Research Article - (2022) Volume 9, Issue 7

Association between Halitosis and Systemic Co - Morbidities: A Retrospective Study

Kiran K and Jayanth Kumar vadivel*
Department of Oral Medicine and Radiology, Saveetha Dental College and Hospital Saveetha Institute of Medical and Technical Science (SIMATS),Saveetha University Chennai, India
*Correspondence: Jayanth Kumar vadivel, Department of Oral Medicine and Radiology, Saveetha Dental College and Hospital Saveetha Institute of Medical and Technical Science (SIMATS),Saveetha University Chennai, India, Email:

Received: Mar 08, 2022, Manuscript No. JEBMH-22-50959; Editor assigned: Mar 11, 2022, Pre QC No. JEBMH-22-50959 (PQ); Reviewed: Mar 25, 2022, QC No. JEBMH-22-50959; Revised: Mar 30, 2022, Manuscript No. JEBMH-22-50959(R); Published: Apr 05, 2022, DOI: 10.18410/jebmh/2022/09.07.45

Citation: Vadivel JK, Kiran K. Association between Halitosis and Systemic Co- Morbidities: A Retrospective Study. J Evid Based Med Healthc 2022;9(7):45.



Halitosis in older adults is a common condition that may have oral or non-oral sources, result from a number of different etiologies, and have more than just social consequences. In some cases, bad breath may reflect serious local or systemic conditions, including gingivitis, periodontal disease, diabetic acidosis, hepatic failure, or respiratory infection. As a dental practitioners our role is first to determine whether the odor has an oral or non - oral cause. Odors can be distinct in their quality and thus can help make this determination.

Materials And Methods

It is a single center retrospective study in a private dental institution samples were taken from the patients who checked in from June 2019 to March 2021, Reported to the dental hospital with data was collected, verified, tabulated and analyzed using SPSS by IBM version 2.0, the Chi square Test was performed to compare the data and check for its distribution. A total of 9 patients which included 2 females and 7 males were found from the dataset,

Result And Discussion

From the study results we can observe that Halitosis is more significant among male population, diabetes was found to be the most common systemic illness in both the populations, and however hypertension is also more commonly observed in males. However there was no association between any systemic illness and halitosis.


This study concludes that there is no association between halitosis and systemic co-morbidities. Diabetes is found to be most commonly occurring system in life that is associated with halitosis and that males are most commonly affected, and the age group between 30 to 50 years has highest prevalence.


Systemic conditions, Including gingivitis, Periodontal disease, Diabetic acidosis


Halitosis is the term given to any unpleasant odor arising from the mouth or expired air and can result from poor oral hygiene, lesions or infectious processes in the oral cavity or pharynx, or it may arise from a deeper systemic cause. Approximately 10 to 30 % of the population suffers from this problem regularly.1 Halitosis can be classified based on its etiology as true halitosis, pseudohalitosis or psychogenic halitosis and halitophobia The diagnosis is made by conducting a simple oropharyngeal examination, by using objective measurements or by performing a complete systemic evaluation.2 Management is based on the etiology of the condition and includes eliminating local factors, modifying habits, implementing mechanical methods, using chemical agents, referral to a specialist, long-term care, patient education and follow up Halitosis is commonly seen in the older adults who may have oral or non-oral causes as the source of the problem.35 The presence of bad breath may be a reflection of local or systemic conditions which include gingivitis, periodontal disease, diabetic ketoacidosis, hepatic failure or respiratory infections The odours may be a manifestation of a deeper systemic problem Odours can be distinct in their quality and thus can help make this determination.6 Identification of the non-oral sources is cumbersome but nevertheless needs to be identified for an effective cure.7 At least 50 % of the population suffers from chronic halitosis and approximately half of these individuals experience a severe problem that creates personal discomfort and social embarrassment.812 A majority of patients are totally clueless about their bad breath problem Inability to smell their own oral malodour has been attributed to a sensory phenomenon known as Adaptation.13 Decreased ability to smell unpleasant odour can be related to specialized olfactory bipolar neurons being constantly occupied with an otherwise offensive substance, making the patients insensitive to odour.14 The most common oral cause of malodour is poor oral hygiene in the form of accumulation of food debris and dental bacterial plaque on the teeth and tongue, resulting from poor oral hygiene and resultant gingivitis or periodontitis.15 A poor gingival health in the form of malodour, acute necrotising ulcerative gingivitis can cause halitosis. The halitosis here is due to the production of odoriferous substances from the plaque biofilm.1621 It is not the presence of calculus that causes halitosis as can be seen be in cases of aggressive periodontitis that is characterized by a paucity of calculus also causes halitosis.22

Materials and Methods

This retrospective cross-sectional study evaluated the records of patients who visited the University Dental Hospital from June 2019 - March 2021. The study was approved by the Institutional Ethical Committee.

Data Collection

After reviewing 86000 patient records, between June 2019 and March 2021, 9 patients were included for the study. Various demographic variables such as age and gender were recorded along with their dental status. Also the systemic status of the disease was recorded.

Statistical Analysis

The data obtained were tabulated in Microsoft Excel 2007 Software and then exported to Statistical Package for the Social Sciences (SPSS) (Chicago, USA) for statistical analysis. Descriptive Statistics, crosstabs and Chi-Square tests were performed on the data sets.


The results of this study shows that only 9 patients have reported to the Dental OP with the primary complaint of halitosis. Among the 9 patients there were 7 males and 2 females. Given the small size there was no gender based association carried out between halitosis and the gender. Among the reasons diabetes accounted for 3 patients followed by 2 patients for hypertension. The remaining diseases of arthritis, coronary artery disease, epilepsy and endocrine diseases accounted for 1 patient each Table 1.

Table 1. Distribution of the Systemic Disorders Among Patients With Halitosis.

Systemic illness frequency
Diabetes 3
Hypertension 2
Arthritis 1
Coronary Artery Disease 1
Epilepsy 1
Endocrine Diseases 1

An association between systemic illness and the patients with halitosis was studied using chi - square test and there was no significant association as the obtained p-value is greater than 0.05 (p value = 0.35) (Figure 1).


Figure 1. Pie chart representing the Distribution of Gender among the Samples.


The most common systemic disorder prevalent in patients with halitosis is diabetes followed by hypertension. This was consistent with two similar studies done in the past.30,31 In diabetes patients, high blood sugar levels increase glucose levels in saliva. This provides an optimum environment for the bacteria inside the oral cavity to cause build-up of dental plaque. If plaque is not removed effectively dental caries or gingival inflammation may occur which also causes halitosis.32,33 The most common percentage of the population was men. This is also acceptable because of the fact that men are smokers and tobacco users more frequently and hence have a higher chance of developing halitosis than women.34 Among females the most common systemic disorder associated with halitosis is endocrine disorders.35 The clinical assessment of halitosis is usually subjective and is based on smelling the exhaled air of the mouth and nose and comparing the two, this is also known as organoleptic assessment. Odour detectable from the mouth but not from the nose is more likely to be of either oral or pharyngeal origin. Odour from the nose is likely to be coming from the nose or nasal sinuses. In rare instances when the odour from the nose and mouth are of similar intensity, a systemic cause of the malodour may be likely. Measurement of oral malodour is done by a variety of parameters including complexity of gaseous molecular species, sampling difficulties, temperature variation, and choice of suieg subject population and lack of agreement on reference standards. Since oral malodour is a perceived olfactory stimulus, direct sampling and assessment by human judges may be the most logical measurement approach. Some shortcomings in this method have led several investigators to propose quantitative approaches based on measurements of volatile sulphur compounds.36 The best way to treat bad breath is to motivate patients to practice good oral hygiene and to ensure that their dentition is properly maintained. Oral hygiene maintenance include Periodic professional oral hygiene maintenance which included a routine scaling.37 By adopting this practice the potential foci of microbial colonization can be reduced.38 One of the major roto cause of oral malodor has been the presence of periodontal diseases and the removal of this plaque biofilm has been associated with instantaneous reduction of halitosis.

However the presence of systemic factors has been associated with immediate or quick relapse of the problem (Figure 2).


Figure 2. Bar Graph Showing The Distribution of the Different Systematic Inlines In Patients With Halitosis .X axis represents the percentage and y axis represents the condition. The predominant condition from the graph is diabates.


From this study it is evident that diabetes seems to be more so often associated with halitosis than the other systemic disorders. However the sample size in this group was small which happens to be a major limitation. Also we need to screen patients with diabetes who may be having incidental halitosis as an incidental finding.