Are stress and symptoms of depression associated with halitosis?

Luiz Alexandre Chisini,Mariana Gonzales Cademartori,Flávio Fernando Demarco,Francine Dos Santos Costa,Marcos Britto Correa,Kauê Collares,Marina Azevedo

doi:10.20396/bjos.v20i00.8661322

Luiz Alexandre Chisini, Mariana Gonzales Cademartori + Show 5 more

Open Access

https://doi.org/10.20396/bjos.v20i00.8661322

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Abstract

Mood disorders such as stress and depression can promote alterations of several hormones Aim: The present study aimed to evaluate if symptoms of depression and stress are associated with halitosis. The hypothesis is that halitosis is associated with stress and depression symptoms. Methods: All university students’ entrants in the Federal University of Pelotas (UFPel) were invited to participate. Self-reported halitosis was measured using a visual analog scale. Students were also asked about the presence of halitosis perceived by close individuals. The stress level was measured using a modified version of the Perceived Stress Scale and symptoms of depression were screened by Patient Health Questionnaire-2. Poisson Regression Models were performed. Results: Of a total of 2,058 students who participated in the study, only 16% of them have reported not having any degree of halitosis and 17.6% were informed of closed individuals having halitosis. After adjustments, stress and depression symptoms remained associated with halitosis selfreported. Individuals from the higher stressed quartile presented higher scores of halitosis (RR 1.37 CI95% [1.24–1.53]). Students who presented depressive symptoms showed higher scores of self-perceived halitosis (RR 1.20 CI95% [1.10–1.32]). When the association of stress and halitosis reported by close individuals was tested, symptoms of depression lost the association in the adjusted model, while individuals from the highest quartile from stress remained associated (PR 1.36 CI95% [1.02–1.81]). Conclusion: Halitosis was associated with stress even after control for oral health and socioeconomic variables.

Highlights

Genuine halitosis is an oral malodor caused mainly due to volatile sulfur compounds produced by microorganisms present in the mouth affecting about 22% to 50% of individuals worldwide[1]
When the association of stress and halitosis reported by close individuals was tested, symptoms of depression lost the association in the adjusted model, while individuals from the highest quartile from stress remained associated (PR 1.36 CI95% [1.02–1.81])
Scores mean of stress was 16.3 (SD ± 6.8), of which 31.1% present more than 20 points in the score

Summary

Introduction

Genuine halitosis is an oral malodor caused mainly due to volatile sulfur compounds produced by microorganisms present in the mouth affecting about 22% to 50% of individuals worldwide[1]. Inadequate oral hygiene practices are strongly associated with self-reported bad breath[2]. In this way, poor oral hygiene causes oral health problems as carious lesions and periodontal disease, which in turn have been attributed as the main reasons for malodor. Poor oral hygiene causes oral health problems as carious lesions and periodontal disease, which in turn have been attributed as the main reasons for malodor Unhealthy habits such as alcohol use, smoking, and an unbalanced diet can be predisposing factors to its development[2,3]. Systemic diseases including gastrointestinal tract disorders, diabetes, renal and hepatic insufficiencies even as chronic sinusitis are some of the systemic factors correlated to self-report of halitosis[2]

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