Abstract
Objective: To perform the transcultural adaptation to Brazil and validation of the Halitosis Associated Life-quality Test (HALT) for use in adolescents. Material and Methods: Students aged 12 to 15 years, of both sexes, with healthy permanent dentition, attending public schools in Piracicaba, Brazil, were selected for this study. The HALT was translated, backtranslated, reviewed by an expert committee and submitted to a pre-test. In the first phase (n = 13), 15% of the sample did not understand items 2, 12 and 15; therefore, these items were reformulated and resubmitted to 13 adolescents. The version with a sociocultural adaptation was self-applied by 56 adolescents (64% females, 13.4 ± 1.0 years), of whom 25 participated in the test-retest. The presence of visible biofilm, gingival bleeding, calculus and tongue coating, was evaluated. Self-perception of halitosis after exhalation/breathing was assessed by a single question. Results: The HALT score ranged from 0 to 62 points (mean = 10.1±13.4) and the floor effect was 5.4%. Internal consistency was excellent (Cronbach's alpha = 0.92) and reproducibility was moderate (Intraclass Correlation Coefficient = 0.59). Individuals with “excessive” tongue coating had a higher HALT score than those with mild and/or moderate coating (p<0.001). Multiple linear regression analysis indicated that only the male sex was related to a higher HALT score (p<0.05). Conclusion: The Brazilian Portuguese version of the HALT was easily understood by adolescents. Those with greater tongue coating accumulation reported more frequently the presence of halitosis, which was only associated to male sex.
Highlights
Halitosis, known as bad breath or malodor, is a term used to describe malodor present in the mouth, with an intraoral or extraoral origin [1,2,3,4]
Those with greater tongue coating accumulation reported more frequently the presence of halitosis, which was only associated to male sex
Previous studies have found a significant association between malodor self-perception and the clinical diagnosis of halitosis in individuals who were not concerned with such a condition [14], as well as in patients seeking dental care [16]. These findings have provided evidence that the subjective method is a valid approach in the evaluation of halitosis
Summary
Known as bad breath or malodor, is a term used to describe malodor present in the mouth, with an intraoral or extraoral origin [1,2,3,4]. This condition may be permanent or transitory depending on oral hygiene habits [5]. Persistent halitosis can be caused by intraoral factors, such as oral diseases (periodontal disease, gingivitis, caries, biofilm accumulation and tongue coating) [4,7] as well as extraoral factors, such as systemic diseases (upper and lower respiratory tract infection, gastrointestinal disorders, metabolic diseases affecting the kidneys and liver, and endocrine disorders such as diabetes mellitus) [1,4,7,8,9]. Previous in vitro studies have shown that gram-positive bacteria such as Peptostreptococcus spp. are able to produce VSC and play an important role in halitosis [7,10]
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