Perception and awareness of halitosis in children by caregivers seen in our pediatric outpatient department

Ibrahim Aliyu; Taslim O Lawal

doi:10.4103/srmjrds.srmjrds_81_17

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ORIGINAL ARTICLE

Year : 2018 | Volume : 9 | Issue : 2 | Page : 63-66

Perception and awareness of halitosis in children by caregivers seen in our pediatric outpatient department

Ibrahim Aliyu, Taslim O Lawal
Department of Paediatrics, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria

Date of Web Publication

18-Jun-2018

Correspondence Address:
Ibrahim Aliyu
Department of Paediatrics, Aminu Kano Teaching Hospital, Kano
Nigeria

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/srmjrds.srmjrds_81_17

Abstract

Introduction: Halitosis is defined as bad breath which is offensive to others, there are several causes of halitosis, however, diseases of the oral cavity are the most common causes such as periodontal disease, bacterial coating of tongue; in addition, sinusitis, suppurative diseases of the lungs, esophageal diseases, systemic disorders, and different types of food have been implicated. It is one of the common indications for dental consultation. However, there are limited studies that have explored caregivers' perception of halitosis in their children and their help-seeking attitudes toward halitosis in children. Materials and Methods: This study was cross sectional. It was conducted over 4 months from August 2017 to December 2017. Pretested questionnaires were administered by trained medical officers and house officers; a systematic random sampling method was employed. Results: There were 31 (20.7%) males and 119 (79.3%) females, with male-to-female ratio of 1:4. Most respondents did not perceived their ward's breath; similarly, they believed their wards did not have bad breath; however, among those with bad breath, majority were concerned, but most had not sought medical treatment. Surprisingly, majority of the respondents did not know the cause of bad breath; and educational qualification and ethnicity had no significant association with knowledge of the causes of halitosis. Majority of the ethnic groups were aware of halitosis, except the Fulanis; and this observation was statistically significant (χ² = 15.170, df = 4, P = 0.004). Conclusion: There was poor knowledge of the causes of halitosis among the respondents; and few respondents sort for medical treatment for halitosis.

Keywords: Caregivers, causes of halitosis, halitosis, help-seeking behavior

How to cite this article:
Aliyu I, Lawal TO. Perception and awareness of halitosis in children by caregivers seen in our pediatric outpatient department. SRM J Res Dent Sci 2018;9:63-6

How to cite this URL:
Aliyu I, Lawal TO. Perception and awareness of halitosis in children by caregivers seen in our pediatric outpatient department. SRM J Res Dent Sci [serial online] 2018 [cited 2023 Jun 3];9:63-6. Available from: https://www.srmjrds.in/text.asp?2018/9/2/63/234596

Introduction

Halitosis is defined as bad breath which is offensive to others, there are several causes of halitosis; however, diseases of the oral cavity are the most common causes ^[1] such as periodontal disease, bacterial coating of tongue;^[2] in addition, sinusitis, suppurative diseases of the lungs, esophageal diseases, systemic disorders, and different types of food have been implicated.^[2],[3],[4] It is one of the common indications for dental consultation.^[5],[6],[7] Halitosis may result in low self-esteem and poor self-image. There are varied prevalences of halitosis reported worldwide ranging 2% in Sweden,^[7] 27.5% in China,^[2] and 14.8% in Nigeria;^[8] although studies among children reported prevalences ranging from 5% to 76.3%.^[9],[10] However, there are limited studies that have explored caregivers perception of halitosis in their children and their help-seeking attitudes toward halitosis in children.^[11] This study, therefore, seeks to determine caregivers understanding and their approach to halitosis.

Materials and Methods

This study was cross sectional. It was conducted over 4 months from August 2017 to December 2017. The sample size was determined using the statistical formula for descriptive studies;^[12] using a prevalence of 89.4% from previous study,^[8] a sample size of 150 was calculated. A systematic random sampling method was employed; the sampling interval was calculated by obtaining the average monthly pediatric outpatient clinic (POPC) attendance of 1000 over the study period divided by 150. Therefore, one in every seven caregivers was selected until the required sample size was obtained.

Pretested questionnaires were administered by trained Medical Officers and House Officers. This was developed in English language and validated (Cronbach's alpha value of 0.8) containing 15 close-ended questions; relevant questions included awareness of halitosis, help-seeking attitude of caregivers toward halitosis, and their understanding of causes of halitosis.

Inclusion criteria

All caregivers attending the POPC during the study period were included.

Exclusion criteria

Caregivers who declined consent were excluded from the study.

Ethical consideration

Ethical approval was obtained from the Ethical Committee of Federal Medical Centre Birnin Kebbi. Consent was obtained from each enrolled caregiver.

Data analysis

Obtained data were entered into Statistical Package for Social Sciences version 16 (SPSS Inc., Chicago, Illinois, USA). Categorical data such as their demographic characteristics were presented as frequencies and percentages. Test of significance using the Chi-square and Fisher's exact tests were used to determine the relationship between categorical variable such as educational qualification and their perception of halitosis; and P < 0.05 was set as statistically significant.

Results

There were 31 (20.7%) males and 119 (79.3%) females, with male-to-female ratio of 1:4.

Most respondents had at least tertiary qualification, they were mostly of the Hausa ethnic group, and they predominantly lived in the towns [Table 1].

Table 1: Demographic characteristics of the respondents

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Most respondents did not perceive their wards breath; similarly, they believed their wards did not have bad breath; however, among those with bad breath, majority were concerned but most had not seek for medical treatment. Surprisingly, majority of the respondents did not know the cause of bad breath [Table 2]. About 101 (67.3%) of the respondents were aware children could suffer from halitosis, while 49 (32.7%) were unaware. Furthermore, 129 (86.0%) of them believed halitosis was a disease while 21 (14.0%) did not know.

Table 2: Perception of bad breath by the respondents

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The respondents in the secondary and tertiary qualification group were mostly aware of halitosis; however, this observation was not statistically significant (Fisher's exact test = 7.568, P = 0.92). Furthermore, irrespective of their educational qualification, majority did not know the cause of halitosis; however, poor oral hygiene was mostly documented among those with secondary and tertiary educational qualification as a cause of halitosis; but this observation was not statistically significant (Fisher's exact test = 18.315, P = 0.262) [Table 3].

Table 3: Comparing the educational status of the respondents and their awareness and causes of halitosis

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Majority of the ethnic groups were aware of halitosis, except the Fulanis; and this observation was statistically significant (χ² = 15.170, df = 4, P = 0.004); however, irrespective of their ethnicity, majority were unaware of the cause of halitosis; and this observation was statistically significant (Fisher's exact test = 29.570, P = 0.004) [Table 4].

Table 4: Comparing the ethnicity of the respondents and their awareness and causes of halitosis

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Discussion

Halitosis is a common oral disorder with varied etiology; however, this study showed that only 12% of respondents reported halitosis; this finding was similar to 14.8% reported by Umeizudike et al.,^[8] 15% reported by Nadanovsky et al.,^[13] 19.39% by Settineri et al.,^[14] 13% by Arinola and Olukoju,^[15] 14.5% by Arowojulo and Dosumu ^[16] but, it was lower than 55% reported by Nwhator et al.;^[17] 44% and 54% reported by Eldarrat et al.^[18] (among male and female respondents, respectively) 30% reported by Nalçaci et al.,^[19] and 68% reported by Motta et al.,^[10] though this disparity is not clearly understood; children are unique because reports relating to their ill health depends on the health consciousness and help-seeking practices of their caregiver; therefore, in a society where bad breath is not considered a major illness, the reporting will be expectantly low as was observed in this study; nearly 54% of the respondents did not routinely perceive the breath of their wards (hand-mouth test) for bad breath. About 16.8% of respondents in this study had ever seek treatment for halitosis for their children; this figure was higher than the 2.5% reported by Eldarrat et al.;^[18] cultural differences may have accounted for this disparity though we had a smaller sample size compared to Eldarrat et al.'s ^[18] study.

Oral halitosis accounts for over 90% of the causes of halitosis,^[17] among other factors implicated such as food spices (garlic and onions), bacteria, and parasitic coating of the tongue have been reported.^[17]Helicobacter pylori, Atopobium parvulum, Eubacterium sulci, Solobacterium moorei^[17],[18] have been isolated in individuals with halitosis; Sayedi et al.^[20] in their report documented the role of metronidazole in treating halitosis. Majority (60%) of respondents in this study did not know the cause (s) of halitosis, only 3% reported oral infections as possible cause of halitosis; this observation was similar to that of Nwhator et al.,^[17] who reported only 2.5% of respondents with such perception.

The educational qualification and ethnicity of the respondents had no significant relationship with their awareness or causes of halitosis; this means, in general, there was poor knowledge of causes of halitosis; surprisingly, there were respondents who believed diarrhoea disease, hereditary factors may be associated with halitosis. Lack of proper information on halitosis may account for this observation. Our schools, health professionals should actively engage the populace on common oral health diseases and the need for proper oral hygiene.^[21],[22]

Limitations

This study was questionnaire-based, and diagnosis was based on subjective perception (organoleptic test) which may be influenced by the olfactory responsiveness of the respondents, their emotional state, and the weather condition of the environment.^[10],[23] Other diagnostic test, such as measurement of volatile sulfur compound, was not done in this study.

Conclusion

The respondents in this study had poor awareness of the causes of halitosis, and this was not influenced by ethnicity or educational heights; furthermore, few had ever sort for medical help.

Recommendation

Patients should be active engaged by physician on oral health irrespective of their presenting complaints, common causes of bad breath should be discussed. The media (radio, television, and social media) are platforms where this information could be disseminated.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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Tables

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

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