{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T09:16:28Z","timestamp":1777972588584,"version":"3.51.4"},"reference-count":24,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T00:00:00Z","timestamp":1777852800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dentistry Journal"],"abstract":"<jats:p>Background\/Objectives: This study evaluated the effectiveness of Cotinus coggygria (Smoke Tree) Flower Water mouthwash in reducing halitosis and improving oral hygiene parameters among adolescents undergoing fixed orthodontic treatment. Methods: A double-blind, randomized, placebo-controlled, parallel-group clinical trial was conducted with 30 individuals undergoing treatment with fixed orthodontic appliances. Participants were allocated (1:1) into two groups: Group A received the Cotinus coggygria mouthwash, while Group B received the placebo mouthwash. Hydrogen sulfide (H2S) concentration in breath, measured by the OralChromaTM II device, was the primary outcome. Secondary outcomes included dimethyl sulfide [(CH3)2S] and methyl mercaptan (CH3SH) levels, assessed with the same device, and oral hygiene status evaluated using the Modified Silness &amp; L\u00f6e Plaque (PI-M) as well as the Silness &amp; L\u00f6e Gingival (GI) indices. Normality of the data distribution was assessed using the Shapiro\u2013Wilk test. Statistical analyses were conducted using the Mann\u2013Whitney U test and Student\u2019s t-test. Results: A statistically significant reduction in H2S levels was observed in the C. coggygria group compared to placebo (p = 0.014). Median H2S levels decreased from 147.00 ppb at baseline (T0) to 35.00 ppb at follow-up (T1) after 2 weeks. A statistically significant reduction in total VSC levels was also observed in the C. coggygria group compared to placebo (p &lt; 0.001). Median total VSC levels decreased from 254.00 ppb at baseline (T0) to 105.00 ppb at follow-up (T1) after 2 weeks. No significant differences were found between groups for the other volatile sulfur compounds. A Significant improvements were noted in periodontal parameters in favor of the C. coggygria group. The Gingival Index decreased from 2.0 to 1.3 (p &lt; 0.001; 95% CI: \u22120.7 to \u22120.2), and the Plaque Index (PI-M) decreased from 1.6 to 1.0 (p = 0.001; 95% CI: \u22120.7 to \u22120.3). Conclusions: Cotinus coggygria mouthwash appeared to be an effective adjunct for managing halitosis and improving oral hygiene parameters in adolescents undergoing fixed orthodontic treatment. No adverse effects were reported.<\/jats:p>","DOI":"10.3390\/dj14050266","type":"journal-article","created":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T07:57:29Z","timestamp":1777967849000},"page":"266","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Effect of Cotinus coggygria Mouthwash on Halitosis and Oral Hygiene in Orthodontic Patients: A Randomized Clinical Trial"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-6211-5900","authenticated-orcid":false,"given":"Angeliki","family":"Granika","sequence":"first","affiliation":[{"name":"School of Dentistry, National and Kapodistrian University of Athens, 2 Thivon Str., 11527 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Konstantinos","family":"Karamesinis","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, School of Dentistry, National and Kapodistrian University of Athens, 2 Thivon Str., 11527 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ioulia-Maria","family":"Mylonopoulou","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, School of Dentistry, National and Kapodistrian University of Athens, 2 Thivon Str., 11527 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3331-1633","authenticated-orcid":false,"given":"Antigoni","family":"Alexiou","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, School of Dentistry, National and Kapodistrian University of Athens, 2 Thivon Str., 11527 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9686-7423","authenticated-orcid":false,"given":"Iosif","family":"Sifakakis","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, School of Dentistry, National and Kapodistrian University of Athens, 2 Thivon Str., 11527 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,4]]},"reference":[{"key":"ref_1","first-page":"6383","article-title":"Halitosis: Etiology, prevention, and the role of microbiota","volume":"27","author":"Li","year":"2023","journal-title":"Clin. Oral Investig."},{"key":"ref_2","first-page":"e43742","article-title":"Causes and Management of Halitosis: A Narrative Review","volume":"15","author":"Khounganian","year":"2023","journal-title":"Cureus"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Olszewska-Czyz, I., Sozkes, S., and Dudzik, A. (2022). Clinical trial evaluating quality of life in patients with intra-oral halitosis. J. Clin. Med., 11.","DOI":"10.3390\/jcm11020326"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1186\/s13063-015-0549-9","article-title":"Effectiveness of three oral hygiene regimens on oral malodor reduction: A randomized clinical trial","volume":"16","author":"Aung","year":"2015","journal-title":"Trials"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1590\/S1806-83242011000500015","article-title":"Halitosis: An overview of epidemiology, etiology and clinical management","volume":"25","author":"Loesche","year":"2011","journal-title":"Braz. Oral Res."},{"key":"ref_6","first-page":"257","article-title":"Examination, classification, and treatment of halitosis; clinical perspectives","volume":"66","author":"Yaegaki","year":"2000","journal-title":"J. Can. Dent. Assoc."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1111\/j.1601-0825.2006.01350.x","article-title":"A review of the current literature on management of halitosis","volume":"14","author":"Feenstra","year":"2008","journal-title":"Oral Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1136\/bmj.38954.631968.AE","article-title":"Oral malodour (halitosis)","volume":"333","author":"Porter","year":"2006","journal-title":"BMJ"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1111\/j.1600-0765.2008.01199.x","article-title":"Oral malodorous compound triggers mitochondrial-dependent apoptosis and causes genomic DNA damage in human gingival epithelial cells","volume":"45","author":"Calenic","year":"2010","journal-title":"J. Periodontal Res."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"S425","DOI":"10.4103\/jpbs.JPBS_589_20","article-title":"Assessment of effect of fixed orthodontic treatment on gingival health: An observational study","volume":"13","author":"Kumar","year":"2021","journal-title":"J. Pharm. Bioallied Sci."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2829","DOI":"10.1007\/s00784-019-03148-9","article-title":"The OralChromaTM CHM-2: A comparison with the OralChromaTM CHM-1","volume":"24","author":"Laleman","year":"2020","journal-title":"Clin. Oral Investig."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1093\/ejo\/cjad036","article-title":"The effect of mastic mouthwash on halitosis and oral hygiene in orthodontic patients: A randomized clinical trial","volume":"45","author":"Tsironi","year":"2023","journal-title":"Eur. J. Orthod."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"046001","DOI":"10.1088\/1752-7163\/adf1bf","article-title":"The effect of Chios mastic toothpaste on halitosis and oral hygiene in orthodontic patients: A randomized clinical trial","volume":"19","author":"Alexiou","year":"2025","journal-title":"J. Breath Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1016\/j.sjbs.2015.05.012","article-title":"Cotinus coggygria Scop.: An overview of its chemical constituents, pharmacological and toxicological potential","volume":"23","year":"2016","journal-title":"Saudi J. Biol. Sci."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.2298\/JSC0711045N","article-title":"Chemical composition, antibacterial and antifungal activity of the essential oils of Cotinus coggygria from Serbia","volume":"72","author":"Novakovic","year":"2007","journal-title":"J. Serb. Chem. Soc."},{"key":"ref_16","first-page":"703","article-title":"Comparison of two plaque indices for use in fixed orthodontic appliance patients","volume":"70","author":"Williams","year":"1991","journal-title":"J. Dent. Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"748","DOI":"10.2319\/050111-312.1","article-title":"Quantifying plaque during orthodontic treatment: A systematic review","volume":"82","author":"Harradine","year":"2012","journal-title":"Angle Orthod."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1902\/jop.1967.38.6_part2.610","article-title":"The Gingival Index, the Plaque Index and the Retention Index Systems","volume":"38","year":"1967","journal-title":"J. Periodontol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1111\/j.1601-0825.2010.01714.x","article-title":"Comparative effects of various commercially available mouthrinse formulations on oral malodor","volume":"17","author":"Saad","year":"2011","journal-title":"Oral Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"5254","DOI":"10.1038\/s41598-020-61912-4","article-title":"Effects of Chlorhexidine mouthwash on the oral microbiome","volume":"10","author":"Bescos","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_21","first-page":"251","article-title":"Halitosis relief effect of mouthwash containing Lespedeza cuneata extract: A randomised, double-blind, placebo-controlled study","volume":"21","author":"Kim","year":"2023","journal-title":"Oral Health Prev. Dent."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1658","DOI":"10.1002\/ptr.4919","article-title":"Antimicrobial, antioxidant and anti-inflammatory activity of young shoots of the smoke tree, Cotinus coggygria Scop","volume":"27","year":"2013","journal-title":"Phytother. Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"4467","DOI":"10.1038\/s41598-024-83177-x","article-title":"Clinical and measurement variables affecting halitosis intensity following cysteine challenge test","volume":"15","author":"Lee","year":"2025","journal-title":"Sci. Rep."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1111\/idh.12518","article-title":"Curcumin mouthwashes versus chlorhexidine in controlling plaque and gingivitis: A systematic review and meta-analysis","volume":"20","author":"Alhajj","year":"2022","journal-title":"Int. J. Dent. Hyg."}],"container-title":["Dentistry Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2304-6767\/14\/5\/266\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T08:42:38Z","timestamp":1777970558000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2304-6767\/14\/5\/266"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,4]]},"references-count":24,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["dj14050266"],"URL":"https:\/\/doi.org\/10.3390\/dj14050266","relation":{},"ISSN":["2304-6767"],"issn-type":[{"value":"2304-6767","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,4]]}}}