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 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).