Halitosis (bad breath)

Halitosis affects men and women of all ages and can have social consequences for those who are affected. A common misconception is that halitosis comes from the stomach. In fact, halitosis originates in the oral cavity in approximately 90 percent of all cases, and the prevalence is high. Studies show that up to 50 percent of the population has problems with halitosis.1,2,3

Halitosis can be divided into two categories: endogenous and exogenous. Exogenous breath is due to external factors such as garlic, tobacco and spicy foods, whereas the endogenous breath originates in the oral cavity (namely in some 90 percent of all cases).

Common endogenous causes for halitosis

  • Poor oral hygiene

  • Gingivitis

  • Dry mouth (xerostomia) due to little or no saliva in the oral cavity. When saliva production decreases, the amount of bacteria normally increases, which in its turn can cause halitosis.

  • Periodontitis is an endemic disease and studies show 40 percent of all adults have some degree of periodontal disease, and that 10 percent have severe periodontal disease. Research shows that there is a clear connection between periodontitis and the amount of volatile sulphur compounds (VSC), in particular the prevalence of methyl mercaptan. Patients who suffer from periodontitis generally also suffer from halitosis.4

  • Implants/prosthetics/braces

How halitosis is formed

Gram negative anaerobic bacteria are found in the oral cavity, in-between teeth, in gum pockets as well as in pits on the back of the tongue. These bacteria are considered to be the primary culprits in the production of sulphurous gases. The gases can also directly harm surrounding tissue in the oral cavity and thus contribute to the periodontitis process. 5

The gram negative anaerobic bacteria have enzymes (cysteine desylphudrase and methionine) which break down amino acids to sulphurous gases (VSC = volatile sulphur compounds) which are then perceived as halitosis in the exhaled air.
The foul-smelling VSC consist mainly of hydrogen sulphide (H2S), methyl mercaptan (CH3SH) and dimethyl sulphide (CH3)2SH. Methyl mercaptan is the component of VSC with the worst odour, even in small quantities, and therefore the primary target for elimination. 6,7

CB12 – clinically proven long-lasting effect against halitosis

CB12 rinse

CB12 was developed at the Odontologic faculty at Oslo University and is a world-patented product which provides 12 hour effect against halitosis. CB12 has a unique and patented composition of low concentrations of zinc acetate (0.3%) and chlorhexidine diacetate (0.025%). These ingredients have a synergistic effect which enables a long-lasting effect in the prevention of halitosis8. CB12 rinse also contains 0.05% sodium fluoride. 

CB12 does not camouflage halitosis, but goes to the root of the problem by neutralising and preventing the formation of sulphur compounds in the oral cavity9. Good bacteria are vital and help sustain a healthy mouth, CB12 only prevents the bacteria from breaking down food particles, saliva etc. to foul-smelling VSC. 

CB12 is tested in several clinical studies by gaschromatographic analysis, halimeter analysis and organoleptic scores 8-12.

Mode of action

The active ingredients in CB12 (zinc acetate and chlorhexidine diacetate) prevent the formation of hydrogen sulphide (H2S), methyl mercaptan (CH3SH) and dimethyl sulphide (CH3)2SH. Zinc acetate by itself eliminates the hydrogen sulphide, but is less effective for methyl mercaptan and dimethyl sulphide, which is why the help of chlorhexidine is needed.

Chlorhexidine breaks down gases containing sulphur molecules, which makes it easier for zinc to react with sulphur so that insoluble sulphides form. In the case of methyl mercaptan, sulphur is so tightly bound that zinc alone is unable to bind the sulphur. However, the addition of chlorhexidine breaks down methyl mercaptan and dimethyl sulphide, allowing the zinc to bind and form odourless insoluble sulphides. Chlorhexidine also has the unique ability to adhere to the oral mucosa, tongue and teeth, thereby providing a long-lasting effect.

The combination of zinc and chlorhexidine has a synergistic effect on halitosis. This also means that the active ingredients in CB12 work in harmony and are effective at very low concentrations. Thanks to the optimal low concentrations of zinc acetate and chlorhexidine, users avoid common side effects that are otherwise associated with use of these ingredients in high concentrations. 8-12

1 Tonzetich J. Production and origin of oral malodor: a review of mechanisms and methods of analysis. Journal of Periodontology (1977) 48: 13-20.

2 Quuirynen M. Management of oral malodour. J Clin Periodontol (2003) 30 (Suppl.5) 17-18.

3 Wåler S.M, Jonski G, Young A and Rölla G. Halitosis - nytt om diagnostikk og behandling. Odontologi (2001).

4 Hugosson, A, Norderyd O, Slotte C, Thorstensson H. Distribution of periodontal disease in a Swedish adult population 1973, 1983 and 1993. J Clin Periodontol (1998) 25: 542-548.

5 Johansson B. Bad breath. Prevalence, periodontal disease, microflora and inflammatory markers.Department of Periodontology, Karolinska Institutet (2005) 9-31.

6 Kleinberg I, Westbay G. Oral malodor. Crit Rev Oral Biol Med (1990) 1: 247-259.

7 Scully C, El-Maaytah M, Porter SR, Greenman J. Breath odor: Etiopathogenesis, assessment and management. Eur J Oral Sci (1997) 105: 287-293.

8 Thrane P, Jonski G, Young A, Rölla G. A New Mouthrinse Combining Zinc and Chlorhexidine in Low Concentrations Provides Superior Efficacy Against Halitosis Compared to Existing Formulations: A Double-Blind Clinical Study. J Clin Dent (2007) 18: 82-86.

9 Thrane P, Jonski G, Young A, Rölla G. Zn and CHX mouthwash effective against VSCs responsible for halitosis for up to 12 hours. Dental Health (2009) 48:2-6.

10 Thrane P, Jonski G, Young A. Comparative effects of various commercially available mouth-rinse formulations on halitosis. Dental Health (2010) 49: 6-10.

11 Saad S, Greenman J, Shaw H. Comparative effects of various commercially available mouthrinse formulations on oral malodor. Oral Diseases (2011) 17: 180-186.

12 Ademoviski et al. Comparison of different treatment modalities for oral halitosis. Acta Odontol. Scand. (2012) 3: 224-233.

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