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

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. 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. 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. 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.