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126 rev port estomatol med dent cir maxilofac. 2019;60(3):125-129

Efetividade do raspador de língua em reduzir a halitose em pacientes
ortodônticos: Estudo clínico

r e s u m o

Palavras-chave: Objetivos: O objetivo do presente estudo foi avaliar o efeito de procedimentos de raspagem
Halitose de língua como parte de um programa de educação em higiene bucal em pacientes orto-
Educação em Saúde Bucal dônticos utilizando aparelhos convencionais fixos afetados por mau odor oral.
Ortodontia Métodos: Uma amostra de 40 pacientes ortodônticos fixos (14 a 18 anos) foi recrutada em
um consultório odontológico privado. Os participantes foram incluídos em um programa de
educação em higiene bucal e, em seguida, os dados foram coletados, com base em entrevis-
tas, deteção de saburra e medição de halitose. Após 28 dias, esses parâmetros foram avalia-
dos novamente. A normalidade dos dados foi avaliada pelo teste de Shapiro-Wilk para as
variáveis quantitativas. A diferença entre antes e depois da intervenção educativa foi testa-
da pelo teste de McNemar, a estatística Kappa para as variáveis categóricas e o teste de
Wilcoxon para a variável quantitativa. A significância foi no nível de confiança de 5% (α=0,05).
Resultados: O programa de higiene bucal aplicado aos pacientes ortodônticos impactou
positivamente na autoperceção da halitose, na mensuração do mau hálito (75%) e no esco-
re de saburra (100%).
Conclusões: A utilização de raspador de língua como parte de um programa de educação em
higiene bucal reduziu o mal odor entre pacientes ortodônticos. (Rev Port Estomatol Med Dent
Cir Maxilofac. 2019;60(3):125-129)
© 2019 Sociedade Portuguesa de Estomatologia e Medicina Dentária.
Published by SPEMD. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).

The placement of orthodontic bands and brackets on
Introduction
teeth surfaces favors the deposition of bacterial biofilm,
In recent years, improvements in the techniques and materi- which is the main factor responsible for inflammation in the
11
als used in orthodontic therapies have been matched by an gingival tissues. Although some studies have shown a low-
increase in undesirable side effects, such as biofilm accumu- er occurrence of oral malodor in patients with self-ligating
12
lation, dental enamel demineralization, gingival inflamma- brackets compared to patients using conventional brackets,
tion, hyperplasia, and also oral malodor. 1-4 Halitosis is the other studies have indicated that self-ligating brackets have
13
generic term used to describe expired air that has an unpleas- a higher potential for bacterial accumulation. Overall, fixed
ant odor, occasionally perceived by the individual themselves, orthodontic therapy interferes with the occurrence of oral
5
and/or by individuals that socialize with them. Its etiology is malodor due to elevated levels of bleeding, gingival inflam-
13
mostly attributed to an origin in the oral cavity (oral malodor), mation and the presence of periodontal pockets. With this
but it may have other factors, either physiological or psycho- reasoning, studies have focused on exploring the oral mal-
5
logical, and may even have an extraoral origin. 6 odor etiopathogeny in fixed-orthodontic users, in order to
Oral malodor results from the proteolytic degradation by determine their particularities and, consequently, conduct
microorganisms, which results in the production of organic an appropriate control.
substrates, including volatile sulfur compounds (VSCs) such Therefore, the present study aimed to evaluate the effect
as hydrogen sulfite (H S), methyl mercaptan (CH SH) and di- of an oral hygiene program, associated with a tongue-scraping
2
3
methyl sulfide ((CH )2S). Such metabolization occurs predom- procedure, on patients with conventional fixed orthodontic
7
3
inantly in a coating on the tongue and periodontal pockets. 7,8 appliances who had oral malodor. It also aimed to verify the
The anatomical structure of the tongue, mainly its poste- hypothesis that the use of a tongue scraper reduces halitosis
rior region, favors the accumulation of debris, thus represent- in orthodontic patients.
ing an excellent ecological niche for bacterial proliferation. The
presence of a sulcus and papillae generates a microenviron-
ment where the low action of salivary flow and masticatory Material and Methods
forces provide reduced levels of oxygen and, thus, anaerobic
9
VSC-producing bacteria have an ecological advantage. Taxa Before beginning the study, the minimum sample size re-
isolated from the tongues of individuals with oral malodor quired for the application of the McNemar and Wilcoxon tests
include Solobacterium moorei and species that do not proliferate was determined, considering the following parameters: test
in culture. 10 power of 80% (β=0.20) and error of 5% (α=0.05). For the McNe-