Prevalence of halitosis in patients with periodontitis: a systematic review and meta-analysis
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Abstract
Background: Halitosis or bad breath affects 22-50% of adults globally, with periodontitis being an important etiological factor for halitosis. Despite established associations, the reported prevalence in patients with periodontitis varies widely (37%-81.7%), showing methodological heterogeneity. No previous meta-analysis has quantified pooled prevalence using objective volatile sulfur compound (VSC) measures.
Methods: Following the PRISMA 2020 guidelines, we systematically searched PubMed, Cochrane, Wiley, and Google Scholar (2000-2025). Observational studies reporting objectively measured halitosis (gas chromatography/sulfide monitors) in patients with periodontitis were included. The risk of bias was assessed using Hoy's tool. Random-effects meta-analysis was performed, with qualitative synthesis to explore heterogeneity sources.
Results: Nine studies (n=529 patients) were analyzed. The pooled prevalence of halitosis was 62.0% (95% CI: 46.6–75.4%), but with substantial heterogeneity (I² = 85.77%, τ²=0.53, p<0.001). Qualitative synthesis identified several important heterogeneity sources: first, Periodontitis diagnostic criteria (2018 AAP/EFP classification vs. PD thresholds); second, the VSC measurement methods (gas chromatography vs. sulfide monitors); third, VSC diagnostic thresholds (80–140 ppb); fourth, Tongue coating assessment inconsistency (WTCI used in 4/9 studies)
Conclusion: Approximately two-thirds of patients with periodontitis exhibit objectively confirmed halitosis. High heterogeneity prevents a definitive prevalence estimate, highlighting the need for standardized diagnostic protocols.
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