Self-reported halitosis in a sample of Brazilians: Prevalence, associated risk predictors and accuracy estimates with clinical diagnosis

Factors associated with halitosis reported by parents/caregivers in individuals with Down syndrome

AIMS

Data on halitosis among individuals with Down syndrome (DS) are scarce. The aim was to evaluate factors associated with the occurrence of halitosis reported by parents/caregivers (P/Cs) in individuals with DS.

METHODS AND RESULTS

A cross-sectional study was conducted in non-governmental assistance institutions in the State of Minas Gerais-Brazil. P/Cs have answered an electronic questionnaire with sociodemographic, behavioral and oral health data. Factors associated with halitosis were evaluated by multivariate logistic regression. The sample comprised 227 P/Cs (age 48.8 ± 13.2 years; 82.9% mothers) of individuals with DS (age 20.8 ± 13.5 years). The prevalence of halitosis in the total sample was 34.4% (n = 78) and its occurrence was associated: 1) in individuals with DS ≤18 years old (26.2%; n = 27)-negative perception of oral health (OR = 3.91); 2) in individuals with DS > 18 years (41.1%; n = 51)-gingival bleeding (OR = 4.53), absence of tongue brushing (OR = 4.50), negative perception of oral health (OR = 2.72).

CONCLUSIONS

The occurrence of halitosis in individuals with DS reported by P/Cs was relevant and associated with dental factors, having a negative impact on the perception of oral health. Oral hygiene practices, especially tongue brushing, should be reinforced to prevent and control halitosis.

Concerning perceived and clinically-measured levels of halitosis

The different types of self-reported halitosis complaints include those where one feels that one’s breath smells bad, where one feels that one has bad breath because of the attitudes of others, and where others have pointed out the presence of bad breath. The results of previous studies comparing the objective and subjectives measures of halitosis are inconsistent, and few studies have used gas chromatography (GC) to measure halitosis in a large sample. This study aimed to examine the objectively measured halitosis levels based on the reasons individuals are concerned about halitosis. We included 2063 patients who visited the halitosis clinic at a university dental hospital. Halitosis was assessed using GC, self-administered questionnaires, and oral examinations. Levels of volatile sulphur compounds (VSCs; H2S, CH3SH, and (CH3)2S) were set as objective measures of halitosis. Patients were grouped based on their answers to ‘What made you concerned about bad breath?’ into groups: ‘self-perceived,’ ‘attitudes of others,’ ‘told by others,’ and other reasons. Univariate and multivariable linear regression analyses were performed to examine factors associated with VSCs and objective halitosis levels. Age, sex, oral health status, smoking, drinking, and breakfast habits were used as confounders. Patients who answered ‘told by others’ (n = 691, 33.5%) showed the highest VSCs. Individuals whose halitosis was pointed out by others had higher objectively measured halitosis levels, while those concerned about the attitudes of others or perceived their own halitosis had lower objectively measured halitosis levels. These results suggest that the objective level of halitosis can differ on the basis of the reason underlying an individual’s concern about their bad breath. Categorizing halitosis complaints and comparing them with objective halitosis levels may help reduce the anxiety of those who are concerned about halitosis and confirm the need for intervention for those with objective halitosis.

Self-perceived halitosis among young adults undergoing orthodontic treatment

INTRODUCTION

Halitosis is a common oral health problem that significantly impacts the quality of life of the affected individuals. In most cases, poor oral hygiene is responsible for the problem. Orthodontic therapy aims to correct malocclusion using different devices. It has been suggested that orthodontic treatment can promote gingival health by facilitating daily oral hygiene measures. However, the treatment may harm gingival health as these appliances may lead to a more significant accumulation of plaque, increasing the microbial load in the subgingival environment leading to halitosis.

OBJECTIVE

The primary goal of this survey is to assess the prevalence of self-perceived halitosis in patients undergoing orthodontic treatment.

MATERIALS AND METHODS

An online questionnaire was randomly distributed to patients undergoing orthodontic treatment. A total of 289 subjects completed the questionnaire. It included questions about: demographic data, medical history, social habits, past dental treatment and oral hygiene habits. Descriptive statistics as frequency distributions and percentages were calculated for the study variables.

RESULTS

The prevalence of self-perceived halitosis was 41.5%. The majority of the participants started to notice this problem during and after orthodontic treatment (62.5%). A statistically significant correlation was found between the regular dental visits and halitosis in patients with fixed orthodontic appliances (p-value = 0.010). Also, those patients had a substantial increase in tongue coating formation (p- value = 0.010).

CONCLUSION

Self-perceived halitosis is a common problem in patients receiving orthodontic treatment.

Self-perceived and self-reported breath odour and the wearing of face masks during the COVID-19 pandemic

Objectives

To assess the self‐perception of breath odour (SPBO) and oral hygiene habits (OHHs) while the wearing of face masks during the COVID‐19 pandemic.

Subjects and Methods

This cross‐sectional study included 4647 individuals who answered a structured questionnaire containing demographic, medical and dental variables and self‐perceived breath odour. Variables associated with changes in self‐perceived breath odour, self‐perceived halitosis and changes in OHHs were assessed through multivariate logistic regression.

Results

Changes in self‐perceived breath odour were reported by 1572 individuals and were associated with smoking, systemic conditions, dry mouth, tongue coating, the period of face mask use and its interaction with prior thinking of having bad breath. Likewise, 645 individuals started to consider having bad breath. This was associated with the interaction between prior family/friends saying they have bad breath and period of face mask use. Changes in OHHs were strongly associated with changes in SPBO and starting to consider having bad breath.

Conclusion

Changes in one's SPBO was associated with the wearing of face masks and was significant for changes in OHHs. Findings may be important to guide comprehensive preventive and therapeutic strategies in relation to oral health care.

Adolescence, Adulthood and Self-Perceived Halitosis: A Role of Psychological Factors

(1) Background: Halitosis is a frequent condition that affects a large part of the population. It is considered a "social stigma", as it can determine a number of psychological and relationship consequences that affect people's lives. The purpose of this review is to examine the role of psychological factors in the condition of self-perceived halitosis in adolescent subjects and adulthood. (2) Type of studies reviewed: We conducted, by the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) guidelines, systematic research of the literature on PubMed and Scholar. The key terms used were halitosis, halitosis self-perception, psychological factors, breath odor and two terms related to socio-relational consequences ("Halitosis and Social Relationship" OR "Social Issue of Halitosis"). Initial research identified 3008 articles. As a result of the inclusion and exclusion criteria, the number of publications was reduced to 38. (3) Results: According to the literature examined, halitosis is a condition that is rarely self-perceived. In general, women have a greater ability to recognize it than men. Several factors can affect the perception of the dental condition, such as socioeconomic status, emotional state and body image. (4) Conclusion and practical implication: Self-perceived halitosis could have a significant impact on the patient's quality of life. Among the most frequent consequences are found anxiety, reduced levels of self-esteem, misinterpretation of other people's attitudes and embarrassment and relational discomfort that often result in social isolation.

Knowledge and Management of Halitosis in France and Lebanon: A Questionnaire-Based Study

Halitosis is a growing issue and its management is highly challenging. The aim of this study was to evaluate the knowledge and treatment strategies used by French (FD) and Lebanese (LD) dentists. A self-administered structured questionnaire was sent to FD and LD comprising questions about professional characteristics, management, and treatment of halitosis, patients’ referral, and halitosis-related knowledge. A multivariate analysis was conducted to determine differences between FD and LD and to identify parameters that could influence dentists’ management of halitosis. The questionnaire was filled out by 156 FD and 257 LD. Among them, 78.8% of FD and 68.9% of LD were confronted with halitosis management, while only a few routinely asked their patients about halitosis (16% FD, 13.2% LD). Regarding anamnesis, oral hygiene habits were more investigated by FD than LD (p < 0.05). The overall treatment satisfaction was low with 39.7% of FD and 28.4% of LD considering their treatment effective. Regarding halitosis-related knowledge, extra-oral causes were overestimated in both populations. FD (83.4%) and LD (65.8%) considered their education regarding halitosis as insufficient. This study highlights the need of professional education in both countries, targeting proper diagnosis and treatment strategies of halitosis.