self assessment of halitosis among diabetic saudi female patients

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  • 7/28/2019 Self Assessment of Halitosis Among Diabetic Saudi Female Patients






    Associate Professor, Division of Periodontics, Department of

    Preventive Dental Science


    Dr. N. Y. Ashri

    Department of dental science

    Division of Periodontics

    College of Dentistry, King Saud University

    P.O. Box 60169, Riyadh 11545

    Telephone numbers:

    Home 966-1-233-2720

    Mobile 966-558-008-80

    Fax 966-1-476-5357

  • 7/28/2019 Self Assessment of Halitosis Among Diabetic Saudi Female Patients



  • 7/28/2019 Self Assessment of Halitosis Among Diabetic Saudi Female Patients



    Aim: The purpose of this study was to assess self-perception of oral malodor

    (Halitosis) in female diabetic patients and the impact of halitosis on their social life.

    Methods: A self-administrated questionnaire was developed and distributed in the

    diabetic clinics in four governmental hospitals. The questioner contained questions

    about past medical history, oral habits, and self-perception of halitosis, in addition, to

    questions about social and psychological impacts of halitosis.

    Results: 175 female diabetic patients participated in this study by completing the

    distributed questionnaire. Fifty two percent of participant were aware of having

    halitosis, 50.3% of these had self-perception of halitosis while 18.3% were told by

    others. Subjects with halitosis reported that the uppermost level of halitosis was

    noticed at waking up 78.3%, followed by the time when they famished 59.4%.

    Participant also reported having caries 58.9% and gingival bleeding 51.4%. Fifty eight

    percent used the toothbrush daily but only 8.6% used the dental floss daily. Past

    medical history included gastric disturbance 25%, sinusitis 23.4%, anemia 14.3%, and

    allergies 19.4%. Twenty percent of subjects seek treatment for halitosis by a dentist,

    and 11.4% consulted a physician, however only 11.4% reported receiving treatment.

    Thirty four percent of participant reported that having halitosis had made them

    hesitant to speak to others and 12.6% completely avoids others. Fifty two percent of

    the subjects gave there own opinion about what is the cause for halitosis; diabetes

    14.9%, caries 13.1%, 13% periodontal disease, and 8% gastric disturbance. It can be

    concluded that self-perception of halitosis is high among female diabetic patients and

    has relative effect on their social and psychological status. Further studies are needed

    to document the prevalence of halitosis among diabetic patients.


  • 7/28/2019 Self Assessment of Halitosis Among Diabetic Saudi Female Patients



  • 7/28/2019 Self Assessment of Halitosis Among Diabetic Saudi Female Patients



    Diabetes Mellitus (DM) is a chronic disorder characterized by hyperglycemia and

    associated with major abnormalities in carbohydrate, fat, and protein metabolism (1). It is

    one of the major public health issues facing the world in the 21 st century (1). It often goes

    undiagnosed and compromises the oral health of an affected patient (1). Prevalence of (DM)

    is about 3%-7% in the western countries (2). In Saudi Arabia, the incidence of DM is rapidly

    increasing with prevalence of 2.55% - 5.32% among males and females respectively (3).

    Diabetes Mellitus is associated with many complications affecting both physical and

    psychological status of patient (4). One of those is periodontal disease which was found to be

    of a high prevalence and severity in DM (5).

    The relationship between DM and periodontitis were reported by several studies (5) (6) (7).

    Yavuzyilmaz et al. 1996 found that alteration in the composition of whole saliva could be

    associated with the increase in severity of PD in diabetic patients (8).

    Halitosis is a common complaint that may periodically affect most of the adult

    population (9) (10).In the large majority of cases, halitosis originates in the oral cavity as the

    result of microbial metabolism (9) (10) (11).Sixty five percent to 85% of halitosis found to be

    caused by periodontal disease (12). It was also found to be associated with systemic disease

    as DM (13) (14) (15). Halitosis is caused by the high activity of bacteria and production of foul

    smelling by products known as volatile sulfur compounds (VSC) (16)(17) (18).

    Halitosis affects a large proportion of the population (19), and may be the cause of a

    significant social and psychological handicap to those who suffer from it (20) (21). However

    not all persons who have halitosis are aware of it (6).


  • 7/28/2019 Self Assessment of Halitosis Among Diabetic Saudi Female Patients


    The aim of this study was to assess the self-perception of Halitosis in a sample of Saudi

    female Diabetic patients and the social effect of Halitosis on their life.


    Patients under treatment in the diabetic centers in four different hospitals in Riyadh,

    Saudi Arabia; King Abdul Aziz university hospital, King Khalid university hospital, The

    Military hospital and the Security forces hospital were requested to participate in the study.

    To assess self-perception and awareness of halitosis (bad breath) in Saudi female

    diabetic patients, Arabic questionnaire was developed consisting of two parts. The first part

    consisted of questions about the presence of medical illness, oral hygiene practice, their

    consumption of coffee, tea, the presence of smoking habit, presence of caries, and finally

    there awareness of having halitosis and whether treatment was seeked. The second part of

    the questionnaire consisted of social and psychological consequence of halitosis if present.

    A nurse was assigned in each hospital to distribute the forms to diabetic Saudi female

    patients in the waiting areas and recollect them in 10-15 minutes and the opportunity for

    verbal inquiry to assist in establishing rapport when ever patient were illiterate.


  • 7/28/2019 Self Assessment of Halitosis Among Diabetic Saudi Female Patients



    One hundred seventy five Saudi female patients with diabetes agreed to

    participate in the present study. Age range was 16-72 years old with the majority

    58.3% ranging between 36 to 55 years old.

    Fifty two percent of participant reported that they have halitosis, from which

    50% made self-diagnosis and 18 % were told that they have halitosis. Table I

    Fifty percent of participant reported having dry mouth, 58.9% reported presence of

    caries, 51.4% reported bleeding during brushing, and 18.9% reported frequent oral

    ulceration. Table I

    Table I: Self-Assessment Questions:

    Question Yes No Don't know

    Presence of halitosis 52% 28% 20%

    Halitosis found by your self 50.3% 49.7% 0Halitosis found by others 18.3% 81.7% 0

    Presence of dry mouth 50.9% 48.56 0.54 %

    Presence of caries 58.9% 21.1% 20 %

    Presence of bleeding with brushing 51.4% 48.6% 0

    Occurrence of frequent ulceration 18.9% 79.4% 1.7 %

    Participants were asked when they feel that they have the highest level of

    halitosis during the day, 61.79 of subjects reported bad breath at awaking up, 46.9%

    when hungry; and 8% at work. Table II.

    However when cross tabulation was done between participant who actually

    said that they have halitosis and time of highest peak of halitosis it was found that

    31.9% of participant found halitosis worst when they are tired, 59.4% when they are

    hungry, 18.8% at work, and 78.3% at waking up.

    Fifty eight percent of participant who reported having halitosis have gingival

    bleeding when brushing, 25% have sinusitis, and 24.6% reported having gastric

    disturbance. Table III


  • 7/28/2019 Self Assessment of Halitosis Among Diabetic Saudi Female Patients


    Table II: Highest Peek of Halitosis

    Time halitosis is highest Yes No

    After waking up 61.7% 38.3%

    When hungry 46.9% 53.1%

    Mid-day 31.4% 68.6%

    During working hours 8.0% 92%

    Table III: Correlation between Halitosis/ Timing and Medical history

    Time/ Medical history Percentage

    When tired 31.9%

    When hungry 59.4%

    During work 18.8%

    When waking up 78.3%

    Gingival bleeding 58%

    Sinusitis 25%

    Gastric disturbance 24.6%

    Regarding patients habits, 58.9% of the participants drink coffee frequently,

    38.3% drank tea with mint and only 5.1 are smokers. Fifty eight percent brush their

    teeth daily and only 8.6% use dental floss regularly. Table IV

    Table IV: Oral Hygiene Care and Different Habits

    Question Yes No Sometimes

    Daily brushing 58.9% 40.6% 0Daily flossing 8.6% 90.9% 0

    Frequency of taking teas 38.3% 18.9% 42.9%

    Frequency of taking coffee 58.9% 10.3% 30.3%

    Smoking 5.1% 94.9% 0

    Past medical history of participant included; sinusitis 23.4%, Gastric disturbance

    25.1%, allergies 19.4%, and anemia 14.3%. Table V

    Table V: Past Medical History


  • 7/28/2019 Self Assessment of Halitosis Among Diabetic Saudi Female Patients


    Medical condition Yes

    Gastric condition 25.1%

    Sinusitis 23.4%

    Anemia 14.3%

    Allergies 19