الفهرس 
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Abstract
Halitosis is a condition where the breath is altered in an unpleasant manner for the affected individuals and impairs them socially as well as psychologically. Pregnant women are considered a risky group to halitosis. Halitosis can be clinically classified as genuine halitosis, pseudohalitosis, and halitophobia. Genuine halitosis has oral and extra-oral etiologies.
The present study was conducted to develop a prediction model for halitosis among pregnant women attending MCH Centers in Alexandria, Egypt, to estimate the prevalence of halitosis among them, to identify a set of exposure variables that gives a good prediction of halitosis and to derive a regression model that can be used to predict future occurrence of halitosis among pregnant women.
The study was conducted among pregnant women attending MCH centers using a cross sectional approach. A stratified random sample of pregnant women was selected from the four MCH centers in Alexandria. Data were collected using a predesigned questionnaire, record review and clinical examination of oral cavity.
The study revealed the following main finding:
More than half of studied women (55.5%) had halitosis and most of them experienced it in the morning and 82.07% were aware of their problem. There was statistically significant difference between studied women who suffered from halitosis and those who do not regarding age (more than 35 years), educational level (illiterate or read and write), rural and squatters residence, multiparity and those in the third trimester.
Halitosis was related to some oral factors such as tooth brushing per day, tongue brushing. About three quarters of those who did not brush their teeth and 60.55% of those who did not brush their tongue suffered from halitosis. Regarding dental visits, 87.23% of studied women who did not visit the dental clinic during pregnancy suffered from halitosis. Clinical examination of oral cavity revealed that 92.19% of those who had grade 2 and 3 tongue coat and 93.46% of those who had score 2 or more of CPI suffered from halitosis A significant association was found between decayed teeth, missed teeth and DMFT and halitosis but there was no significant association between filled teeth and halitosis.
There was a statistically significant difference between those who had halitosis and those who do not have regarding self-reported symptoms. The majority (81.69%) of those who had dry mouth and 76.53% of mouth breather women in the current study suffered from halitosis.
Halitosis was also related to non-oral factors such as some dietary habits as eating garlic and onion, drinking tea twice or more per day, eating cabbage, hotsause and fish. Concerning associated diseases, 79.25% of studied women who had different diseases suffered from halitosis.
Logistic regression analysis for factors associated with halitosis using enter, reduced enter, backward and forward methods were used to develop the prediction model that will help pregnant women in eliminating halitosis in the future. The comparison between the models revealed that forward selection model was the best fit model for halitosis prediction. This model was found to be better than the enter model as measured by the Hosmer Lemeshow goodness of fit (p= 0.98 compared to 0.91) where p value closer to 1 is better. In addition, the AIC (77.66) was found to be better than that of the enter method (81.83) where smaller AIC are better.
6.2 Conclusion
from this study we can conclude the following:
• The prevalence of halitosis among pregnant women attending MCH centers in Alexandria, Egypt is high (more than half of the sample).
• Halitosis is related to many factors as age, low educational level, rural areas residence, multipara women in first and third trimester, some dietary habits as drinking tea, hot sauce, onion and garlic rich food, cabbage and fish eating. Dry mouth, mouth breathing, and associated diseases especially respiratory diseases also related to halitosis. Other factors as negligence of hygiene practices as tooth brushing, tongue brushing, and dental visits, and tongue coating, CPI, DMFT, and incorrect filling.
• The regression model made to predict future occurrence of halitosis among pregnant women showed that, garlic eating, CPI, dental visits frequency, dry mouth, missed teeth due to caries and tongue coating, were the most prominent predictor factors to halitosis.