Prevalence and determinants of self-reported halitosis in Saudi Arabia: a nationwide cross-sectional study

Halitosis, or oral malodor, is a common condition with important psychosocial consequences. Self-reported halitosis (SRH) reflects perceived oral malodor rather than objectively confirmed halitosis and remains insufficiently studied in Saudi Arabia. This study aimed to determine the prevalence of SRH among Saudi adults and to examine its associations with demographic, systemic, and oral health-related factors.

A nationwide cross-sectional survey was conducted between February and June 2025 using a 38-item self-administered web-based questionnaire developed from previous literature, reviewed by experts, and pilot-tested before data collection. The questionnaire was distributed via social media platforms and collected data on demographics, systemic health, oral health practices and conditions, and medication use. A total of 1,064 complete responses were analyzed. Descriptive statistics summarized participant characteristics. Chi-square tests examined bivariate associations, and multivariable binary logistic regression identified independent factors associated with SRH.

Among 1,064 participants, 46.9% reported SRH, with the highest prevalence observed among adults aged 31-50 years (55.4%, p < 0.0015). Self-reported halitosis was significantly associated with age, self-reported general health, gastritis, long-term sedative intake, and several oral and nasal health indicators (p < 0.0015). The multivariate logistic regression model identified self-reported oral health as a significant predictor of SRH. Compared with participants who reported good oral health, those reporting poor oral health were nearly fourteen times as likely to report SRH (OR = 13.97; 95% CI: 7.45-26.22; p < 0.001). Brushing teeth also emerged as a significant predictor; participants who brushed their teeth were less likely to report SRH (OR = 0.54; 95% CI: 0.33-0.88; p = 0.01). No additional demographic, general health, or oral health variables were significant predictors of SRH in the adjusted model.

SRH is common among Saudi adults and appears to be more closely related to perceived oral health and oral hygiene behaviours than to sociodemographic factors and systemic or nasal conditions assessed in this study. These findings support integrating SRH assessment into oral health promotion and routine dental care, with emphasis on preventive oral hygiene, professional consultation, and culturally appropriate public health strategies. Future studies combining self-reported measures with objective clinical assessment are needed to distinguish perceived from clinically confirmed halitosis and to guide targeted interventions.