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Abstract

Halitosis, commonly referred to as oral malodor, is a prevalent condition affecting a significant portion of the global population and is often associated with social embarrassment, reduced self-esteem, and impaired quality of life. The condition primarily arises due to the production of volatile sulfur compounds (VSCs), such as hydrogen sulfide, methyl mercaptan, and dimethyl sulfide, by anaerobic microorganisms residing in the oral cavity, particularly on the dorsum of the tongue and within periodontal pockets. In addition to intraoral factors, extraoral causes such as respiratory tract infections, gastrointestinal disorders, and systemic diseases may also contribute to halitosis. Conventional therapeutic approaches, including mechanical cleaning methods and chemical agents like mouthwashes, sprays, and lozenges, provide only temporary relief and are often associated with limitations such as short duration of action, unpleasant taste, mucosal irritation, and reduced patient compliance. These drawbacks highlight the need for innovative, effective, and patient-friendly delivery systems. Mouth dissolving strips (MDS) have emerged as a novel oral drug delivery platform characterized by rapid disintegration, ease of administration without water, precise dosing, and improved bioavailability. These thin polymeric films dissolve quickly upon contact with saliva, ensuring immediate release of active constituents directly at the site of action, thereby offering a rapid onset of therapeutic effect. (1,3,9) The incorporation of polyherbal ingredients into mouth dissolving strips presents a promising approach due to their synergistic antimicrobial, antioxidant, anti-inflammatory, and deodorizing properties. Such formulations not only target the underlying microbial etiology of halitosis but also help in neutralizing malodorous compounds and maintaining overall oral hygiene. Recent advancements in formulation technologies have enabled the development of stable, flexible, and palatable polyherbal mouth dissolving strips with enhanced therapeutic efficacy and patient acceptability. Additionally, emerging strategies such as nanocarrier incorporation, mucoadhesive systems, and sustained-release formulations are further expanding the potential of this drug delivery system in oral healthcare. This review aims to comprehensively discuss the etiology, pathophysiology, and current management strategies of halitosis, while emphasizing recent developments and future prospects of polyherbal mouth dissolving strips as an effective and innovative approach for its management. (20)

Keywords

Halitosis, Malodor, Strips, Films, Polyherbal, VSC, Antimicrobial, Herbal, Buccal, Deodorizin, Compliance, Disintegration, Hygiene, Therapeutics, Delivery

Introduction

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Halitosis, commonly known as oral malodor, is a widespread condition characterized by an unpleasant odor originating from the oral cavity. It affects individuals of all age groups and can significantly impact social interactions, confidence, and overall quality of life. The primary cause of halitosis is the production of volatile sulfur compounds (VSCs) such as hydrogen sulfide and methyl mercaptan by anaerobic bacteria present on the tongue surface and in periodontal pockets. (11) Poor oral hygiene, tongue coating, dental caries, and periodontal diseases are the major intraoral contributors, while systemic conditions like respiratory infections and gastrointestinal disorders may also play a role. The condition is often persistent and requires effective management strategies targeting both symptoms and underlying causes. Conventional treatment methods such as mouthwashes, chewing gums, and sprays provide only temporary relief and may be associated with side effects like altered taste and mucosal irritation. Therefore, there is a growing need for innovative, fast-acting, and patient-friendly drug delivery systems. Mouth dissolving strips have emerged as a promising approach in oral care due to their rapid disintegration, ease of administration without water, and ability to deliver active ingredients directly into the oral cavity. These thin films enhance patient compliance and provide immediate breath freshening effects. When combined with polyherbal ingredients, they offer additional advantages such as natural antimicrobial activity, reduced toxicity, and improved therapeutic efficacy.Thus, polyherbal mouth dissolving strips represent a novel and effective strategy for the management of halitosis, addressing both the microbial cause and the need for convenient drug delivery.

Etiology and Pathophysiology of Halitosis

Etiology of Halitosis

Halitosis (oral malodor) is a multifactorial condition that originates from both intraoral and extraoral sources. Approximately 85–90% of cases are intraoral in origin, primarily due to microbial activity.

Intraoral Causes (Primary Halitosis)

a) Tongue Coating (Major Cause)

  • The posterior dorsum of the tongue provides an ideal anaerobic environment.
  • Accumulation of:
    • Food debris
    • Desquamated epithelial cells
    • Salivary proteins
  • These act as substrates for anaerobic bacteria.

b) Periodontal Diseases

  • Gingivitis and periodontitis create deep pockets.
  • These pockets harbor anaerobic Gram-negative bacteria such as:
    • Porphyromonas gingivalis
    • Treponema denticola
  • These bacteria produce foul-smelling gases.

c) Dental Conditions

  • Dental caries
  • Food impaction
  • Poorly fitted restorations
  • Oral infections

d) Reduced Salivary Flow (Xerostomia)

  • Saliva acts as a natural cleanser.
  • Reduced flow leads to:
    • Increased bacterial growth
    • Reduced clearance of debris

Extraoral Causes (Secondary Halitosis)

a) Respiratory Tract Disorders

  • Sinusitis
  • Tonsillitis
  • Lung infections

b) Gastrointestinal Disorders

  • Gastric reflux
  • Helicobacter pylori infection

c) Systemic Conditions

  • Diabetes mellitus → fruity odor (ketones)
  • Liver failure → musty odor
  • Kidney failure → ammonia-like odor

d) Dietary and Lifestyle Factors

  • Garlic, onion, alcohol
  • Smoking and tobacco use

Pathophysiology of Halitosis

The pathophysiology of halitosis is primarily associated with the production of volatile sulfur compounds (VSCs) by oral microorganisms. (11)

Formation of Volatile Sulfur Compounds (VSCs)

Fig. no. 1- Mechanism of VSCs compound

Stepwise Mechanism:

  1. Accumulation of Substrates
    • Proteins from saliva, food debris, and epithelial cells accumulate in the oral cavity.
  2. Bacterial Colonization
    • Anaerobic bacteria colonize tongue coating, plaque, and periodontal pockets.
  3. Proteolysis
    • Bacterial enzymes break down proteins into peptides and amino acids.
  4. Amino Acid Degradation
    • Sulfur-containing amino acids such as:
      • Cysteine
      • Methionine
        are metabolized.
  5. Enzymatic Reactions
    • Enzymes like desulfhydrases convert amino acids into sulfur compounds.
  6. Formation of VSCs
    • Major compounds produced:
      • Hydrogen sulfide (H?S) → rotten egg smell
      • Methyl mercaptan (CH?SH) → fecal odor
      • Dimethyl sulfide ((CH?)?S) → cabbage-like odor
  7. Release and Perception
    • These gases volatilize and are perceived as bad breath.

2.2 Role of Oral Microbiota

  • Predominantly Gram-negative anaerobes
  • Thrive in low oxygen environments
  • Produce enzymes responsible for protein degradation

2.3 Contributing Factors in Pathophysiology

  • Poor oral hygiene
  • Reduced salivary flow
  • High protein diet
  • Oral infections
  • Biofilm formation on tongue and teeth

2.4 Types of Halitosis (Based on Origin)

1. Genuine Halitosis

  • Physiological (morning breath)
  • Pathological (oral/systemic disease)

2. Pseudo-halitosis

  • No detectable odor, but patient perceives it

3. Halitophobia

  • Persistent belief of bad breath even after treatment

Current Approaches for Halitosis Management

Mechanical Methods

  • Tooth brushing
  • Tongue cleaning
  • Flossing

Chemical Methods

  • Mouthwashes (chlorhexidine, cetylpyridinium chloride)
  • Zinc-based formulations
  • Oxidizing agents

Limitations

  • Short duration of action
  • Altered taste sensation
  • Poor patient compliance
  • Possible side effects with long-term use

Mouth Dissolving Strips (MDS) as Drug Delivery System

Mouth dissolving strips are thin, flexible films that dissolve rapidly when placed on the tongue without the need for water.

Advantages

  • Rapid onset of action
  • Improved patient compliance
  • Accurate dosing
  • Portable and convenient
  • Bypasses first-pass metabolism

Mechanism

The strip hydrates in saliva → disintegrates → releases active ingredients → acts locally in the oral cavity.

Fig. no 2 Mouth dissolving strip mechanism

Role of Polyherbal Approach in Halitosis Management

Polyherbal formulations combine multiple herbal ingredients to achieve synergistic effects. (13)

Benefits

  • Broad-spectrum antimicrobial activity
  • Natural deodorizing effect
  • Reduced side effects
  • Improved therapeutic efficacy

Mechanisms of Action

  • Inhibition of odor-causing bacteria
  • Neutralization of volatile sulfur compounds
  • Anti-inflammatory action on oral tissues
  • Salivary stimulation

Recent Advances and Future Perspectives

  • Use of nanotechnology for enhanced delivery
  • Incorporation of probiotics for oral microbiome balance
  • Development of sustained-release strips
  • Personalized oral care formulations

Polyherbal mouth dissolving strips represent a promising advancement in oral healthcare due to their rapid action, natural composition, and improved patient acceptability.

RESULT

Based on available literature, polyherbal mouth dissolving strips are expected to show effective management of halitosis by reducing volatile sulfur compounds (VSCs) and inhibiting odor-causing oral bacteria. The strips provide rapid disintegration, immediate drug release, and improved patient compliance. The polyherbal approach enhances antimicrobial and deodorizing effects with minimal side effects. Overall, this drug delivery system demonstrates promising potential for safe, convenient, and effective control of oral malodor. (11)

CONCLUSION

Polyherbal mouth dissolving strips represent a promising and innovative approach for the management of halitosis. They offer rapid action, improved patient compliance, and effective reduction of odor-causing bacteria. The combination of herbal ingredients provides a safe and multifunctional therapeutic effect. Overall, this system has strong potential as an efficient, convenient, and patient-friendly alternative for oral malodor management.

DISCUSSION

The reviewed literature suggests that polyherbal mouth dissolving strips are an effective approach for managing halitosis by targeting its primary cause—odor-producing oral bacteria. The rapid disintegration and local drug delivery of the strips ensure quick action and improved patient compliance compared to conventional methods. The inclusion of multiple herbal components provides synergistic antimicrobial and deodorizing effects while minimizing side effects. However, most findings are based on preliminary studies, and further clinical validation is required to confirm long-term efficacy, safety, and stability of these formulations.

ACKNOWLEDGEMENT

I would like to express my sincere gratitude to my guide and faculty members for their valuable guidance, support, and encouragement throughout the preparation of this review paper. I am also thankful to my institution for providing the necessary resources and academic environment. Lastly, I extend my heartfelt thanks to my family and friends for their constant support and motivation.

REFERENCES

  1. Wu J, Cannon RD, Ji P, Farella M, Mei L. Halitosis: prevalence, risk factors, sources, measurement and treatment—a review of the literature. Aust Dent J. 2020;65(1):4–11.
  2. Cho MY, Eom JH, Choi EM, Kim JW, Kim YY, Yang SJ, et al. Short-term effects of oral dissolving film on halitosis and oral pathogenic bacteria: a pilot study. Front Microbiol. 2025; 16:1639960.
  3. Li Z, Li J, Fu R, Liu J, Wen X, Zhang L. Halitosis: etiology, prevention, and the role of microbiota. Clin Oral Investig. 2023;27(11):6383–6393.
  4. Lee YH, Hong JY. Oral microbiome as a co-mediator of halitosis and periodontitis: a narrative review. Front Oral Health. 2023; 4:1229145.
  5. Zhang Y, Lo KL, Liman AN, Feng XP, Ye W. Tongue-coating microbial and metabolic characteristics in halitosis. J Dent Res. 2024;103(5):484–493.
  6. Wadia R. Tongue-coating characteristics in halitosis. Br Dent J. 2024; 236:829.
  7. Iranitalab M, Ouanounou A. Drug-related halitosis: a narrative review. Int Dent J. 2026;76(2):109332.
  8. Wang N, Chen L, Zhang J, Wang L, Yang J. Association between halitosis and periodontitis: a systematic review and meta-analysis. Clin Oral Investig. 2024;28(6):341.
  9. Memon MA, Memon HA, Muhammad FE, Siddiqui A, Lee KY, Tahir MJ, et al. Aetiology and associations of halitosis: a systematic review. Oral Dis. 2023;29(4):1432–1438.
  10. Porter SR, Scully C. Oral malodour (halitosis). BMJ. 2006; 333:632–635.
  11. Tonzetich J. Production and origin of oral malodor: a review. J Periodontol. 1977; 48:13–20.
  12. Yaegaki K, Coil JM. Clinical application of breath odor measurement. J Clin Periodontol. 2000; 27:758–764.
  13. Saini R. Halitosis: etiology and management. Indian J Dent Res. 2011; 22:523–528.
  14. Dixit RP, Puthli SP. Oral strip technology: overview and future potential. J Control Release. 2009; 139:94–107.
  15. Sharma D, Kaur D, Verma S, Singh D, Singh M. Fast dissolving oral films: a review. Int J Pharm Sci Rev Res. 2015; 30:80–87.
  16. Boateng JS, Auffret AD, Matthews KH, Humphrey MJ, Stevens HNE, Eccleston GM. Characterisation of freeze-dried wafers for drug delivery. Eur J Pharm Biopharm. 2010; 76:224–233.
  17. Garsuch V, Breitkreutz J. Comparative investigations on different polymers for the preparation of fast-dissolving oral films. J Pharm Pharmacol. 2010; 62:539–545.
  18. Cilurzo F, Cupone IE, Minghetti P, Selmin F, Montanari L. Fast dissolving films made of maltodextrins. Eur J Pharm Biopharm. 2008; 70:895–900.
  19. Kaur M, Rana AC, Seth N. Fast dissolving films: an innovative drug delivery system. Int J Pharm Res Allied Sci. 2013; 2:14–24.
  20. Borges AF, Silva C, Coelho JFJ, Simões S. Oral films: current status and future perspectives. J Control Release. 2015; 206:1–19.
  21. Preis M, Knop K, Breitkreutz J. Mechanical strength test for oral films. Int J Pharm. 2014; 461:22–29.
  22. Arya A, Chandra A, Sharma V, Pathak K. Fast dissolving oral films: an innovative drug delivery system. Int J ChemTech Res. 2010; 2:576–583.
  23. Bhyan B, Jangra S, Kaur M, Singh H. Orally fast dissolving films: innovations in formulation. Int J Pharm Sci Rev Res. 2011; 9:50–57.
  24. Rathbone MJ, Hadgraft J, Roberts MS. Modified-release drug delivery technology. 2nd ed. New York: Informa Healthcare; 2008.
  25. Mishra R, Amin A. Quick API delivery: a novel approach using oral strip technology. Int J Pharm Investig. 2011; 1:2–10.

Reference

  1. Wu J, Cannon RD, Ji P, Farella M, Mei L. Halitosis: prevalence, risk factors, sources, measurement and treatment—a review of the literature. Aust Dent J. 2020;65(1):4–11.
  2. Cho MY, Eom JH, Choi EM, Kim JW, Kim YY, Yang SJ, et al. Short-term effects of oral dissolving film on halitosis and oral pathogenic bacteria: a pilot study. Front Microbiol. 2025; 16:1639960.
  3. Li Z, Li J, Fu R, Liu J, Wen X, Zhang L. Halitosis: etiology, prevention, and the role of microbiota. Clin Oral Investig. 2023;27(11):6383–6393.
  4. Lee YH, Hong JY. Oral microbiome as a co-mediator of halitosis and periodontitis: a narrative review. Front Oral Health. 2023; 4:1229145.
  5. Zhang Y, Lo KL, Liman AN, Feng XP, Ye W. Tongue-coating microbial and metabolic characteristics in halitosis. J Dent Res. 2024;103(5):484–493.
  6. Wadia R. Tongue-coating characteristics in halitosis. Br Dent J. 2024; 236:829.
  7. Iranitalab M, Ouanounou A. Drug-related halitosis: a narrative review. Int Dent J. 2026;76(2):109332.
  8. Wang N, Chen L, Zhang J, Wang L, Yang J. Association between halitosis and periodontitis: a systematic review and meta-analysis. Clin Oral Investig. 2024;28(6):341.
  9. Memon MA, Memon HA, Muhammad FE, Siddiqui A, Lee KY, Tahir MJ, et al. Aetiology and associations of halitosis: a systematic review. Oral Dis. 2023;29(4):1432–1438.
  10. Porter SR, Scully C. Oral malodour (halitosis). BMJ. 2006; 333:632–635.
  11. Tonzetich J. Production and origin of oral malodor: a review. J Periodontol. 1977; 48:13–20.
  12. Yaegaki K, Coil JM. Clinical application of breath odor measurement. J Clin Periodontol. 2000; 27:758–764.
  13. Saini R. Halitosis: etiology and management. Indian J Dent Res. 2011; 22:523–528.
  14. Dixit RP, Puthli SP. Oral strip technology: overview and future potential. J Control Release. 2009; 139:94–107.
  15. Sharma D, Kaur D, Verma S, Singh D, Singh M. Fast dissolving oral films: a review. Int J Pharm Sci Rev Res. 2015; 30:80–87.
  16. Boateng JS, Auffret AD, Matthews KH, Humphrey MJ, Stevens HNE, Eccleston GM. Characterisation of freeze-dried wafers for drug delivery. Eur J Pharm Biopharm. 2010; 76:224–233.
  17. Garsuch V, Breitkreutz J. Comparative investigations on different polymers for the preparation of fast-dissolving oral films. J Pharm Pharmacol. 2010; 62:539–545.
  18. Cilurzo F, Cupone IE, Minghetti P, Selmin F, Montanari L. Fast dissolving films made of maltodextrins. Eur J Pharm Biopharm. 2008; 70:895–900.
  19. Kaur M, Rana AC, Seth N. Fast dissolving films: an innovative drug delivery system. Int J Pharm Res Allied Sci. 2013; 2:14–24.
  20. Borges AF, Silva C, Coelho JFJ, Simões S. Oral films: current status and future perspectives. J Control Release. 2015; 206:1–19.
  21. Preis M, Knop K, Breitkreutz J. Mechanical strength test for oral films. Int J Pharm. 2014; 461:22–29.
  22. Arya A, Chandra A, Sharma V, Pathak K. Fast dissolving oral films: an innovative drug delivery system. Int J ChemTech Res. 2010; 2:576–583.
  23. Bhyan B, Jangra S, Kaur M, Singh H. Orally fast dissolving films: innovations in formulation. Int J Pharm Sci Rev Res. 2011; 9:50–57.
  24. Rathbone MJ, Hadgraft J, Roberts MS. Modified-release drug delivery technology. 2nd ed. New York: Informa Healthcare; 2008.
  25. Mishra R, Amin A. Quick API delivery: a novel approach using oral strip technology. Int J Pharm Investig. 2011; 1:2–10.

Photo
Shrawani Choudhari
Corresponding author

Samarth Institute of Pharmacy, Belhe, Maharashtra, India,

Photo
Sachin Datkhile
Co-author

Associate Professor of Samarth Institute of Pharmacy, Belhe, Maharashtra, India

Photo
Aishwary Shinde
Co-author

Samarth Institute of Pharmacy, Belhe, Maharashtra, India,

Photo
Sakshi Sadgir
Co-author

Samarth Institute of Pharmacy, Belhe, Maharashtra, India,

Photo
Alisha Sayyad
Co-author

Samarth Institute of Pharmacy, Belhe, Maharashtra, India,

Shrawani Choudhari*, Sachin Datkhile, Aishwary Shinde, Sakshi Sadgir, Alisha Sayyad, Advances in Polyherbal Mouth Dissolving Strips for The Management of Halitosis: A Comprehensive Review, Int. J. of Pharm. Sci., 2026, Vol 4, Issue 5, 477-484. https://doi.org/10.5281/zenodo.20019595

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