Self-assessed and Clinical Halitosis among Patients in the UAE: Agreement and Associated Risk Factors

To evaluate the relationship between self-assessed and clinically measured halitosis, identify associated risk factors, and assess the diagnostic accuracy of a simple self-assessment method.

A cross-sectional study was conducted among 102 adults in the UAE. Self-perceived halitosis was assessed via questionnaire and the cupping-hands technique (0-5 scale). Clinical halitosis was determined using Oral Chroma (Nissha FIS; Osaka, Japan) to measure volatile sulfur compounds (VSCs). Oral examinations recorded oral hygiene status, tongue coating, periodontal health, caries, and restoration quality. Associations were analyzed using bivariate and multivariate regression. The diagnostic accuracy of self-assessment was evaluated against Oral Chroma findings.

Self-reported halitosis prevalence increased from 26% (questionnaire) to 57.8% (cupping-hands), while clinical halitosis was detected in 63.7% of participants. Self-assessment showed moderate agreement with clinical diagnosis (κ = 0.426) and a sensitivity and specificity of 73.9% and 70.3%, respectively. Methyl mercaptan had the strongest association with perceived odor (AUC = 0.782). Both self-assessed and clinical halitosis were statistically significantly associated with tongue coating, poor oral hygiene, gingival bleeding, periodontal pockets, caries, imperfect restorations, and BANA positivity (all p 0.05). Multivariate analysis identified smoking, prosthesis use, infrequent dental visits, and inadequate use of dental floss and mouthwash as independent predictors.

Halitosis was highly prevalent and strongly linked to modifiable oral hygiene and behavioral factors. The cupping-hands method correlated with VSC measurements and may be a useful screening tool. Public health strategies and clinical practice should emphasize tongue cleaning, periodontal care, and regular dental visits to reduce oral malodor.