Summary Review/Orthodontics

Evidence-Based Dentistry (2006) 7, 78. doi:10.1038/sj.ebd.6400433

Tongue scrapers may reduce halitosis in adults

Is tongue scraping more effective than other interventions, such as mouthwashes, in controlling halitosis?

Address for correspondence: Luisa M Fernandez Mauleffinch, Cochrane Oral Health Group, MANDEC, School of Dentistry, University of Manchester, Higher Cambridge Street, Manchester M15 6FH, UK.

Rainer Seemann1

1Department of Operative and Preventive Dentistry, Universitätsmedizin Berlin–Charité, Berlin, and Dentsply DeTrey GmbH, Konstanz, Germany

Outhouse TL, Al-Alawi R, Fedorowicz Z, Keenan JV. Tongue scraping for treating halitosis. Cochrane Database of Systematic Reviews 2006, issue 2



Data sources


Studies were searched for in the Cochrane Oral Health Group Trials Register (up to 15 September 2005), the Cochrane Central Register of Controlled Trials (Cochrane Library 2005, issue 3), Medline (from 1966 up to September 2005, and Embase (1974 to September 2005.

Study selection


Only randomised controlled trials (RCT) were included that compared different methods of tongue cleaning to reduce mouth odour in adults who had halitosis. Selected studies were graded independently for quality of randomisation, allocation concealment, blinding of outcomes assessment, and handling of losses and withdrawals.

Data extraction and synthesis


Data were extracted independently by two review authors; clinical heterogeneity precluded pooling of data.



Two trials involving a total of 40 participants were included. Neither trial included data for the primary outcomes specified in this review, ie, self expressed (perceived) and organoleptic (human nose) assessments of halitosis using any validated malodour intensity scale. Secondary outcomes, volatile sulphur compound (VSC) levels, were assessed using a portable sulphide monitor in both trials. Based on the independent data from these two trials, there was a statistically significant difference between the effectiveness of either the tongue cleaner or the tongue scraper in reducing VSC levels when compared with the toothbrush. Adverse effects in one trial were nausea (60%) and trauma (10%) with the toothbrush and all participants were receptive to using the tongue scraper.



There is weak and unreliable evidence suggesting a small but statistically significant difference in reduction of VSC levels when tongue scrapers or cleaners rather than toothbrushes are used to reduce halitosis in adults. We found no high-level evidence comparing mechanical with other forms of tongue cleaning.