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Objectively measured halitosis is not significantly associated with tongue coating, sleep quality, or psychological symptoms among university students

In a cross-sectional study of 62 Brazilian university students, halitosis was detected in 40.3% (95% CI: 29.0-52.7%) using a portable breath detector. No statistically significant associations were found between halitosis and tongue coating, sleep quality (PSQI), or anxiety, depression, and stress (DASS-21). However, significant positive correlations were observed between stress and sleep disturbance, anxiety and sleep disturbance, and depression with sleep latency, daytime dysfunction, and overall sleep quality.

Last updated: Aug 28, 2026•0 RCTs•📖 Read as article →

Evidence Score

Evidence Score38/100
Human RCT☆☆☆☆☆
Meta-analysis☆☆☆☆☆
Mechanism★★★★★
Safety★★★★☆
Confidencelow

Study Evidence

Study 1. Halitosis and Its Association with Sleep Quality and Psychological Factors Among University Students: A Cross-Sectional Study.

observational

Gallo JMAS, Mandetta ARH, Sobral APT, Gonçalves MLL, Costa MO, Ribeiro CDPV, Machado MM, Malavasi A, Santos EM, Duran CCG, Bussadori SK · International journal of environmental research and public health (2026)

Participants: N/A
Duration: Not specified (cross-sectional)
Intervention: None (observational study; assessed halitosis, tongue coating, sleep quality, and psychological symptoms)
Outcome: Presence of halitosis (objectively measured), tongue coating index, sleep quality (PSQI), symptoms of anxiety, depression, and stress (DASS-21)
Effect Size: N/A (no significant associations reported)
Population: 62 Brazilian university students enrolled in health-related undergraduate programs, mostly in their first academic year (61.3%) and residing in Santos (59.7%)

Result:

PubMed: 42652358DOI: 10.3390/ijerph23081043

Mechanism Graph

Halitosis is a common oral condition that may affect social interactions and psychological well-being.
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The study assessed halitosis using a portable breath detector and tongue coating using the Coated Tongue Index.
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Sleep quality and psychological symptoms were measured via PSQI and DASS-21.
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No significant associations were found between halitosis and the measured factors, but psychological symptoms correlated with sleep disturbances.

Limitations

  • ⚠Cross-sectional design limits causal inference.
  • ⚠Small sample size (n=62) may reduce statistical power.
  • ⚠Single-center study among health-related students may limit generalizability.
  • ⚠Objective halitosis measurement may not reflect self-perceived halitosis.

Frequently Asked Questions

What is the prevalence of halitosis among university students in this study?▼

The prevalence was 40.3% (95% CI: 29.0-52.7%) based on objective measurement with a portable breath detector.

Is halitosis associated with poor sleep quality or psychological symptoms?▼

No statistically significant associations were found between objectively measured halitosis and sleep quality or symptoms of anxiety, depression, and stress in this study.

What factors were significantly correlated with sleep disturbances?▼

Stress and anxiety were positively correlated with sleep disturbance, and depression was correlated with sleep latency, daytime dysfunction, and overall sleep quality.

How was halitosis measured in this study?▼

Halitosis was objectively measured using a portable breath detector, and tongue coating was assessed using the Coated Tongue Index.

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References

  1. 1.Gallo JMAS, Mandetta ARH, Sobral APT, Gonçalves MLL, Costa MO, Ribeiro CDPV, Machado MM, Malavasi A, Santos EM, Duran CCG, Bussadori SK. "Halitosis and Its Association with Sleep Quality and Psychological Factors Among University Students: A Cross-Sectional Study.." International journal of environmental research and public health, 2026. PMID: 42652358 DOI: 10.3390/ijerph23081043
Disclaimer: This content is for educational purposes only and is not medical advice. Evidence scores reflect the quality and quantity of available research, not clinical recommendations. Always consult a healthcare professional before starting any supplement or intervention.