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Copyright  © 2024 The  Author(s): This is an open-access article distributed under the terms of the CC BY-NC 4.0 
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Knowledge, Self-Perception, Attitude of Halitosis Among Students in 
Chengalpet: A Questionnaire Study 

Naveena Srinivasam * , Nethra Devi ,  Nandhitha Ravichandran , Nithya Sree Thurkkaram , Pavithra 
Rajamurthi , Dr. Lakshmiganthan , Dr. Aneez  

Karpaga Vinayaga Institute of Dental Sciences, Padalam, Tamil Nadu 603308, India 

Article Info: 
_____________________________________________ 
Article History: 

Received   11 December 2023     
Reviewed  04 January 2024 
Accepted   16 January 2024 
Published 15 March 2024 

_____________________________________________ 
Cite this article as:  

Srinivasam N, Devi N, Ravichandran N, Thurkkaram 
NS, Rajamurthi P, Lakshmiganthan, Aneez, 
Knowledge, Self-Perception, Attitude of Halitosis 
Among Students in Chengalpet: A Questionnaire 
Study, Asian Journal of Dental and Health Sciences. 
2024; 4(1):4-8 

DOI: http://dx.doi.org/10.22270/ajdhs.v4i1.66 

_____________________________________________ 

*Address for Correspondence:   

Naveena Srinivasam, Karpaga Vinayaga Institute of 
Dental Sciences, Padalam, Tamil Nadu 603308, 
India          

Abstract 
_________________________________________________________________________________________________________________ 

Aim: To measure self-perception, knowledge, and awareness of halitosis among students studying 
in Karpaga Vinayaga educational groups 

Materials and Methods: In this study, total of 240 participants who are students of Karpaga 
Vinayaga educational group were recruited. A questionnaire was created online using Google 
Forms, and the link was sent to the participants through different social media platforms such as 
WhatsApp and Emails. Their responses were recorded. 

Result: A widespread issue that affects people all over the world, halitosis or bad breath, has social 
and psychological as well as medical repercussions. There is ample evidence that halitosis is 
common everywhere in the world. Our study found that the self-perception of poor breath is 
significantly influenced by age. Most of the respondents in our study did not report to dentist for 
having bad breath. Instead, they tried to solve by using chewing gums, mouth wash and sweets. This 
gave us the conclusion that they lack knowledge about the cause and management plan. 

Conclusion: Oral malodour is generally poorly understood in all of its facets. Therefore, it is 
important to promote increased public awareness and education. To lessen this issue, regular visits 
to dentists and other healthcare providers should be promoted. It should be stressed that dentists 
have a responsibility to educate and advise their patients about oral malodour, and dental students 
should receive enough training in handling this problem by organising dental camps, lectures 
should be provided to students so as to improve knowledge about halitosis14 

Keywords: Halitosis, Awareness, Self-perception, Bad breath, Oral Malodor 

 

INTRODUCTION: 

Halitosis is a broad word for an unpleasant smell in the mouth 
that is difficult to remove as a result of poor oral hygiene. 
Halitosis comes from the Latin word “halitus” meaning breath 
and the Greek word “osis” which means abnormal or disease. 
Bad odour from inhaling is known as halitosis. the offensive 
smell brought on by the emission of volatile sulphur 
compounds (VSCs) as a result of gram-negative bacteria's 
activity during decay1. There are three different types of 
halitosis: true halitosis, pseudo halitosis, and halitophobia2. 
Although the exact source of halitosis is still unknown, food 
scraps left in the mouth are the most common cause. 

Halitosis is a problem that has an impact on social, medical, and 
psychological facets of life. The extra-oral factors can include 
breathing issues, digestive tract issues, sinus issues, diabetes, 
renal issues, and sometimes drug reactions3. 

Foods with onion, garlic, pepper, smoking, drinking alcohol, and 
morning bad breath are all temporary causes of odour. 

Bad breath, if present, often results in decreased self-esteem 
and avoidance behaviours, especially in social settings.4 Certain 
substances are widely used by the general public to reduce or 
eliminate odours, such as toothpaste, mouthwash, chewing 
gum, floss, etc 

Most of the time, a person with bad breath doesn’t even know 
they have bad breath because they are not aware of it. 
Improving oral hygiene practices has been shown to decrease 
bad breath and improve self-esteem and confidence.5 The lack 
of self-awareness about halitosis results in carelessness to treat 
it. 

This study is conducted to assess the knowledge, awareness, 
self-perception and cause of halitosis 

MATERIALS AND METHODS 

In this study, total of 240 participants who are students of 
Karpaga Vinayaga educational group were recruited. The 
duration of data collection was one month. 

A questionnaire was created online using Google Forms, and 
the link was sent to the participants through different social 
media platforms such as WhatsApp and Emails. Their 
responses were recorded. 

A questionnaire that was created based on another study was 
modified to take the goals of the current study into account. 

Our study's main focus was on the knowledge, self-perception, 
and attitude toward halitosis among students studying in 
Karpaga Vinayaga educational group utilizing validated 
instruments. Secondarily, demographic factors such as age, 
gender, and educational attainment were evaluated. 

                     Open Access                                                                                                                                                                                                       Research Article                                                                           

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Srinivasam et al                                                                                                                               Asian Journal of Dental and Health Sciences. 2024; 4(1):4-8 

[5]                                                                                                                                                                                                                                              AJDHS.COM 

The survey comprised two parts: 1) demographic inquiries and 
2) in-depth questions examining the participants' self-
perception of halitosis and their understanding of the causes 
and remedies for oral malodour and their attitude towards 
halitosis. 

The questionnaire included questions about their oral health, 
oral hygiene practices underlying medical conditions, personal 
habits (smoking and alcohol consumption), whether or not the 
person believes they have bad breath, how long they have been 
aware of it, where they first noticed it, steps to minimize it, 
dental procedures and the existence of dry mouth. 

Students who are studying MBBS, Engineering, Nursing and 
other paramedical courses in Karpaga Vinayaga educational 
groups were included in this study. Dental Students of Karpaga 
Vinayaga educational groups were excluded in this study. The 
data collected from the respondents via the completed 
questionnaires was kept private and anonymous. 

RESULT: 

This study is the first questionnaire study done among medical, 
engineering, nursing, paramedical students in Karpaga 
Vinayaga institution, Chengalpet regarding self-perception, 
knowledge and attitude of halitosis among students in Karpaga 
Vinayaga educational group. In this study 240 students had 
participated in which 125 students were medical, 79 students 
were engineering ,12 students were nursing and 24 students 
were paramedical the mean age of students participating in the 
study was 22.5 years among them 69.2% were females and 
30.8% were males. The number of answers given for each 
question in the questionnaire was calculated and the 
percentage of correct answers for each question were 
calculated for the entire sample. In response to questions about 
halitosis, 15.8% said they have halitosis ,52.8% said they did 
not, 31.7% said they have while eating onion and garlic. 
Predominately 71.3% of participants have no coatings on 
tongue, 13.3% of participants have coatings in their tongue and 
15.4% of are not aware of coatings in their tongue. Majority of 
the participants don’t have any medical problems and 5.4% 
participants have medical problems. Among them 90.8% of 
participants are didn’t take any medications and 9.2% of 
participants are under medications. Of those with halitosis, the 
majority knew they had it from “days ago” (62.1%),19.6% for 
“month ago” and 18.3% for a “year ago” among them 78.3% of 
participants are not mouth breather, 8.8% are mouth breather 
and 12.9% of participants are not sure about mouth breathing. 
Of the participants, 30 % noticed they have bad breath and 70% 
said they don’t have bad breath. Among them 87.5% didn’t had 
an examination for bad breath and 12.5% of participants had 
an examination for bad breath. Majority of participants 78.8% 
don’t have bleeding gums and 21.3% of participants have 
bleeding gums. About 37.1% of participants selected 
mouthwash as a halitosis reducing measure.25.4% of 
participants selected nothing, 23.8% of participants selected 
chewing gums, 13.3% of participated selected they avoid 
certain foods to avoid halitosis. Regarding to personal habits 
88.8% of participants are non- smoker and 11.3% are smoker. 
88.8% of participants are non- alcoholic and 11.3% are 
alcoholic. Approximately 88.3% of the participants did not go 
to dentist for a checkup due to foul smell and 11.7% said they 
go to the dentist for halitosis. In terms of dental hygiene, 65.4% 
said improper brushing and diet is one of the causes for bad 
breath and 34.6% said that’s not the cause for halitosis. 
Majority of participants brush their teeth once a day around 
70.4% and 29.6% said that they brush their teeth twice a day. 
About tongue cleaner 55% of participants doesn’t use tongue 
cleaner and 45% of participants uses tongue cleaner. Regarding 
deposits in teeth 41.7% of participants don’t have deposits in 
teeth, 20.4% of participants have deposits in teeth and 37.9% 
of participants were not sure about deposits in teeth. Majority 

of participants don’t know they have halitosis or not (47.9%) 
,32.5% of participants answered that they just know they have 
bad breath,15% of participants said that someone told them 
they have halitosis and 4.5% of participants came to know 
through non-verbal communications of other people. 
Individuals reported with bad breath about 52.1% of 
participants felt uneasy whenever need to talk,45% of 
participants hesitate to talk to people,16.3% of participants 
don’t like to meet other people and 6.3% of participants said 
other people avoid them .77.5% of participants are not aware 
of tests used to detect halitosis and 22.5% of participants are 
aware of tests used to detect halitosis. Among 240 participants 
56.3% of people are not willing to go for treatment for halitosis 
and 43.8% of people are willing to go for treatment of halitosis 

DISCUSSION: 

A widespread issue that affects people all over the world, 
halitosis or bad breath, has social and psychological as well as 
medical repercussions. There is ample evidence that halitosis is 
common everywhere in the world.6 Our study found that the 
self-perception of poor breath is significantly influenced by age. 
Younger folks may be more conscious of their breath since they 
participate in more social events than older adults, which could 
be one explanation for this.7 However, our study found no 
evidence that education level was a significant factor in 
determining one’s poor breath. This is in contrast to earlier 
research that found poorer self-perception of halitosis is 
associated with lower levels of education.8 

Brushing the tooth at least twice a day has been the followed 
protocol to maintain keep the optimum oral hygiene. Majority 
reported brushing their teeth regularly, but many brushed only 
once that may cause halitosis. Even if oral hygiene is good yet 
they develop halitosis, then the cause will be the coated 
tongue.9 This may be the reason why students in this study with 
minimal tongue cleaner users reported bad breath. Most of the 
respondents in our study did not report to dentist for having 
bad breath. Instead, they tried to solve by using chewing gums, 
mouth wash and sweets.10This gave us the conclusion that they 
lack knowledge about the cause and management plan. 

Organoleptic score is the gold standard method of measuring 
halitosis. In this study the students participated have not 
undergone these methods, instead they evaluated. By their own 
and some came to know while they interacted with other 
people. 

Some systemic illnesses are known to cause bad breath which 
is a rare scenario in our study. Systemic conditions like 
Diabetes, tonsilitis, sinusitis, stomach problems cause 
halitosis.11 This correlation was found minimally in our study 
but some are affected with PCOD, wheezing and ulcer. 

Improper breathing like mouth breathing may lead to bad 
breath12 where 21 individuals were mouth breathers and 
suggested to be a cause of bad breath. Smoking was found 
among 27 participants in this study. In previous study, it was 
reported that individuals use smoking as management tool. 
Flossing has also been an auxiliary method to maintain oral 
hygiene along with brushing and using mouth wash.13 In our 
study we questioned about the use of mouthwash and most of 
them were using it regularly and occasionally.  

Diet also plays a role in the halitosis. In this study some of them 
mentioned they had bad breath while eating onion, garlic. One 
of this study’s strength is the usefulness of a validated tool. 
However, the study had limitations because the assessment of 
poor breath was done without a clinical examination and 
instead based on self-perceived data. Those students who said 
that they did not have halitosis, it is not clear that they did were 
free from it or because of that they were afraid to say confusion.



Srinivasam et al                                                                                                                               Asian Journal of Dental and Health Sciences. 2024; 4(1):4-8 

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Table 1: Demographic data of respondents (n=240) 

AGE n(%) 

17-19 years 20.1% 

20-22 years 57.2% 

23-25 years 20.4% 

26-28 years 2.3% 

GENDER  

Males 30.8% 

Females 69.2% 

COURSE  

MBBS 52.1% 

Engineering 32.9% 

Nursing 5% 

Paramedical 10% 

 

Table 2: Oral hygienic status 

   Frequency % 

How often do you brush your teeth?                                           

                                              ONCE  169 70.4% 

                                              TWICE 71 29.6% 

Do you use mouth wash?   

                                              YES 62 25.8% 

                                               NO 127 52.9% 

                              OCCASIONALLY 51 21.3% 

Do you use tongue cleaner?   

                                              YES 108 45% 

                                              NO 132 55% 

Do you have deposits on your teeth?   

                                              YES 49 20.4% 

                                               NO 100 41.7% 

                                              MAY BE 91 37.9% 

Are there any coating on your tongue?   

                                              YES 32 13.3% 

                                               NO 171 71.3% 

                                              MAY BE 37 15.4% 

Do you have bleeding gums?   

                                              YES 51 21.3% 

                                              NO 189 78.8% 

 

 

 

 

 

 



Srinivasam et al                                                                                                                               Asian Journal of Dental and Health Sciences. 2024; 4(1):4-8 

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Table 3: Perception and knowledge towards halitosis 

Do you have bad breath?                                  % 

                                             YES 38 15.8% 

                                              NO 126 52.5% 

Sometimes while eating onion, garlic 76 31.7% 

 How do you know do you have bad breath?                                            

                                          I don’t know 115 47.9% 

                                          I just know 78 32.5% 

                                  Someone told me 36 15% 

Nonverbal communication of other people 11 4.6% 

Do you think improper brushing and diet is one of the cause 
for bad breath? 

  

                                                   YES 157 65.4% 

                                                    NO 83 34.6% 

Did you consult any dentist because of your bad breath?   

                                                   YES 28 11.7% 

                                                    NO 212 88.3% 

Are you aware of the test used to detect bad breath?   

                                                   YES 54 22.5% 

                                                    NO 186 77.5% 

Are you willing to under go treatment for bad breath?   

                                                   YES 105 43.8% 

                                                    NO 135 56.3% 

 

CONCLUSION: 

The current study discovered that a very small percentage of 
participants self-reported having halitosis, a much higher 
proportion said that their stench bothered those around them. 
The majority of respondents said that instead of treating the 
underlying cause of foul breath, they would disguise it. Oral 
malodour is generally poorly understood in all of its facets. 
Therefore, it is important to promote increased public 
awareness and education. To lessen this issue, regular visits to 
dentists and other healthcare providers should be promoted. It 
should be stressed that dentists have a responsibility to educate 
and advise their patients about oral malodour, and dental 
students should receive enough training in handling this 
problem1by organising dental camps, lectures should be 
provided to students so as to improve knowledge about 
halitosis14. 

Financial support and sponsorship  

Nil 

Conflicts of interest 

There are no conflicts of interest 

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