Multifactorial assessment of halitosis in systemically and orally healthy orthodontic patients: Airway dimensions, breathing pattern, and comparison with a portable breath analyzer

AIM: Halitosis is a multifactorial condition influenced by airway-related factors and breathing patterns. This study aimed to evaluate the relationship between airway dimensions, craniofacial morphology, and breathing type with halitosis in orthodontic patients. In addition, the agreement between the portable breath analyzer and the organoleptic method, as well as the role of self-reported and physiological halitosis, was investigated. Methods: This cross-sectional study included 113 systemically and orally healthy orthodontic patients. Lateral cephalometric radiographs were used to assess the sagittal and vertical skeletal patterns and pharyngeal airway dimensions. Halitosis was evaluated using an organoleptic method as the reference standard and a portable breath analysis device for comparison. Oral hygiene habits, breathing type, and perception of halitosis were recorded using a structured questionnaire. Statistical analyses included appropriate parametric and nonparametric tests as well as multivariate logistic regression. Agreement was assessed using Cohen's kappa coefficient. Results: The overall prevalence of halitosis was 8.9% based on organoleptic assessment. Tooth brushing frequency (p = 0.041) and oral dryness (p = 0.004) were significantly associated with halitosis, whereas airway dimensions, skeletal patterns, and breathing types were not (p > 0.05). Physiological halitosis (p = 0.003) and oral dryness (p = 0.047) were significant predictors of self-reported halitosis. The agreement between the self-reported and objective measurements was weak (κ = 0.264; p < 0.001). A statistically significant and substantial level of agreement was observed between the portable device and the organoleptic assessment (κ = 0.698). Conclusion: Airway-related parameters were not identified as significant determinants of halitosis. Within the limitations of this study, halitosis was more closely associated with self-reported oral dryness and tooth-brushing frequency than with airway morphology. Portable breath analyzers may serve as practical adjunctive tools for clinical assessments when used under standardized conditions. .