Halitosis among racially diverse populations: an update

Int J Dent Hyg. 2008 Feb;6(1):2-7. doi: 10.1111/j.1601-5037.2007.00274.x.


The aim of this paper is to highlight the cultural perceptions of halitosis to dental professionals. Halitosis (oral malodour or bad breath) is caused mainly by tongue coating and periodontal disease. Bacterial metabolism of amino acids leads to metabolites including many compounds, such as indole, skatole and volatile sulphur compounds (VSC), hydrogen sulphide, methyl mercaptan and dimethyl sulphide. They are claimed to be the main aetiological agents for halitosis. Gastrointestinal diseases are also generally believed to cause halitosis. In general, physicians and dentists are poorly informed about the causes and treatments for halitosis. The paper reviews the prevalence and distribution of halitosis, oral malodour, its aetiology, concepts of general and oral health and diseases and their perception among racially diverse population. Eating, smoking and drinking habits and understanding of halitosis as a social norm among different people has been highlighted. The treatment options have also been presented very briefly. A brief discussion about general importance within existing healthcare services has been highlighted. Oral malodour may rank only behind dental caries and periodontal disease as the cause of patient's visits to the dentist. It is a public social health problem. The perception of halitosis is different in culturally diverse populations. So the dental professionals should be aware of the cultural perceptions of halitosis among racially and culturally diverse populations. There is a need to integrate the cultural awareness and knowledge about halitosis among the dental professional for better understanding of halitosis to treat patients with the social dilemma of halitosis to improve the quality of life and well-being of individuals with the problem. It is concluded that dental professionals (especially dental hygienists) should be prepared to practice in a culturally diverse environment in a sensitive and appropriate manner, to deliver optimal oral health and hygiene care.

Publication types

  • Review

MeSH terms

  • Alcohol Drinking
  • Cultural Competency*
  • Dental Hygienists / psychology*
  • Feeding Behavior
  • Halitosis / ethnology*
  • Halitosis / psychology
  • Halitosis / therapy
  • Health Knowledge, Attitudes, Practice
  • Health Status Disparities
  • Humans
  • Oral Hygiene
  • Smoking
  • Social Perception
  • Sulfur Compounds / metabolism
  • United States / epidemiology


  • Sulfur Compounds