Chewing gum on postoperative oral Malodor in patients undergoing general anesthesia: a randomized non-inferiority trial

Abstract Background We aimed to determine whether preoperative chewing gum is non-inferior to Chlorhexidine (CHX) mouthwash in reducing halitosis in patients undergoing elective general anesthesia with endotracheal intubation. Methods We conducted a randomized, single-blind, non-inferiority controll...

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Main Authors: Baohua Zhang, Yang Han, Huan He, Li Jin, Lidong Zhang
Format: Article
Language:English
Published: BMC 2025-05-01
Series:BMC Anesthesiology
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Online Access:https://doi.org/10.1186/s12871-025-03134-7
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author Baohua Zhang
Yang Han
Huan He
Li Jin
Lidong Zhang
author_facet Baohua Zhang
Yang Han
Huan He
Li Jin
Lidong Zhang
author_sort Baohua Zhang
collection DOAJ
description Abstract Background We aimed to determine whether preoperative chewing gum is non-inferior to Chlorhexidine (CHX) mouthwash in reducing halitosis in patients undergoing elective general anesthesia with endotracheal intubation. Methods We conducted a randomized, single-blind, non-inferiority controlled trial involving patients undergoing surgery requiring endotracheal intubation for ≤ 3 h. Participants were randomly assigned to either the CHX mouthwash group (Group M) or the chewing gum group (Group N). Thirty minutes before general anesthesia, patients in Group M rinsed their mouths with 10 ml of CHX mouthwash, while those in Group N chewed Trident mint gum. The primary outcome was the incidence of halitosis in both groups, assessed before endotracheal intubation and at extubation. Results A total of 733 patients were included, with 365 patients in Group M and 368 patients in Group N. The incidence of halitosis in both groups was significantly reduced compared to baseline. Before extubation, the improvement in halitosis was greater in Group N than in Group M (P < 0.05). After extubation, the improvement in halitosis in Group N was non-inferior to that in Group M (Z = 1.96, 95% CI: -0.0898 to 0.0944, p = 0.0023). Conclusions In patients undergoing elective general anesthesia with endotracheal intubation, chewing gum was found to be non-inferior to CHX mouthwash in improving postoperative halitosis. Trial registration Chictr.org.cn ChiCTR2400082035 (date of registration: 19/03/2024).
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spelling doaj-art-9e36b829871a4e2cbf0651e1a93b12142025-08-20T03:48:18ZengBMCBMC Anesthesiology1471-22532025-05-012511810.1186/s12871-025-03134-7Chewing gum on postoperative oral Malodor in patients undergoing general anesthesia: a randomized non-inferiority trialBaohua Zhang0Yang Han1Huan He2Li Jin3Lidong Zhang4Department of Anesthesiology, Jinling Hospital, Affiliated with the Medical School of Nanjing UniversityDepartment of Anesthesiology, Jinling Hospital, Affiliated with the Medical School of Nanjing UniversityDepartment of Anesthesiology, General Hospital of the Southern Theater Command of PLADepartment of Anesthesiology, Jinling Hospital, Affiliated with the Medical School of Nanjing UniversityDepartment of Anesthesiology, Jinling Hospital, Affiliated with the Medical School of Nanjing UniversityAbstract Background We aimed to determine whether preoperative chewing gum is non-inferior to Chlorhexidine (CHX) mouthwash in reducing halitosis in patients undergoing elective general anesthesia with endotracheal intubation. Methods We conducted a randomized, single-blind, non-inferiority controlled trial involving patients undergoing surgery requiring endotracheal intubation for ≤ 3 h. Participants were randomly assigned to either the CHX mouthwash group (Group M) or the chewing gum group (Group N). Thirty minutes before general anesthesia, patients in Group M rinsed their mouths with 10 ml of CHX mouthwash, while those in Group N chewed Trident mint gum. The primary outcome was the incidence of halitosis in both groups, assessed before endotracheal intubation and at extubation. Results A total of 733 patients were included, with 365 patients in Group M and 368 patients in Group N. The incidence of halitosis in both groups was significantly reduced compared to baseline. Before extubation, the improvement in halitosis was greater in Group N than in Group M (P < 0.05). After extubation, the improvement in halitosis in Group N was non-inferior to that in Group M (Z = 1.96, 95% CI: -0.0898 to 0.0944, p = 0.0023). Conclusions In patients undergoing elective general anesthesia with endotracheal intubation, chewing gum was found to be non-inferior to CHX mouthwash in improving postoperative halitosis. Trial registration Chictr.org.cn ChiCTR2400082035 (date of registration: 19/03/2024).https://doi.org/10.1186/s12871-025-03134-7HalitosisChewing gumCHX mouthwashEndotracheal intubation
spellingShingle Baohua Zhang
Yang Han
Huan He
Li Jin
Lidong Zhang
Chewing gum on postoperative oral Malodor in patients undergoing general anesthesia: a randomized non-inferiority trial
BMC Anesthesiology
Halitosis
Chewing gum
CHX mouthwash
Endotracheal intubation
title Chewing gum on postoperative oral Malodor in patients undergoing general anesthesia: a randomized non-inferiority trial
title_full Chewing gum on postoperative oral Malodor in patients undergoing general anesthesia: a randomized non-inferiority trial
title_fullStr Chewing gum on postoperative oral Malodor in patients undergoing general anesthesia: a randomized non-inferiority trial
title_full_unstemmed Chewing gum on postoperative oral Malodor in patients undergoing general anesthesia: a randomized non-inferiority trial
title_short Chewing gum on postoperative oral Malodor in patients undergoing general anesthesia: a randomized non-inferiority trial
title_sort chewing gum on postoperative oral malodor in patients undergoing general anesthesia a randomized non inferiority trial
topic Halitosis
Chewing gum
CHX mouthwash
Endotracheal intubation
url https://doi.org/10.1186/s12871-025-03134-7
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