Effects of Tongue Cleaning with Papain-containing Gel on Removing Tongue Coatings

NOHNO Kaname, YAMAGA Takayuki, KANEKO Noboru, MIYAZAKI Hideo

doi:10.5834/jdh.66.1_9

Many microorganisms have been found to colonize the dorsum of the tongue, and they cause oral halitosis and aspiration pneumonia. Since the components of such biofilm (tongue coating) mainly consist of protein debris, bacteria, desquamated epithelial cells, and leukocytes, the purpose of this study was to evaluate the effects of a protease (papain)-containing gel as an adjuvant for mechanical tongue cleaning to remove tongue coatings. The subjects were 20 healthy adult volunteers (13 males and 7 females) aged from 23 to 53 years. We conducted a double-blind randomized crossover trial. Subjects were administrered gels without (placebo) or with papain. On the experimental day, subjects had 2.5 g of the assigned test or a placebo gel applied to their tongue dorsum and it was left for 1 min. Then, the same dentist cleaned their tongues using a tongue brush with a load range from 100 to 150 g. Subjects were instructed to gargle with 20 mL of water for 10 sec after tongue cleaning. We carried out an assessment of the amounts of tongue coating before and after tongue cleaning. Pictures of their tongue dorsum were taken to evaluate area ratios of tongue coating per whole area of the dorsum based on image analysis. Each day was followed by a 14-day washout interval. For analysis of dorsum images, three trained dentists who were blinded to the subjects traced outlines of both the dorsum and tongue coating and evaluated the tongue coating thickness they recognized visually using the software Image J. The Wilcoxon signed-rank test was employed to compare the tongue coating status between the two groups. When compared with the results from the control group, the ratio of tongue coating per whole area of the dorsum was significantly decreased (p<0.05), and the remaining ratio of the tongue coating was significantly lower (p<0.05) in the test group after tongue cleaning. The tongue coating thicknesses were significantly decreased (p<0.05) in both groups after tongue cleaning. These results suggest that the gel containing papain is effective for removing tongue coatings as an adjuvant for mechanical cleaning.

Effects of Tongue Cleaning with Papain-containing Gel on Removing Tongue Coatings

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