The relation between foetor ex ore, oral hygiene and periodontal disease

Bad breath usually originates in the mouth. It is described with different names as oral malodor, halitosis or foetor ex ore. Dental plaque, bacterial products from deep periodontal pockets and bacterial products from the tongue probably cause bad breath but also bacterial products from tonsils and pharynx probably are involved. In this study we clinically examined subjects with very strong bad breath, foetor ex ore. Foetor ex ore was defined as strong evil-smelling odor from the mouth of the patient which had an affect on the examiner and made the oral examination excruciating. Subjects with foetor ex ore are not aware of it. It is usually noticed by others. There are also persons who complain of bad breath that cannot be detected by others, halitophobia. Our aim was to study the relation between foetor ex ore, halitophobia and oral hygiene, periodontal disease. A total of 840 men, mean age 35.7(+/- 2.8 SD) and 841 women, mean age 35.7+/- 2.9 SD), participated. Clinical findings were noted, including the presence or absence of foetor ex ore. The subjects also filled in a self-reported questionnaire concerning problems in the oral cavity and teeth. Foetor ex ore was present in 2.4 percent of the subjects. Multiple regression analysis showed that calculus (P < 0.001), plaque (P < 0.01), and dental visits once every 3 yr. (P < 0.01) were significantly correlated to foetor ex ore. Periodontitis patients with foetor ex ore had more severe disease (P < 0.001) than those without. Foetor ex ore was not related to suspected halitosis. One percent of the subjects had suspected halitosis. Using multiple regression analysis, we found a significant correlation between calculus (P < 0.001) and suspected halitosis. In conclusion this study shows that foetor ex ore was correlated to oral hygiene and dental visits. Periodontitis patients with foetor ex ore had more severe disease than those without.