Journals / Journal of Kocaeli Health and Technology University / 2026 / Cilt: 4 Sayı: 2

Halitosis and Probiotics–Postbiotics

Halitozis ve Probiyotikler-Postbiyotikler

Ayşegül Sunar(KOCAELİ SAĞLIK VE TEKNOLOJİ ÜNİVERSİTESİ, AVRUPA MESLEK YÜKSEKOKULU)0000-0002-6340-8092
Eda Sır(KOCAELİ SAĞLIK VE TEKNOLOJİ ÜNİVERSİTESİ, DİŞ HEKİMLİĞİ FAKÜLTESİ)0009-0005-4174-6380
Çağan Taş(KOCAELİ SAĞLIK VE TEKNOLOJİ ÜNİVERSİTESİ, DİŞ HEKİMLİĞİ FAKÜLTESİ)0009-0007-2675-5689
Enes Tekin(KOCAELİ SAĞLIK VE TEKNOLOJİ ÜNİVERSİTESİ, DİŞ HEKİMLİĞİ FAKÜLTESİ)0009-0007-3666-2259
Pages
188–210
Publication Date
2026-08-24
🏛️Bibliographic metadata and full text access for this article are provided via DergiPark.
DergiPark Record ↗
✨

AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

In conclusion, probiotic and postbiotic approaches represent sustainable and innovative therapeutic strategies for halitosis management; however, further well-designed clinical trials with larger sample sizes are required to establish their definitive efficacy.

📌 3 Key Takeaways

🎯
Objective & Hypothesis:Halitosis is a multifactorial condition primarily associated with increased levels of volatile sulfur compounds (VSCs) and may significantly affect an individual’s social interactions and psychological well-being.
📊
Key Findings & Data:In recent years, probiotics and postbiotics have emerged as biologically based alternative strategies for the management of halitosis.
💡
Conclusion & Impact:In conclusion, probiotic and postbiotic approaches represent sustainable and innovative therapeutic strategies for halitosis management; however, further well-designed clinical trials with larger sample sizes are required to establish their definitive efficacy.
🔬Design:Review & Systematic Survey
📍Scope:Comprehensive Sample
⚙️Variables:Diş Hekimliği · Ağız kokusu · Probiyotikler

Abstract

Halitosis is a multifactorial condition primarily associated with increased levels of volatile sulfur compounds (VSCs) and may significantly affect an individual’s social interactions and psychological well-being. In the majority of cases, the etiology is of oral origin, with periodontal diseases, bacterial colonization on the dorsal surface of the tongue, and dental biofilm identified as the principal contributing factors. Gram-negative anaerobic bacteria are mainly responsible for VSC production. Conventional treatment approaches include mechanical debridement, antiseptic mouthrinses, and zinc-containing agents; however, these methods generally provide only short-term benefits and fail to achieve long-term modulation of the oral microbiome. In recent years, probiotics and postbiotics have emerged as biologically based alternative strategies for the management of halitosis. Species belonging to the genera Lactobacillus, Streptococcus, and Weissella have been reported to exert beneficial effects through competitive inhibition of periodontal pathogens, suppression of biofilm formation, reduction of VSC production, and modulation of the host immune response. In particular, Streptococcus salivarius K12 and several Lactobacillus strains have demonstrated promising outcomes in reducing halitosis. Postbiotics, characterized by the absence of live microorganisms, structural stability, and favorable safety profiles, have also gained increasing attention. Clinical studies suggest that specific postbiotics may contribute to halitosis reduction by regulating the oral microbiome and altering the composition of volatile organic compounds. In conclusion, probiotic and postbiotic approaches represent sustainable and innovative therapeutic strategies for halitosis management; however, further well-designed clinical trials with larger sample sizes are required to establish their definitive efficacy. This narrative review evaluates the etiology of halitosis, its relationship with the oral microbiota, and the potential effects of probiotic and postbiotic approaches in light of current literature.

Özet

Halitozis, çoğunlukla uçucu sülfür bileşiklerinin (VSC) artışıyla ilişkili, bireyin sosyal yaşamını ve psikolojik durumunu etkileyebilen multifaktöriyel bir durumdur. Vakaların büyük çoğunluğunda etiyoloji oral kaynaklı olup; periodontal hastalıklar, dil dorsumunda bakteri kolonizasyonu ve dental biyofilm başlıca nedenler arasında yer almaktadır. VSC üretiminden özellikle Gram-negatif anaerob bakteriler sorumludur. Geleneksel tedavi yaklaşımları mekanik debridman, antiseptik gargaralar ve çinko içeren ajanları kapsamakta; ancak bu yöntemler genellikle kısa süreli etki göstermekte ve oral mikrobiyom dengesini kalıcı olarak düzenleyememektedir. Son yıllarda probiyotikler ve postbiyotikler, halitozis yönetiminde biyolojik temelli alternatif yaklaşımlar olarak öne çıkmaktadır. Lactobacillus, Streptococcus ve Weissella türlerinin; periodontal patojenlerle rekabet, biyofilm oluşumunun inhibisyonu, VSC üretiminin azaltılması ve konak immün yanıtının modülasyonu yoluyla olumlu etkiler gösterebildiği bildirilmektedir. Özellikle Streptococcus salivarius K12 ve çeşitli Lactobacillus suşlarının halitozis üzerinde umut verici sonuçlar sunduğu belirtilmektedir. Postbiyotikler ise canlı mikroorganizma içermemeleri, stabil yapıları ve güvenli kullanım profilleri nedeniyle dikkat çekmektedir. Klinik çalışmalar, belirli postbiyotiklerin ağız mikrobiyomunu düzenleyerek ve uçucu organik bileşiklerin kompozisyonunu değiştirerek halitozisin azaltılmasına katkı sağlayabileceğini göstermektedir. Sonuç olarak, probiyotik ve postbiyotik yaklaşımlar halitozisin yönetiminde sürdürülebilir ve yenilikçi tedavi stratejileri sunmakta; ancak etkinliklerinin netleştirilmesi için daha geniş örneklemli, iyi tasarlanmış klinik çalışmalara ihtiyaç bulunmaktadır. Bu derlemede halitozisin etiyolojisi, oral mikrobiyota ile ilişkisi ve probiyotik/postbiyotik yaklaşımların potansiyel etkileri güncel literatür ışığında değerlendirilmiştir.

🔖

Cite This Article

Sunar, A., Sır, E., Taş, Ç., Tekin, E. (2026). Halitosis and Probiotics–Postbiotics. Journal of Kocaeli Health and Technology University, Cilt: 4 Sayı: 2, 188–210. https://doi.org/10.66163/jokohtu.1932102

📄 Full Text PDF Viewer

📄

PDF görüntüleyici hazırlanıyor...

References (51)

  1. Yoneda, M., Naito, T., Suzuki, N., Yoshikane, T., & Hirofuji, T. (2006). Oral malodor associated with internal resorption. Journal of oral science, 48(2), 89–92. doi:10.2334/josnusd.48.89
  2. Hampelska, K., Jaworska, M. M., Babalska, Z. Ł., & Karpiński, T. M. (2020). The Role of Oral Microbiota in Intra-Oral Halitozis. Journal of clinical medicine, 9(8), 2484. doi:10.3390/jcm9082484
  3. Ratcliff, P. A., & Johnson, P. W. (1999). The relationship between oral malodor, gingivitis, and periodontitis. A review. Journal of periodontology, 70(5), 485–489. doi:10.1902/jop.1999.70.5.485
  4. Fukamachi, H., Nakano, Y., Okano, S., Shibata, Y., Abiko, Y., & Yamashita, Y. (2005). High production of methyl mercaptan by L-methionine-alpha-deamino-gamma-mercaptomethane lyase from Treponema denticola. Biochemical and biophysical research communications, 331(1), 127–131. doi:10.1016/j.bbrc.2005.03.139
  5. Passadakis, G., Neophytou, C., Davidopoulou, S., & Papadimitriou, K. (2025). Effectiveness of Probiotics in Managing Oral Halitosis: A Systematic Review of Randomized Controlled Trials. Journal of International Society of Preventive & Community Dentistry, 15(4), 301–312. doi:10.4103/jispcd.jispcd_19_25
  6. Bicak D. A. (2018). A Current Approach to Halitozis and Oral Malodor- A Mini Review. The open dentistry journal, 12, 322–330. doi:10.2174/1874210601812010322
  7. Yaegaki, K., & Coil, J. M. (2000). Examination, classification, and treatment of halitozis; clinical perspectives. Journal (Canadian Dental Association), 66(5), 257–261.
  8. Murata, T., Yamaga, T., Iida, T., Miyazaki, H., & Yaegaki, K. (2002). Classification and examination of halitozis. International dental journal, 52 Suppl 3, 181–186. doi:10.1002/j.1875-595x.2002.tb00921.x
  9. Tangerman, A., & Winkel, E. G. (2010). Extra-oral halitozis: an overview. Journal of breath research, 4(1), 017003. doi:10.1088/1752-7155/4/1/017003
  10. Aydin, M., & Harvey-Woodworth, C. N. (2014). Halitozis: a new definition and classification. British dental journal, 217(1), E1. doi:10.1038/sj.bdj.2014.552
  11. Sanz, M., Roldán, S., & Herrera, D. (2001). Fundamentals of breath malodour. The journal of contemporary dental practice, 2(4), 1–17.
  12. AlSadhan S. A. (2016). Self-perceived halitozis and related factors among adults residing in Riyadh, Saudi Arabia. A cross sectional study. The Saudi dental journal, 28(3), 118–123. doi:10.1016/j.sdentj.2016.06.001
  13. Yang, Y., Ge, J., Chen, Y., & Liu, H. (2025). Efficacy and safety of probiotic therapy for halitozis: a systematic review and meta-analysis of randomized controlled trials. Journal of breath research, 20(1), 10.1088/1752-7163/ae23f0. doi:10.1088/1752-7163/ae23f0
  14. Krespi, Y. P., Shrime, M. G., & Kacker, A. (2006). The relationship between oral malodor and volatile sulfur compound-producing bacteria. Otolaryngology--head and neck surgery: official journal of American Academy of Otolaryngology-Head and Neck Surgery, 135(5), 671–676. doi:10.1016/j.otohns.2005.09.036
  15. Tonzetich, J., & Kestenbaum, R. C. (1969). Odour production by human salivary fractions and plaque. Archives of oral biology, 14(7), 815–827. doi:10.1016/0003-9969(69)90172-1
  16. Takeuchi, H., Machigashira, M., Yamashita, D., Kozono, S., Nakajima, Y., Miyamoto, M., Takeuchi, N., Setoguchi, T., & Noguchi, K. (2010). The association of periodontal disease with oral malodour in a Japanese population. Oral diseases, 16(7), 702–706. doi:10.1111/j.1601-0825.2010.01685.x
  17. Aylıkcı, B. U., & Colak, H. (2013). Halitozis: From diagnosis to management. Journal of natural science, biology, and medicine, 4(1), 14–23. doi:10.4103/0976-9668.107255
  18. Khaira, N., Palmer, R. M., Wilson, R. F., Scott, D. A., & Wade, W. G. (2000). Production of volatile sulphur compounds in diseased periodontal pockets is significantly increased in smokers. Oral diseases, 6(6), 371–375. doi:10.1111/j.1601-0825.2000.tb00129.x
  19. Pandey, K. R., Naik, S. R., & Vakil, B. V. (2015). Probiotics, prebiotics and synbiotics- a review. Journal of food science and technology, 52(12), 7577–7587. doi:10.1007/s13197-015-1921-1
  20. Eslami, M., Yousefi, B., Kokhaei, P., Jazayeri Moghadas, A., Sadighi Moghadam, B., Arabkari, V., & Niazi, Z. (2019). Are probiotics useful for therapy of Helicobacter pylori diseases?. Comparative immunology, microbiology and infectious diseases, 64, 99–108. doi:10.1016/j.cimid.2019.02.010
  21. Nadelman, P., Magno, M. B., Masterson, D., da Cruz, A. G., & Maia, L. C. (2018). Are dairy products containing probiotics beneficial for oral health? A systematic review and meta-analysis. Clinical oral investigations, 22(8), 2763–2785. doi:10.1007/s00784-018-2682-9
  22. Bermudez-Brito, M., Plaza-Díaz, J., Muñoz-Quezada, S., Gómez-Llorente, C., & Gil, A. (2012). Probiotic mechanisms of action. Annals of nutrition & metabolism, 61(2), 160–174. doi:10.1159/000342079
  23. Özener, H. Ö., Kuru, L., Kadir, T., & Kuru, B. (2023). Bifidobacterium animalis subsp. lactis as adjunct to non-surgical periodontal treatment in periodontitis: a randomized controlled clinical trial. Clinical oral investigations, 27(5), 1965–1972. doi:10.1007/s00784-023-04870-1
  24. Kang, M. S., Chung, J., Kim, S. M., Yang, K. H., & Oh, J. S. (2006). Effect of Weissella cibaria isolates on the formation of Streptococcus mutans biyofilm. Caries research, 40(5), 418–425. doi:10.1159/000094288
  25. Vivekananda, M. R., Vandana, K. L., & Bhat, K. G. (2010). Effect of the probiotic Lactobacilli reuteri (Prodentis) in the management of periodontal disease: a preliminary randomized clinical trial. Journal of oral microbiology, 2, 10.3402/jom.v2i0.5344. doi:10.3402/jom.v2i0.5344
  26. Rossoni, R. D., de Barros, P. P., de Alvarenga, J. A., Ribeiro, F. C., Velloso, M. D. S., Fuchs, B. B., et al. (2018). Antifungal activity of clinical Lactobacillus strains against Candida albicans biyofilms: identification of potential probiotic candidates to prevent oral candidiasis. Biofouling, 34(2), 212–225. doi:10.1080/08927014.2018.1425402
  27. Poorni, S., Srinivasan, M. R., & Nivedhitha, M. S. (2019). Probiotic Streptococcus strains in caries prevention: A systematic review. Journal of conservative dentistry: JCD, 22(2), 123–128. doi:10.4103/JCD.JCD_505_18
  28. Bustamante, M., Oomah, B. D., Mosi-Roa, Y., Rubilar, M., & Burgos-Díaz, C. (2020). Probiotics as an Adjunct Therapy for the Treatment of Halitozis, Dental Caries and Periodontitis. Probiotics and antimicrobial proteins, 12(2), 325–334. doi:10.1007/s12602-019-9521-4
  29. Oliveira, L. F., Salvador, S. L., Silva, P. H., Furlaneto, F. A., Figueiredo, L., Casarin, R., et al. (2017). Benefits of Bifidobacterium animalis subsp. lactis Probiotic in Experimental Periodontitis. Journal of periodontology, 88(2), 197–208. doi:10.1902/jop.2016.160217
  30. Tekce, M., Ince, G., Gursoy, H., Dirikan Ipci, S., Cakar, G., Kadir, T., et al. (2015). Clinical and microbiological effects of probiotic lozenges in the treatment of chronic periodontitis: a 1-year follow-up study. Journal of clinical periodontology, 42(4), 363–372. doi:10.1111/jcpe.12387
  31. İnce, G., Gürsoy, H., İpçi, Ş. D., Cakar, G., Emekli-Alturfan, E., & Yılmaz, S. (2015). Clinical and Biochemical Evaluation of Lozenges Containing Lactobacillus reuteri as an Adjunct to Non-Surgical Periodontal Therapy in Chronic Periodontitis. Journal of periodontology, 86(6), 746–754. doi:10.1902/jop.2015.140612
  32. Invernici, M. M., Salvador, S. L., Silva, P. H. F., Soares, M. S. M., Casarin, R., Palioto, D. B., et al. (2018). Effects of Bifidobacterium probiotic on the treatment of chronic periodontitis: A randomized clinical trial. Journal of clinical periodontology, 45(10), 1198–1210. doi:10.1111/jcpe.12995
  33. Vohra, F., Bukhari, I. A., Sheikh, S. A., Albaijan, R., Naseem, M., & Hussain, M. (2020). Effectiveness of scaling and root planing with and without adjunct probiotic therapy in the treatment of chronic periodontitis among shamma users and non-users: A randomized controlled trial. Journal of periodontology, 91(9), 1177–1185. doi:10.1002/JPER.19-0464
  34. Petersen, P. E., & Ogawa, H. (2012). The global burden of periodontal disease: towards integration with chronic disease prevention and control. Periodontology 2000, 60(1), 15–39. doi:10.1111/j.1600-0757.2011.00425.x
  35. Wu, J., Cannon, R. D., Ji, P., Farella, M., & Mei, L. (2020). Halitozis: prevalence, risk factors, sources, measurement and treatment - a review of the literature. Australian dental journal, 65(1), 4–11. doi:10.1111/adj.12725
  36. Appanna V. D. (2018). Dysbiosis, Probiotics, and Prebiotics: In Diseases and Health. Human Microbes - The Power Within: Health, Healing and Beyond, 81–122. doi:10.1007/978-981-10-7684-8_3
  37. Madhushankari, G. S., Yamunadevi, A., Selvamani, M., Mohan Kumar, K. P., & Basandi, P. S. (2015). Halitozis - An overview: Part-I - Classification, etiology, and pathophysiology of halitozis. Journal of pharmacy & bioallied sciences, 7(Suppl 2), S339–S343. doi:10.4103/0975-7406.163441
  38. Choi, J. H., Song, S., Jang, M. J., Haque, M. A., Lee, H. E., Kim, D. H., et al. (2026). A Randomized, Double-Blind, Placebo-Controlled Study on Probiotic Treatment for Halitozis: Novel Insights into Glucose and Phosphorus Metabolism. Probiotics and antimicrobial proteins, 18(2), 1722–1735. doi:10.1007/s12602-025-10603-5
  39. Fijan S. (2014). Microorganisms with claimed probiotic properties: an overview of recent literature. International journal of environmental research and public health, 11(5), 4745–4767. doi:10.3390/ijerph110504745
  40. Hyink, O., Wescombe, P. A., Upton, M., Ragland, N., Burton, J. P., & Tagg, J. R. (2007). Salivaricin A2 and the novel lantibiotic salivaricin B are encoded at adjacent loci on a 190-kilobase transmissible megaplasmid in the oral probiotic strain Streptococcus salivarius K12. Applied and environmental microbiology, 73(4), 1107–1113. doi:10.1128/AEM.02265-06
  41. Meurman, J. H., & Stamatova, I. (2007). Probiotics: contributions to oral health. Oral diseases, 13(5), 443–451. doi:10.1111/j.1601-0825.2007.01386.x
  42. Laleman, I., Yilmaz, E., Ozcelik, O., Haytac, C., Pauwels, M., Herrero, E. R., et al. (2015). The effect of a streptococci containing probiotic in periodontal therapy: a randomized controlled trial. Journal of clinical periodontology, 42(11), 1032–1041. doi:10.1111/jcpe.12464
  43. Ding, L., Wang, Y., Jiang, Z., Tang, X., Mao, B., Zhao, J., et al. (2024). Effects of Lactiplantibacillus plantarum CCFM1214 and Ligilactobacillus salivarius CCFM1215 on halitozis: a double-blind, randomized controlled trial. Food & function, 15(16), 8386–8394. doi:10.1039/d4fo02280g
  44. Meyer, A. L., Elmadfa, I., Herbacek, I., & Micksche, M. (2007). Probiotic, as well as conventional yogurt, can enhance the stimulated production of proinflammatory cytokines. Journal of human nutrition and dietetics: the official journal of the British Dietetic Association, 20(6), 590–598. doi:10.1111/j.1365-277X.2007.00807.x
  45. Schlagenhauf, U., & Jockel-Schneider, Y. (2021). Probiotics in the management of gingivitis and periodontitis: A review. Frontiers in Dental Medicine, 2, 708666. doi:10.3389/fdmed.2021.708666
  46. Liu, Y., Wu, P., Li, Y., Chen, X., Wang, L., Su, Y., et al. (2025). Probiotics and amelioration of periodontitis: significant roles of Lacticaseibacillus casei DS31. Frontiers in microbiology, 16, 1715664. doi:10.3389/fmicb.2025.1715664
  47. Lin, C. W., Chen, Y. T., Ho, H. H., Kuo, Y. W., Lin, W. Y., Chen, J. F., et al. (2022). Impact of the food grade heat-killed probiotic and postbiotic oral lozenges in oral hygiene. Aging, 14(5), 2221–2238. doi:10.18632/aging.203923
  48. Wuri, G., Liu, F., Sun, Z., Fang, B., Zhao, W., Hung, W. L., et al. (2023). Lactobacillus paracasei ET-22 and derived postbiotics reduce halitozis and modulate oral microbiome dysregulation - a randomized, double-blind placebo-controlled clinical trial. Food & function, 14(16), 7335–7346. doi:10.1039/d3fo02271d
  49. Homayouni Rad, A., Pourjafar, H., & Mirzakhani, E. (2023). A comprehensive review of the application of probiotics and postbiotics in oral health. Frontiers in cellular and infection microbiology, 13, 1120995. doi:10.3389/fcimb.2023.1120995
  50. Krespi, Y. P., Shrime, M. G., & Kacker, A. (2006). The relationship between oral malodor and volatile sulfur compound-producing bacteria. Otolaryngology--head and neck surgery: official journal of American Academy of Otolaryngology-Head and Neck Surgery, 135(5), 671–676. doi:10.1016/j.otohns.2005.09.036
  51. Poorni, S., Srinivasan, M. R., & Nivedhitha, M. S. (2019). Probiotic Streptococcus strains in caries prevention: A systematic review. Journal of conservative dentistry: JCD, 22(2), 123–128. doi:10.4103/JCD.JCD_505_18