|Year : 2016 | Volume
| Issue : 2 | Page : 65-68
Social stigma related to halitosis in Saudi and British population: A comparative study
Mohammad Yunis Saleem Bhat1, Afnan Abdulgaffar Alayyash2
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 Publication||16-Jun-2016|
Mohammad Yunis Saleem Bhat
Department of Periodontics and Community Dental Sciences, King Khalid University, Abha
Kingdom of Saudi Arabia
Source of Support: None, Conflict of Interest: None
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 2020 Apr 6];3:65-8. Available from: http://www.jdrr.org/text.asp?2016/3/2/65/184215
| Introduction|| |
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. 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. 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. The primary molecules, which are responsible for oral malodor, are volatile sulfur compounds such as hydrogen sulfide, methyl mercaptan, and dimethylsulfide.,, 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.
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. 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.,
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. 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.
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|| |
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|| |
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.
| Discussion|| |
Halitosis is a very interesting symptom because the victim is often unaware of its presence and severity. 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. Physiological halitosis like morning bad breath is transient and does not carry any clinical significance., 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.
In majority of the cases, halitosis originates from intra-oral source. The most common intraoral causes of halitosis is coating of the tongue, and the other reasons can be associated periodontal diseases, stomatitis, and xerostomia. In addition to infectious causes, mucosal ulceration, impacted food or debris, and tongue coating are related to halitosis. Dietary habits can influence halitosis. Various studies have stated that drinking, smoking, and diet are allied with halitosis.,,
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%. 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.
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. Study conducted in the USA revealed self-reported prevalence of (50%), 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.
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.,
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|| |
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.
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
Conflicts of interest
There are no conflicts of interest.
| References|| |
Nachnani S. Oral malodor: Causes, assessment, and treatment. Compend Contin Educ Dent 2011;32:22-4, 26-8, 30-1.
Innocent-Ituah I. Halitosis: Hindrance or hint? J Miss State Med Assoc 2009;50:422-5.
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.
van den Velde S, Quirynen M, van Hee P, van Steenberghe D. Halitosis associated volatiles in breath of healthy subjects. J Chromatogr B Analyt Technol Biomed Life Sci 2007;853:54-61.
Tonzetich J. Production and origin of oral malodor: A review of mechanisms and methods of analysis. J Periodontol 1977;48:13-20.
Yaegaki K, Coil JM. Examination, classification, and treatment of halitosis; clinical perspectives. J Can Dent Assoc 2000;66:257-61.
Delanghe G, Bollen C, Desloovere C. Halitosis – Foetor ex ore. Laryngorhinootologie 1999;78:521-4.
Rosenberg M. Bad breath and periodontal disease: How related are they? J Clin Periodontol 2006;33:29-30.
Rosenberg M. Bad Breath: Research Perspectives. Ramat Aviv: Ramot Publishing-Tel Aviv University Press; 1997.
Al-Ansari JM, Boodai H, Al-Sumait N, Al-Khabbaz AK, Al-Shammari KF, Salako N. Factors associated with self-reported halitosis in Kuwaiti patients. J Dent 2006;34:444-9.
Iwakura M, Yasuno Y, Shimura M, Sakamoto S. Clinical characteristics of halitosis: Differences in two patient groups with primary and secondary complaints of halitosis. J Dent Res 1994;73:1568-74.
Eli I, Baht R, Koriat H, Rosenberg M. Self-perception of breath odor. J Am Dent Assoc 2001;132:621-6.
Scully C, Porter S, Greenman J. What to do about halitosis. BMJ 1994;308:217-8.
Suarez FL, Furne JK, Springfield J, Levitt MD. Morning breath odor: Influence of treatments on sulfur gases. J Dent Res 2000;79:1773-7.
Delanghe G, Ghyselen J, van Steenberghe D, Feenstra L. Multidisciplinary breath-odour clinic. Lancet 1997;350:187.
Motta LJ, Bachiega JC, Guedes CC, Laranja LT, Bussadori SK. Association between halitosis and mouth breathing in children. Clinics (Sao Paulo) 2011;66:939-42.
Han J, Bao-Jun T, Du MQ, Wei H, Bin P. Study of dental caries and the influence of social-behavioral risk factors on dental caries of 1,080 15-year-old adolescents. Hua Xi Kou Qiang Yi Xue Za Zhi 2010;28:626-8.
Scully C, Greenman J. Halitology (breath odour: Aetiopathogenesis and management). Oral Dis 2012;18:333-45.
Cortelli JR, Barbosa MD, Westphal MA. Halitosis: A review of associated factors and therapeutic approach. Braz Oral Res 2008;22 Suppl 1:44-54.
de Wit G. Foetor ex ore. Ned Tijdschr Geneeskd 1966;110:1689-92.
Liu XN, Shinada K, Chen XC, Zhang BX, Yaegaki K, Kawaguchi Y. Oral malodor-related parameters in the Chinese general population. J Clin Periodontol 2006;33:31-6.
Al-Shehri FA. Knowledge and attitude of Saudi individuals towards self-perceived halitosis. Saudi J Dent Res 2015;7:91-5.
Levit B. Oral malodor. J Am Dent Assoc 2003;134:209-14.
Hammad MM, Darwazeh AM, Al-Waeli H, Tarakji B, Alhadithy TT. Prevalence and awareness of halitosis in a sample of Jordanian population. J Int Soc Prev Community Dent 2014;4 Suppl 3:S178-86.
Zaitsu T, Ueno M, Shinada K, Wright FA, Kawaguchi Y. Social anxiety disorder in genuine halitosis patients. Health Qual Life Outcomes 2011;9:94.
Kursun S, Acar B, Atakan C, Oztas B, Paksoy CS. Relationship between genuine and pseudohalitosis and social anxiety disorder. J Oral Rehabil 2014;41:822-8.