial metabolic processes that produce volatile sulfur compounds in the oral cavity (Order No.

1569178). Available from Health & Medical Collection.(1625666282). Retrieved fromhttps://search.proquest.com/docview/1625666282?accountid=89121 Laleman I, Koop R, Teughels W, Dekeyser C, Quirynen M. (2017). Influence of tongue brushingand scraping on the oral microflora of periodontitis patients.

J Periodontal Res.; 53:73–79. https://doi.org/10.1111/jre.12489 Matsui, M.

, Chosa, N., Shimoyama, Y., Minami, K., Kimura, S.

, & Kishi, M. (2014). Effects oftongue cleaning on bacterial flora in tongue coating and dental plaque: a crossoverstudy. BMC Oral Health, 14, 4. http://doi.

org/10.1186/1472-6831-14-4 Van der Sleen, M., Slot, D., Van Trijffel, E.

, Winkel, E. and Van der Weijden, G. (2010),Effectiveness of mechanical tongue cleaning on breath odour and tongue coating: asystematic review. International Journal of Dental Hygiene, 8: 258–268.doi:10.1111/j.

1601-5037. 2010.00479.x Winnier, J. J.

, Rupesh, S., Nayak, U. A.

, Reddy, V., & Prasad Rao, A. (2013). The ComparativeEvaluation of the Effects of Tongue Cleaning on Existing Plaque Levels inChildren. International Journal of Clinical Pediatric Dentistry, 6(3), 188–192.http://doi.org/10.5005/jp-journals-10005-1216 

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