TONGUE tongue, tooth spacing, pits, and fissures. As



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Tongue Cleaning and Oral Hygiene
It 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 Americans
suffer 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 for
prolonged periods of time (Duwaji, 2009).” Although halitosis is sometimes difficult to get rid
of, there is a method that has been proven to work. Studies have shown that when combining the
use of tooth brushing incorporated with tongue scraping to physically remove bacterial flora and
dental plaque from the dorsum of the tongue, one can significantly reduce bad breath (Matsui, et
al., 2014). Tongue cleaning is an essential part of oral hygiene, by using the combined method of
tongue cleaning and tooth brushing one can reduce bacteria on the teeth and tongue, halt bad
breath, and promote a healthy oral environment for teeth to flourish in (Matsui, et al., 2014). The
purpose of this paper is to explore the research conducted by professionals and examine their
literature peer-reviews regarding the effectiveness of reducing or curing halitosis in healthy and
unhealthy 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 the
bacteria decompose the retained food toxic substances, plaque and tartar (advanced formation of
plaque) cause bad breath, gum inflammation, and dental caries (Dentech, inc., 2013). Dental
plaque is a biofilm that is formed by colonizing bacteria that try to attach themselves to the
smooth superficial portion of the oral cavity they are considered a highly complex organization


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 colonize
the superficial part of the oral cavity with the tongue having the highest load of bacterial in
relations to other oral tissue and contributes to the largest number of bacteria found in the oral
cavity (Winnier, et al., 2013). More than 100 microorganisms can be attached to a single
epithelial cell of the tongue and when shredded the debris can contribute to the plaque formation
on 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 can
subsequently, 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 severe
periodontitis 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 a
tongue scraper to clean the tongue (Laleman, et al., 2017). The amount of coating, the microbial
load of saliva, and the tongues dorsum were observed at a baseline for two weeks (Laleman, et
al., 2017). The results after two weeks showed that the use of either a toothbrush or tongue
scraper, 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 breath
odor 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 their
tongues seemed much cleaner at the end of the study (Laleman, et al., 2017). The study deduced
that tongue cleaning does not have any influence on bacteria present in saliva or on the dorsum
of the tongue in regard to a patient that has periodontitis (Laleman, et al., 2017).


In contrast, a different study was conducted using 45 male students. The selection criteria
were 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 be
able to adhere to twice a day brushing routine and have at least four restored, decayed and/or
missing teeth (Winnier, et al., 2013). The subjects were then blindly separated into three groups
of 15 (Winnier, et al., 2013). A baseline reading was taken at the start and compared with results
from day 10 and 21 (Winnier, et al., 2013). The first group was given a mental tongue scraper to
use in conjunction with tooth brushing (Winnier, et al., 2013). Instructions for the first group
included scraping the dorsum of tongue twice a day (morning and night), spitting out the
additional 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 brush
the dorsum of the tongue twice daily as well as, to firmly rub the toothbrush onto the deepest
posterior part of the dorsum of the tongue to the apex of the tongue, rinse, and repeat the steps
three additional times. The final group continued with their normal routine of brushing their teeth
twice a day (Winnier, et al., 2013). The findings from the study proved that tongue cleaning was
effective at reducing both the risks of caries and bad breath when unitizing the combined method
of either tongue brushing or tongue scraping with regular tooth brushing twice a day (Winnier, et
al., 2013). In addition, it was noted that tongue scraping produced a higher statistical reduction
of plaque on the dorsum of the tongue in comparison to tongue brushing at the end of day 10 and
21 (Winnier, et al., 2013).

Another study, compared clinical trials conducted on people that were generally in good
health (Sleen Slot, Trijffel, Winkle, and Weijden, 2010). The study examined the effectiveness of


reducing halitosis using mechanical tongue cleaning versus non-mechanical tongue cleaning on
subjects older than seventeen years old (Sleen, et al., 2010). The aim was to assess if tongue
cleaning along with tooth brushing could cure halitosis (Sleen, et al., 2010). The principles for
the 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; an
intervention group using toothbrushes or tongue scrapers to clean the dorsum of the tongue
versus a control group that only brushed their teeth (Sleen, et al., 2010). The results from the five
trials (three randomized and two controlled) noted that mechanical tongue cleaning was
definitely effective against halitosis; however, it only reduced, but did not eliminate, volatile
sulfur-containing compounds (which are anaerobic-bacteria that cause a rotten egg smell when
expelling sulfur compounds) in people with chronic halitosis (Sleen, et al., 2010).

The results of the three studies may conflict somewhat, however, each study gives a
comprehensive understanding of the effectiveness of tongue cleaning on various degrees of oral
health. 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 not
experience a reduction in bad breath, they did experience the feeling of a cleaner tongue. This
suggests that people are better off incorporating tongue cleaning into their daily regime than not
incorporating it.



Dentech, inc.; (2013). “oral hygiene products and method” in patent application approval

process. Pediatrics Week Retrieved from
Duwaji, 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 from

Laleman I, Koop R, Teughels W, Dekeyser C, Quirynen M. (2017). Influence of tongue brushing
and scraping on the oral microflora of periodontitis patients. J Periodontal Res.; 53:73–

Matsui, M., Chosa, N., Shimoyama, Y., Minami, K., Kimura, S., & Kishi, M. (2014). Effects of
tongue cleaning on bacterial flora in tongue coating and dental plaque: a crossover
study. BMC Oral Health, 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: a
systematic 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 Comparative
Evaluation of the Effects of Tongue Cleaning on Existing Plaque Levels in
Children. International Journal of Clinical Pediatric Dentistry, 6(3), 188–192. 


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