981 D3000 new imprint Word template


 

Vol 13, No 1 (2025) 
ISSN 2167-8677 (online) 

DOI 10.5195/d3000.2025.981  

 

	

	

http://dentistry3000.pitt.edu	

Impact of Smoking on Halitosis and Oral Bacterial Infections 
 
Doaa Raad Alghaffari1, Mays Wael Sulaiman Al Alousi2, Raya Alani3, Dina Ahmed Mahdi4  
 
1Boston Univers,y School of Public Health, Boston, USA 
2Private Prac,ce, Zionsville, Indiana, USA 
3Private Prac,ce, Boynton Beach, Florida, USA 
4College of Den,stry, Albayan University, Baghdad, Iraq 

Abstract 

Objec<ve: The present study sought to invesHgate the frequency of halitosis in a sample of 
smokers and non-smokers and the associaHon of smoking and perceived oral bacterial infec-
Hons. Material and Methods: A quesHonnaire was administered to 301 respondents. The 
structured quesHonnaire included demographics, oral hygiene behaviors, medical and dental 
history, lifestyle behaviors, awareness of halitosis and its social consequences in others. Sta-
HsHcal analyses were performed with chi-square tests to idenHfy any associaHons of halitosis 
and possible risk factors. Results: Among respondents, 22.9% self-reported using tobacco 
products while 63.4% self-reported experiencing halitosis someHmes or frequently. Smoking, 
periodontal disease, dental caries, poor clinical hygiene (not brushing, not flossing or using 
mouthwash) and some systemic diseases were related to self-reporHng halitosis (P < 0.01). 
Only 9.6% of respondents accessed treatment. Most respondents (86%) realized their halito-
sis themselves rather than it being diagnosed professionally. Conclusion: This study provides 

insight into the relaHonship between 
smoking and self-reported halitosis and 
the need for greater awareness and tai-
lored public health iniHaHves.  

Open Access 
Cita%on: Alghaffari DR, et al. (2025) Impact of Smoking 
on Halitosis and Oral Bacterial Infec%ons. Den%stry 
3000. 1:a001 doi:10.5195/d3000.2025.981 
Received: July 5, 2025  
Accepted: July 6, 2025 
Published: August 21, 2025 
Copyright: ©2025 Alghaffari DR, et al. This is an open ac-
cess ar%cle licensed under a Crea%ve Commons AUribu-
%on Work 4.0 United States License. 
Email: duaaraad@bu.edu

	

Introduc)on 
Halitosis,	also	known	as	bad	breath,	is	a	com-
mon	problem	for	many	people	all	around	the	
world.	It	can	result	from	many	local	or	sys-
temic	factors	–	almost	90%	of	halitosis	cases	
are	due	to	oral	factors.	Among	these	oral	rea-
sons,	oral	malodor	comes	from	an	imbalance	
in	the	oral	ecosystem,	so	that	microbial	deg-
radation	of	 food	debris,	 epithelial	 cells	 and	
blood	products	 in	 the	mouth	 cause	volatile	
sulfur	 compounds	 (VSCs),	 including	 hydro-
gen	sulGide	and	methyl	mercaptan,	which	are	
the	principal	odor	components	of	oral	malo-
dor	[1].	
It	is	well	known	that	one	of	the	greatest	risk	
factors	 for	halitosis	 is	 smoking,	due	among	
other	 factors	to	multiple	effects	on	the	oral	
ecosystem.	 For	 example,	 smoking	 worsens	
plaque	 accumulations,	 decreases	 salivary	
Glow,	 changes	 the	 oral	 Glora,	 and	 increases	

pathogenic	 anaerobic	 bacteria	 producing	
VSCs	 [2].	 Additionally,	 smokers	 are	 more	
likely	to	have	periodontal	diseases	and	den-
tal	caries,	both	of	which	are	strongly	related	
to	halitosis	and	bacterial	overgrowth	[3].	
Aside	from	its	physiological	effects,	halitosis	
has	psychosocial	outcomes,	 such	as	embar-
rassment,	poor	self-esteem,	and	social	isola-
tion	 among	 individuals	 when	 they	 do	 not	
know	they	have	it	or	want	to	treat	it	[4].	
Several	studies	have	examined	the	relation-
ship	between	smoking	and	oral	ailment,	but	
focused	 investigations	 that	assess	 the	 com-
bined	effect	of	smoking	on	halitosis	and	oral	
bacterial	infections	in	a	population-based	re-
search	design	are	still	necessary.	The	survey-
based	studies	provide	an	insight	into	the	re-
spondents'	personal	habits	and	hygiene	be-
havior,	as	well	as	their	perceptions	of	them-
selves	regarding	oral	health.	

Consequently,	this	study,	sought	to	establish	
the	prevalence	of	halitosis	 and	 its	 relation-
ship	with	the	infection	caused	from	oral	bac-
teria	in	smokers.	The	outcomes	of	this	study	
should	 help	 establish	 the	 behavioral	 and	
clinical	aspects	of	both	problems	of	halitosis	
and	 support	 the	 development	 of	 public	
health	strategies	to	address	the	overall	oral	
health	issue	of	smokers	[5].	
	
Materials and Methods 
The	study	included	301	participants	from	all	
age	groups,	backgrounds	and	 levels	of	edu-
cation.	Participants	provided	the	study	with	
social	 diversity	 through	 convenience	 sam-
pling.	 Also,	 participants	 under	 10	 years	 of	
age	were	excluded,	as	well	as	individuals	un-
willing	 to	 participate.	 Initially,	 participants	
completed	verbal	informed	consent	from	the	



  Impact of Smoking on Halitosis and Oral Bacterial InfecHons 

Vol 13, No 1 (2025)    DOI 10.5195/d3000.2025.981 

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2	

study	 crew.	 The	 study	 consisted	 of	 a	 fully	
voluntary	written	questionnaire.	
The	 questionnaire	 had	 both	 closed-ended	
and	 multiple-choice	 questions.	 The	 ques-
tionnaire	 asked	 basic	 participant	 demo-
graphical	 information	 and	was	 constructed	
in	5	areas	of	interest:	
•	 Demographical	 Information:	 age,	
gender,	 and	 highest	 educational	 level	 com-
pleted.	
•	 Dental	 Hygiene	 Practices:	 fre-
quency	of	brushing	teeth,	use	of	mouthwash,	
tongue	 cleaning,	 Glossing,	 brushing	 tech-
nique,	and	how	the	participant	brushes.	
•	 Dental	and	Health	History:	history	
of	 periodontal	 disease/periodontal	 disease,	
history	of	decay,	malocclusion	of	teeth,	and	
systemic	diseases.	
•	 Lifestyle:	 history	 of	 smoking	
(length	of	time	and	quantity	of	smoking),	his-
tory	of	using	vape	products,	consumption	of	
alcohol,	and	food	choices.	
•	 Halitosis:	participant	self-reported	
frequency	 of	 halitosis,	 indication	 of	 when	
participants	 report	 awareness	 of	 halitosis	
awareness,	 treatment	 history,	 and	 psycho-
logical	 or	 social	 problems	 associated	 with	
halitosis.	
In-person	 administration	 of	 the	 question-
naire	was	utilized	with	the	researcher	clari-
fying	any	item	that	may	not	have	been	fully	
understood	 to	 adequately	 avoid	 any	misin-
terpretation	by	 the	participants.	Given	 that	
all	 responses	were	anonymous,	 the	partici-
pants	were	excited	 to	 reflect	 their	 thinking	
honestly	 and	 demonstrate	 their	 skills	 to	
their	peers.	
The	 data	 were	 statistically	 analyzed	 using	
IBM	SPSS	Statistics	(version	26),	(2019).	De-
scriptive	statistics	were	used	to	summarize	
frequencies	 and	 percentages.	 Chi-square	
tests	(χ²)	were	utilized	to	determine	the	as-
sociations	between	halitosis	and	other	cate-
gorical	variables	such	as	smoking	status,	oral	
hygiene	behaviors,	sickness	and	health	con-
ditions.	
The	statistical	significance	was	examined	at	
two	levels:	
•	 P	≤	0.05:	Statistically	significant	
•	 P	≤	0.01:	Highly	statistically	signifi-
cant	
•	 NS:	Not	Significance	(P	>	0.05)	
This	 analysis	 provided	 signiGicant	 associa-
tions	 between	 smoking	 and	 halitosis	 and	
other	oral	health	indicators.	

Results 
A	total	of	301	participants	were	included	in	
this	 study;	218	(72.4%)	were	male,	and	83	
(27.6%)	were	 female.	The	age	group	21-31	
years	had	the	highest	representation	of	par-
ticipants	 (56.8%),	 followed	 by	 the	 10-20	
years	group	(20.9%).	Most	participants	were	
educated	 at	 the	 university	 level	 (78.4%),	
with	 no	 participants	 having	 attained	 post-
graduate	education	(10.6%)	or	had	less	than	
high	school	education.	
	
Oral	Hygiene	Practices	
Most	 (94.4%)	 of	 the	 participants	 reported	
brushing	their	teeth,	with	46.2%	responding	
they	 brushed	 their	 teeth	 twice	 a	 day	 and	
14.3%	 brushing	 three	 or	 more	 times.	 Ap-
proximately	 32.2%	 of	 individuals	 used	
mouthwash,	 while	 52.8%	 cleaned	 their	
tongue.	Nonetheless,	a	considerable	number	
of	participants	 (67.8%)	did	not	use	mouth-
wash	 consistently.	With	 respect	 to	 the	 fre-
quency	of	visiting	the	dentist,	half	of	the	par-
ticipants	(51.5%)	visited	the	dentist	once	per	
year	 and	 just	 14.3%	 reported	 having	more	
than	three	visits	a	year.	
	
Smoking	and	Halitosis	
Of	 the	 participants,	 69	 (22.9%)	 reported	
smoking.	Most	of	them	had	been	smoking	for	
more	than	3	years	(10%);	6%	and	4.3%	re-
ported	 smoking	 for	 3	 and	 2	 years	 respec-
tively.	 A	 small	 number	 of	 participants	 re-
ported	 daily	 smoking	 of	 1-20	 cigarettes	
(9.3%),	and	12.6%	reported	vaping.		
Self-reported	halitosis	was	prevalent:	
•	 59.1%	said	they	sometimes	had	it,	
•	 4.3%	often	had	it,	
•	 and	 36.5%	 said	 they	 rarely	 or	
never	had	it.	
Just	 3%	 admitted	 to	 suffering	 from	 bad	
breath	 and	 12%	 said	 they	 had	 bad	 breath	
sometimes.	In	fact,	86%	of	the	respondents	
said	 they	 realized	 they	 had	 bad	 breath	 by	
having	self-realization	and	only	10.3%	were	
notiGied	of	having	bad	breath.	
	
Oral	and	Systemic	Health	
•	 32.2%	 of	 respondents	 had	 perio-
dontal	disease,	
•	 62.1%	had	dental	caries,	
•	 35.9%	reported	malocclusion.	
•	 11.6%	 had	 systemic	 disease,	 with	
the	most	common	being	paranasal	sinus	con-
ditions	 (27.9%),	 allergies	 (12.6%)	 and	 res-
piratory	issues	(7%).	
There	was	a	significant	association	for	hali-
tosis	and	smoking	status	(P	<	0.0001),	dental	
caries	(P	<	0.0001),	and	periodontal	disease	
(P	<	0.0001).	Lifestyle	factors	including	not	
cleaning	the	tongue,	irregular	brushing	hab-
its	 and	 infrequent	 floss	 or	mouthwash	 use	
were	 also	 statistically	 associated	 with	 bad	
breath.		

	
Social	Impact	of	Halitosis	
Only	9.6%	of	participants	indicated	that	they	
had	 received	 any	 treatment	 for	 halitosis,	
with	17.3%	used	techniques	associated	with	
oral	hygiene	(like	cleaning	the	mouth).	Most	
(59.9%)	did	not	have	a	method	 for	dealing	
with	halitosis.	Some	social	effects	were	also	
related,	such	as	8%	indicated	they	had	social	
problems	due	to	bad	breath	and	40.9%	were	
concerned	about	how	others	perceived	their	
breath.		
	
Statistical	Summary	
Using	the	Chi-square	test,	statistically	signif-
icant	relationships	(P	≤	0.01)	were	found	be-
tween	halitosis	and	the	following	factors,	see	
table	1:	
•	 Smoking	Habits	
•	 Technique	 and	 frequency	of	 tooth	
brushing	
•	 Use	of	floss	and	rinses	
•	 Periodontal	and	dental	disease	
•	 Pattern	of	breathing	
•	 The	presence	of	systemic	illness	
		

Discussion 
The	results	of	this	study	shown	a	marked	as-
sociation	 between	 smoking	 and	 the	 preva-
lence	 of	 halitosis	 and	 oral	 microbial	 infec-
tions	for	the	participants	surveyed.	The	ma-
jority	 of	 participants	 reporting	 halitosis	
were	 smokers,	 indicating	 a	 strong	 connec-
tion	between	tobacco	use	and	the	presence	
of	oral	malodor.	This	agrees	with	other	stud-
ies	that	demonstrated	smoking	predisposes	
individuals	to	pathogenic	dental	plaque	and	
periodontal	 pathogens,	 and	 smoking	 is	
known	to	reduce	salivary	flow	[3,6].		
The	high	percentage	of	individuals	reporting	
occasional	 halitosis	 (59.1%)	 shows	 how	
common	 this	 condition	 is.	 However,	 the	
much	lower	percentage	of	individuals	seek-
ing	care	for	this	condition	(9.6%)	speaks	to	
the	public's	lack	of	awareness.	Halitosis	is	a	
socially	sensitive,	stigmatizing	condition,	in-
cluding	 data	 from	 this	 study	 that	 indicated	
that	most	participants	(86%)	reported	notic-
ing	 their	 own	 halitosis	 and	 did	 not	 have	 a	
medical	professional	document	their	appar-
ent	halitosis	[1].	This	may	delay	or	ignore	ap-
propriate	management.	
Poor	 oral	 hygiene	 practices	 were	 signifi-
cantly	related	to	halitosis	and	are	consistent	
with	previous	 literature.	 Irregular	brushing	
habits,	no	flossing	habits,	and	limited	use	of	
mouthwash	and	tongue	cleaning	had	statisti-
cally	 significant	 associations	 with	 bad	
breath.	These	behaviors	provide	areas	for	re-
tention	of	 food	debris	 and	bacterial	 plaque	
and	are	compounded	 in	smokers	who	have	
an	already	altered	oral	microbiome	[2].	The	
amount	 of	 mouthwash	 use	 (32.2%)	 is	



  Impact of Smoking on Halitosis and Oral Bacterial InfecHons 

Vol 13, No 1 (2025)    DOI 10.5195/d3000.2025.981 

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important	because	it	is	known	to	reduce	an-
aerobic	 bacteria	 loads	 and	 VSCs	 when	 uti-
lized	regularly	[7]	and	highlights	the	need	for	
educating	the	population	on	the	importance	
of	preventive	care.		
This	study	also	confirmed	the	strong	associ-
ation	of	halitosis	and	oral	diseases,	especially	
periodontal	disease	(32.2%)	and	dental	car-
ies	 (62.1%).	These	 two	diseases	have	been	
established	in	previous	literature	to	promote	
oral	malodor	due	to	 the	colonization	of	an-
aerobic	bacteria	in	periodontal	pockets	and	
carious	 lesions	 [8].	 Furthermore,	 systemic	
illnesses	such	as	rhinosinusitis,	allergies,	and	
respiratory	 diseases	 also	 showed	 significa-
tion	 correlation	with	halitosis	 and	 lends	 it-
self	to	some	consideration	of	the	notion	that	
it	 should	 be	 recognized	 that	 extraoral	
sources	must	be	determined	as	part	of	diag-
nosis	and	treatment	[4].	
The	 psychosocial	 burden	 of	 halitosis	 was	
evident	 with	 40.9%	 of	 respondents	
concerned	with	how	others	perceived	their	
breath	 and	 8%	 of	 participants	 reported	
social	problems.	These	findings	corroborate	
previous	 research	 demonstrating	 a	
psychological	 burden	 related	 to	 halitosis	
including	embarrassment,	social	anxiety	and	
reduction	 in	 self-esteem	 [9].	 The	 gap	
between	 symptom	 perception	 and	 action	
supports	the	need	for	public	health	materials	
around	 halitosis,	 as	 well	 as	 provide	 some	
access	 to	 dental	 services.	 Overall,	 our	
findings	highlight	the	multifactorial	etiology	
of	halitosis,	where	smoking	is	an	important	
modifiable	 risk	 factor.	 Addressing	 smoking	
cessation	 while	 supporting	 oral	 hygiene	
practices	 and	 regular	 visits	 to	 the	 dentist,	
may	 lessen	 the	 burden	 of	 halitosis	 and	
infections.	
 
Conclusions 
This	 study	 showed	 a	 strong	 relationship	
between	 tobacco	 use	 and	 the	 incidence	 of	
halitosis	and	oral	bacterial	disease.	Smokers	
were	more	likely	to	report	symptoms	of	bad	
breath,	 and	 had	 higher	 prevalence	 of	
periodontal	disease	 and	dental	 caries,	 both	
of	 which	 are	 major	 contributors	 to	 oral	
malodor.	 Inadequate	 oral	 hygiene	 such	 as	
sporadic	 brushing	 habits,	 lack	 of	 tongue	
cleaning,	and	less	 frequent	mouthwash	and	
flossing	habits	were	also	strongly	associated	
with	halitosis.	
These	results	suggest	that	halitosis	is	not	just	

a	social	or	aesthetic	issue;	it	may	be	a	clinical	
reflection	 of	 serious	 oral	 health	 issues,	
especially	 when	 observed	 in	 an	 individual	
with	 poor	 hygiene	 behaviors	 or	 tobacco	
habits.	 Finally,	 the	 observed	 low	 levels	 of	
treatment-seeking	 behavior	 and	 awareness	
of	 halitosis,	 highlights	 the	 need	 for	 more	
public	education	and	the	need	for	preventive	
strategies.	
In	conclusion,	halitosis	can	be	limited	by	ad-
dressing	 risk	 factors	 that	 are	 potentially	
modiGiable	(e.g.	tobacco	habits,	oral	hygiene	
practices),	 and	 implementing	 better	 access	
to	dental	care,	and/or	awareness	programs	
will	potentially	reduce	the	burden	of	halito-
sis	or	related	oral	bacterial	infections	among	
non-clinical	populations. 

References 
1.Porter,	 S.	 R.,	 &	 Scully,	 C.	 (2006).	 Oral	malodor	
(halitosis).	 BMJ,	 333(7569),	 632–635.	
https://doi.org/10.1136/bmj.38954.631968.AE	
2.Lee,	S.	S.,	Zhang,	W.,	&	Li,	Y.	(2007).	The	antimi-
crobial	potential	of	14	natural	herbal	dentifrices:	
A	 comparative	 study	 using	 an	 in	 vitro	 biofilm	
model.	Journal	of	the	American	Dental	Association,	
138(3),	351–357.	
3.Aylıkcı,	B.	U.,	&	Çolak,	H.	(2013).	Halitosis:	From	
diagnosis	 to	management.	 Journal	of	Natural	Sci-
ence,	 Biology,	 and	 Medicine,	 4(1),	 14–23.	
https://doi.org/10.4103/0976-9668.107255	
4.Miyazaki,	 H.,	 Sakao,	 S.,	 Katoh,	 Y.,	 Takehara,	 T.	
(1995).	 Correlation	between	volatile	 sulfur	 com-
pounds	and	certain	oral	health	measurements	 in	
the	general	population.	Journal	of	Periodontology,	
66(8),	679–684.	
5.Alkhafaji,	 S.	 H.	 A.,	 Al-Sudani,	 S.	 F.	 K.,	 &	
Alsunbuli,	M.	M.	B.	(2025).	Smoking	and	the	
hidden	consequences:	Bad	breath	and	oral	
infection	 of	 bacteria.	 Microbial	 Biosystems,	
10(4),	[in	press].	
6.Scully,	 C.,	 &	 Greenman,	 J.	 (2012).	 Halitosis	
(breath	odor).	Periodontology	2000,	48(1),	66–75.	
https://doi.org/10.1111/j.1600-
0757.2008.00267.x	
7.Young,	A.,	Jonski,	G.,	&	Rölla,	G.	(2003).	A	study	of	
triclosan	 and	 zinc	 citrate	 as	 combined	 agents	 in	
mouthwash:	 the	 effect	 on	 volatile	 sulfur	 com-
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8.Rosenberg,	 M.,	 &	 McCulloch,	 C.	 A.	 G.	 (1992).	
Measurement	 of	 oral	 malodor:	 current	 methods	
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9.Kumar,	 S.,	 Tadakamadla,	 J.,	 &	 Johnson,	 N.	 W.	
(2016).	Effect	of	self-perceived	halitosis	on	social	
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Rehabilitation,	 43(10),	 875–883.	
https://doi.org/10.1111/joor.12438	

	
	
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

	
	
	
	
	
	
	



  Impact of Smoking on Halitosis and Oral Bacterial InfecHons 

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Table	1.	Associations	between	halitosis	and	the	different	factors.	
	
Questionnaire	

Number	 of	 respond-
ents	

Percentage	(%)	 χ2	(P-value)	

Gender 	 	

Males	 218	 72.4%	 60.548	**	
(0.0001)	

Females	 83	 27.6%	

Total		 301	 100%	 --	

Age	 	

10-20	 63	 20.9%	 	
	
72.605	**	
(0.0001)	21-31	 171	 56.8%	

32-43	 47	 15.6%	

44-55	 14	 4.7%	

56-66	 5	 1.7%	

More	than	66	 1	 0.3%	

Total	 301	 100%	 --	

Education	level	 	

Primary	School	 8	 2.7%	 	
648.11	**	
(0.0001)		

Junior	high	school	 8	 2.7%	

High	School	 17	 5.6%	

University	 236	 78.4%	

Master	degree	 32	 10.6%	

Total		 301	 100%	 	

Frequency	of	dental	visit	per	year	 	

1	 155	 51.5%	 	
114.82	**	
(0.0001)	

2	 59	 19.6%	



  Impact of Smoking on Halitosis and Oral Bacterial InfecHons 

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3	 44	 14.6%	

3<	 43	 14.3%	

Total	 301	 100%	 	

Do	you	brush	your	teeth?	 	

Yes	 284	 94.4%	 236.84	**	
(0.0001)	

No	 17	 5.6%	

Total	 301	 100%	 	

Frequency	of	toothbrush	per	day	 	

1	 116	 38.5%	 	
159.26	**	
(0.0001)	

2	 139	 46.2%	

3	 43	 14.3%	

3<	 3	 1%	

Total	 301	 100%	 	

Do	you	use	mouthwash?	 	

Yes	 97	 32.2%	 38.04	**	
(0.0001)	

No	 204	 67.8%	

Total	 301	 100%	 	

Tongue	cleaning	 	

Yes	 159	 52.8%	 0.960	NS	
(0.3272)	

No	 142	 47.2%	

Total	 301	 100%	 	

Suffering	from	halitosis	 	

Never/rarely	 110	 36.5%	 	
122.87	**	



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Sometimes	 178	 59.1%	 (0.0001)	

Frequently	 13	 4.3%	

Total	 301	 100%	 	

Frequency	of	tooth	brushing	 	

After	every	meal	 41	 13.6%	 	
107.67	**	
(0.0001)	

Twice/day	 136	 45.2%	

Once/day	 100	 33.2%	

Some	times	 24	 8%	

Total	 301	 100%	 	

Timing	of	tooth	brushing	 	

Before	bed	 55	 18.3%	 	
86.920	**	
(0.0001)	

Morning	 46	 15.2%	

Morning	and	before	bed	 145	 48.2%	

No	Gixed	time	 55	 18.3%	

Total	 301	 100%	 	

Way	of	tooth	brushing	 	

Vertical	stroke	 63	 20.9%	 	
11.758	**	
(0.0083)	

Horizontal	stroke	 61	 20.3%	

Semi-circular	 79	 26.2%	

Gum	to	incisal	edge	 98	 32.6%	

Total	 301	 100%	 	

Carbohydrate	foods	 	

Yes	 240	 79.7%	 106.44	**	
(0.0001)	



  Impact of Smoking on Halitosis and Oral Bacterial InfecHons 

Vol 13, No 1 (2025)    DOI 10.5195/d3000.2025.981 

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7	

No	 61	 20.3%	

Total	 301	 100%	 	

Breathing	Pattern	 	

Through	the	mouth	 29	 9.6%	 	
78.160	**	
(0.0001)	

Through	the	nose	 144	 47.8%	

Both	 128	 42.5%	

Total	 301	 100%	 	

Smoking	history	 	

Yes	 69	 22.9%	 157.89	**	
(0.0001)	

No	 232	 77.1%	

Total	 301	 100%	 	

Systemic	disease	 	

No	 266	 88.4%	 177.28	**	
(0.0001)	

Yes	 35	 11.6%	

Total	 301	 100%	 	

Periodontal	disease	 	

Yes	 97	 32.2%	 38.036	**	
(0.0001)	

No	 204	 67.8%	

Total	 301	 100%	 	

Dental	caries	 	

Yes	 187	 62.1%	 17.704	**	
(0.0001)	

No	 114	 37.9%	

Total	 301	 100%	 	



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Vol 13, No 1 (2025)    DOI 10.5195/d3000.2025.981 

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Malocclusion	 	

Yes	 108	 35.9%	 24.003	**	
(0.0001)	

No	 193	 64.1%	

Total	 301	 100%	 	

Medical	history	regarding	diseases	of	the	blood,	heart,	respiratory	system,	intestines,	liver,	kid-
neys,	and	known	allergies	

	

Heart	diseases	 21	 7%	 	
	
52.702	**	
(0.0001)	Respiratory	diseases	 21	 7%	

Liver	diseases	 12	 4%	

Renal	diseases	 18	 5.9%	

allergies	 38	 12.6%	

paranasal	sinuses	 84	 27.9%	

Other	than	that	 61	 20.3%	

Don’t	have	any	diseases	 46	 15.3%	

Total	 301	 100%	 	

a	history	of	diabetes	was	recorded	 	

Yes	 13	 4.3%	 251.24	**	
(0.0001)	

No	 288	 95.7%	

Total	 301	 100%	 	

Do	you	use	Sloss	 	

Yes	 53	 17.6%	 	
37.266	**	
(0.0001)	

Sometimes	 137	 45.5%	

Never	 111	 36.9%	

Total	 301	 100%	 	



  Impact of Smoking on Halitosis and Oral Bacterial InfecHons 

Vol 13, No 1 (2025)    DOI 10.5195/d3000.2025.981 

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Do	you	use	any	mouth	rinses	 	

Yes	 58	 19.3%	 	
33.948	**	
(0.0001)	

sometimes	 103	 34.2%	

Never	 140	 46.5%	

Total	 301	 100%	 	

Consumption	of	alcoholic	beverages	 	

Never	 272	 90.4%	 	
690.61	**	
(0.0001)	

Rarely	 25	 8.3%	

Dilly	 3	 1%	

Several	times	per	day	 1	 0.3%	

Total	 301	 100%	 	

Smoking:	The	exact	number	of	cigarettes	smoked	daily	 	

1-20	 28	 9.3%	 	
	
163.85	**	
(0.0001)	20-40	 4	 1.3%	

40-60	 2	 0.7%	

Never	 229	 76.1%	

Vape	 38	 12.6%	

Total	 301	 100%	 	

How	long	have	you	been	smoking?	 	

1	Year	 9	 3%	 	
	
207.44	**	
(0.0001)	2	Year	 13	 4.3%	

3	Year	 18	 6%	

More	than	3	Year	 30	 10%	



  Impact of Smoking on Halitosis and Oral Bacterial InfecHons 

Vol 13, No 1 (2025)    DOI 10.5195/d3000.2025.981 

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Never	 231	 76.7%	

Total	 301	 100%	 	

Do	you	suffer	from	bad	breath	odor	?	 	

Yes	 9	 3%	 369.63	**	
(0.0001)	

Sometimes	 36	 12%	

Never	 256	 85%	

Total	 301	 100%	 	

How	did	you	know	that	you	suffer	from	bad	breath	odor	 	

Someone	told	me	 31	 10.3%	 	
	
218.91	**	
(0.0001)	People	act	funnily	around	me	 0	 0%	

I	just	know	 259	 86%	

My	dentist	 11	 3.7%	

Total	 301	 100%	 	

Have	you	had	any	treatments	for	bad	breath	odor	 	

Yes	 29	 9.6%	 196.17	**	
(0.0001)	

No	 272	 90.4%	

Total	 301	 100%	 	

If	you	got	it	treated,	what	measurement	did	you	use	 	

Drugs	 9	 2.9%	 	
	
328.74	**	
(0.0001)	Don’t	Suffering	from	halitosis	 10	 3.3%	

Cleaning	mouth	 52	 17.3%	

Don’t	use	any	things	 180	 59.9%	

Other	than	that	 50	 16.6%	



  Impact of Smoking on Halitosis and Oral Bacterial InfecHons 

Vol 13, No 1 (2025)    DOI 10.5195/d3000.2025.981 

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Total	 301	 100%	 	

Do	you	have	any	social	problems	because	of	your	bad	breath	odor	 	

Yes	 24	 8%	 212.65	**	
(0.0001)	

No	 277	 92%	

Total	 301	 100%	 	

Are	you	concerned	about	other	people's	behavior	toward	yourself	on	account	of	your	breath	odor	 	

Yes	 123	 40.9%	 10.049	**	
(0.0015)	

No	 178	 59.1%	

Total	 301	 100%	 	

*	(P≤0.05),	**	(P≤0.01),	NS:	Non-SigniGicant.		

	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	



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Figure	1.	The	bar	graph	illustrates	the	inhibition	zones	(mm)	for	Staphylococcus	aureus	isolates	at	three-time	intervals	(T0	(A),	T1	(B),	T2	
(C)),	when	exposed	to	six	different	antibiotics:	Amoxicillin,	Vancomycin,	Ampicillin,	Erythromycin,	Azithromycin,	and	Clindamycin.		Statistical	
comparisons	between	groups	are	indicated	with	asterisks	(*	for	p	<	0.05,	**	for	p	<	0.01,	***	for	p	<	0.001)	and	"ns"	for	non-signiGicant	differ-
ences.		



  Impact of Smoking on Halitosis and Oral Bacterial InfecHons 

Vol 13, No 1 (2025)    DOI 10.5195/d3000.2025.981 

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Figure	2.	The	bar	graph	illustrates	the	inhibition	zones	(mm)	for	Candida	albicans	isolates	at	three-time	intervals	(T0	(A),	T1	(B),	T2	(C)),	when	
exposed	to	six	antifungal	agents:		Clotrimazole,	Fluconazole,	Nystatin,	5-Flucytosine,	Caspofungin,	and	Amphotericin	B.	Statistical	com-
parisons	between	groups	are	annotated	with	***	for	p	<	0.001	and	“ns”	for	non-signiGicant	differences.