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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 3  |  Issue : 2  |  Page : 65-68

Social stigma related to halitosis in Saudi and British population: A comparative study


1 Department of Periodontics and Community Dental Sciences, King Khalid University, Abha, Kingdom of Saudi Arabia
2 Department of College of Dentistry, King Khalid University, Abha, Kingdom of Saudi Arabia

Date of Web Publication16-Jun-2016

Correspondence Address:
Mohammad Yunis Saleem Bhat
Department of Periodontics and Community Dental Sciences, King Khalid University, Abha
Kingdom of Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2348-2915.184215

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  Abstract 

Introduction: Oral malodor or halitosis is a common problem in the general population throughout the world. Results of previous research findings suggest that there is a relationship between oral malodor and social anxiety disorder. Halitosis can be very damaging to someone psychologically due to the social stigma. In this study, we tried to assess the social stigma related to halitosis and compare that in Saudi and British population. Methodology: A pretested questionnaire was distributed among Saudi and British population. Responses were obtained from 308 (Kingdom of Saudi Arabia) and 304 (United Kingdom) participants. The purpose of this study was explained to the participants before distributing questionnaire form and the information was collected accordingly. Results: A total of 612 participants, 308 (Jeddah and Abha) and 304 (Cardiff, Edinburgh, and Glasgow) were selected and all the participants were aware of their halitosis. Selected Saudi population assessed their halitosis as mild (50.6%), moderate (30.12%) and severe (19.28%). Selected British population assessed their halitosis as mild (39.71%), moderate (36.76%), and severe (23.53%). 71.2% of the Saudi population selected and 56.6% of the United Kingdom population selected responded that they encountered individuals with halitosis. 76.9% of Saudi population selected and 55.8% of United Kingdom population selected encountered social embarrassment due to halitosis. Conclusion: Considerable amount of stigma associated with halitosis persists in both countries. Though there are no significant differences in the social stigma attached with halitosis between the United Kingdom and Kingdom of Saudi Arabia, it is still a matter of concern.

Keywords: Halitosis, population, stigma


How to cite this article:
Bhat MY, Alayyash AA. Social stigma related to halitosis in Saudi and British population: A comparative study. J Dent Res Rev 2016;3:65-8

How to cite this URL:
Bhat MY, Alayyash AA. Social stigma related to halitosis in Saudi and British population: A comparative study. J Dent Res Rev [serial online] 2016 [cited 2019 May 20];3:65-8. Available from: http://www.jdrr.org/text.asp?2016/3/2/65/184215


  Introduction Top


Oral malodor or halitosis is a common problem in the general population throughout the world, nearly more than 50% of the general population have halitosis.[1] Halitosis, oral malodor, or bad breath are the general terms used to describe unpleasant breath emitted from a person's mouth regardless of whether it originate from oral or nonoral sources.[2] Having Halitosis can be very damaging to someone psychologically due to the social stigma that it has in many cultures. It is not uncommon for people who have halitosis to have poor self-esteem. Although oral malodor is an unpleasant condition experienced by most of the people, it typically results in transitory embarrassment.

Halitosis arises by the action of Gram-negative anaerobic bacteria on sulfur containing substance in the saliva, such as debris and plaque.[3] The primary molecules, which are responsible for oral malodor, are volatile sulfur compounds such as hydrogen sulfide, methyl mercaptan, and dimethylsulfide.[3],[4],[5] Various etiological factors are associated with halitosis that may be intraoral or extraoral.

When dealing with halitosis, it is important to distinguish between genuine halitosis and pseudo-halitosis. Genuine halitosis is where the breath malodor is a real problem. Pseudo-halitosis is defined as when the patient believes that he or she has oral malodor but in reality it does not exist. If after effective treatment for either genuine halitosis or pseudo-halitosis the patient still considers that he or she has halitosis, it is termed as halitophobia.[6]

In approximately, 87% of the cases had halitosis of oral origin, 7% had malodor originating in the ears, nose, and throat region, 1% digestive tract and in 5% of the patients, the cause could not be determined.[7] The tongue is considered to be major site of oral malodor, while periodontal disease and other factors such as deep carious lesions, periodontal disease, oral infections, peri-implant disease, pericoronitis, mucosal ulcerations, impacted food or debris, seem to be only a fraction of the overall problem.[7],[8]

According to the studies, the prevalence of oral malodor in the general population ranges from 22% to >50%. In addition, approximately 50% of adults and elderly individuals emit socially unacceptable breath, related to physiological causes, upon arising in the morning.[9] A multicenter study in Kuwait assessed the prevalence of self-reported halitosis was 23.3%. Use of the toothbrush less than once daily was the factor most strongly associated with self-perceived halitosis.[10]

Research comparing lifestyles of Kingdom of Saudi Arabia population with population in the United Kingdom are lacking. The objective of the present study was to evaluate the social stigma related to halitosis and compare that in Saudi and British population. The two countries are diverse in terms of cultural, social, and environmental characteristics. This study will add to the limited research related to lifestyle behaviors across different ethnic, cultural, and environmental backgrounds.


  Methodology Top


The present study is a cross-sectional survey to evaluate the social stigma related to halitosis and descriptively define the same between Saudi and British population. A draft questionnaire was constructed with 10 items both in English and Arabic language and was checked for face validity by a language expert. The items in the questionnaire were related to self-awareness of personal halitosis status and extent of social embarrassment encountered. The responses to the 9 items were typical multiple choice options and one response regarding the level of social embarrassment due to bad breath was obtained by visual analog scale with scores ranging from 1 to highest level of embarrassment being 10. The approval for this survey was taken from the Institutional Review Board, College of Dentistry, King Khalid University, Abha, Kingdom of Saudi Arabia.

The sampling technique employed was grab sampling method. Two places in Saudi Arabia and three places in the United Kingdom were randomly selected. The study subjects were general population at public places such as shopping malls and universities. The survey was conducted for 1 month in each country mentioned. All subjects with Saudi Arabia and British nationalities who agreed to participate were involved in the study. The collected data were further analyzed statistically to extract meaningful results using MS Office Excel 2013 (Microsoft Inc., USA).


  Results Top


A total of 612 participants enrolled in the study. Out of the total, 308 were from Kingdom of Saudi Arabia (Jeddah and Abha) and 304 were from United Kingdom (Cardiff, Edinburgh and Glasgow). The responses of the participants are summarized in [Table 1] as per the responses received in the questionnaire. 51.9% of the Kingdom of Saudi Arabia population selected and 54.9% of the United Kingdom population selected were aware of their halitosis. Kingdom of Saudi Arabia population selected assessed their halitosis as mild (50.6%), moderate (30.12%), and severe (19.28%). British population selected assessed their halitosis as mild (39.71%), moderate (36.76%), and severe (23.53%). 71.2% of the Kingdom of Saudi Arabia population selected and 56.6% of the United Kingdom population selected responded that they encountered individuals with halitosis, and their responses are depicted in the graph. 76.9% of the Kingdom of Saudi Arabia population selected and 55.8% of the United Kingdom population selected encountered social embarrassment due to halitosis, and the severity of that is depicted in the graph.
Table 1: Responses of Saudi and British population to halitosis

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  Discussion Top


Halitosis is a very interesting symptom because the victim is often unaware of its presence and severity.[11] Foul breath is, therefore, a condition to which one's attention may have to be drawn by someone else. Self-perception of halitosis is closely related to one's body image and psychopathological profile of the individual.[12] Physiological halitosis like morning bad breath is transient and does not carry any clinical significance.[13],[14] Researchers have found that the individuals with positive feelings about their body generally score their breath odor as being less malodorous than trained organoleptic judges.[12]

In majority of the cases, halitosis originates from intra-oral source.[15] The most common intraoral causes of halitosis is coating of the tongue, and the other reasons can be associated periodontal diseases, stomatitis, and xerostomia.[16] In addition to infectious causes, mucosal ulceration, impacted food or debris, and tongue coating are related to halitosis.[17] Dietary habits can influence halitosis. Various studies have stated that drinking, smoking, and diet are allied with halitosis.[17],[18],[19]

The purpose of this study was to determine the prevalence of self-perceived oral malodor, social stigma linked to halitosis and comparison of same in Saudi and British population. In the present study oral malodor was assessed through questionnaire with no clinical examination to grade the halitosis. Therefore, the reliability of the self-perceived prevalence of halitosis cannot be ascertained.

A large multicentric study was conducted in the Netherlands among 11,625 individuals revealed a prevalence of approximately 25% in subjects older than 60 years. In subjects under 20 years showed the prevalence of oral halitosis of about 10%.[20] In Japan, the prevalence of halitosis in population is approximately 14%. In a recent study, in China, the incidence of oral halitosis was surveyed in a sample of 2000 individuals. They found that approximately 27.5% of the population was suffering from halitosis.[21]

In this study, 51.9% of the Kingdom of Saudi Arabia population and 54.9% of the United Kingdom population were aware of their halitosis. In another similar type of study the prevalence of self-reported oral malodor in Kingdom of Saudi Arabia population was 68.5%, which is slightly higher than the present result.[22] Study conducted in the USA revealed self-reported prevalence of (50%),[23] which is almost similar to the results of the present study. In contrast to that, study conducted in a sample of Jordanian population revealed only 20% of individuals who are aware of their halitosis.[24]

In this study, the severity of self-assessed halitosis is graded into mild, moderate, and severe based on the 0–10 scale in the questionnaire form. According to the obtained results, 50.6% of Kingdom of Saudi Arabia population assessed their halitosis as mild, 30.12% as moderate and 19.28% severe. In British population, 39.71% assessed their halitosis as mild, 36.76% as moderate and 23.53% as severe.

Social anxiety disorder and social stigma are problems closely associated with the patients of halitosis. In this study, 76.9% of the Kingdom of Saudi Arabia population and 55.8% of the United Kingdom population encountered social embarrassment due to the presence of halitosis. Various studies have evaluated statistically significant relationship between anxiety and halitosis. These patients have difficulty in overcoming their anxiety about oral malodor. Oral malodor treatment of halitosis patients requires not only regular oral malodor treatment but also attention to social anxiety disorder.[25],[26]

This survey has several limitations. It only relies on self-evaluation by the patient, and no clinical examination was performed to detect the halitosis. Furthermore, the study has a relatively small sample size from a selected area of the country. Future multicenter study with large sample size is required to overcome these limitations.


  Conclusion Top


Considerable amount of stigma associated with halitosis persists in both the countries. There are no significant differences in the social stigma related with halitosis between the United Kingdom and Kingdom of Saudi Arabia; it is still a matter of concern. More frequent Oral health educational programs especially pertaining to oral hygiene should be delivered to the general population of the United Kingdom and Kingdom of Saudi Arabia. Treatment of halitosis patients requires not only regular oral malodor treatment but also attention.

Acknowledgment

The authors are grateful to Dr. Shreyas Tikare, Dr. Mohasin Abdul Kader, Dr. Shahabe Saquib for their kind support during the research period.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

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