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 Table of Contents  
Year : 2017  |  Volume : 9  |  Issue : 2  |  Page : 79-83

Knowledge and attitude of indian population toward “self-perceived halitosis”

1 Department of Orthodontics, Baba Jaswant Singh Dental College, Hospital and Research Institute, Ludhiana, Punjab, India
2 Department of Periodontics, Baba Jaswant Singh Dental College, Hospital and Research Institute, Ludhiana, Punjab, India
3 Department of Oral and Maxillofacial Surgery, Baba Jaswant Singh Dental College, Hospital and Research Institute, Ludhiana, Punjab, India
4 Intern, Baba Jaswant Singh Dental College, Hospital and Research Institute, Ludhiana, Punjab, India

Date of Web Publication26-May-2017

Correspondence Address:
Saurabh Goel
Department of Orthodontics, Baba Jaswant Singh Dental College, Hospital and Research Institute, Ludhiana, Punjab
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/IJDS.IJDS_15_17

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Aims: The aim of this study was to assess the level of knowledge and attitude of Indian population toward self-perceived halitosis, about its possible causes, available treatments, its influence on social relations and level of confidence. Materials and Methods: The questionnaire was distributed among 200 people in the outpatient department of Dental Hospital. It had four sections that included sociodemographic data, presence or absence of medical conditions and habits, knowledge about causes and treatment of malodor, oral hygiene practices, whether the subject had halitosis and measures employed to manage the condition, its influence on social relations, and level of confidence. Statistical Analysis Used: Chi-square test. Results: A total of 200 subjects were participated in the study. The prevalence of self-perceived halitosis was 52.5%. There was a significant association between knowledge about causes such as certain foods (P = 0.0004) and tongue coating (P = 0.002) with self-perceived malodor. There were significant associations between self-perceived halitosis and hesitation to talk to other people (P = 0.002) and uneasy feeling when someone was nearby (P = 0.010). Most of the respondents (61.25%) were not willing to visit a dentist or a physician for the condition. Conclusions: The Indian population lacked the knowledge regarding self-perceived halitosis. They had a negative attitude toward it as well.

Keywords: Attitude, Indian population, knowledge, self-perceived halitosis

How to cite this article:
Goel S, Chaudhary G, Kalsi D S, Bansal S, Mahajan D. Knowledge and attitude of indian population toward “self-perceived halitosis”. Indian J Dent Sci 2017;9:79-83

How to cite this URL:
Goel S, Chaudhary G, Kalsi D S, Bansal S, Mahajan D. Knowledge and attitude of indian population toward “self-perceived halitosis”. Indian J Dent Sci [serial online] 2017 [cited 2023 Sep 29];9:79-83. Available from: http://www.ijds.in/text.asp?2017/9/2/79/207099

  Introduction Top

Oral malodor, also known as bad breath or halitosis, is a common complaint among the general population. Its prevalence has been reported to be as high as 50%.[1] However, only a few of the individuals visit dentists to seek advice or treatment for the same.

It can be associated with both physiological and pathological causes such as smoking, certain medications, alcohol, intake of certain foods, periodontal diseases, respiratory tract infections, and gastrointestinal disorders.[2] It is an incredibly embarrassing medicosocial problem that affects a significant number of people irrespective of race. Halitosis results from the release of volatile sulfur compounds by anaerobic Gram-negative bacteria, for example, Prevotella, Porphyromonas gingivalis, and Treponema denticola that interact with sulfur containing substances in saliva, gingival crevicular fluid, blood and cells leading to production of odoriferous products.[3]

However, no obvious association exists between oral malodor and any specific bacterial infection that clearly suggests that halitosis reflects complex interactions between several oral bacterial species.[4] It is commonly diagnosed during routine dental visits for treatment of dental caries and periodontal disease.[5]

A study by McNamara et al. revealed that the major cause of bad breath is oral microflora.[6] Subsequent studies noted that malodor can be controlled by cleaning teeth and tongue.[2],[7] Results from a questionnaire study that involved 4817 French individuals reported 22% participants complaining of bad breath.[8] Similarly, clinical examinations of 2762 Japanese individuals indicated that 23% individuals had self-perceived malodor.[9]

The American dental association estimates that 50% of adult population have an occasional complaint of malodor and 25% have severe chronic problem.[10] McKeown observed that 15% patients reported decreased self-confidence and insecurity in social relations that led them to seek therapy.[11] A similar study was conducted in Saudi Arabia and it was observed that 68.5% of the subjects had self-perception of halitosis.[12]

  Materials and Methods Top

This study was conducted in outpatient department (OPD) of a dental hospital. A questionnaire was prepared to assess the person's awareness and knowledge about possible causes and available treatments of malodor. This specially designed questionnaire was then distributed among 200 patients randomly.

The questionnaire was composed of 4 parts. The first part inquired about sociodemographic data, including age, gender, marital status, and occupation. The second part included questions about the presence of medical conditions and habits. Furthermore, the participant's knowledge on halitosis was assessed through questions about their opinion on causes and treatment of malodor. Patients were also supposed to reveal the oral hygiene practices followed by them. In third part, the respondents were asked if they perceived to have halitosis, when did they first notice the condition and what measures at individual level did they employ to manage it. The subjects were also enquired for any associated complaint with bad breath and their willingness to visit a dentist or a physician for the same. The fourth part focused on influence of halitosis on social relations and the level of confidence.

The data were compiled, tabulated, and statistically analyzed using Chi-square test for association between different variables. A critical P= 0.05 was regarded as statistically significant [Questionnaire [Additional file 1]].

  Results Top

[Table 1] summarizes the sociodemographic characteristics of the participants. Of the total 200 respondents, 119 (59.5%) were males and 81 (40.5%) were females. The mean age of patients included in the study was 35 years (range 15–75 years).
Table 1: Sociodemographic characteristics of the participants

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[Table 2] reveals the association of medical history of the patients to self-perceived halitosis.
Table 2: Medical history and its association with self-perceived halitosis

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The knowledge of the study subjects regarding the causes of self-perceived malodor are grouped in [Table 3]. Majority of the population only knew tongue coating (35.5%, P= 0.002) and foods (40.5%, P = 0.0004) as possible causes of bad breath.
Table 3: Knowledge of participants regarding causes of halitosis

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[Table 4] shows that about 52.5% of the respondents had self-perception of halitosis. Out of 52.5% individuals, 76.2% had never visited a dentist or a physician for the same and if given a chance, 61.25% were not even willing to see one. This depicts the negative attitude of the Indian population toward halitosis.
Table 4: Attitude of individuals toward self-perceived halitosis

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The influence of halitosis on social relations and level of one's confidence is summarized in [Table 5]. There was a significant association between self-perceived malodor and an individual's hesitation to talk to others (P = 0.002) and also the feeling of uneasiness when someone was nearby (P = 0.01).
Table 5: Association between self-perceived halitosis and social relations

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  Discussion Top

Oral malodor is a recognizable condition that warrants professional attention by dental care providers.[13] For proper diagnosis and treatment, contributing factors must be identified.

This study was undertaken to assess the knowledge and attitude of Indian individuals toward self-perceived halitosis and to identify possible factors associated with this condition.

Oral malodor was assessed through a questionnaire that was distributed in OPD of a dental hospital. No clinical examination was performed in this study. Therefore, the reliability cannot be ascertained. Self-estimation of oral malodor has been demonstrated to be largely unreliable and that objective assessments do not correlate well with a patient's perception of his/her bad breath.[14] However, this unreliability was reported in patients who already believed they had oral malodor.[15] In the general population, self-assessment of halitosis has been found to be more reliable and positively correlated with objective assessments.[16]

In the present study, 52.5% of the total study population reported the self-perception of oral breath. A similar study by Ali Alshehri in Saudi Arabia reported comparatively higher figures (68.5%) of people with self-perceived halitosis.[12]

In our study, the subjects with halitosis had no significant association (P > 0.05) with the medical problems such as gastrointestinal disorders and diabetes as found by Youngnak-Piboonratanakit and Vachirarojpisan.[17] In contrast, significantly higher number of subjects (P < 0.0001) with halitosis had associated medical problems in a study by Arora and Sharma.[18] Furthermore, our results depict that there was no statistically significant association between self-perceived halitosis and habits such as smoking (P = 0.76), tobacco chewing (P = 0.96), and alcohol consumption (P = 0.39).

Our study showed that 40.5% (P = 0.0004) participants out of a total of 200 study subjects agreed that smelly foods are an important cause of halitosis. Furthermore, 35.5% (P = 0.002) of the respondents had an idea about tongue coating as one of the causative factors for bad breath. A very few people, i.e., 20%, 19%, and 15.5% (P > 0.05) knew about other essential reasons of malodor such as decayed teeth, gastrointestinal disturbances, and gum diseases, respectively. A comparatively lesser information related to dry mouth (5.5%), medicines (3.5%), tonsillitis and sinusitis (1.5%), and lung problems (0.5%) as causes was known.

When subjects were asked about different oral symptoms related to halitosis, there was a strong association between having “bad taste” (33.3%) in mouth and having “white or yellowish tongue coating” (7.6%) with self-perceived halitosis.

According to the results obtained in the study, it was seen that people are only aware about tooth brushing and tongue scrapping as the remedial measures for halitosis. There was a lack of knowledge among the respondents about the availability of other oral hygiene methods such as mouthwash or flossing.

The results reveal that only 23.8% study subjects had visited a dentist or a physician for their bad breath. This depicts a low level of awareness regarding oral malodor among the Indian population. From the analysis, it seems that the study subjects reporting halitosis were more phobic and less willing to see a dentist (61.25%). This clearly shows a negative attitude of Indian individuals toward halitosis.

Like any other study, this survey has limitations as well. The self-perception and self-reported data need to be analyzed carefully due to the concerns about the reliability of the information. Estimation of oral malodor using standard techniques (portable volatile sulfide monitor such as Halimeter, gas chromatography, dark-field or phase-contrast microscopy, saliva incubation test) is recommended in further studies. The electronic devices such as Halimeter analyze the concentration of hydrogen sulfide and methyl mercaptan, but without discriminating them. Gas chromatography can analyze air, (incubated) saliva, or crevicular fluid for any volatile component.[19]

  Conclusions Top

The results of our study indicate that not only does the Indian population lack the knowledge regarding halitosis but also they have a negative attitude toward it as most of the individuals are not willing to visit a dentist for the problem. Halitosis can also significantly affect self-confidence and social interaction with others. There is awareness among Indian population that tongue coating and smelly food are the main causes of oral malodor. However, there is lack of knowledge about other important causes of malodor such as gum diseases, dry mouth, gastric ailments, medicines, and sinusitis. Oral hygiene measures can significantly reduce malodor. The need of the hour is to organize dental camps, lectures, demonstrations, and field trips to various places in India so as to enhance the individual's knowledge regarding halitosis. Oral health education must also be provided at several other places including private medical and dental clinics, various departments of dental colleges. Awareness must also be spread through mass media using pamphlets, newspapers, and radio and television programs.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Sulser GF, Brening RH, Fosdick LS. Some conditions that affect the odor concentration of the breath. J Dent Res 1939;18:355-9.  Back to cited text no. 1
Tonzetich J. Production and origin of oral malodor: A review of mechanisms and methods of analysis. J Periodontol 1977;48:13-20.  Back to cited text no. 2
Awano S, Gohara K, Kurihara E, Ansai T, Takehara T. The relationship between the presence of periodontopathogenic bacteria in saliva and halitosis. Int Dent J 2002;52 Suppl 3:212-6.  Back to cited text no. 3
Porter SR, Scully C. Oral malodour (halitosis). BMJ 2006;333:632-5.  Back to cited text no. 4
Loesche WJ, Kazor C. Microbiology and treatment of halitosis. Periodontol 2000 2002;28:256-79.  Back to cited text no. 5
McNamara TF, Alexander JF, Lee M. The role of microorganisms in the production of oral malodor. Oral Surg Oral Med Oral Pathol 1972;34:41-8.  Back to cited text no. 6
Tonzetich J, Ng SK. Reduction of malodor by oral cleansing procedures. Oral Surg Oral Med Oral Pathol 1976;42:172-81.  Back to cited text no. 7
Frexinos J, Denis P, Allemand H, Allouche S, Los F, Bonnelye G. Descriptive study of digestive functional symptoms in the French general population. Gastroenterol Clin Biol 1998;22:785-91.  Back to cited text no. 8
Miyazaki H, Sakao S, Katoh Y, Takehara T. Correlation between volatile sulphur compounds and certain oral health measurements in the general population. J Periodontol 1995;66:679-84.  Back to cited text no. 9
ADA Council on Scientific Affairs. Oral malodor. J Am Dent Assoc 2003;134:209-14.  Back to cited text no. 10
McKeown L. Social relations and breath odour. Int J Dent Hyg 2003;1:213-7.  Back to cited text no. 11
Ali Alshehri F. Knowledge and attitude of Saudi individuals toward self-perceived halitosis. Saudi J Dent Res 2016;7:91-5.  Back to cited text no. 12
Tessier JF, Kulkarni GV. Bad breath: Etiology, diagnosis and treatment. Oral Health 1991;81:19-22, 24.  Back to cited text no. 13
Rosenberg M, Kozlovsky A, Gelernter I, Cherniak O, Gabbay J, Baht R, et al. Self-estimation of oral malodor. J Dent Res 1995;74:1577-82.  Back to cited text no. 14
Eli I, Baht R, Koriat H, Rosenberg M. Self-perception of breath odor. J Am Dent Assoc 2001;132:621-6.  Back to cited text no. 15
Rosenberg M, Kozlovsky A, Wind Y, Mindel E. Self-assessment of oral malodor 1 year following initial consultation. Quintessence Int 1999;30:324-7.  Back to cited text no. 16
Youngnak-Piboonratanakit P, Vachirarojpisan T. Prevalence of self-perceived oral malodor in a group of Thai dental patients. J Dent (Tehran) 2010;7:196-204.  Back to cited text no. 17
Arora L, Sharma A. A study to find out the dental and associated psychosocial factors in patients of halitosis. Delhi Psychiatry J 2012;15:122-9.  Back to cited text no. 18
Goldberg S, Kozlovsky A, Gordon D, Gelernter I, Sintov A, Rosenberg M. Cadaverine as a putative component of oral malodor. J Dent Res 1994;73:1168-72.  Back to cited text no. 19


  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]

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