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ORIGINAL ARTICLE
Year : 2022  |  Volume : 20  |  Issue : 2  |  Page : 206-211

Assessment of self-perceived oral malodor, oral hygiene practices, and smoking habits among dental and engineering students: A cross-sectional study


Department of Public Health Dentistry, ACPM Dental College, Dhule, Maharashtra, India

Date of Submission16-May-2019
Date of Decision24-Sep-2019
Date of Acceptance19-Apr-2022
Date of Web Publication8-Jun-2022

Correspondence Address:
Rahul Nivrutti Deokar
ACPM Dental College, Post Box No. 145 Opp. Jawahar Soot Girni, Sakri Road, Dhule - 424 001, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaphd.jiaphd_59_19

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  Abstract 


Aim and Objectives: This study aimed to assess the prevalence and knowledge of self-perceived oral malodor, oral hygiene practices, and smoking habits among dental and engineering students of Dhule district. Materials and Methodology: A structured self-administered, close-ended questionnaire was prepared and was given to 435 dental and engineering e students. This was to assess the self-reported perception of oral breath, awareness of bad breath, timing of bad breath, treatment received for bad breath, oral hygiene practices, caries and bleeding gums, dryness of the mouth, smoking and tea-drinking habits, and tongue coating. The students who responded to the questionnaire were included in the study. Informed consent was obtained from the subjects willing to participate in the study. Results: Toothbrushing was prevalent among 100% of dental students and 87% of engineering students. Self-perception of oral malodor was prevalent among 7% of dental students and 66% of engineering students. Smoking habit was prevalent in 26% of engineering students and 8% of dental students, for which self-treatment was sought for bad breath by 6% of dental students and 8% of engineering students. Conclusion: Dental students had increased awareness regarding self-perceived oral malodor, oral hygiene practices, and smoking habits compared to engineering students.

Keywords: Oral hygiene, oral malodor, self-perceived, smoking habits


How to cite this article:
Deokar RN, Dodamani AS, Vishwakarma K P, Hoshing AA, Jain VM, Mali GV. Assessment of self-perceived oral malodor, oral hygiene practices, and smoking habits among dental and engineering students: A cross-sectional study. J Indian Assoc Public Health Dent 2022;20:206-11

How to cite this URL:
Deokar RN, Dodamani AS, Vishwakarma K P, Hoshing AA, Jain VM, Mali GV. Assessment of self-perceived oral malodor, oral hygiene practices, and smoking habits among dental and engineering students: A cross-sectional study. J Indian Assoc Public Health Dent [serial online] 2022 [cited 2022 Jun 30];20:206-11. Available from: https://www.jiaphd.org/text.asp?2022/20/2/206/346886




  Introduction Top


Oral health is an integral part of general health. Poor oral health can have a profound effect on the quality of life. Poor oral health can affect general health, and several oral diseases are related to chronic systemic diseases. Hence, the oral cavity can serve as a diagnostic mirror for various systemic diseases. In spite of the great triumphs in oral health, the burden of oral health diseases remains still higher all over the world. This could be mainly because of a lack of acceptance of healthy oral habits that are crucial in controlling the most common oral diseases such as dental caries and periodontal disease, which are mainly considered behavioral diseases.[1]

Oral hygiene practices such as brushing regularly, using fluoridated toothpaste, using aids such as floss to clean interdental spaces, avoiding in-between meals, changing toothbrush at frequent intervals, visiting the dentist regularly, and avoiding tobacco products holistically assist in accomplishing proper oral health.[2] According to the WHO, six million people die because of tobacco smoking, and an estimated 6 lack individuals lose their lives due to secondhand smoke globally each year. A recent study found that smoking is related to about 20% of adult mortality worldwide.[3]

Oral malodor is the general term used to describe any disagreeable odor in expired air, regardless of whether the odorous substances originate from oral or nonoral sources. It is known as fetor ex ore, fetor oris, bad or foul breath, breathe malodor, or halitosis.[4] Literature reviews suggest that 80%–90% of halitosis originates within the oral cavity, where anaerobic bacteria degrade sulfur-containing amino acids to the foul-smelling volatile sulfur compounds (VSCs), namely hydrogen sulfide and methyl mercaptan.[5],[6] Accordingly, it has been classified into three main categories: genuine which includes physiologic and pathologic halitosis of oral and systemic origin, pseudohalitosis, and halitophobia.[7]

Furthermore, it is classified according to its etiology as oral causes and nonoral causes. Oral cause includes periodontal infections of various etiologies such as smoking, stress, insufficient oral hygiene practice, xerostomia, and tongue coating, also other contributory causes such as dry socket, exposed necrotic pulp, and food impaction.[8],[9] Nonoral cause includes infections from the ear, nose, throat, tonsils, maxillary sinuses, or pulmonary system. Being multifactorial in origin, it requires an interdisciplinary assessment and treatment from professionals such as dentists, physicians, nutritionists, and psychologists.[10]

Oral malodor is a major social impact factor for the sufferers; it hampers their normal daily life activities such as social and professional interactions affecting the individual's self-esteem and confidence, causes embarrassment, reduces employment and carrier opportunity, and decreases the quality of life.[11] Hence, it may require one's self-knowledge about oral hygiene maintenance, ill effects of smoking habits, and self-perceived oral malodor.[12]

The present research aims at investigating self-perceived oral malodor, oral hygiene practices, and smoking habits among dental and engineering students [Figure 1].
Figure 1: Self-perceived oral malodor

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  Materials and Methodology Top


Study design

The present study was a cross-sectional study targeted toward undergraduate students of dental and engineering faculty in two different institutions of Dhule city.

Sample size and sampling technique

The present study was based on a convenience sampling technique where participants were selected on the basis of their convenient accessibility and proximity to the researcher.

The sample size was determined using G Power softwarev3.1 from the data obtained from a study conducted by Penmetsa et al. (2017).[9] Keeping the power of the study at 80%, the level of significance at 5%, and using data on the proportion of self-perceived malodor among medical (48.9%) and engineering students (60%), the sample size calculated was 248 per group, i.e., total 496 samples to be included which was rounded off to 500.

Questionnaire preparation

After obtaining approval from the Ethical Review Committee, a structured and self-administered questionnaire of 40 closed ended questions was prepared. It was tested by a pilot study on 20 subjects, each from dentistry and engineering.

Content of questionnaire

The questionnaire was developed by reviewing the literature and making modifications according to local culture and was administered in the English language. The questionnaire was tested in a pilot study, and necessary modifications were done based on the results of the pilot study. The questionnaire was anonymous (no identification of individuals was possible). The final version of the questionnaire consisted of questions on self-perception of oral health, awareness of bad breath, timing of bad breath, treatment received for bad breath, prevalence of oral hygiene habits, caries and bleeding gums, dryness of mouth, smoking and tea-drinking habits, and tongue coating. The questionnaire was explained to the class leaders before the start of the study [Figure 2].
Figure 2: Questionnaire

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Data collection

The purpose of the present study was explained to every participant, and written informed consent was obtained from each participant. The questionnaire was distributed to all the dental and engineering students in the mentioned institutions with the permission and cooperation of the head of the institute and the respective head of the departments.

Administration of the questionnaire: the questionnaire was administered to dental and engineering students in the form of hard copy, and a sufficient amount of time was given to complete the questionnaire. The study was completed within a period of 2 months.

Accordingly, the questionnaire was distributed to all 435 dental and engineering students studying in Dhule city (Maharashtra state). Out of 435 students, 222 dental and 213 engineering students responded. Thus, the response rate was 100% for both the groups.

Statistical analysis

The data were compiled using Microsoft Excel software and were analyzed using Statistical Package for the Social Sciences (SPSS-version 20.0) IBM SPSS Statistics for Windows, Version 20.0. (Armonk, NY, USA: IBM Corp) was used for analysis. The data were analyzed for frequency distributions. Chi-square test was used for comparisons among dental and engineering students. The significance level (P value) was set at 0.05.


  Results Top


Among the 500 questionnaires, incomplete questionnaires were dropped from the study, and thus, a total of 435 questionnaires were available for data analysis. The average response rate was 100% for both the groups. The respondents were in the age group of 18–26 years.

Oral hygiene practices

The results show that all the dental students reported cleaning their teeth daily with toothbrush as compared to 87.3% of engineering students. Few of the engineering students reported the use of fingers and other aids for cleaning their teeth. This difference in tooth-cleaning habits among dental and engineering students was significant (P = 0.001). Toothpaste as a dentifrice was used by 222 (100%) dental students and 185 (87%) engineering students, whereas tooth powder as a dentifrice was used by the remaining 28 (13%) students. Frequency of toothbrushing with dentifrice was used by 201 (90%) dental students twice a day and 21 dental students (9%) once daily, whereas in the engineering faculty, it was 54 students (25%) twice a day and 159 students (74%) once daily [Table 1].
Table 1: Assessment of oral hygiene practices n (%)

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Prevalence of smoking habits

Around 47 (21%) dental students had smoking habits, whereas 91 (40%) engineering students had smoking habits. Smoking habit and frequency of smoking was more prevalent in engineering students as compared to dental students [Table 2].
Table 2: Smoking prevalence among dental and engineering students

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Self-perception of oral malodor and dryness of mouth

Around 141 (66%) of engineering students experienced oral malodor, whereas 196 (88%) dental students did not experience self-perception of oral malodor using a hand-on mouth technique. Chi-square tests showed that engineering students had significantly higher perceived malodor than dental students. Moreover, the prevalence of dry mouth was more in engineering students as compared to dental students, approximately 27% of engineering students and 7% of dental students, respectively [Table 3].
Table 3: Prevalence of self-perception of oral malodor by hand-on technique and dryness of mouth

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Remedies used for bad breath and its social effects on life

Among the study sample with self-perceived oral malodor habit of tongue cleaning daily after tooth brushing was more in dental students as compared to engineering students as 88% and 17% respectively. 57% of dental students and 15% engineering students were using mouth freshener for overcoming oral malodor while among use it. Out of total subjects 15% of dental students and 2% of engineering students received treatment for their bad breath or oral malodor from professional dentist.

The effect of halitosis or oral malodor on social life from the respondents' point of view is presented in [Table 4]. Around 59% of the respondents with self-perceived oral malodor from each group stated that oral malodor affected their social life.
Table 4: Remedies used for bad breath and its social effects on life

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The result showed that majority of students were aware of halitosis as bad breath, wherein significantly higher number of dental students could smell their own breath as compared to engineering students (P < 0.05). Research has indicated that prevalence and incidence ratios between the dental and engineering students are the same though engineering students tend to seek treatment more often than dental students.


  Discussion Top


Oral malodor is a common problem among the general population, and evidence reveals that it forms about 85% of all bad breath.[4] It can have distressing effects that may become a social handicap, and the affected person may avoid socializing. Hence, self-perception is very important for diagnosing and controlling bad breath by seeking appropriate dental treatment.[5] The present study was undertaken to assess the prevalence and knowledge of self-perceived oral malodor, oral hygiene practices, and smoking habits among dental and engineering students in Dhule district.

Assessment or diagnosis of oral malodor can be done by questioning about the history of halitosis, dental, and medical history. Depending on this, it can be self-diagnosed or professionally diagnosed.[6] Self-diagnosis includes hand-over technique, smelling metallic or nonodorous plastic spoon, toothpick after inserting in interdental area, smelling saliva spit in small cup or spoon, and licking the wrist, whereas professional diagnosis includes direct methods such as organoleptic method, gas chromatography, sulfide monitors, and electric nose and indirect methods such as bacterial culturing and smear and enzyme assays.[10]

Oral hygiene habits were assessed depending on the type of oral hygiene practices such as method of cleaning their teeth, frequency, and type of dentifrice used,[11] results of which showed that awareness regarding oral hygiene practices is more in dental students as compared to engineering students. also smoking habit is more common in engineering students as compared to dental students. The results of the present study are contradictory to the studies conducted by Almas et al.[4] and Sing et al.[5] In these mentioned studies, the authors have not compared dental and nondental students, so in the present study, an attempt was made to compare dental and nondental students, i.e., engineering students regarding self-perceived oral malodor, oral hygiene practices, and smoking habits.

In the present study, subjects were questioned about their self-perception for the presence or absence of oral malodor. In comparison, engineering students showed a higher prevalence rate of 66%, whereas dental students showed a lesser prevalence rate of 7%. These results were in concordance with a similar study done by Bandyopadhyay et al.[11] From the above results, it can be concluded that dental students were more aware than engineering students about their oral malodor highlighting the role of oral hygiene maintenance.

Smoking and tobacco chewings are an important extrinsic etiology for oral malodor as described by Almas et al.[4] and Eldarrat et al.[6] Furthermore, smoking reduces olfactory sensitivity, thus impairing individual's ability for self-perception of halitosis.[10] Since the study was conducted among a young age group of individuals in the district of Dhule, the relation between oral hygiene practices, smoking, and self-perception could be significantly established.

Another causative factor for oral malodor is dryness of the mouth (xerostomia). This is due to a lack of salivary flow and leads to an increase in the amount of plaque accumulation, Gram-positive and Gram-negative microorganisms, and the VSCs.[9],[10],[12] In the present study, out of the total students, 60% of engineering students and 16% of dental students felt the dryness of mouth after they were questioned and asked to perform hand over technique. It is similar to the findings of the study conducted by Panicker et al.[8] and Nazir et al.[12] which stated that there is a significant relationship between oral malodor and dryness of mouth and smoking. Thus, it can be concluded that there is a positive correlation between bad breath and dry mouth because they usually share the same microbes. This also suggests a positive correlation between the depth of the periodontal pockets and concentrations of VSC in the mouth.[5],[6]

So for controlling the same, literature has suggested various treatment modalities, which include patient's education for the prevention and reduction of plaque accumulation. These can be achieved by proper demonstration of brushing technique, flossing, and cleaning or scraping the tongue, particularly in people with poor oral hygiene and related gingival and periodontal disease. Apart from all these treatment options, all the subjects were provided with mouthwashes such as chlorhexidine (CHX), cetylpyridinium chloride with a combination of CHX and zinc lactate, triclosan, and amine fluoride. These agents can be used as sprays containing antimicrobial agents, mint tablets, or chewing gums containing xylitol which help to reduce VSCs.[10]

The present study has its own limitations. The present study was limited to Dhule city only, and data were collected without giving any educational program before or after. This study was limited by the survey design being self-reported behaviors which may have led to overreporting of oral hygiene practices. The psychological and socioeconomic factors were not taken into consideration. Moreover, a small sample size of 435 students may limit the generalizability of data.


  Conclusion Top


The knowledge among the young population regarding oral malodor and oral hygiene habits is inadequate. Furthermore, students are unaware of the different etiological factors for halitosis and end up thinking that it is because of a dental origin.

The results of the present study showed more awareness among dental students regarding oral hygiene practices compare to engineering students; moreover, the habit of smoking and oral malodor problems were more evident in engineering students.

Recommendations

It is important to investigate the importance of oral hygiene maintenance at a young age. Dental camps and regular checkups should be carried out to spread awareness about halitosis and oral hygiene habits. Smokers should be encouraged to refrain from smoking, suggesting good oral hygiene maintenance. Further studies can be recommended with proper investigation using the standard clinical methods available to assess the bad breath problem.

Acknowledgment

The authors would like to thank Dr. Mahesh Khairnar, Biostatistician, Department of Public Health Dentistry, BVDU Dental College and Hospital, Sangli, Maharashtra, for helping them with the statistical analysis.


  Clinical significance Top


The present study highlighted that there is lack of knowledge among young individuals regarding the ill effects of smoking which may lead to fatal diseases.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Kasila K, Poskiparta M, Kettunen T, Pietilä I. Oral health counselling in changing schoolchildren's oral hygiene habits: A qualitative study. Community Dent Oral Epidemiol 2006;34:419-28.  Back to cited text no. 1
    
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AlSadhan SA. Self-perceived halitosis and related factors among adults residing in Riyadh, Saudi Arabia. A cross sectional study. Saudi Dent J 2016;28:118-23.  Back to cited text no. 2
    
3.
World Health Organization. WHO Global Report on Trends in Tobacco Smoking 2000-2025. Available from: http://www.who.int/tobacco/publications/ surveillance/reportontrendstobaccosmoking/en/. [Last accessed on 2016 Sep 12].  Back to cited text no. 3
    
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Almas K, Al-Hawish A, Al-Khamis W. Oral hygiene practices, smoking habit, and self-perceived oral malodor among dental students. J Contemp Dent Pract 2003;4:77-90.  Back to cited text no. 4
    
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Sing A, Raja S, Mandalay A, Pitale U. Self perceived oral malodor and oral hygiene practices among undergraduate dental students. NJDSR 2016;1:64-7.  Back to cited text no. 5
    
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Eldarrat A, Alkhabuli J, Malik A. The prevalence of self-reported halitosis and oral hygiene practices among Libyan students and office workers. Libyan J Med 2008;3:170-6.  Back to cited text no. 6
    
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Mehta SP, Bapatla S, Pathak T, Verma J, Thakkar V, Iyer J. Self-perceived halitosis amongst school, junior college and dental college students in Navi Mumbai Region-'a kap survey'. J Dent Treat Oral Care 2017;2:101.  Back to cited text no. 7
    
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Panicker K, Devi R, Honibald EN, Prasad AK. Oral malodor: A review. J Indian Acad Dent Spec Res 2015;2:49-54.  Back to cited text no. 8
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Penmetsa GS, Singh S, Gadde P, Teja RG, Bhaskar UR. Periodontal health awareness and self-perceived halitosis among various professional students of West Godavari District of Andhra Pradesh. J Indian Assoc Public Health Dent 2017;15:378-82.  Back to cited text no. 9
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Porter SR, Scully C. Oral malodour (halitosis). BMJ 2006;333:632-5.  Back to cited text no. 10
    
11.
Bandyopadhyay A, Bhuyan L, Panda A, Dash KC, Raghuvanshi M, Behura SS. Assessment of oral hygiene knowledge, practices, and concepts of tobacco usage among engineering students in Bhubaneswar, Odisha, India. J Contemp Dent Pract 2017;18:423-8.  Back to cited text no. 11
    
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Nazir MA, Almas K, Majeed MI. The prevalence of halitosis (oral malodor) and associated factors among dental students and interns, Lahore, Pakistan. Eur J Dent 2017;11:480-5.  Back to cited text no. 12
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