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Am Fam Physician. 2008;78(6):767-768

Background: Halitosis has a prevalence rate of approximately 25 percent in the general population. Oral conditions are reported to be the most common cause of halitosis. These may be difficult to distinguish from other potential causes, such as gastroesophageal reflux disease (GERD). To evaluate the association between GERD and halitosis, Struch and colleagues reviewed data on edentulous and dentate patients from a large population-based study.

The Study: The authors analyzed a cross-sectional health survey of 4,310 patients. Data collection included medical and oral examinations, a medical history interview, and a health-related questionnaire completed by the patient. The outcome variable, halitosis, was defined according to patient perception of a bad taste in the mouth or bad breath. The authors grouped patients by ages depending on whether they had natural teeth or were edentulous. Patients on antacid therapy were excluded. The final sample consisted of 1,388 women and 1,200 men in the dentate sample, and 206 women and 211 men in the edentulous sample. The analysis focused on the relationship between halitosis and GERD, controlling for confounding variables.

Results: Of the 2,588 dentate patients, 21.8 percent reported halitosis. The authors found a dose-response relationship between mild, moderate, and severe GERD-related symptoms and halitosis in the dentate and edentulous groups. Depressive symptoms met the study criteria for a confounder in the dentate group. Disorders of the gastrointestinal tract met the confounder criteria in the edentulous group. Although GERD was an independently associated variable, other oral conditions were important contributors to halitosis in dentate patients. A subanalysis of dentate patients without depression did not change the finding of an association between GERD and halitosis.

Conclusion: The authors found an association between GERD-related symptoms and halitosis in dentate and edentulous patients. The association was more marked in edentulous patients than in patients with one or more teeth. GERD should be considered in the differential diagnosis of halitosis. Even though GERD is a readily treatable condition, research is needed to study whether GERD treatment alleviates halitosis. It is important to note that patients with GERD may experience a bad taste as a result of the disease. Therefore, these patients are more likely to answer positively to experiencing a bad taste or bad breath, which is how the authors defined halitosis.

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