Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Mar 6:9:316-322.
doi: 10.1016/j.toxrep.2022.02.012. eCollection 2022.

Influence of tobacco smoking on the development of halitosis

Alba Romero Kauss  1 , Meagan Antunes  1 , Filippo Zanetti  1 , Matthew Hankins  1 , Julia Hoeng  1 , Annie Heremans  1 , Angela van der Plas  1
Affiliations

Influence of tobacco smoking on the development of halitosis

Alba Romero Kauss et al. Toxicol Rep. .

Abstract

Background: Halitosis is the general term used to describe any disagreeable odor in exhaled air, regardless of whether the odorous substances originate from oral or non-oral sources. Previous research has strongly associated tobacco smoking in the development of halitosis, as it increases the synthesis of toxic volatile sulfur compounds in diseased periodontal pockets. In this review, we summarize the etiopathology and epidemiology of halitosis as well as the current evidence on the impact of smoking by means of a meta-analysis.

Methods: PubMed and Embase were searched to identify publications that reported halitosis in smokers and nonsmokers. Meta-analyses were performed if a sufficient number (n ≥ 3) of articles were available that evaluated the same outcome.

Results: The meta-analyses showed that there was an increased risk of halitosis in current smokers versus nonsmokers (odds ratios). These results were consistent both in fixed and random effects models. Even though the interstudy heterogeneity was high (I2 = 91%), sensitivity analysis by limiting the number of studies yielded similar results, with no-to-moderate heterogeneity (I2 = 0-65%). The analysis comparing ever smokers with never smokers showed no significant difference in the risk of halitosis in ever smokers. The same effect was observed when upon stratifying the analyses on the basis of ascertainment of halitosis (self-reported or measured by a Halimeter).

Conclusions: Halitosis is a common condition which can affect the quality of life of those affected. The results from this literature review and meta-analysis show that current smokers are more likely to suffer from halitosis, even if they are less likely to report it.

Keywords: Halitosis; Oral health; Smoking; Tobacco.

PubMed Disclaimer

Conflict of interest statement

This work was supported by Philip Morris International.

Figures

Fig. 1
Fig. 1
PRISMA chart detailing the literature search results.
Fig. 2
Fig. 2
Forest plot meta-analysis of risk of halitosis in current smokers versus nonsmokers.
Fig. 3
Fig. 3
Funnel plot meta-analysis of risk of halitosis in current smokers versus nonsmokers.
Fig. 4
Fig. 4
Forest plot meta-analysis of risk of halitosis in current smokers versus nonsmokers (sensitivity analysis).
Fig. 5
Fig. 5
Forest plot meta-analysis of risk of halitosis in ever smokers versus never smokers.
Fig. 6
Fig. 6
Funnel plot meta-analysis of risk of halitosis in ever smokers versus nonsmokers.
Fig. 7
Fig. 7
Forest plot meta-analysis of risk of halitosis in smokers versus nonsmokers (self-reported outcome).
Fig. 8
Fig. 8
Funnel plot meta-analysis of risk of halitosis in smokers versus nonsmokers (self-reported outcome).
Fig. 9
Fig. 9
Forest plot meta-analysis of risk of halitosis in smokers versus nonsmokers (Halimeter-measured outcome).
Fig. 10
Fig. 10
Funnel plot meta-analysis of risk of halitosis in smokers versus nonsmokers (Halimeter-measured outcome).
See this image and copyright information in PMC

References

    1. Bollen C.M., Beikler T. Halitosis: the multidisciplinary approach. Int. J. Oral Sci. 2012;4(2):55–63. - PMC - PubMed
    1. van den Broek A.M., Feenstra L., de Baat C. A review of the current literature on aetiology and measurement methods of halitosis. J. Dent. 2007;35(8):627–635. - PubMed
    1. A.D.A Council on Scientific Affairs. J. Am. Dent. Assoc. 2003;134(35):209–214. - PubMed
    1. Lee H.J., Kim H.M., Kim N., Oh J.C., Jo H.J., Lee J.T., et al. Association between halitosis diagnosed by a questionnaire and halimeter and symptoms of gastroesophageal reflux disease. J. Neurogastroenterol. Motil. 2014;20(4):483–490. - PMC - PubMed
    1. Miyazaki H., Sakao S., Katoh Y., Takehara T. Correlation between volatile sulphur compounds and certain oral health measurements in the general population. J. Periodontol. 1995;66(8):679–684. - PubMed

LinkOut - more resources