Older adults are more susceptible to chronic oral health problems, including tooth decay, periodontal disease, and bad breath (halitosis). In a new study, researchers assessed the prevalence of halitosis and related factors among older adults.
Population aging will be a challenge for all health systems, including aspects related to oral health. One such factor is halitosis, which affects millions of people around the world. Although many oral hygiene products can mask it, these products do not fix the underlying problem.
“Halitosis is considered a serious health problem because it can lead to serious social consequences, causing personal discomfort and social embarrassment,” write the authors, led by Laura Barreto Moreno of the Federal University of Pelotas in Brazil.
The two main causes of halitosis are plaque on the tongue and periodontal disease. Previous studies have shown that patients with gingivitis or periodontitis are more likely to develop halitosis than patients with good periodontal health. In addition, age can affect a person's ability to perform proper oral hygiene, including removing plaque from the tongue.
The researchers assessed the prevalence of halitosis and associated factors among the elderly, which they reported themselves. Participants included persons over 60 years of age. Socio-demographic factors, presence of other health problems, medication use, smoking and alcohol exposure, access to dental care, frequency of toothbrush use, flossing use, number of teeth present, and need for dentures were taken into account.
About 570 participants were included in this study. Nearly 36% of participants self-reported bad breath, suggesting a high prevalence of the disease among older adults.
In total, 85% of the participants reported health problems and continued medication. There was no significant association between self-reported halitosis and these variables. However, some medications can cause decreased salivation, which is often associated with halitosis.
It is important to emphasize that halitosis in this study was measured using self-perception. And self-perception is now considered the true outcome, called the measurement of patient-reported outcomes.
Self-perception as the primary measurement is a potential limitation of this study, as self-perception may not reflect reality as measured clinically or by the perceptions of those who have a close relationship with that person. However, quality of life often deteriorates when a person becomes aware of this problem, and the validity of this study is significant.
Factors causing halitosis
Many factors may be associated with bad breath in older adults, including oral health, other health problems, medication use, high salivary flow (hyposalivation), and sociodemographic and behavioral factors. It can be hypothesized that physiological, behavioral, and medical impairments in older people make them more susceptible to developing halitosis.
The results of the study showed that the level of education is directly related to the presence of halitosis in an elderly person. The authors noted that the level of education is one of the most important factors associated with oral health, since education is an indicator of greater knowledge and best oral hygiene practices. People with higher levels of education tend to visit dentists more often; hence, they have fewer oral health problems.
Another factor associated with bad breath is the number of teeth present. Since halitosis can have both oral and non-oral origins, it can be assumed that some causes depend on the presence of teeth in the mouth. This study did not take into account dental caries or periodontal disease, which is a limitation.
The authors of the study concluded that older people are more likely to self-report halitosis. This condition is associated with lower age and lower levels of education, lack of access to dental care, and a large number of existing teeth.
“Assessing bad breath is important because of the high prevalence of this condition, including its consequences, strong social restrictions, impact on quality of life, and possible association with systemic disease,” the study authors write.