Emotional impact of halitosis

Emotional and Social Impact of Halitosis on Adolescents and Young Adults: A Systematic Review

Background and Objectives: Halitosis is a condition characterized by unpleasant breath smell that is starting to receive serious scientific attention, considering it reflects on people’s social and personal life. While most studies focus on the prevalence of halitosis, its medical etiology, and the psychological impact on adults, there is a lack of evidence regarding the social impact of halitosis on the younger population. Therefore, this systematic review aimed to observe the social and emotional impact that halitosis has on adolescents and young adults. Materials and Methods: The review followed the PRISMA protocol, and four electronic databases (Scopus, Scholar, Web of Science, and ProQuest) were searched. From a total of 593 studies retrieved, only 6 were included in the study after assessing the eligibility criteria. Results: The main results showed that the levels of self-reported halitosis ranged from 23.1% to 77.5%, with an average of 44.7%, indicating a significant heterogeneity among the studies reporting this issue. Adolescents and young adults who experienced bad breath were feeling more anxious and depressed according to the non-standardized questionnaires and the standardized questionnaires (OHIP-14 and SCL-9-R). The respondents were isolated from social interactions and consequently had lower self-esteem and impaired quality of life. Conclusions: The conclusions drawn indicate the need for action on a medical level, as well as on a psychological level, in order to improve people’s oral health and help them navigate through the difficulties of maintaining social interactions as they live with halitosis.

Clinical Trial Evaluating Quality of Life in Patients with Intra-Oral Halitosis

Halitosis is considered to be extremely unattractive in the context of social interactions. The main research objective of this study was to evaluate whether intra-oral halitosis may impact patients’ quality of life (QOL). One hundred generally healthy adult participants complaining about oral malodor and diagnosed with intra-oral halitosis were enrolled in this study. For halitosis diagnosis, a gas chromatography (GC) analysis by the Oral Chroma portable device was used. QOL assessment was based on the Short Form 36-item Health Survey (SF-36). The respondents had the highest scores in the physical functioning (PF), activity limitations caused by emotional problems (RE) and activity limitations caused by physical problems (RP) domains, and the weakest in the general health perception (GH), vitality (VT) and emotional wellbeing (MH) ones. The total volatile sulfur compounds (VSCs) level was negatively correlated with SF-36 domains. The SF-36 domains’ scores decreased the higher the level of VSC was. The respondents assessed their QOL to be at its best in physical functioning and activity limitations caused by emotional and physical problems and the worst in general health perception, vitality and emotional wellbeing. The strongest correlation between halitosis and decreased QOL was found in the social functioning (SF), vitality, emotional wellbeing and general health perception domains.

Effect of fixed orthodontic appliances on self-assessment and diagnosis of halitosis in undergraduate dental students

Background:

The effects of fixed orthodontic therapy on the occurrence of halitosis are not yet fully understood. This study aimed to evaluate the effect of fixed orthodontic appliances on self-assessment and diagnosis of halitosis in undergraduate dental students.

Materials and Methods:

Sixty-two undergraduate dental students were included in this cross-sectional study. Two groups (n = 31 per group) were composed of participants with (study group) or without (control group) fixed orthodontic appliance. Halitosis self-assessment and clinical diagnosis were assessed using a visual analogic scale (VAS) and sulfur volatile compounds (SVCs) assessment, respectively. The subjective (VAS) and objective (SVC) malodor assessments were classified in absence, light, moderate, or severe malodor. Chi-square Pearson test and Spearman's correlation were applied for data analysis, with a significance level of 5%.

Results:

The use of fixed orthodontic appliances had no effect on self-assessment (P = 0.490) or clinical diagnosis (P = 0.610) of halitosis. Self-assessment was not significantly associated with the diagnosis of halitosis regardless the use of fixed orthodontic appliance (P ≥ 0.737). Male participants showed higher diagnosis of halitosis (P = 0.007). SVC measurements showed the absence of halitosis in 51.6% and 58.1% of participants with or without orthodontic appliances, respectively.

Conclusion:

The use of fixed orthodontic appliances affected the self-assessment of halitosis but no SVC measurements. It was not verified a correlation between subjective and objective methods to diagnose halitosis in dental students.

Self-reported halitosis and oral health related quality of life in adolescent students from a suburban community in Nigeria

Background

Halitosis is an important cause of impaired quality of life in adolescents. Little is known about the prevalence of self-reported halitosis in adolescents in Nigeria and the extent to which self-reported halitosis impairs their oral health related quality of life.

Objectives

To determine the prevalence and impact of self-reported halitosis on the oral health related quality of life of adolescent students in a suburban community in Nigeria.

Methods

An analytical cross-sectional study. Pre-tested self-administered pro-forma was used to obtain the adolescents' demographic data and their self-perception of halitosis. The Oral Health Impact Profile (OHIP-14) was used to assess the adolescents' OHRQoL. The Mann-Whitney U test was used to compare the median OHIP-14 scores between adolescents who reported halitosis and those who did not. The level of significance was set at p < 0.05. Ethics approval for this study was obtained from the Health Research and Ethics Committee of the Lagos University Teaching Hospital.

Results

A total of 361 adolescents aged 10 – 19 years (mean age 14.1 ± 1.79 years) took part in the study. Of these, 32.7% (n=118) had self-reported halitosis. The median OHIP-14 score among adolescents with self-reported halitosis was 3 (0–9) while those who did not report halitosis had a median OHIP-14 score of 0 (0 – 5). This difference was statistically significant (p < 0.0001).

Conclusion

Self-reported halitosis significantly impaired the oral health related quality of life of the adolescents.

Halitosis, reduced salivary flow and the quality of life in pre-kidney transplantation patients

Background

Halitosis is a condition that affects 50% of adults and one third of patients with chronic kidney disease. The aim of this study was to evaluate oral manifestations and volatile sulfur compounds (VSCs) associated with halitosis and quality of life in pre-kidney transplantation candidates.

Material and Methods

The organoleptic test (OT) and halimetry (HA) (before and after cysteine mouthwash) were performed in patients with the Oralchroma® device, stimulated (SE) and non-stimulated sialometry (SN), Tongue Coating Index (TCI). The OHIP-14 questionnaire was administered to assess the impact of oral health on quality of life.

Results

Fourteen individuals with a mean age of 49.64 ± 13.35 years were evaluated. In the organoleptic test, 57.14% of the individuals presented halitosis. Oralchroma results showed that dimethyl sulfide was above the threshold in 85.71% of the individuals, while hydrogen sulfide and methyl mercaptan were above threshold in 28.57%; after the use of cysteine, hydrogen sulfide was present in 100% of the cases, dimethyl sulfide in 57.14% and methyl mercaptan in 50%. In the non-stimulated sialometry, 57.14% of the individuals presented hyposalivation and 21.42% in the stimulated. Regarding the tongue coating index, 100% of the individuals presented tongue coating, with a mean of 7.64. The assessment of impact of oral health on quality of life showed a negative impact in all dimensions.

Conclusions

Tongue coating, in association with hydrogen sulfide, was the main cause of halitosis in the study subjects, and hyposalivation may contribute to higher tongue-coating indices. These oral changes negatively affect the quality of life for pre-kidney transplantation patients.

Key words:Halitosis, chronic kidney disease, quality of life, kidney transplantation.

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

AIMS

To evaluate the prevalence of self-reported halitosis and its predictors, and to determine the accuracy estimates of self-reported measures with clinical evaluation of halitosis.

MATERIALS AND METHODS

This cross-sectional study comprised 5,420 individuals (teaching staff, administrative personnel and ongoing students from Federal University of Minas Gerais), who answered a structured questionnaire containing sociodemographic, medical and dental data, and self-reported halitosis measures. A subsample (n = 159) underwent halitosis assessment through the organoleptic method. Predictors for self-reported halitosis were determined through univariate and multivariate analyses. Accuracy estimates of self-reported measures were evaluated in this subsample.

RESULTS

Prevalence of self-reported halitosis varied from approximately 4%-35%, depending on the self-reported measure. Self-reported halitosis was mainly associated with socio-economic variables (age, gender, educational level), parameters of oral health (gingival bleeding, gingival infections, tongue coating, general oral health evaluation) and impacts on daily activities (family/social environment and intimate relations). Specificity values for self-reported halitosis measures were determined to be high for clinical (organoleptic score ≥2) and strong (organoleptic score ≥4) halitosis. Combinations of self-reported measures retrieved useful accuracy estimates for strong halitosis.

CONCLUSION

Prevalence rates of self-reported halitosis may be considered moderate. Accuracy diagnostic estimates were determined to be useful, with good prediction for non-diseased individuals.

Impact of the halitosis on QoL in overweight and obese patients: Based on six years of experience in two centers in sulaimani governorate, Kurdistan Region/Iraq, and case series study

BACKGROUND/OBJECTIVES

The patients who are overweight and obese, are under stress of excess body weight, embarrassed, one may imagine the impact of halitosis on this group of patients, this is an attempt to evaluate this extra impact, and which aspect of quality of life will be affect in the overweight and obese.

SUBJECTS/METHODS

A prospective case series study including 885 overweight or obese patients, they were consulting for advice, diet and or drugs and various bariatric operations. A group of normal weight patients with halitosis, matched in age group and gender were enrolled as a control group for comparison. Patients who have either oral causes of the condition or pseudo halitosis or halite-phobia or were using drugs like phenytoin, cyclosporine or calcium channel blockers, isosorbide di-nitrate, Chloral hydrate, Nitrites and Nitrates, Dimethyl sulphoxide, Disulphiram, cytotoxic agents, Phenothiazine were excluded.

INTERVENTIONS/METHODS

The work conducted over a period of 6 years from February 1st, 2012 to March 1st, 2018. Prospective evaluation of the type and etiology of halitosis was done by using organoleptic measurement, which is not a slandered but evaluated by a group of academic colleagues. The patients were advised to avoid eating odiferous foods for 48 hours before the assessment and both the patient and the examiner should refrain from drinking coffee, tea or juice, smoking and using scented cosmetics before the assessment.

RESULTS

Halitosis in the overweight and obese patients magnifies the negative aspects of quality of life: avoidance, narrow social circle (P Value = 0.3415, 95% confidence interval = 11.43924-29.67085), avoidance of sex by partner (P Value = 0.0143, 95% confidence interval = 04.11537-17.08480), low self-esteem (P Value = 0.0100, 95% confidence interval = 10.66794-28.44776), teasing by others and negative thoughts (P Value = 0.4013, 95% confidence interval = 11.43924-29.67085). While obesity was not a cause of avoidance of to be kissed by partner in obese patients, but was a direct cause for this avoidance in obese patients with halitosis (P Value = 0.0143, 95% confidence interval = 04.11537-17.08480). Halitosis in normal weight patients affects the quality of life remarkably but not to the extent of halitosis in overweight and obese patients, especially social life and self-esteem which will suffer most.

CONCLUSIONS

The quality of life of overweight and obese, especially emotional and social aspects was significantly disturbed by halitosis more than normal weight subjects with halitosis.

Quality and readability of internet-based information on halitosis

OBJECTIVE

To evaluate quality and readability of Internet-based information on halitosis.

STUDY DESIGN

An Internet search through 3 engines (Google, Yahoo, and Bing) was done with the terms ("bad breath," "halitosis," "oral malodor," "foul breath," "mouth malodor," "breath malodor," "fetor ex ore," "fetor oris," "ozostomia," and "stomatodysodia"). The first 50 websites from each engine resulting from each search term were screened. Included websites were evaluated using Health on the Net (HON) criteria, Journal of American Medical Association (JAMA) benchmarks, DISCERN, Ensuring Quality Information for Patients (EQIP), Flesch Reading Ease (FRE) score, and Flesch-Kincaid Grade level.

RESULTS

A total of 101 websites were included. HON, DISCERN, EQIP, and FRE score were 42.9%, 37.6%, 37.4%, and 51.9% of the maximum score, respectively. Fewer than 50% of sites displayed attribution, disclosure, and currency according to JAMA benchmarks. HON score, DISCERN score, and EQIP score had significant correlation with each other and were significantly higher in sites displaying the HON seal.

CONCLUSION

The current quality and readability of informative websites on halitosis are generally low and poorly organized. Clinicians should be able to assess the Internet-based information on halitosis, as well as give accurate advice and guide patients concerning this issue.

The long-term effect of a zinc acetate and chlorhexidine diacetate containing mouth rinse on intra-oral halitosis-A randomized clinical trial

AIM

To evaluate the long-term effects of a zinc acetate and chlorhexidine diacetate mouth rinse (Zn/CHX) on intra-oral halitosis.

MATERIALS AND METHODS

Forty-six adults with intra-oral halitosis were randomized into a 6-month, double-blind, placebo-controlled clinical study. The presence of intra-oral halitosis was evaluated at baseline, 3 and 6 months after treatment by assessment of organoleptic score (OLS) and by total volatile sulphur compounds (T-VSC), hydrogen sulphide (H₂ S) and methyl mercaptan (MM) concentrations in exhaled air.

RESULTS

A Zn/CHX mouth rinse provided significantly better control of intra-oral halitosis than a placebo mouth rinse. At 3 and 6 months, individuals rinsing with the Zn/CHX rinse presented with reductions of the OLS, T-VSC (p < .01, respectively), H₂ S (p < .001), and MM (p < .01) in subjects' exhaled air. At 6 months, 68.2% of individuals using the Zn/CHX rinse experienced a 1 or 2 category improvement in OLS compared with 19.1% of placebo-treated subjects. 91% of subjects in the Zn/CHX group were categorized as being effectively treated for intra-oral halitosis (i.e. H₂ S < 112 ppb), compared to 43% in the placebo group.

CONCLUSION

Zn/CHX mouth rinse provides effective long-term efficacy against intra-oral halitosis, assessed both objectively and subjectively. With regular rinsing, the effect was sustained for 6 months.

Self-perception, knowledge, and awareness of halitosis among female university students

Background

Halitosis or oral malodor is defined as an unpleasant breath odor. It can become a serious problem affecting individuals’ social communication and self-confidence. Furthermore, it is a discomforting issue for the people around the person affected, because they consider it embarrassing to inform the person of the problem.

Aim

This study was designed to measure self-perception, knowledge, and awareness of halitosis among female university students in Saudi Arabia.

Materials and methods

A cross-sectional survey was implemented with 392 volunteer participants who responded to a questionnaire on their self-perception, knowledge, and awareness of halitosis.

Results

The response rate was 89.1% (392/440). Self-perception of halitosis was low (21.4%), whereas a larger percentage (78.1%) indicated noticing people with bad breath. Most participants (80.4%) thought that the gastrointestinal tract is the primary source of halitosis. Seventy-seven percent preferred using personal methods such as mouthwash and chewing gum to treat oral malodor. According to 82.1% of respondents, a dentist is the most appropriate professional to treat halitosis.

Conclusion

The investigation revealed low self-perception and limited knowledge regarding halitosis. Therefore, the role of dentists in informing and educating their patients concerning oral malodor should be enhanced. Public education about the causes of and possible ways of managing bad breath should be increased.