ORIGINAL ARTICLE Effects of oral prophylaxis including tongue cleaning on halitosis and gingival inflammation in gingivitis patients—a randomized controlled clinical trial Buket Acar 1 & Ezel Berker 1 & Çağman Tan 2 & Yağmur D. İlarslan 1 & Meryem Tekçiçek 3 & İlhan Tezcan 2 Received: 30 October 2017 /Accepted: 4 September 2018 # Springer-Verlag GmbH Germany, part of Springer Nature 2018 Abstract Objective The objective of this study was to assess the effect of oral prophylaxis including tongue scraping on level of halitosis, clinical periodontal parameters and local cytokine response in gingivitis patients. Materials and methods In this randomized controlled clinical trial, 36 gingivitis patients were randomly assigned into two subgroups after scaling and polishing. Group 1 received oral hygiene instructions including the use of tongue scraper; group 2 received oral hygiene instructions alone without tongue cleaning. Levels of volatile sulfur compounds (VSC), organoleptic and tongue coating scores, clinical periodontal parameters and gingival crevicular fluid (GCF) samples were collected at baseline and 7 days after oral prophylaxis. GCF samples were analyzed using multiplexing analysis for the simultaneous measurements of cytokines. The Chi-square, Mann-Whitney U, Wilcoxon, and Student’ s paired and unpaired t tests were used for statistical analysis. Results Statistically significant reductions were found in terms of clinical periodontal parameters in both groups. However, significant improvements in VSC levels, organoleptic and tongue coating scores were observed just in tongue scraping group. Moreover, the GCF levels of IL-1β and IL-8 significantly decreased after the treatment in group 1 according to the baseline values. Conclusion The present study indicated that oral prophylaxis including tongue scraping was effective in improving intra-oral halitosis and pro-inflammatory cytokine response in GCF in gingivitis patients. Clinical relevance The results suggest that tongue scraping can be taken into consideration in order to manage gingival inflam- mation as well as VSC levels in gingivitis patients but further clinical studies are required to judge the clinical relevance. Keywords Tongue coating . Halitosis . Cytokines . Gingival crevicular fluid . Gingivitis Introduction Halitosis, also called oral malodor, is a general term used to describe offensive odor in expiration air and frequently orig- inates from the oral cavity. The main components of intra-oral halitosis are volatile sulfur compounds (VSC), which are mainly composed of methyl mercaptan, hydrogen sulfide and dimethyl sulfide, resulting from the degradation of organ- ic substrates [1]. The sources of VSC production in the oral cavity are bacterial plaque retention areas including the peri- odontal pockets, gingival sulcus and dorsal tongue surface [2]. Gingivitis may also play a contributory role in halitosis [3, 4]. A previous study with a large population found that halitosis was related to oral cavity (76%), tongue coating (43%), gingivitis/periodontitis (11%) or a combination of both tongue coating and gingivitis/periodontitis (18%) [5]. It is assumed that tongue dorsum is the primary source of intra-oral halitosis [6]. The papillary structure of the tongue provides a large surface area for the accumulation of oral debris, which are desquamated epithelial cells, different nutrients, blood metab- olites, leucocytes coming from periodontal pockets and * Buket Acar buket.acar@hacettepe.edu.tr 1 Department of Periodontology, Faculty of Dentistry, Hacettepe University, 06100 Ankara, Turkey 2 Department of Pediatric Immunology, Faculty of Medicine, Hacettepe University, Ankara, Turkey 3 Department of Pediatric Dentistry, Faculty of Dentistry, Hacettepe University, Ankara, Turkey Clinical Oral Investigations https://doi.org/10.1007/s00784-018-2617-5