Oral Hygiene Practices and Self-Perceived Halitosis Among Dental Students
Oral Hygiene Practices and Self-Perceived Halitosis Among Dental Students
ABSTRACT
Background: Halitosis represents a common dental condition, although sufferers are often not conscious of it. It is
common among humans around the world and is usually caused by an accumulation of bacteria in the mouth as a
result of gum disease, food, or plaque. This study aimed to determine the prevalence of oral hygiene practices,
smoking habits and halitosis among undergraduate dental students and correlate the oral hygiene practices, oral
health conditions to the prevalence of self perceived oral malodor.
Materials and Methods: Clinical examination of 250 dental students and a self-administered questionnaire were
included in this study. A questionnaire was developed to assess the self-reported perception of oral breath,
awareness of bad breath, timing of bad breath, oral hygiene practices, caries and bleeding gums, dryness of the
mouth, smoking and tongue coating.
Results: The results indicated that female students had better oral hygiene practices. Significantly less self-reported
oral bad breath (P = 0.000) was found in female dental students (40%) as compared to male (70%). It was found that
smoking had statistically highly significant correlation with halitosis (P = 0.000). Presence of other oral conditions such
as dental caries and filled carious lesions also showed higher prevalence of halitosis in dental students.
Conclusion Oral hygiene practices and oral health conditions are very important factors in halitosis. Females
exhibited better oral hygiene practices and less prevalence of halitosis as compared to male students.
Key words: Halitosis, oral hygiene, oral malodor, smoking. (J Bagh Coll Dentistry 2014; 26(3):58-62)
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J Bagh College Dentistry Vol. 26(3), September 2014 Oral hygiene practices
between 2011 and 2013). The final sample Do you brush three times daily?
consisted of 250 (150 females and 100 males) Do you brush more than three times daily?
dental students. Those students were examined Do you change your toothbrush every 3 months?
clinically by the author for the presence of dental Do you change your toothbrush every 6 months?
caries, bleeding on probing, dryness of the mouth Do you change your toothbrush after 6 months?
and tongue coating. Are you using a dental floss?
A self-administered questionnaire was Are you using a mouth wash?
developed to assess the prevalence of oral hygiene Are you smoker?
habits including brushing, flossing, use of At what time of day is your breath worst:-
mouthwash, self-perception of oral health, - After waking up?
awareness of bad breath (by asking student: are - When hungry?
you have bad breathing and how do you know you - When thirsty?
have bad breathing, someone told you or you just - While talking with other people?
know), timing of bad breath, asking the student if - All day?
he/she noticed bleeding when you brush your
teeth or in saliva when you spit), dryness of Statistical Analysis
mouth (by visual examination to notice if there The data was entered into Statistical Package
was a dry tongue and cracked lips or by asking for Social Sciences (SPSS) version 19.0 and was
student if there was a sticky or dry feeling in the utilized for data analysis. Chi-square test was used
mouth or trouble chewing or tasting), smoking detect the genders difference regarding the
habits, and coating over tongue (by visual halitosis and to investigate the relation between
examination to notice a coating area or the halitosis and other parameters. The
discoloration on tongue's dorsum). significance level (p value) was set at 0.05.
The questionnaire was made by reviewing the
literature, and making modifications according to RESULTS
local culture oral hygiene practices and habits (16).
Two hundred and fifty students filled the
questionnaire and responded. The results
Questionnaire
indicated the presence of high significant genders
Do you brush your teeth every day?
difference with males had higher percentage than
Do you brush once daily?
females (Table 1).
Do you brush twice daily?
Table 1: The prevalence of self-perceived halitosis and gender difference among dental students
Males Females Total Genders
Halitosis (N=100) (N=150) (N=250) Difference
No. % No. % No. % X2 p-value
Present 70 70 60 40 130 52
21.635 0.000
Absent 30 30 90 60 120 84
The majority of students (70% of males and demonstrated equal percentages of halitosis
80% of females) experienced bad breath after (4.3%) when they were thirsty and all day and this
wake up, while the equal percentage in males percentage increased up to 10 % while talking
(5%) of bad breath occurred when they hungry with other people. Generally, there was non-
and while talking with other people and increased significant gender difference (Table 2).
to 10 % when thirsty and in all day. Females
Table 2: The timing of self perceived bad breath during the day
Males Females Total
Timing of self-perceived bad Genders difference
(N=100) (N=150) (N=250)
breath during the day
No. % No. % No. % X2 p-value
After wake up 42 70 56 80 98 75.4
When hungry 3 5 1 1.4 4 3.1
When thirsty 6 10 3 4.3 9 6.9 5.865 0.209
While talking with other people 3 5 7 10 10 7.7
All day 6 10 3 4.3 9 6.9
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J Bagh College Dentistry Vol. 26(3), September 2014 Oral hygiene practices
Regarding the relation between the halitosis that there was highly significant relation between
and the frequency of brushing, the results revealed the increase of the frequency of brushing and
absence of halitosis (Table 3).
Table 3: The halitosis presence to brushing
Halitosis Relation
Brushing Present Absent
X2 p-value
No. % No. %
Daily brushing habit (250 students) 130 52 120 48
Brushing once daily (64 students) 50 78.1 14 21.9
Brushing twice daily (140 students) 70 50 70 50 35.91 0.000
Brushing three times daily (40 students) 10 25 30 75
Brushing more than three times daily (6 students) 0 0 6 100
Relating the frequency of changing the tooth student used dental floss and mouth wash and
brush with halitosis revealed high significant reported no halitosis and this confirmed by the
relation being higher percentage of absence of significant relation between the use of dental floss
halitosis if the student changed his/her tooth brush and mouth wash with the absence of halitosis
within 3 months (Table 4). On the other hand, 100 (Table 5).
Table 4: The relation between halitosis and the frequency of changing tooth brush
Halitosis Relation
Frequency of changing the brush Present Absent 2
X p-value
No. % No. %
Changing brush within 3 months (100 students) 40 40 60 60
Changing brush within 6 months (90 students) 50 55.6 40 44.4 11.396 0.003
Changing brush after 6 months (60 students) 40 66.7 20 33.3
Table 5: The relation between halitosis and the use of dental floss and mouth wash
Halitosis Relation
Use of dental floss and mouth wash Present Absent
X2 p-value
No. % No. %
Use of dental floss (40 students) 20 50 20 50
Use of mouth wash (50 students) 25 50 25 50 9.091 0.011
Use of dental floss and mouth wash (10 students) 0 0 10 100
Table 6 demonstrated the relation between students reported halitosis. Dry mouth ranked
halitosis with other predisposing factors and the secondly then the carious lesion, coating over
results revealed highly significant relation. tongue, etc.
Generally, 45 students (90%) out of 50 smoker
Table 6: The relation between halitosis and smoking, dry mouth, caries, bleeding gums and
coated tongue
Halitosis Relation
Oral hygiene practices Present Absent
X2 p-value
No. % No. %
Smoking habit (50 students) 45 90 5 10
Presence of dryness of mouth (25 students) 20 80 5 20
Presence of filled carious lesions (70 students) 40 57.1 30 42.9
22.607 0.000
Presence of dental caries (75 students) 50 66.7 25 33.3
Presence of bleeding gums (40 students) 20 50 20 50
Presence of coating over the tongue (25 students) 15 60 10 40
Self-reported prevalence of dryness of mouth, dental students. Statistically, there was highly
dental caries, bleeding gums and coating over significant gender difference in the results
tongue were assessed among males and females (Table7).
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Table 7: The prevalence of self- assessed presence of dry mouth, dental caries, coating over the
tongue and bleeding gums amongst dental students
Males (N=100) Females (N=150) Genders difference
Oral hygiene
No. % No. % X2 p-value
Dryness of mouth N=25 15 15 10 6.7
Dental caries N=70 35 35 35 23.3
11.42 0.009
Bleeding gums N=40 10 10 30 20
Coating over the tongue N=25 15 15 10 6.7
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