Assessment of Subjective Oral Factors Associated with Self-Reported Halitosis among Adults

Halitosis is the unpleasant breath emitted from a person’s mouth regardless of whether the odorous substances in the breath originate from oral or non-oral sources [1]. Halitosis may play an important role in social communication and, therefore, may be the origin of concern not only for a possible health condition but also for frequent psychological alterations leading to social and personal isolation [2]. It is now widely accepted that the primary cause of halitosis is the release of volatile sulphur compounds (VSCs), which include hydrogen sulphide, dimethyl sulphide, and methyl mercaptan [3]. These compounds result from the proteolytic degradation by predominantly anaerobic Gramnegative oral microorganisms of various sulphur-containing substrates in food debris, saliva, blood, and epithelial cells [4]. Van den Broek et al. [5] concluded that in 90% of cases, the causes of halitosis are located in the mouth and can be related to deep carious lesions, periodontal disease, oral infections, peri-implant disease, peri-coronitis, mucosal ulcerations, impacted food or debris, factors causing decreased salivary flow rate and tongue coating [5]. Also, Nalcaci et al. [6] found that the factors most strongly associated with self-reported halitosis and perceived taste disturbance were subjective oral dryness, tongue coating, inadequate oral hygiene practice, smoking and partial and/ or complete denture wear. Patients with periodontal diseases were found to have deep periodontal pockets that are associated with increased levels of VSCs [7,8]. Not only the periodontal pockets, but also the presence of active periodontal inflammation was suggested to be more important for the production of oral malodour [9]. Recent studies showed that tongue coating was one of the most important factors causing halitosis [10,11]. Bad breath was also found to be correlated to oral hygiene and dental visits [12,13]. The aim of this study is to assess the relation of subjective oral factors and self-reported halitosis among adults living in Riyadh, Saudi Arabia.