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SÃO PAULO, Brazil: Mouth breathing affects around half of the population and can lead to halitosis, a condition that, in turn, is associated with negative psychological and social development in children. Antimicrobial photodynamic therapy (aPDT) is a proven treatment for halitosis, and researchers from universities in Brazil and Uruguay have tested its efficacy when used with an annatto-based dye against the condition in mouth-breathing children. An orange-reddish pigment derived from the urucum shrub, annatto can be targeted with blue light from a common dental photopolymerising device, and the researchers say that it could provide dentists with increased affordability and access in the treatment of halitosis.
In the study, 52 mouth-breathing children with halitosis were divided into two groups, Group 1 receiving tooth brushing, flossing and aPDT treatment using a 20% concentration annatto spray on the dorsum of the tongue, and Group 2 receiving tooth brushing, flossing and tongue scraping. Halitosis was measured using a halimeter immediately after treatment, and at seven and 30 days post-treatment. In both groups, the researchers observed a significant decrease in halitosis immediately after treatment and a statistically negligible change in halitosis levels in the post-treatment follow-ups, both courses of treatment having shown high and lasting efficacy; however, a significant difference was found between the groups in post-treatment observations, indicating greater efficacy of aPDT treatment.
Co-author and paediatric dentist Prof. Sandra Kalil Bussadori explained in a press release that aPDT is typically associated with high cost as it requires red laser light and blue methylene photosensitiser. “But why not offer health professionals a more affordable option? It was this insight that led me to develop a photosensitiser for use with the LED photopolymerisation device dentists already have. For devices fitted with a blue LED, we would need to develop a red colourant. That’s why I thought of annatto,” Prof. Bussadori said, adding that easier access to the required photopolymerising device would facilitate adoption. After several formulations and clinical trials, she patented an annatto spray in 2020.
Discussing the results, the authors said that they could contribute to the clinical treatment of halitosis in daily practice. “This is particularly relevant, given that the majority of dentists already have this light source in their offices. Moreover, the use of annatto as a natural photosensitiser is an innovative approach. Due to the accessibility of both the light source and photosensitiser, this technique could be effectively and easily reproduced,” they wrote. Annatto is derived from the seeds of the urucum shrub—also known as achiote or Bixa orellana—and is native to tropical regions of the Americas.
The study, titled “Assessment of photodynamic therapy with annatto and led for the treatment of halitosis in mouth-breathing children: Randomized controlled clinical trial”, was published online on 3 September 2024 in PLOS ONE.
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