Association between perceived stress and self-reported halitosis among university students: the mediating role of xerostomia, a cross-sectional study.

BACKGROUND: Halitosis is a common oral health concern with notable psychosocial consequences. Although psychological stress has been linked to various oral conditions, the specific mechanism through which perceived stress contributes to self-reported halitosis remains unclear. This study aimed to determine the prevalence of self-reported halitosis among university students and to evaluate the associations between perceived stress levels, oral hygiene behaviors, xerostomia, and self-reported halitosis, with a particular focus on the potential mediating role of xerostomia.

METHODS: A cross-sectional study was conducted among 400 students from Çankırı Karatekin University's Faculty of Dentistry and Faculty of Health Sciences, Department of Nursing, using a non probability voluntary response sampling method. Data were collected via a self administered online questionnaire (Google Forms) that included items on demographic characteristics, oral hygiene behaviors, and single item questions on xerostomia and self-reported halitosis. Perceived stress was assessed using the validated Turkish version of the Perceived Stress Scale (PSS-10). Associations were examined using chi square tests and binary logistic regression. The mediating role of xerostomia in the relationship between perceived stress and self-reported halitosis was evaluated through mediation analysis.

RESULTS: The prevalence of self-reported daytime halitosis was 18.5%, and 67.8% of participants reported xerostomia. Perceived stress was significantly associated with both self-reported halitosis and xerostomia. Mediation analysis revealed that xerostomia statistically mediated the association between perceived stress and self-reported halitosis (indirect effect = 0.653, 95% bootstrap CI [0.184, 1.122]). Xerostomia was a significant predictor of halitosis (OR = 3.249, 95% CI: 1.647-6.408, p = 0.001). Additionally, self-reported halitosis was significantly associated with brushing frequency, gingival bleeding, and smoking status. Statistically significant differences in perceived stress levels were observed based on gender and faculty of enrollment.

CONCLUSIONS: Perceived stress is associated with self-reported halitosis among university students, and this association is statistically mediated by xerostomia. These findings suggest that xerostomia may represent a potential mechanism linking perceived stress and self-reported halitosis. Future studies employing larger samples and objective clinical measurements, such as sialometry and volatile sulfur compound analysis, are needed to confirm these associations.