Halitosis in Young Adults: Prevalence, Risk Factors, and Oral Hygiene Practices

Introduction

Halitosis can simply be defined as an unpleasant odour that emanates from the mouth.¹ It has been classified into three main categories: genuine, pseudo, and halitophobia.² Halitosis is genuine if it is beyond a socially acceptable level; pseudo if it is only perceived by the affected person while halitophobia is halitosis that the affected person perceives as persisting after treatment.² Halitosis ranks as the third most common presenting complaint of dental patients following dental caries and periodontal diseases.¹⁶ It has been shown to impair health because it affects overall health, well-being and self-esteem negatively.¹⁴ Studies worldwide indicate a high prevalence of moderate halitosis, whereas severe cases are restricted to around 5% of the populations.¹⁵

Prevalence and Risk Factors of Halitosis

Halitosis is predominantly intra-oral in origin, with tongue coating, periodontal disease, and poor oral hygiene responsible for approximately 80–90% of cases globally.¹ Gram-negative anaerobic bacteria such as Porphyromonas gingivalis and Fusobacterium nucleatum metabolise sulphur-containing amino acids to produce volatile sulphur compounds (VSCs), which are the major cause of oral malodour.²

Studies in Nigeria reflect similar patterns while revealing significant behavioural and educational gaps. Surveys among tertiary institution students and hospital attendees in Lagos reported prevalence rates ranging from 13–15%, with male gender, gingival inflammation, and poor oral hygiene significantly associated with halitosis.³-⁵ Research among Nigerian young adults also demonstrated a direct relationship between periodontal disease severity and VSC concentration, confirming the role of periodontal pathology in disease progression.⁶ Furthermore, non-surgical periodontal therapy significantly reduced VSC levels, indicating that halitosis is both preventable and treatable.⁷

Behavioural factors such as irregular toothbrushing, infrequent dental visits, and academic stress have also been identified among Nigerian students.⁸ Beyond oral health, halitosis has important psychosocial consequences, including reduced self-esteem and impaired oral health-related quality of life among adolescents and young adults.⁹ However, awareness remains inadequate, with studies showing poor knowledge of halitosis even among healthcare trainees.¹⁰

Recommendations

Promoting awareness and education on halitosis and oral hygiene among young adults is essential. Proper oral hygiene practices such as regular tooth brushing, tongue cleaning, and flossing should be encouraged. Good oral care helps reduce bacterial growth and minimizes the production of unpleasant oral odours.¹¹

The use of oral irrigators should be encouraged. Oral irrigators help flush out food debris and dental plaque from areas that may be difficult to clean with toothbrushes alone, thereby reducing factors that contribute to bad breath.¹²

Certain antimicrobial agents help control the microorganisms responsible for oral malodour. Chlorhexidine mouthwash has been shown to be highly effective for short-term reduction of oral bacteria associated with halitosis. Other agents such as triclosan, cetylpyridinium chloride, and essential oils may also provide benefits, although their long-term effectiveness may vary.¹²

Products that neutralize VSCs may be beneficial. Oxidizing agents such as hydrogen peroxide and chlorine dioxide can help reduce oral malodour by neutralizing odour-producing compounds. In addition, zinc-containing products are recommended because zinc salts can bind to sulphur compounds and reduce their unpleasant smell.¹²

Halitosis may also arise from causes outside the oral cavity. Persistent bad breath can sometimes indicate underlying medical conditions such as gastrointestinal disorders, systemic diseases, malignancies, or adverse effects of certain medications. Individuals with persistent halitosis despite maintaining adequate oral hygiene should seek medical evaluation. Healthcare professionals should conduct comprehensive assessments to identify possible extra-oral causes.

Key Takeaways

• Halitosis affects up to 50% of the population, with varying prevalence due to cultural factors.¹⁶
• 90% of bad breath originates in the oral cavity, emphasizing the need for dental intervention.¹⁶
• The etiology includes volatile sulfur compounds (VSCs) produced by bacteria in the mouth.¹⁶
• As little as brushing twice daily and observing good oral hygiene can benefit.

References

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