Aim: To investigate risk factors associated with halitosis in children using OralChroma™. Materials and methods: Sixty-seven children between the ages of 3 and 8 who attended a pre-general anesthesia assessment at the Dental University Hospital at King Saud University, Riyadh, Saudi Arabia, were enrolled in this study after satisfying the inclusion criteria. Demographic data, medical history, and oral hygiene practices were obtained by a standardized questionnaire completed by the parents of each child. Clinical dental examination was conducted to record the following: caries index (dmft/DMFT), simplified debris index (DI-S), modified gingival index (MGI), and Winkel tongue coating index (WTCI). Clinical halitosis was assessed using the OralChroma™ device that measures the concentration of volatile sulfur compounds (VSCs) including hydrogen sulfide (H2S), methyl mercaptan (CH3SH), and dimethyl sulfide (CH3SCH3). Statistics were completed using Spearman\'s correlation coefficient and Mann–Whitney U-test to assess the association with the VSC scores with continuous and binary variables, respectively. Then, multivariate linear regression analysis was performed to detect the degree of association. Results: High VSC measures were detected in 58 children (87%). The dmft/DMFT was significantly associated with H2S level (β = 26.84, p = 0.034) and CH3SH level (β = 19.96, p = 0.016) after controlling possible confounders. There was no significant association of DI-S, MGI, and WTCI with the VSC measures. Conclusion: The result suggested that dmft/DMFT score (children\'s caries experience) is associated significantly with high levels of H2S and CH3SH in the sample studied. Clinical significance: Caries experience in children is a significant risk factor for halitosis and should be considered during the management of halitosis.
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