The effect of Chios mastic toothpaste on halitosis and oral hygiene in orthodontic patients: a randomized clinical trial.

Chios mastic gum, derived from Pistacia lentiscus variation chia, has emerged as a significant natural remedy to improve oral health and mitigate halitosis. This study aimed to examine the effect of mastic toothpaste on halitosis, plaque, and gingival indices in adolescents undergoing orthodontic treatment with fixed appliances. This study was a double-blind, placebo-controlled, parallel-group, randomized clinical trial. Thirty-two patients were randomly divided into two groups: A) mastic-toothpaste group and B) placebo-toothpaste group. Participants in both groups used the assigned toothpaste three times daily for 14 d. The primary outcome was objective hydrogen sulfide (H2S) levels in breath, measured using a gas chromatograph. The secondary outcomes were dimethyl sulfide and methyl-mercaptan levels, as well as the Silness and Löe Gingival Index (GI) and the Modified Silness and Löe Plaque Index (PI-M). Assessments were conducted at baseline and after two weeks. Data were analyzed using the Mann-WhitneyUtest and Student'st-test. A statistically significant difference was found between interventions, in favor of the mastic group's H2S (p= 0.001). The H2S median levels decreased from 158 parts per billion (ppb) to 26 ppb. Neither treatment group experienced a different decline in the levels of the other two components. Statistically significant differences were observed in the periodontal parameters, favoring the mastic group. The GI index decreased from 1.8 to 1 [p< 0.001, 95% CI: -0.7, -0.4], whereas the PI-M index decreased from 1.2 to 0.8 [p< 0.001, (95% CI: -0.5, -0.2)]. Mastic toothpaste may be an alternative option to reduce halitosis in adolescents undergoing orthodontic treatment with fixed appliances. Regular use of this toothpaste may lead to a clinically meaningful reduction in plaque and gingival indices (ClinicalTrials.gov, NCT06766097).