Prevalence and correlates of self-reported halitosis in Hong Kong adolescents

Abstract

Background Halitosis or bad breath is an understudied dental public health problem with adverse effects on general, social and mental health. Little is known about the epidemiology of halitosis in Hong Kong adolescents.

Objectives To assess the prevalence of self-reported halitosis in Hong Kong Chinese adolescents and its association with socio-demographic characteristics, behavioral characteristics, gastro-esophageal disease (GERD) and self-rated health.

Methods An anonymous questionnaire was completed by students in 42 randomly selected local secondary schools in the Hong Kong Student Obesity Surveillance (HKSOS) project 2006/07. Of 25187 students aged 11-18 (mean 14.5, SD 1.9), 42.1% were boys. Students were asked to choose from a list of health problems encountered in the past30 days, including “bad breath” (yes vs no). Socio-demographic variables included age (continuous variable), sex, place of birth (non-Hong Kong vs Hong Kong), highest parental education (primary or below, secondary, tertiary) and perceived family affluence (high, medium vs low). Behavioral factors included smoking (past smoker, current smoker vs never smoker) and alcohol consumption (< 6 days per week, everyday vs no consumption). Students chose from a list of diseases including GERD (yes vs no) that was diagnosed by a western medical practitioner. Self-rated health in the past 3 months was also assessed (very poor/poor vs good/very good). Logistic regression was then used to calculate crude odds ratio (OR) and adjusted odds ratios (AORs) for self-reported halitosis.

Results The prevalence of self-reported halitosis was 5.1% and similar prevalence was observed in boys (5.0%) and girls (5.2%). Self-reported halitosis was significantly associated with age (AOR per year1.07, 95% CI 1.04-1.11), non-Hong Kong place of birth (AOR 1.25, 95% CI 1.10-1.41), and perceived family affluence of medium (AOR 0.54, 95% CI 0.48-0.61) and high level (AOR 0.73, 95% CI 0.60-0.90) (vs low). Self-reported halitosis was significantly associated with current smoking (AOR 1.50, 95% CI 1.19-1.90) but not associated with former smoking. No significant association was observed for highest parental education and alcohol drinking.

Similarly, self-reported halitosis was also significantly associated with GERD (AOR 3.67, 95% CI 2.73-4.94) and poor self-rated health with an AOR (95% CI) of 1.90 (1.63-2.22). Conclusions One in 20 Hong Kong Chinese adolescents reported halitosis in the past 30 days, which could be an underestimation as halitosis is often unnoticed by oneself. Although the prevalence was not high, self-reported halitosis was associated with disadvantaged socio-demographic characteristics, smoking, GERD and poor self-rated health. More detailed investigations on the severity, risk factors and effects of halitosis in Hong Kong adolescents are warranted.