Bad breath

Halitosis or oral malodour is a common complaint amongst the general population which if severe or longstanding may decrease self confidence and social interactions (1)

Bad breath experienced on awakening is a common occurrence and should not be considered as halitosis (1).

Bad breath may arise form the tongue coating, gingival crevice, and periodontal pockets and posterior dorsal tongue (1,2)

Halitosis can be classified as

• genuine halitosis
  • physiological halitosis
  • pathological halitosis
    • oral – halitosis due to disease or pathological condition of the oral tissue
    • extraoral – malodour originating from outside the oral cavity (pulmonary or upper digestive tract)
• pseudo halitosis – the patient believes that he/she has bad breath which is not perceived by others around him
• halitophobia – even after treatment for halitosis (genuine halitosis or pseudo-halitosis) patients believes that they still have bad breath (3)

Patients with psychosomatic halitosis interpret other people’s reactions such as covering the nose, averting the face or stepping back as signs of having bad breath. These patients may have psychological conditions such as socialphobia (anxiety about other individuals’ behaviour towards them) and clinicians should focus on identifying symptoms of socialphobia rather than looking for halitosis (3).

Reference:

• (1) Porter S.R, Scully C. Oral malodour (halitosis). BMJ 2006;333(7569):632–635
• (2) Coventry J et al. ABC of oral health: periodontal disease. BMJ 2000;321(7252),36-39
• (3)Yaegaki K, Coil J.M.Examination, Classification, and Treatment of Halitosis; Clinical Perspectives. J Can Dent Assoc 2000; 66:257-61