Evaluation of the Effects of Different Orthodontic Treatment Methods on Halitosis

Year 2025, Volume: 12 Issue: 3, 457 - 460, 29.12.2025

Özge Müftüoğlu , Mediha Nur Nişancı Yılmaz , Ömer Faruk Sarı , Arif Yiğit Güler

https://doi.org/10.15311/selcukdentj.1801534

https://izlik.org/JA66YC54NM

Abstract

Background: Halitosis is a common oral health problem that negatively affects individuals' social relationships and quality of life. Orthodontic appliances may increase halitosis by increasing plaque retention and altering the oral microbiome. The aim of this study is to compare the level of halitosis and oral health-related quality of life in individuals undergoing fixed orthodontic treatment, clear aligner treatment and a control group.
Methods: This study included a total of 42 systemically healthy, non-smoking individuals (14 in each group). Fixed orthodontic treatment, clear aligner treatment, and a control group were evaluated. At baseline, all participants underwent periodontal treatment and received standard oral hygiene instruction. Clinical parameters, halitosis and quality of life were measured.
Results: In the fixed orthodontic treatment group, full-mouth plaque score, tongue coating index, halitosis, and OHIP-14 scores were significantly higher compared to the clear aligner treatment group and control groups (p<0.05). The clear aligner treatment group showed better results than the fixed orthodontic treatment group but exhibited more negative values than the control group. No significant differences were found between the groups in terms of pocket depth and tongue coating pH values.
Conclusion: While fixed orthodontic treatment have negative effects on halitosis and quality of life, clear aligner treatment is more advantageous in terms of oral hygiene and quality of life due to its removable nature. Orthodontists should consider these findings in treatment planning and place particular emphasis on individualized oral hygiene instruction for patients undergoing fixed orthodontic treatment.
Keywords: Halitosis; Orthodontic Appliances; Oral Hygiene

Keywords

Halitosis , Orthodontic Appliances , Oral Hygiene

Ethical Statement

This study was approved by Research Ethics Committee of Ankara Medipol University. (Decision Number: 134). All participants provided written informed consent.

Supporting Institution

None

Thanks

None

References

• 1. Tangerman A, Winkel EG. The portable gas chromatograph OralChroma™: a method of choice to detect oral and extra-oral halitosis. J Breath Res. 2008;2(1):017010.
• 2. Abdulraheem S, Paulsson L, Petrén S, Sonesson M. Do fixed orthodontic appliances cause halitosis? A systematic review. BMC Oral Health. 2019;19(1):72.
• 3. Schaefer I, Braumann B. Halitosis, oral health and quality of life during treatment with Invisalign(®) and the effect of a low-dose chlorhexidine solution. J Orofac Orthop. 2010;71(6):430–41.
• 4. Guedes CC, Bussadori SK, Garcia ACM, Motta LJ, Gomes AO, Weber R, et al. Accuracy of a portable breath meter test for the detection of halitosis in children and adolescents. Clinics (Sao Paulo). 2020;75:e1764.
• 5. Slade GD. Derivation and validation of a short-form oral health impact profile. Community Dent Oral Epidemiol. 1997;25(4):284–90.
• 6. Faul F, Erdfelder E, Lang A-G, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39(2):175–91.
• 7. Dos Santos DDL, Besegato JF, Vieira SM, Rached Dantas AA, Silva AM, da Silva AM. Effect of fixed orthodontic appliances on self-assessment and diagnosis of halitosis in undergraduate dental students. J Indian Soc Periodontol. 2021;25(5):432–7.
• 8. O'Leary TJ, Drake RB, Naylor JE. The plaque control record. J Periodontol. 1972;43(1):38.
• 9. Lang NP, Adler R, Joss A, Nyman S. Absence of bleeding on probing. An indicator of periodontal stability. J Clin Periodontol. 1990;17(10):714–21.
• 10. Winkel EG, Roldán S, Van Winkelhoff AJ, Herrera D, Sanz M. Clinical effects of a new mouthrinse containing chlorhexidine, cetylpyridinium chloride and zinc-lactate on oral halitosis. A dual-center, double-blind placebo-controlled study. J Clin Periodontol. 2003;30(4):300–6.
• 11. Ramesh G, Nagarajappa R, Madhusudan AS, Sandesh N, Batra M, Sharma A, et al. Estimation of salivary and tongue coating pH on chewing household herbal leaves: A randomized controlled trial. Anc Sci Life. 2012;32(2):69–75.
• 12. Sökücü O, Akpınar A, Özdemir H, Birlik M, Çalışır M. The effect of fixed appliances on oral malodor from beginning of treatment till 1 year. BMC Oral Health. 2016;16:14.
• 13. Schertel Cassiano L, Abdullahi F, Leite FRM, López R, Peres MA, Nascimento GG. The association between halitosis and oral-health-related quality of life: A systematic review and meta-analysis. J Clin Periodontol. 2021;48(11):1458–69.
• 14. Rouzi M, Zhang X, Jiang Q, Long H, Lai W, Li X. Impact of Clear Aligners on Oral Health and Oral Microbiome During Orthodontic Treatment. Int Dent J. 2023;73(5):603–11.
• 15. Babacan H, Sokucu O, Marakoglu I, Ozdemir H, Nalcaci R. Effect of fixed appliances on oral malodor. Am J Orthod Dentofacial Orthop. 2011;139(3):351–5.
• 16. Baidas LF, AlJunaydil N, Demyati M, Sheryei RA. Fixed orthodontic appliance impact on oral health-related quality of life during initial stages of treatment. Niger J Clin Pract. 2020;23(9):1207–14.
• 17. Musa H, Bratu D-C, Pașca IG, Popa M, Luca MM, Balean O, et al. Comparative Assessment of Halitosis and Oral Health-Related Quality of Life Among Children and Young Adults with Clear Aligners, Those with Lingual Orthodontics, and Non-Orthodontic Controls: A Cross-Sectional Study with Dietary Subgroup Analyses. J Clin Med. 2025;14(11).
• 18. Levrini L, Department of S, Morphological Sciences UoIVI, Posimo D, Tieghi G, Gualandi G, et al. Halitosis with fixed orthodontic appliance vs removable orthodontic aligners: a pilot study. STOMATOL EDU J. 2016;3(3-4):150–5.
• 19. Zamora-Martínez N, Paredes-Gallardo V, García-Sanz V, Gandía-Franco JL, Tarazona-Álvarez B. Comparative Study of Oral Health-Related Quality of Life (OHRQL) between Different Types of Orthodontic Treatment. Medicina (Kaunas). 2021;57(7).
• 20. Correa L, Albaladejo A, Curto A. A longitudinal pilot study examining the influence of the orthodontic system chosen in adult patients (brackets versus aligners) on oral health-related quality of life and anxiety. BMC Oral Health. 2024;24(1):745.