SRM Journal of Research in Dental Sciences

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

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

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.



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;9:63-66


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 2022 Oct 4 ];9:63-66
Available from: https://www.srmjrds.in/text.asp?2018/9/2/63/234596


Full Text

 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}

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}

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}

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}

 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.

References

1Messadi DV, Younai FS. Halitosis. Dermatol Clin 2003;21:147-55, viii.
2Miyazaki 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.
3American Academy of Periodontology. Glossary of Periodontal Terms. 4th ed. Chicago: American Academy of Periodontology; 2001. p. 56.
4Loesche WJ, Kazor C. Microbiology and treatment of halitosis. Periodontol 2000 2002;28:256-79.
5Loesche WJ, Grossman N, Dominguez L, Schork MA. Oral malodour in the elderly. In: van Steenberghe D, Rosenberg M, editors. Bad Breath: A Multidisciplinary Approach. Leuven: Leuven University Press; 1996. p. 181-94.
6Frexinos J, Denis P, Allemand H, Allouche S, Los F, Bonnelye G, et al. Descriptive study of digestive functional symptoms in the French general population. Gastroenterol Clin Biol 1998;22:785-91.
7Söder B, Johansson B, Söder PO. The relation between foetor ex ore, oral hygiene and periodontal disease. Swed Dent J 2000;24:73-82.
8Umeizudike KA, Oyetola OE, Ayanbadejo PO, Alade GO, Ameh PO. Prevalence of self-reported halitosis and associated factors among dental patients attending a tertiary hospital in Nigeria. Sahel Med J 2016;19:150-4.
9Kharbanda OP, Sidhu SS, Sundaram K, Shukla DK. Oral habits in school going children of Delhi: A prevalence study. J Indian Soc Pedod Prev Dent 2003;21:120-4.
10Motta LJ, Bachiega JC, Guedes CC, Laranja LT, Bussadori SK. Association between halitosis and mouth breathing in children. Clinics (Sao Paulo) 2011;66:939-42.
11Villa A, Zollanvari A, Alterovitz G, Cagetti MG, Strohmenger L, Abati S, et al. Prevalence of halitosis in children considering oral hygiene, gender and age. Int J Dent Hyg 2014;12:208-12.
12Araoye MO. Research Methodology with Statistics for Health and Social Sciences. Ilorin, Nigeria: Nathadex; 2004. p. 123-9.
13Nadanovsky P, Carvalho LB, Ponce de Leon A. Oral malodour and its association with age and sex in a general population in Brazil. Oral Dis 2007;13:105-9.
14Settineri S, Mento C, Gugliotta SC, Saitta A, Terranova A, Trimarchi G, et al. Self-reported halitosis and emotional state: Impact on oral conditions and treatments. Health Qual Life Outcomes 2010;8:34.
15Arinola JE, Olukoju OO. Halitosis amongst students in tertiary institutions in Lagos state. Afr Health Sci 2012;12:473-8.
16Arowojulo MO, Dosumu EB. Halitosis (Fetor oris) in patients seen at the periodontology clinic of the university college hospital, Ibadan – A subjective evaluation. Niger Postgrad Med J 2004;11:221-4.
17Nwhator SO, Isiekwe GI, Soroye MO, Agbaje MO. Bad-breath: Perceptions and misconceptions of Nigerian adults. Niger J Clin Pract 2015;18:670-5.
18Eldarrat A, Alkhabuli J, Malik A. The prevalence of self-reported halitosis and oral hygiene practices among Libyan students and office workers. Libyan J Med 2008;3:170-6.
19Nalçaci R, Sönmez IS. Evaluation of oral malodor in children. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;106:384-8.
20Sayedi SJ, Modaresi MR, Saneian H. Effect of metronidazole on halitosis of 2 to 10 years old children. Iran J Pediatr 2015;25:e252.
21Ibrahim ZF, Teslim LO, Aliyu I. Oral hygiene practices of non-dental nurses in a tertiary hospital in North-West Nigeria. SRM J Res Dent Sci 2017;8:105-9.
22Aliyu I, Michael GC, Teslim LO, Ibrahim ZF. Oral hygiene practices among patients seen in the general outpatient clinic of a tertiary health center. SRM J Res Dent Sci 2017;8:152-6.
23Donaldson AC, McKenzie D, Riggio MP, Hodge PJ, Rolph H, Flanagan A, et al. Microbiological culture analysis of the tongue anaerobic microflora in subjects with and without halitosis. Oral Dis 2005;11 Suppl 1:61-3.