Indian J Stomatol 2018;9(1):16-19

Perception Halitosis of Students in Al Jouf University

Khaled Mohamed Elrahawy1, Ahmed Ata Alfurhud1, Mazen Awad Alhassan2

Abstract
Aim: Oral malodour is one of the most common complaints with which patients approach the dentists, thinking it can be
detrimental to their self-image and confidence. The aim of the present study was to evaluate the self-perception of oral malodour
and oral hygiene habits amongst students.
Material and methods: A structured questionnaire consisting of 10 questions was administered to 180 undergraduate students
of the Medical and Dental College. The questionnaire was designed to evaluate the self-perception of halitosis, identify the oral
hygiene aids used, and assess the presence of dental caries, gingival bleeding, and dryness of mouth.
Results: Of the 180 students, 150 students completed the questionnaire. The response rate was 89%, with the male response rate
being 83.6% and 90.2% for the female. Self-perceived halitosis was reported by 42.3% of males and 43.3% of females. The
difference in the reporting of the self-perception of halitosis between females and males was found to be statistically significant
(p<0.05). A significant difference was found for use of mouth wash, presence of carious teeth, bleeding gums, and use of tongue
cleaners between females and males (p<0.05).
Conclusion: The results of this study indicate a higher prevalence of halitosis among this population consisting of medical and
dental students. The awareness of halitosis was also higher among this population. Thus, the awareness of halitosis as an
individual entity should be promoted to the general population, and therapeutic measures should be made available to all.

Keywords: Dental students; halitosis; oral hygiene; oral malodour.

Introduction the malodour, such as mouth rinses, chewing gums, etc.,

The word ‘halitosis’ is derived from the Latin word ‘halitus’
which means ‘exhalation’. Thus, unpleasant odour emitted
from a person's oral cavity is referred to as halitosis. The
other common terminology used to denote halitosis is ‘oral
malodour’. Halitosis is an oral health condition
characterized by consistently emanating odorous breath
and may be caused by several agents, including poor oral
hygiene, improper cleaning of dentures, reduced salivary
flow rate, use of tobacco in any form, or certain systemic
conditions.1 Its aetiology could be attributed to both
intraoral and extraoral factors. However, in about 84% of
the cases, the cause is intra oral, with the reason being deep
carious lesions, periodontal disease, mucosal ulcers, food
debris, reduced salivary flow rates, or tongue coating.2
Among the listed intraoral causes for halitosis, tongue
coating is the most common reason in otherwise healthy
individuals, with the odour arising from the dorsal aspect of
the tongue.3 The main compounds that lead to bad breath
emanating from the oral cavity are the volatile sulphide
compounds (VSC’s), especially hydrogen sulphide (H2S),
methyl mercaptan (CH3SH), and dimethylsulphide
[(CH3)2S].4 These compounds are produced by the
anaerobic gram-negative micro-organisms such as
Treponema denticola, Porphyromonas gingivalis,
Porphyromonas endodontalis, Bacteroides loescheii,
Enterobacteriaceae, and Fusobacterium nucleatum, which
inhabit the oral cavity.5 The micro-organisms interact with
the sulphur-containing substances that are present in saliva,
gingival crevicular fluid, blood, and cells leading to the
production of odiferous products.6
Halitosis, a common condition, can result in a serious social
stigma. There are several agents that can temporarily mask
1
Department of Oral and Dental Pathology, 2Department of Preventive Dentistry, 3College of Dentistry, Al-Jouf University, Sakaka, Saudi
Arabia. Correspondence: Dr. Ahmed Ata Alfurhud, email: aalfurhud1@gmail.com
which in turn, prevent the individual from reporting to the
dentist for conclusive treatment. Very rarely, this can have
serious medical implications because there are numerous
medical conditions that predispose individuals to oral
malodour.7-9 There is a need to enhance the knowledge of
self-perception of oral and general health among dental
students.10
The objectives of the present study were to evaluate the
self-perception of oral malodour by male and female
medical and dental students studying in the Medical and
Dental College of Al Jouf University, Saudi Arabia. The
prevalence of oral hygiene habits and awareness of
common dental problems, such as dental caries, gingival
bleeding, and dryness of mouth, were also evaluated.
Material and methods
The study involved 150 medical and dental undergraduate
students of the Medical and Dental College, Al Jouf
University. All the participants signed a written informed
consent form prior to the initiation of this study. A
structured questionnaire was developed and tested on a
pilot population prior to its administration in this study.
The responses were evaluated, and modifications were
made as required. The final questionnaire included ten
questions (Figure 1), which evaluated the presence and
self-perception of halitosis and the treatment (self or
professional) for halitosis. The oral hygiene habits of the
subjects, including frequency of teeth brushing and use of
interdental aids and mouth rinses, were evaluated. The
questionnaire was anonymous with no column for
identification of the individual. The questions were
explained to the participants, and clarifications were made.

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 Indian J Stomatol 2018;9(1):16-19

Figure 1: Questionnaire used in the study

Yes No Don’t know Yes No Don’t Know

Male Female

Graph 1: Frequency of self-perception of oral malodour

-
Statistical analysis
Statistical Package for Social Science version 15 was
utilized for statistical analysis (SPSS, Inc., Chicago Illinois
USA). The Chi square test was performed for comparison
of the responses obtained from males and females. The
level of statistical significance was set at a p-value of
<0.05.
Results
The study population included 180 participants in the age
range of 18-24 years. A total of 150 participants answered
all the questions provided, and these were included for
statistical analysis. Questionnaires that were incomplete
were excluded from the final analysis. The overall
response rate was 83.3%. There were 80 (44.4%) males
and 70 (38.8%) females.
Among males 25 (24.1%) reported perceiving halitosis, 65
(55.2%) gave a negative answer, and 16 (11.1%) were not
aware of its presence or absence. Whereas among the
female participants, 45 (33.4%) reported self-perception,
50 (35.4%) gave a negative response, and 37 (31.8%) were
not aware of its presence or absence (Graph 1). The

17

Table 1: Responses for the questions based on gender
difference was found to be significant (p<0.05).
The answers to all the questions provided in the
questionnaire were categorized according to gender and
analysed using the Chi-square test (Table 1). A significant
difference was observed for self-perception of halitosis,
use of mouth wash, presence of carious teeth, bleeding
gums, and use of tongue cleaners (p<0.05).
Discussion
Since halitosis is a relatively common problem, with many
ramifications and with personal, professional, and social
effects, the data on its prevalence can be of importance.
The literature reveals that the prevalence of halitosis is
around 50% in the USA, 27.5% in China, and 22% in
France.11-13 This highlights the significance of halitosis as a
widespread global problem. It has been estimated that in
the developed world, 8%-50% of the people perceive oral
malodour.14 As dental professionals are most likely to
diagnose halitosis, the percentage of individuals getting
professional treatment for halitosis remains minimal.
The presence of halitosis is often discerned by individuals.
The aetiology could be either intraoral or extraoral causes.
The diagnosis is usually subjective, as there are no standard
criteria that define a patient with halitosis.1 The results of
the present study showed greater self-perception of
halitosis among females (p>0.05). This was similar to
results obtained in previous studies.10,15,16 Self-perception of
halitosis is a psycho-physiological issue with multi-
factorial aetiology closely related to each individual's
psychopathological profile.17
In younger persons, the presence of oral malodour in the
absence of periodontal disease has been attributed to
tongue coating.18 If oral hygiene is already good, or if it
improves and yet the oral malodour persists, the tongue
may be the likely source of the odour. The use of tongue
cleaners was very minimal, which could be a reason for the
self-perception of halitosis in the present study population.
There is a positive correlation between the oral malodour
and the levels of VSCs on the dorsum surface of the tongue
and the propensity of micro-organisms colonized on the
surface of the tongue itself.19,20 A recent systematic review
concluded that tongue scraping may have a limited benefit
Indian J Stomatol 2018;9(1):16-19
in reducing oral malodour in the long term.21
The oral hygiene habits were excellent among the study
population, with most of the subject population reporting
brushing twice daily. This was, however, anticipated, as the
subject population comprised students. Effective tooth
brushing and flossing can significantly reduce oral
malodour, especially in people with poor oral hygiene and
related gingival and periodontal disease.22,24 The usage of
mouth rinses was two-fold higher among females
compared with males. This could imply a more conscious
attitude among females than among males.
The prevalence of dental caries among the subject
population was higher than that of gingival bleeding or
dryness of mouth. Dental caries was reported to be higher
in males than in females as was gingival bleeding. A similar
study suggested that females have significantly higher
positive practise towards dental health as compared to
males.23 The intra-oral factors that are implicated in
contributing to halitosis are tongue coating, gingival
bleeding, and dental calculus.13,24 The extra-oral factors that
are associated with halitosis include gastrointestinal tract
disorders, chronic sinusitis, upper respiratory tract
infections, and lower socioeconomic status.1
Conclusion
The results indicate that the prevalence of self-perceived
malodour among medical and dental students is in the
similar range as reported by other similar studies.
However, these findings need to be corroborated by
objective examination to ascertain the prevalence. The role
of dental professionals in maintaining a good oral health
should be emphasized in the community.
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