The present study aimed to validate (cross-culturally adapt and test psychometric properties) the Brazilian version of the Halitosis Associated Life-Quality Test (HALT). A process of translation and cross-cultural adaptation was conducted by a group of dental researchers. The first draft of the Brazilian Portuguese version was pretested on a sample of 33 individuals leading up to the final version of the questionnaire. The Brazilian version of the HALT (B-HALT) was applied to 100 individuals with halitosis (organoleptic score ≥ 2) and 100 individuals without halitosis (organoleptic score < 2). Exploratory factor analysis (EFA) was performed to evaluate the dimensionality of B-HALT. Cronbach's alpha (α) and interclass correlation coefficient (ICC) were used to measure its reliability. For convergent validity, Spearman's correlation was conducted between the B-HALT and the organoleptic scores. The discriminant validity was evaluated through the Mann-Whitney and Kruskal-Wallis tests. EFA confirmed the unidimensionality of B-HALT, which has also demonstrated excellent internal consistency (α = 0.96) and test-retest reliability (ICC = 0.93). There was a positive correlation between B-HALT and organoleptic scores (r = 0.33; p < 0.001). B-HALT was able to discriminate between the groups with and without halitosis measured by the organoleptic method (p < 0.001) and self-reported halitosis (p < 0.001). B-HALT has demonstrated to be a reliable and valid tool to evaluate the oral health-related quality of life associated to halitosis in Brazilian adults.

Aims:To evaluate the prevalence of self-reported halitosis and its predictors, and to determine the accuracy estimates of self-reported measures with clinical evaluation of halitosis. Materials and Methods:This cross-sectional study comprised 5,420 individuals (teaching staff, administrative personnel and ongoing students from Federal University of Minas Gerais), who answered a structured questionnaire containing sociodemographic, medical and dental data, and self-reported halitosis measures.A subsample (n = 159) underwent halitosis assessment through the organoleptic method. Predictors for self-reported halitosis were determined through univariate and multivariate analyses. Accuracy estimates of self-reported measures were evaluated in this subsample.Results: Prevalence of self-reported halitosis varied from approximately 4%-35%, depending on the self-reported measure. Self-reported halitosis was mainly associated with socio-economic variables (age, gender, educational level), parameters of oral health (gingival bleeding, gingival infections, tongue coating, general oral health evaluation) and impacts on daily activities (family/social environment and intimate relations). Specificity values for self-reported halitosis measures were determined to be high for clinical (organoleptic score ≥2) and strong (organoleptic score ≥4) halitosis. Combinations of self-reported measures retrieved useful accuracy estimates for strong halitosis. Conclusion:Prevalence rates of self-reported halitosis may be considered moderate.Accuracy diagnostic estimates were determined to be useful, with good prediction for non-diseased individuals. K E Y W O R D Sepidemiology, halitosis, prevalence, risk factors, self-report, sensitivity and specificity

Breath odour is the scent from the air exhaled through the mouth.The unpleasant odour from the oral cavity is named commonly as bad breath or halitosis (Kumbargere Nagraj et al., 2019;Madhushankari et al., 2015). Breath odour changes are multifactorial, both physiological or pathological, and may be associated with intra or extraoral factors. In 80%-90% of the cases, the main causes of halitosis are related to intraoral factors such as poor oral hygiene, tongue coating, periodontal diseases and dental caries (Geest et al., 2016;Scully & Greenman, 2008). Extra-oral causes are related to diseases of the upper and lower respiratory tract, diabetes, liver problems, gastrointestinal tract conditions, use of medications, the intake of certain foods, alcohol consumption and smoking (Madhushankari et al., 2015;Zalewska et al., 2012).Halitosis categories include genuine halitosis, pseudo-halitosis and halitophobia (Scully & Greenman, 2008;Wu et al., 2020).Halitosis has a worldwide occurrence and its prevalence has been estimated at around 25%-40% (Silva et al., 2018). However, this prevalence may be underestimated as many people do not notice their own breath or are aware of having halitosis (Mubayrik et al.,

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