Eur J Oral Sci 2020; 1–11 © 2020 The Authors.

© 2020 The Authors. Eur J Oral Sci published by John Wiley & Sons Ltd
DOI: 10.1111/eos.12745 European Journal of
Printed in Singapore. All rights reserved
Oral Sciences

Review article
Effect of essential oils on oral Dorota Dobler , Frank Runkel,
Thomas Schmidts
Institute of Bioprocess Engineering and

halitosis treatment Pharmaceutical Technology, Technische

Hochschule Mittelhessen - University of
Applied Sciences, Giessen, Germany

Dorota Dobler, Institute of Bioprocess

Dobler D, Runkel F, Schmidts T. Effect of essential oils on oral halitosis treatment. Engineering and Pharmaceutical Technology,
Eur J Oral Sci. 2020; 00: 1–11. © 2020 The Authors. Eur J Oral Sci published by Technische Hochschule Mittelhessen -
John Wiley & Sons Ltd University of Applied Sciences, Wiesenstr. 14,
D-35390 Giessen, Germany
Halitosis is a very common condition which may affect up to 30% of the popula-
tion. In about 90% of the cases, halitosis originates in the mouth due to inadequate E-mail: Dorota.Dobler@lse.thm.de
plaque control, periodontal disease, dry mouth, faulty restorations, and in particular
due to excessive bacterial growth. Oral malodor is mainly caused by a microbial Key words: essential oils; halitosis; sulfur-
degradation of amino acids into volatile, bad-smelling gases (volatile sulfur com- reducing bacteria
pounds – VSCs). Management of oral malodor is directed primarily at managing This is an open access article under the
and reducing the VSC-producing bacteria count as well as masking the odor. Essen- terms of the Creative Commons Attribution
tial oils have been used for this purpose in traditional medicine for centuries. In the License, which permits use, distribution and
present review, data on the antimicrobial activity of essential oils against relevant reproduction in any medium, provided the
oral VSC-producing bacteria are compiled and compared. Additionally, other posi- original work is properly cited.
tive aspects of essential oils with regard to oral odor are considered. Accepted for publication October 2020

Halitosis is a general term used to define an unpleasant
or offensive odor emanating from the mouth, which
originates from oral or non-oral sources (1,2). It is a
very common problem and moderate chronic halitosis
affects up to 50% of the population independent of
periodontal diseases (3). In about 90% of the cases,
halitosis originates in the mouth due to inadequate pla-
que control, periodontal disease, dry mouth, faulty
restorations, and in particular due to excessive bacterial
growth. Oral malodor is mainly caused by a microbial
degradation of amino acids into volatile, bad-smelling
gases (volatile sulfur compounds – VSCs), such as
hydrogen sulfide (H2S), methyl mercaptan, dimethyl
sulfide, dimethyl disulfide, and sulfur dioxide (1). Due
to the topography of the tongue, the anaerobic bacte-
rial groups especially favor colonization of the tongue
and thus play an important role in oral malodor forma-
tion (4,5). Although oral malodor is not directly caused
by periodontal disease, it has been suggested that peri-
odontal disease contributes to an increased tongue
coating and higher production of volatile sulfur com-
pounds (6). Among the cultivable oral bacteria, the
most active producers of hydrogen sulfide in vitro are
Treponema denticola, Porphyromonas gingivalis, Porphy-
romonas endodontalis, Prevotella intermedia, and Bac-
teroides loescheii (7). Other bacterial species associated
with periodontal disease, such as Enterobacteriaceae,
Tannerella forsythia, Centipeda periodontii, Eikenella
corrodens, and Fusobacterium periodonticum, also have
a high capability to generate VSCs in vitro (7,8). In
recent years, VSC-producing bacteria have become
quantifiable using polymerase chain reaction. Based on
the data, the most common bacteria occurring in hali-
tosis patients are Porphyromonas gingivalis, T. forsythia,
Fusobacterium nucleatum, Prevotella intermedia and
Treponema denticola (9,10). Furthermore, it is observed
that persons with T. forsythia in their saliva have a
higher level of VSCs in their breath compared to sub-
jects without these bacteria (9). The other species that
produces VSCs and is found only in persons with hali-
tosis is Solobacterium moorei (10). However, no obvious
association between halitosis and any specific bacterial
genus has been found. Halitosis may therefore be more
the result of complex interactions between several bac-
terial species (5,11).
Treatment of halitosis using essential oils
Among the methods for treatment of halitosis are prod-
ucts that (i) chemically and mechanically reduce the
number of microorganisms, (ii) mask the odor, and (iii)
chemically neutralize VSCs (12). The most effective
method is the reduction of VSC-producing bacteria. In
recent years, there has been a growing interest in the
research and development of new antimicrobial agents
from natural sources. Essential oils are of special inter-
est as they are a mixture of multifarious chemical sub-
stances that belong to different chemical families,
including terpenes, aldehydes, alcohols, esters, pheno-
lics, ethers, and ketones (13). The antimicrobial impact
of essential oils and their chemical components has
been investigated by several research groups in the past
(14,15). The antibacterial activity of essential oils seems
2 Dobler et al.

to be mainly achieved by the destruction of the cell Table 1

membrane. Increased membrane permeability may lead Summary of published MIC values of essential oils tested on
to a loss of vital intracellular components such as pro- several VSCs producing bacteria strains
teins, sugars, ATP and DNA, while decreasing the pro-
duction of ATP and thereby leading to cell damage Bacterial MIC value µg/ml
accompanied by leakage of electrolytes (16,17). In gen- Essential oil strain (reference number)
eral, gram-negative bacteria are more resistant to essen- Aloysia gratissima P. gingivalis 125 (27)
tial oils than gram-positive bacteria (18). Commonly F. nucleatum 125 (27)
used essential oils are thyme oil, eucalyptus oil and Aloysia triphylla P. gingivalis 250 (27)
peppermint oil. Accordingly, a number of mouth-rins- F. nucleatum 125 (27)
ing solutions based on essential oils are available. The Alpinia speciose P. gingivalis 125 (27)
best known is Listerine, which contains eucalyptol F. nucleatum 125 (27)
Artemisia Capillaris P. gingivalis 200 (76)
(0.092%), menthol (0.042%), methyl salicylate F. nucleatum 100 (76)
(0.060%) and thymol (0.064%) as active ingredients. P. intermedia 25 (76)
Eucalyptol acts as an antibacterial and anti-fungal Artemisia feddei P. gingivalis 100 (75)
agent, thymol has antiseptic properties, and menthol is F. nucleatum 25 (75)
known for its local anesthetic and counterirritant activ- P. intermedia 25 (75)
ity. Multiple studies confirmed the positive effect of Lis- Baccharis P. gingivalis 125 (27)
dracunculifolia F. nucleatum 125 (27)
terine as a treatment for halitosis (19–23).
Callitris glaucophylla P. gingivalis 2000 (80)
Although many studies highlight the antimicrobial (White cypress oil)
activity of essential oils against oral bacteria, investiga- Chrysanthemum P. gingivalis 100 (77)
tions mostly focus on non-VSC-producing species such indicum F. nucleatum 200 (77)
as Staphylococcus spp. In the present review, data on P. intermedia 200 (77)
the antimicrobial activity of several essential oils Cinnamomum P. gingivalis 630 (67), 6.25 (68), 2000
zeylanicum (80), 250 (27), 250 (83)
against relevant oral VSC-producing bacteria are com-
(Cinnamon oil) F. nucleatum 420 (67), 250 (27), 125
piled and compared. Table 1 summarizes the minimum (83)
inhibitory concentration (MIC) values of essential oils S. moorei 414 (69)
tested on several VSC-producing bacteria which are Commiphora myrrha P. gingivalis 250 (83)
described in the literature. Additionally, other positive F. nucleatum 250 (83)
aspects of essential oils with regard to oral odor are S. moorei 6250 (69)
taken into account. These include anti-inflammatory Coriandrum sativum P. gingivalis 125 (27)
(Coriander oil) F. nucleatum 15 (27)
and antioxidant properties as well as the potential S. moorei 1350 (69)
impact on relevant clinical parameters linked to mouth Croton cajucara P. gingivalis 31.2 (82)
health status and gingival inflammation: plaque index Cryptomeria japonica P. gingivalis 25 (74)
(PI) and gingival index (GI). F. nucleatum 50 (74)
P. intermedia 50 (74)
Cymbopogon citratus P. gingivalis 55–110 (61), 4000 (80),
(Lemongrass oil) 50 (27), 220 (84), 133
Mentha oil (62)
F. nucleatum 250 (27)
Mints (Mentha spp.) are medicinal herbs that are val- Cymbopogon martini P. gingivalis 250 (27)
ued worldwide in traditional medicines for their antimi- F. nucleatum 125 (27)
crobial and antioxidant properties. They are also odor- Cymbopogon P. gingivalis 250 (27)
masking agents, as menthol and menthyl acetate are winterianus F. nucleatum 125 (27)
Cyperus articulatus P. gingivalis 250 (27)
responsible for a pungent and refreshing odor. There-
F. nucleatum 250 (27)
fore Mentha extracts are extensively used in oral Elyonurus muticus P. gingivalis 250 (27)
hygiene products, mouth fresheners, toothpastes, and F. nucleatum 250 (27)
chewing gums. The most widely used herb of this group Eugenia P. gingivalis 160 (70), 100 (71), 2000
is Mentha piperita. The main components of the oil are caryophyllata (80), 2 (85)
menthol, isomenthone, limonene, iso-menthanol, men- (Clove oil) F. nucleatum 80 (70), 100 (71), 1 (85)
thyl acetate, b-pinene, and a-pinene (24). P. intermedia 100 (71), 2 (85)
Eugenia florida P. gingivalis 125 (27)
Despite the common use of mint oil in oral hygiene F. nucleatum 125 (27)
products, only a few studies have investigated its Eugenia uniflora P. gingivalis 250 (27)
antimicrobial activity against oral bacteria. In general, F. nucleatum 125 (27)
it has been shown that the antimicrobial activity of Eucalyptus globulus P. gingivalis 2270–4545 (47), 280 (55),
mint oils against gram-positive bacteria is higher com- (Eucalyptus oil) 1000 (83)
pared to gram-negative bacteria (24,25). F. nucleatum 1180–2270 (47), 1140
(55), 1000 (83)
The MIC values of peppermint oil against different
Ficus deltoidea P. gingivalis 630 (81)
VSC-producing bacteria are found to be between 62.5 F. nucleatum 630 (81)
and 2,800 µg ml 1, although large differences were Juniperus communis L. P. gingivalis 3460 (40)
found between existing studies (26,27) (see Table 1). (Juniper oil) F. nucleatum 3460 (40)
Using the disc diffusion method, peppermint oil showed P. intermedia 3460 (40)
 Effect of essential oils on halitosis 3

Table 1 Continued Table 1 Continued

Bacterial MIC value µg/ml Bacterial MIC value µg/ml

Essential oil strain (reference number) Essential oil strain (reference number)

Ledum S. moorei 1.56 (69) Thujopsis dolabrata P. gingivalis 1000 (80)

groenlandicum (Asunaro oil)
(Labrador tea) Thymus vulgaris P. gingivalis 32 (43), 500 (83)
Lavandula stoechas P. gingivalis 4400–8800 (47), 3520 (Thyme oil) F. nucleatum 500 (83)
(Lavender oil) (40) S. moorei 1470 (69)
F. nucleatum 2200 (47), 3520 (40) Ziziphus joazeiro P. gingivalis 250 (27)
P. intermedia 3520 (40) F. nucleatum 250 (27)
Lippia alba (leaves) P. gingivalis 6.25 (86), 250 (27) Chlorhexidine P. gingivalis 3 (88), 4 (80), 8 (26), 15
F. nucleatum 800 (86), 125 (27) (27)
Lippia sidoides P. gingivalis 250 (27) F. nucleatum 8 (26), 15 (27)
F. nucleatum 125 (27) P. intermedia 3 (88)
Leptospermum P. gingivalis 275 (47) P. endodentalis 3 (88)
scoparium (Manuka F. nucleatum 275 (47) a
oil) Multiple isolates were tested.
Melaleuca alternifolia P. gingivalis 1140–4390 (47), 61 (46),
(Tea tree oil) 966 (29) a higher antimicrobial activity against P. gingivalis than
F. nucleatum 527 (47), >5270 (29)
spearmint oil and many other essential oils (28), and
P. intermedia 26–880a (48)
P. endodentalis 61 (46), 220–880a (48) the antimicrobial activity was only exceeded by tea tree
Fusobacterium 2200–17,560a (48) and cinnamon oils. Another study showed a higher
spp. antimicrobial activity of sage oil in comparison to pep-
S. moorei ≥ 5 (49) permint oil (29). Antimicrobial activity of mint oil
Mentha pipperita P. gingivalis 62.5 (26), 2000 (29), 250 against Streptococcus mutans, another oral pathogenic
(Peppermint oil) (27)
bacterium, has been observed by several research
F. nucleatum 1000 (26), 2000 (29), 250
(27) groups (26,28,30). In contrast, CHAUDARI et al.
S. moorei 2810 (69) observed no activity against this strain (31). This dis-
T. denticola 1000 (29) crepancy probably points to various compositions of
Mikania glomerata P. gingivalis 500 (27) available essential oils. The minimum bactericidal con-
F. nucleatum 250 (27) centrations (MBCs) of other mint plants of the family
Myrtus communis L. P. gingivalis 220 (40), 880–7040a (41), Lamiaceae, i.e., kitchen mint and Japanese mint,
(Myrtle oil) 125–62.5a (39)
F. nucleatum 220–440 (40)
against P. gingivalis were found as 821 and
P. intermedia 1760 (40) 6,537 µg ml 1, respectively (32).
Ocimum americanum P. gingivalis 350 (87), >4450 (62) Furthermore, components of the essential oils from
F. nucleatum 700 (87) Mentha spp. can significantly retard biofilm formation
P. intermedia 350 (87) and thereby decrease the number of bacteria that pro-
Ocimum basilicum P. gingivalis >4450 (62) duce VSCs (33–35).
Ocimum sanctum L. P. gingivalis >4450 (62)
The main component of Mentha (menthol) seems to
Origanum majorana S. moorei 1400 (69)
(Sweet marjoram) be the major constituent responsible for the bioactivity
Orthosiphon P. gingivalis 1250 (81) of mint oil, whereas other terpenes in the essential oils
stamineus F. nucleatum 1250 (81) display some synergistic effects (36).
Pistacia atlantica P. gingivalis 11,380 (78) Peppermint oil can also increase salivation, which
Kurdica has positive effects since a dry mouth may intensify hal-
Romarinus officialis P. gingivalis 4540–9080a (47), 1000
itosis (37).
(Romarinus oil) F. nucleatum 4405 (47)
Salvia officinalis P. gingivalis 600 (29)
(Sage oil) F. nucleatum 800 (29)
S.
T.
moorei
denticola
5740 (69)
2000 (29)
Myrtus communis oil (myrtle oil)
Salvia fruticose M. P. gingivalis 7300 (40) The pharmacological activities of myrtle oil (Myrtus
F. nucleatum 7300 (40) communis), including its anti-inflammatory, antimicro-
P. intermedia 7300 (40)
Satureja hortensis oil P. gingivalis <113 (40)
bial, antioxidant, and hypoglycemic properties, have
(Summer savory F. nucleatum <113 (40) been widely investigated. The major components are a-
oil) P. intermedia <113 (40) pinene, limonene, 1,8-cineole, 4-terpineol, a-terpineol,
T. forsythia <113 (40) and linalool (38).
Satureja montana S. moorei 1400 (69) As shown in Table 1, myrtle oil exhibits a strong
(Winter savory oil) antimicrobial activity on several tested oral pathogens.
Siparuna guianenses P. gingivalis 62 (27)
The MIC values for several VSC-producing bacteria
F. nucleatum 62 (27)
Syzygium P. gingivalis 250 (27), 6.25 (72) are found between 62.5 and 7,040 µg ml 1 (39,40).
aromaticum F. nucleatum 250 (27) Using the disc diffusion assay, the antimicrobial activity
of myrtle oil was compared for different P. gingivalis
4 Dobler et al.

strains. All tested isolates of P. gingivalis (n = 20) were Table 2

sensitive to 125 µg ml 1 of myrtle oil, while 66.6% of Summary of published MIC values of main components of
P. gingivalis isolates were resistant to concentrations up essential oils for several VSC-producing bacterial strains.
to 62.5 lg ml 1 (39). Moreover, P. gingivalis is less sen-
sitive to myrtle oil than S. mutans. In another study, Bacterial MIC value
considerably higher values up to >7,000 lg ml 1 were Substance strain lg ml 1 (reference number)
found (41). 1,8-Cineole P. gingivalis 6400 (75)
(eucalyptol)
F. nucleatum 3200 (75)
P. intermedia 1600 (75)
Thymus oil (thyme oil) a-Pinene P. gingivalis 1600 (74), 800 (77)
Thyme possesses various beneficial effects due to its F. nucleatum 1600 (74), 3200 (77)
P. intermedia 400 (74), 800 (77)
antiseptic, carminative, antimicrobial, and antioxidative a-Terpineol P. gingivalis 200 (75), 100–400 (101)
properties. Commercially available thyme oils are F. nucleatum 400 (75), 100–400 (101)
mostly derived from the species Thymus zygis or Thy- P. intermedia 200 (75), 400 (101)
mus vulgaris. The main compounds of this oil are the b-Caryopyllene P. gingivalis 400 (75), 630 (81)
natural terpenoid thymol and its isomer carvacrol (42). F. nucleatum 12800 (75), 630 (81)
Several studies have shown the antimicrobial activity P. intermedia 800 (75)
Bomeol P. gingivalis 800 (75)
of thyme oil and its single components against oral
F. nucleatum 200 (75)
pathogen bacteria (29,43). As shown in Table 1, MIC P. intermedia 200 (75)
values for VSC-producing bacteria were found ranging Carvacrol P. gingivalis 70 (102), 2400 (103)
between 32 and 1,470 lg ml 1 (43,44). The MIC value F. nucleatum 30 (102), 2400 (103)
of the main component of thyme oil, thymol, for P. intermedia 125 (45)
P. gingivalis was found as 300 lg ml 1 (29,44) and for Camphor P. gingivalis 6400 (75)
F. nucleatum 6400 (75)
P. intermedia as 125 lg ml 1 (45) (see Table 2). How-
P. intermedia 1600 (75)
ever, no direct comparison between thyme oil and thy- Cinnamaldehyde P. gingivalis 0.3 (67), 0.33 (68)
mol is possible, due to different methods used in the F. nucleatum 0.3 (67)
selected studies. P. intermedia 125 (45)
The antimicrobial activity of thyme oil in comparison Citral P. gingivalis 210 (62)
to lavender oil, tea tree oil, peppermint oil, and eugenol Citronellal P. gingivalis 640 (62)
oil was evaluated using four common oral pathogens: Cuparene P. gingivalis 4000 (80)
Eugenol P. gingivalis 5.13 (72), 100 (71), 800 (67),
Staphylococcus aureus, Enterococcus fecalis, 1250 (81), 600 (29), 3180 (62)
Escherichia coli and Candida albicans (37). In general, F. nucleatum 100 (71), 800 (67), 1250 (81)
the MIC values of thyme oil were significantly higher P. intermedia 100 (71), 250 (45)
compared to those of peppermint oil and eugenol oil, Geraniol P. gingivalis 1110 (62)
indicating a lower antimicrobial activity. However, no Germacrene D P. gingivalis 1250 (81)
VSC-producing bacteria were tested. F. nucleatum 1250 (81)
Linalool P. gingivalis 100–800* (101), 4290 (62)
F. nucleatum 100–200* (101)
P. intermedia 200–1600* (101)
Melaleuca alternifolia oil (tea tree oil) Macrocarpal P. gingivalis 0.5–5 (57), 0.2–0.39* (104)
F. nucleatum 100 (57), 0.78–6.25* (104)
The essential oil of Melaleuca alternifolia (Myrtaceae), P. intermedia 1–10 (57), 0.39–1.56* (104)
known as tea tree oil, has been valued in medicine for Sabinene P. gingivalis 50 (74)
F. nucleatum 800 (74)
many years. Tea tree oil mainly contains terpinen-4-ol,
P. intermedia 200 (74)
c-terpinene, and a-terpinene (about 70% to 90% of the Terpinen-4-ol P. gingivalis 400 (75), 600 (102)
oil as a whole). The oil exhibits strong antimicrobial F. nucleatum 200 (75), 600 (102)
properties and is often used in the superficial treatment P. intermedia 200 (75)
of skin infections. Thujopsene P. gingivalis 500 (80)
It has been shown that the essential oil of Melaleuca Thymol P. gingivalis 300 (29)
alternifolia can inhibit strong oral bacterial growth and P. intermedia 125 (45)
VSC production (46,47). The MIC values were found *Multiple isolates were tested.
to range between 26 and above 17,000 lg ml 1
(Table 1), whereas MBC values were reported at
4,390 lg ml 1 (46–48). Some studies could even show strains (48). Time kill experiments performed in this
an antimicrobial activity of tea tree oil exceeding the study demonstrated a rapid killing of S. mutans and
activity of chlorhexidine. Additionally, M. alternifolia Lactobacillus rhamnosus after 30 s treatment with as lit-
significantly reduces the production of H2S by P. gingi- tle as 0.5% of tea tree oil. FORRER et al. determined the
valis and the H2S and methyl mercaptan (CH3SH) antimicrobial activity of tea tree oil in combination
levels of P. endodontalis. HAMMER et al. determined an with a-bisabolol and found that tea tree oil was potent
in vitro activity of Melaleuca alternifolia oil against 161 against S. moorei at concentrations of 5% and 0.5%,
isolates of oral bacteria including some VSC-producing efficiently killing the bacteria even after a short

incubation time (49). Furthermore, the combination of
0.1% a-bisabolol plus 0.05% tea tree oil could increase
antimicrobial activity compared to the single compo-
nents. Besides its antimicrobial activity, tea tree oil
showed significant adhesion-inhibiting effects on P. gin-
givalis in vitro (47). This effect suggests that tea tree oil
might suppress the biofilm formation.
All of these studies suggest that tea tree oil may be
an effective active ingredient in antiseptic mouth rinses.
Thus, several studies assessing the effects of tea tree oil
on oral bacteria as well as plaque formation in vivo
have been conducted (50,51). A tea tree oil-containing
mouthwash was effective in decreasing salivary bacterial
counts for a short period of time. However, it neither
reduced the clinical parameters (PI and plaque area)
nor the vitality of the plaque flora significantly (50).
The same effects were obtained using a tea tree oil-con-
taining gel (51). However, decreased gingival inflamma-
tion, despite a lack of a significant decrease in plaque
scores, indicates its anti-inflammatory rather than
antibacterial activity (51). A significant decrease in the
full mouth bleeding score, as an index value of active
inflammation, along with the GI using mouth rinse
containing tea tree oil was also found in a clinical study
performed by SALVATORI et al. (52). The effect was even
better compared to a mouthwash containing 0.12%
chlorhexidine. Another study compared mouthwashes
containing tea tree oil (0.2%), garlic (2.5% solution),
or chlorhexidine (0.12%), by determining levels of
S. mutans and other oral microorganisms in saliva sam-
ples upon usage of the different products (53). Signifi-
cant reduction in viable counts after application of tea
tree oil was found. Additionally, in contrast to
chlorhexidine, a further reduction of bacteria was
observed after a period of 5 wk of use.
Some studies also report adverse effects of the use of
mouthwashes containing tea tree oil, such as a burning
sensation and a stinging and unpleasant taste (53,54).
However, it is possible that those effects could be
attributed to the alcohol of the mouthwashes (54).
Eucalyptus globulus oil (eucalyptus oil)
Eucalyptus oil is extracted from the leaves of the euca-
lyptus tree (Eucalyptus globulus) native to Australia.
The main group of constituents of eucalyptus oil are
monoterpenes such as eucalyptol (1,8-cineole), a-pinene
and d-limonene. Eucalyptus oil has antibacterial and
freshening properties, and is therefore often used in
mouthwashes and chewing gums.
Several studies confirm the antimicrobial activity of
eucalyptus oil against oral bacteria including VSC-pro-
ducing strains (47,55). The reported MIC values for
several VSC-producing bacteria are between 280 and
4,540 lg ml 1 (see Table 1) (47,55). The MIC values of
eucalyptus oil are found to be higher than for manuka
oil, tea tree oil, romarinus oil, and comparable with
those reported for lavendula oil (47). The lower antimi-
crobial activity of eucalyptus oil in comparison to tea
tree oil was confirmed by PARK & YOON (28).
Effect of essential oils on halitosis 5
In vivo experiments, using toothpaste containing
eucalyptus oil, confirmed the antibacterial activity as
well as inhibition of dental biofilm formation (33). Fur-
thermore, SATO et al. demonstrated that 0.3% eucalyp-
tus-extract-containing chewing gum significantly
inhibited plaque accumulation in comparison to a con-
trol chewing gum without eucalyptus extract in human
volunteers (56).
Besides the native oil, the antimicrobial activity of
selected components of eucalyptus oil has been tested
in some studies (57,58). However, only a few studies
were performed using oral bacteria. The effect of
macrocarpals, which are phloroglucinol derivatives con-
tained in eucalyptus leaves, on periodontopathic bacte-
ria, especially P. gingivalis, were tested (57). The
growth of all tested oral bacteria was strongly inhib-
ited. The MIC values of macrocarpals were 10–1,000
times lower than for native eucalyptus oil (see Table 2).
Additionally, macrocarpals inhibited P. gingivalis Arg-
and Lys-specific proteinases. This resulted in an inhibi-
tion of the binding behaviour towards saliva-coated
hydroxyapatite beads, suggesting that macrocarpals
also attenuate P. gingivalis adherence. In contrast, the
antimicrobial activity of the main component of euca-
lyptus oil (eucalyptol) is lower than the activity of
native oil (58).
Cymbopogon citratus oil (lemongrass oil)
Lemongrass oil (Cymbopogon citratus) is a volatile oil
obtained from lemongrass leaves. Lemongrass oil is
usually made up of citral at an average of 65%–80%,
and citral is a natural mixture of geranial and neral
(59). Lemongrass oil has antibacterial, anti-fungal,
antioxidant, antiseptic, astringent, anti-inflammatory,
analgesic, antipyretic, and carminative properties.
The antimicrobial activity of lemongrass oil against
oral bacteria has been determined in several studies (60–
62). The MIC values against VSC-producing bacteria
were reported to range between 55 and 4,000 lg ml 1
(see Table 1). An in vitro time kill study showed that
C. citratus oil rapidly reduced viable numbers of P. gin-
givalis (62). In another study, the antimicrobial activity
against common VSC-producing microorganisms of
lemongrass oil, and a lemongrass mouth rinse containing
1% lemongrass oil, was compared with chlorhexidine
digluconate, using a broth micro-dilution assay and the
disc diffusion method (61). In this study, lemongrass oil
was effective against A. actinomycetemcomitans and
P. gingivalis, but less effective against S. mutans. Using a
mouth rinse containing lemongrass, lower MIC and
MBC values were found than for pure lemongrass oil
and a chlorhexidine digluconate solution. However, the
mouth rinse contained an additional 0.003% of a flavor
mixture containing menthol, peppermint oil, anise oil,
and vanilla in ethanol. These compounds can enhance
the activity of lemongrass oil by synergistic effects. In
contrast, the inhibition zone of the lemongrass mouth
rinse was smaller than that of lemongrass oil alone, and
of chlorhexidine digluconate. This discrepancy was
6 Dobler et al.
explained by different diffusion of the formulation in the
agar. An in vivo study using this mouth rinse showed
that it can significantly reduce VSC production in the
oral cavity (61).
Double-blinded clinical trials have been conducted to
check the efficacy of lemongrass oil as a mouthwash in
comparison to a 0.2% chlorhexidine mouthwash (63).
The lemongrass oil mouthwash group showed a higher
reduction in the PI score and the GI than the chlorhex-
idine group. The higher reduction in the GI score was
probably due to the antioxidant and anti-inflammatory
effect of lemongrass oil. These properties can be also
utilized in the prevention and treatment of periodonti-
tis, where application of lemongrass oil mouthwash
leads to an increased level of thiol antioxidants (64).
Moreover, lemongrass oil can be an effective anti-
plaque agent by reducing the adherence of cells and
thereby having an inhibitory effect on biofilm forma-
tion (65). A reduction of biofilm formation up to
99.8% could be shown for S. mutans at a concentration
of 0.5 % v/v C. citratus oil (62). Another in vitro study
showed that application of lemongrass oil mouthwash
(0.25% and 0.5% solutions) results in better plaque
reduction compared to a solution containing chlorhexi-
dine (66).
Cinnamomum zeylanicum oil (cinnamon
oil)
Cinnamon oil, obtained from the Cinnamomum zeylan-
icum plant, has been successfully used in traditional
medicine for decades. Cinnamaldehyde has been identi-
fied as the major component of cinnamon oil in con-
centrations of up to 80% (67).
The antimicrobial activity of cinnamon oil against
oral bacteria is described in several studies (67,68). The
MIC values of the native oil were compared to MIC
values of its main component, cinnamaldehyde (67).
The antimicrobial activity of cinnamaldehyde against
P. gingivalis and F. nucleatum (MIC = 0.3 lg ml 1)
(see Table 2) was significantly higher than the activity
of cinnamon oil (MIC = 630 and 420 lg ml 1, respec-
tively). A similar trend was found for P. gingivalis in
another study. However, the MIC values determined
for cinnamon oil were significantly lower, at
6.25 lg ml 1 (68). Additionally, in both studies, the
increased translucency of S. mutans, P. gingivalis and
F. nucleatum cells after an exposure to cinnamon oil
was explained as the destruction of the bacterial cell
membrane (67,68). In another study, the antimicrobial
activity of cinnamon oil against S. moorei was found to
be superior to all other tested essential oils, such as
peppermint, sage, or thyme oils (69). In the same study,
a reduced biofilm growth even below MIC values was
observed. However, cinnamaldehyde had no effect on
the established biofilm mass, whereas the preformed
biofilm mass was inhibited by the native oil (68). Fur-
thermore, cinnamon oil inhibited the ability of
S. moorei to produce H2S in vitro even at concentra-
tions below the MIC value (69).
Clove oil
Several studies have shown that the essential oil of the
Eugenia caryophyllata (clove) leaf and its main compo-
nent eugenol has an antibacterial activity against VSC-
producing bacteria. However, there are significant dif-
ferences between the data described in the literature.
The MIC values for oral bacteria were found ranging
between 1 and 2,000 lg ml 1 (see Table 1) (70–72). A
similar antimicrobial activity was found for clove oil
and its main compound, eugenol, against all tested
strains of F. nucleatum, P. gingivalis and P. intermedia,
whereas another active compound, b-caryophyllene,
showed a significantly lower activity (71).
Furthermore, E. caryophyllata oil suppressed the
adhesion of bacteria and disrupted biofilm formation at
concentrations ranging from 0.63 to 5.0 mg ml 1 (73).
Other essential oils
Apart from the oils described above, many other essen-
tial oils have been tested with regard to oral bacteria
(47). Manuka oil and tea tree oil had the strongest
antibacterial activity compared to eucalyptus oil, lavan-
dula oil, and romarinus oil against P. gingivalis and
F. nucleatum (47). Additionally, they have shown a sig-
nificant adhesion-inhibiting activity against P. gingi-
valis. In another study, the antimicrobial efficacy of
Satureja hortensis L. (summer savory), Salvia fruticosa
M. (sage), Lavandula stoechas L. (lavender), Myrtus
communis L., and Juniperus communis L. (juniper)
essential oils was compared (40). S. hortensis L. essen-
tial oil was the most effective, showing inhibitory activ-
ity against all tested VSC-producing bacteria. However,
S. hortensis L. essential oil had no anti-biofilm activity
against most tested periodontal bacteria (40).
The essential oil of Cryptomeria japonica exhibited con-
siderable inhibitory effects against several VSC-producing
bacteria at MIC values ranging from 25 to 50 lg ml 1
(74). In another publication the same research team pub-
lished MIC values for Artemisia feddei oil ranging between
25 and 100 lg ml 1 (75). Comparable results were
obtained for Artemisia capillaris oil (76). Furthermore, the
antimicrobial activity of all of these oils is similar to the
activity of ampicillin with regard to P. intermedia. How-
ever, the main components of these oils, such as a-pinene,
sabinene, a-terpineol, terpinen-4-ol, camphor, and 1,8-ci-
neole, have a lower antimicrobial activity than the native
oils, pointing to a synergistic effect of all components.
Similar synergistic effects are found for the essential oil of
Chrysanthemum indicum (77). The published MIC values
of this essential oil for P. gingivalis, F. nucleatum, and
P. intermedia range between 100 and 200 lg ml 1 (see
Table 1) and are thereby lower than those seen for the sin-
gle components of the oil as well as the antibiotics ampi-
cillin and gentamicin.
The essential oils from coriander, Labrador tea,
sweet marjoram, thyme, and winter savory exhibited a
MIC of 1.56 mg ml 1 and a MBC of 3.13 mg ml 1 for
S. moorei (69). Essential oils from balsam fir, myrrh,

peppermint, and sage were less effective, with MIC and
MBC values ≥3.13 and ≥6.25 mg ml 1, respectively
(69).
Pistacia atlantica Kurdica essential oil demonstrated
an antimicrobial effect against P. gingivalis as well as
significant wound healing effect due to a reduction of
the lipid peroxidation, thus improving collagen synthe-
sis (78).
The antimicrobial efficacy of various concentrations
of chamomile oil and turmeric oil against P. gingivalis
was assessed via the disc diffusion test (79). Both oils
were less effective than eucalyptus oil and tea tree oil.
The antibacterial effect of forty-eight selected plant
essential oils against P. gingivalis was evaluated with
the MIC and MBC assay (80). Ten samples showed an
inhibitory activity, whereas asunaro oil
(MIC = 1 mg ml 1) and cypress oil (0.5 mg ml 1) were
selected as the two most effective essential oils. Further-
more, four active compounds were isolated. Among
them, thujopsene was the most effective with
MIC = 0.5 mg ml 1.
The antimicrobial activity of the essential oils of
Orthosiphon stamineus Benth and Ficus deltoidea Jack,
containing b-caryophyllene as the main component,
against P. gingivalis and F. nucleatum has been com-
pared (81). The MIC values of Ficus deltoidea oil were
similar to the MIC values of b-caryophyllene, whereas
the activity of Orthosiphon stamineus oil was lower,
probably due to a lower concentration of b-caryophyl-
lene. However, these essential oils showed no inhibition
on bacterial biofilms. Furthermore, the combination of
both oils with amoxicillin at concentrations of 1 9 and
2 9 MIC values demonstrated an additive antibacterial
effect.
The antimicrobial activity of Croton cajucara oil and
its main component linalool has been tested against
P. gingivalis (82). The oil activity was found compara-
ble with the activity of chlorhexidine, but linalool
showed no measurable activity. This result suggests that
although linalool is a major component of the essential
oil from C. cajucara, it is not responsible for its
antibacterial effects.
The activity of several less common essential oils on
oral biofilms has been tested by BERSAN et al. (27).
Most of the essential oils presented a moderate to
strong antimicrobial activity against the oral pathogens.
The essential oil of Coriandrum sativum inhibited all
oral species at the lowest MIC values, whereas Cyperus
articulates exhibited the best ability to control biofilm
formation.
Mouth hygiene products containing several
essential oils
Mouthwashes and toothpastes containing essential oils
are common oral hygiene products. Their aim is to
reduce oral bacteria and to decrease oral odor by
masking. Most of these products contain more than
one essential oil. However, most of these products have
not yet been investigated with regard to the efficiency
Effect of essential oils on halitosis 7
of the oils used. Only a few studies with this research
topic have been published. Most of them are related to
Listerine products, and have been summarized by HAAS
et al. (89). This systematic review demonstrated that
mouthwashes containing essential oils, used as adju-
vants to mechanical oral hygiene, are more efficient
than mechanical oral hygiene alone. Furthermore, Lis-
terine has been shown to be highly effective against oral
malodor due to its antimicrobial action (90). Moreover,
Listerine products with essential oils were more efficient
than cetylpyridinium chloride (89). The irritation poten-
tial of an essential oil-containing mouth rinse (Listerine
Antiseptic) was found to be minimal (91).
Another study has been performed using a mouth-
wash containing essential oils of lemon and mint. Sig-
nificant differences between the control mouthwash
(mouthwash without essential oils) and the test mouth-
wash were found regarding the PI, bleeding on probing,
GI, BANA test results, and organoleptic examination
values, confirming the hypothesis that the essential oils
in the tested formulation had a beneficial clinical effect
on halitosis (92).
A mixture of tea tree (Melaleuca alternifolia), pepper-
mint (Mentha piperita), and lemon oil (Citrus limon)
has been used to treat oral malodor in 32 intensive care
unit patients (93). The level of oral malodor was signifi-
cantly lower 5 min after the essential oil treatment ses-
sion, even though the first decrease of VSCs was
detected after 1 h. These data indicate that besides
antimicrobial activity, components of essential oils can
act as masking agents.
The effect of a mouth rinse, consisting of the essen-
tial oils Cymbopogon flexuosus, Thymus zygis and Ros-
marinus officinalis (Parodolium), was tested in a
randomized clinical trial against oral pathogen bacteria
in patients with generalized moderate chronic periodon-
titis (94). A significant decrease of T. denticola, F. nu-
cleatum, T. forsythia, and P. micra was determined
after 3 months of use.
The antimicrobial activity of the mouthwash
Salviathymol N, containing 1% of essential oils (Euca-
lyptus globulus oil, Foeniculum vulgare oil, camphor,
Mentha piperita oil, menthol, Rosmarinus officinalis oil,
Salvia officinalis oil) in comparison to that of a mouth-
wash containing 0.12% w/v chlorhexidine, was tested
using experimental microorganisms including F. nuclea-
tum (95). This study showed that the chlorhexidine
solution had a higher antibacterial effect against the
tested organisms than Salviathymol, which exhibited
moderate antibacterial effects.
Antimicrobial activity and synergism
between oil components
The reactivity of an essential oil depends on the nature,
the composition, and the orientation of its functional
groups. Usually, the chemical characterization of many
essential oils reveals the presence of only two or three
major components at a fairly high concentration (20%–
80%), compared to other components present in trace
8 Dobler et al.
amounts. Thus, the biological properties of the essential
oils are determined mostly by their major components.
Among the essential oil constituents, the phenolic
compounds have been found to possess major antimi-
crobial activities (96). The hydroxyl group of phenol
interacts with the cell membrane, causing leakage of
cellular components, a change in fatty acids and phos-
pholipids, and an influence on genetic material synthe-
sis. Similarly to phenolic compounds, the site of action
of the terpenes is the cell membrane. They permeate
through the membrane, causing a swelling and an inhi-
bition of respiratory enzymes (97). The MIC values of
some common compounds have been compiled in
Table 2.
However, as shown above, compounds in essential
oils can interact and cause synergistic, additive, indiffer-
ent, or antagonistic effects. In recent years, many stud-
ies have investigated combinations of essential oils and
their components with the aim to increase their efficacy
(98,99). However, there are only a few studies per-
formed on VSC-producing bacteria. Nevertheless, simi-
lar mechanisms can be expected as for other gram-
negative pathogens. The synergism could be due to the
increase of one of three factors which determine the
antimicrobial property of essential oil components:
their lipophilic properties, the potency of their func-
tional groups, and their aqueous solubility by either
compound of a paired combination (98).
Synergistic effects on the growth inhibition of gram-
negative bacterium E. coli has been found for thymol/
eugenol, thymol/carvacrol, carvacrol/eugenol, car-
vacrol/linalool, carvacrol/menthol, menthol/thymol,
eugenol/linalool, and eugenol/cinnamaldehyde combi-
nations (45,98,99). Eugenol and thymol are believed to
work synergistically, with thymol disrupting and disin-
tegrating the outer membrane of gram-negative species
and allowing eugenol to access the cytoplasm and
destroy enzymes (99). The synergism between eugenol
and cinnamaldehyde is probably caused by the different
protein target sites of the two compounds: eugenol
inhibits the enzymatic activity while cinnamaldehyde
interferes with the action of amino acid decarboxylases
(100). The absence of synergistic effects observed
between linalool and menthol, lacking an aromatic
ring, suggests that the aromatic ring may significantly
contribute to synergism (98).
Discussion
Several in vitro and in vivo studies have investigated
the effect of herbal essential oils in treating dental dis-
eases, including halitosis. In this context the strong
antimicrobial activity of several oils against VSC-pro-
ducing bacteria could be shown. Some studies could
even show that the effect of essential oils is superior to
that of the commonly used chlorhexidine solution
(shown in Table 1). Based on the published literature,
the highest antimicrobial activities are described for
cinnamon oil, clove oil, lemongrass oil, myrtle oil, and
summer savory oil, whereas the commonly used
eucalyptus oil and peppermint oil show a significantly
lower antimicrobial activity. It has been shown that
organisms growing in biofilms are more resistant to
antimicrobial agents than the same species growing in a
planktonic state. However, biofilm formation seems to
be one of the main challenges in the treatment of hali-
tosis. Several studies have shown that the inhibition of
biofilm formation by essential oils is due to an attenua-
tion of bacterial growth. Although chlorhexidine is
mostly used for the elimination of oral bacteria, essen-
tial oils have several other benefits regarding the treat-
ment of halitosis. These particularly include their anti-
inflammatory and odor-masking properties. Therefore,
mouthwashes containing essential oils are more effec-
tive for the treatment of halitosis.
Most of the studies presented were performed
in vitro. The bactericidal effects seen in vitro may not
necessarily be transferred to an in vivo application,
e.g., using a mouthwash solution. Due to the presence
of unpredictable amounts of saliva as well as exogenous
protein in the oral cavity, the activity of essential oils
might be influenced. Therefore, clinical trials are
required to determine the in vivo efficacy and to inves-
tigate optimal oil concentrations and compositions.
Essential oils are natural products and thereby not
synthesized de novo following existing protocols.
Therefore, their chemical composition strongly
depends on several factors, such as seasonal variation,
harvesting time and procedure, the age of a plant and
the selected part of the plant used for extraction of
the oil (105). This might contribute to the partially
contradictory results from the existing studies. How-
ever, not all observed differences can be explained in
this way. Thus, different methods, such as different
media, different cultivation conditions, and different
inoculum sizes can also have an impact on the out-
come. A further explanation for the differences in the
MIC values published for a single compound could
be related to the different sensitivity of strains of one
species against the tested inhibitory compounds. Sev-
eral studies demonstrated that MIC values for a sin-
gle compound can be found to differ by several
orders of magnitude. Therefore, a direct comparison
of data, obtained by various research groups, is not
possible in most cases.
When using essential oils, several safety aspects
must be taken into account. These include the allergic
and toxic potential as well as patient compliance. Lim-
ited data are available on the safety and toxicity of
the described oils. Studies have shown that many
essential oils could be toxic at higher doses and also
cause skin irritation at higher concentrations (106).
The spectrum of reported skin reactions to essential
oils include allergic contact dermatitis, irritant contact
dermatitis, phototoxic reactions and contact urticaria
(107). These allergic reactions arise from certain con-
stituents, e.g., benzyl alcohol, cinnamyl alcohol, euge-
nol, iso-eugenol, hydroxycitronellal, geraniol, and
many others. However, the use of low concentrations
of essential oils showed hardly any negative side
effects.

Most essential oils have a strong smell. This fra-
grance is often used to mask mouth odor. However,
not all fragrances are considered pleasant by patients.
Thus, oils with a camphoraceous odor, such as eucalyp-
tus oil or tea tree oil, are less accepted than citral- or
menthol-containing oils, such as lemongrass oil or pep-
permint oil. Therefore, most antimicrobial oral prod-
ucts contain a mix of several essential oils. In this way,
a pleasant smell with the desired antimicrobial activity
can be achieved.
Conclusion
As described in this review, there is considerable evi-
dence that essential oils have the potential to be further
developed as preventive or therapeutic agents for the
treatment of halitosis. However, there is a need to con-
duct further research to establish their safety and effi-
cacy before including them in common clinical practice.
Presently, the composition of oral products seems
based more on traditional use than on clinical data.
There are only a few studies which include clinical data
regarding an effective treatment of halitosis using essen-
tial oils contained in mouth rinses or toothpastes.
Acknowledgements – Open access funding enabled and organized
by Projekt DEAL.
Conflicts of interest – The authors declare that they have no con-
flicts of interest. This research received no specific grant from any
funding agency in the public, commercial, or non-profit sectors.
No funding was accepted for this study, and no ethical approval
was required.
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