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Background: Halitosis appears to have significant impacts on quality of life, necessitating reliable assessment tools. The Halitosis Associated Life-Quality Test (HALT) has been validated in various populations, but not among Thai people. While HALT provides a valuable foundation, there is a need for a culturally adapted and expanded instrument for the Thai context. Consequently, this study aimed to develop and validate a comprehensive questionnaire for assessing halitosis-related quality of life in Thai populations, incorporating a Thai version of HALT (T-HALT) as a core component., Materials and Methods: This cross-sectional study involved 200 dental patients at Mahidol University. The original HALT was translated into Thai using forward-backward translation. Cultural adaptation and psychometric properties of T-HALT were evaluated through multiple approaches. Content validity was ensured through expert reviews, while face validity was assessed by patient feedback. Reliability was examined via test-retest and internal consistency measures. Criterion and discriminant validity was evaluated by correlating T-HALT scores with self-perceived halitosis and volatile sulfur compound (VSC) measurements, respectively. VSCs were quantified using the OralChroma™ device, which analyzes breath samples collected directly from patients' mouths. Construct validity was assessed through exploratory (EFA) and confirmatory factor analysis (CFA), providing insights into the questionnaire's underlying structure., Results: T-HALT demonstrated excellent internal consistency (Cronbach's alphas = 0.940-0.943) and test-retest reliability (ICC = 0.886). Criterion validity was supported by a significant correlation between T-HALT scores and self-perceived halitosis (r = 0.503, P < 0.001). Discriminant validity was confirmed by the absence of a significant correlation between T-HALT scores and VSC levels (r = 0.071, P = 0.32). EFA revealed a four-factor structure, which was subsequently confirmed by CFA. However, Items 1 and 7 were excluded due to poor standardized factor loadings., Conclusion: T-HALT demonstrates good reliability and validity for assessing halitosis-related quality of life in Thai populations. It performs well as a unidimensional measure, but its multidimensional application requires modifications. Future research should validate a modified version excluding Items 1 and 7 across diverse Thai populations, potentially enhancing its cultural specificity., (© 2024. The Author(s).)

Background: Bad breath (halitosis) is a common problem affecting psycho-social wellbeing of young people. We aimed to explore the extent of self-perceived halitosis and associated factors among university students in Dhaka, Bangladesh., Methods: A cross-sectional study was conducted among university students from November 2021 to April 2022. Six private and two public universities were approached. A total of 318 participants were conveniently selected for the study. A self-administered questionnaire was used for data collection. Students unwilling to participate were excluded. Multivariable logistic regression analysis was used to examine factors associated with halitosis. Statistical analysis was conducted using Stata Version 17., Results: A total of 55.97% of students had self-perceived halitosis, with females (74.53%) having a significantly higher proportion than males (36.94%) (p < 0.001). A significantly higher proportion of halitosis was found among participants who were overweight ( 61%), had obesity (60.77%), smoked cigarette (46.79%), consumed alcohol (71.43%), lacked exercise (66.29%), were on unhealthy diet (57.35%), consumed coffee/tea (61.35%), breathed through mouth (64.60%), brushed tooth infrequently (85.71%), changed toothbrush after 6 months (77.42%), did not use toothpaste (94.74%), did not use/ sometimes used fluoride toothpaste (75.76%), lacked dental floss use (60.85%), did not use toothpick (62.87%), did chew or sometimes chewed sugar-free chewing gum (75.82%), did not clear / cleaned tongue sometimes (76.14%), did use mouth freshener regularly or occasionally (64.97%), did not use or used mouthwash sometimes (58.87%) were also associated with higher self-perceived halitosis (p < 0.05 for all). Students with gum bleeding, swollen gums, dry mouth, dental caries, food accumulation, and tooth sensitivity had a significantly (p < 0.05 for all) higher proportion of self-perceived halitosis (76.85%, 81.82%, 72.50%, 67.78%, 64.13% and 67.40%, respectively) compared to those without this problem. Being female (OR = 5.04; 95% CI: 2.01-12.62; p < 0.001), alcohol consumers (OR 7.35; 95% CI: 1.77-30.50; p = 0.006); not using sugar free chewing gum (OR = 0.25; 95% CI: 0.10-0.58; p = 0.001), lack of tongue cleaning (OR 4.62; 95% CI: 2.16-9.84; p < 0.001), and gum bleeding (OR = 7.43; 95% CI: 3.00-18.35; p < 0.001) were independently associated with halitosis on multivariable regression., Conclusion: This study reveals a high proportion of self-perceived halitosis and relevant factors. There should be more public education on the causes of halitosis and potential management approaches., (© 2024. The Author(s).)

Design: A retrospective, uncontrolled, questionnaire-based, pre-post study involving adult male smoker volunteers who were invited to attend a one-day smoking cessation event at their workplace., Objective: To assess the effect of feedback on motivation for smoking cessation using oral-malodor measurements., Methods: At baseline, the participants attended a brief video presentation regarding various oral health-specific effects of smoking, joined a group introduction to smoking-cessation aids, and were given questionnaires that inquired information about smoking status including type, daily consumption, and duration. Subsequently, respiratory function and oral-malodor assessment were conducted using exhaled and oral cavity air, respectively. To measure oral-malodor, hydrogen sulfide, methyl mercaptan, and dimethyl sulfide concentrations were determined. Participants' intention for smoking cessation was evaluated through questionnaire before and after the event, classifying their intentions as aiming to quit within the next month, within the next 6 months, or having no intention to quit smoking. Immediate feedback on respiratory function and oral malodor measurements was provided by medical and dental blinded examiners, respectively., Results: A total of 241 men, aged 20-54 years, were enrolled and included: 169 (70.1%) exclusive cigarette smokers, 39 (16.2%) exclusive heated-tobacco product users, and 33 (13.7%) users of both. Prior to the health event, 8.7%, 17.0%, and 74.3% of smokers expressed intentions to quit within the next month, the next 6 months, or had no intention to quit, respectively. After the event, the corresponding percentages shifted to 17.8%, 26.6%, and 55.6%. In multivariable logistic regression analysis, the association with intention to quit in the next month was significant only for methyl mercaptan concentration in oral cavity air, with an adjusted odds ratio (AOR) of 4.24 (95% CI: 1.52-11.84; p = 0.006). Sensitivity analysis revealed that this association was concentration-dependent. On the other hand, higher daily tobacco consumption (≥ 15 pieces) was significantly associated with less likely intention to quit in the next 6 months (AOR = 0.37; 95% CI: 0.15-0.92, p = 0.032)., Conclusion: Feedback on oral malodor measurement may support the motivation of men to quit smoking within the next month, rather than waiting for the next 6 months., (© 2024. The Author(s), under exclusive licence to British Dental Association.)

Objective: To compare the personalities, social avoidance and distress, and anxiety status of Chinese patients with and without objective halitosis, and investigate the association among these psychological disorders., Methods: Patients who complained of bad breath and diagnosed with objective halitosis were enrolled into the halitosis group, while patients without objective halitosis were enrolled into the control group. The questionnaires included the sociodemographic profile of the participants, Eysenck Personality Questionnaire (EPQ), Social Avoidance and Distress Scale (SAD), and Beck Anxiety Inventory (BAI)., Results: A total of 280 patients were assigned into objective halitosis group (n = 146) and control group (n = 134). The extraversion subscales (E) score of the EPQ in the halitosis group were significantly lower than that in the control group (p = 0.001). The total SAD score and proportion of patients with anxiety symptoms in the BAI scale in the objective halitosis was significantly higher than that in the control group (p < 0.05). There was a negative correlation between the extraversion subscale and the total SAD score, Social Avoidance and Social Distress subscales (p < 0.001)., Conclusion: Patients with objective halitosis have more introverted personality traits and are more likely to have social avoidance and distress than the nonhalitosis population., (© 2023 Wiley Periodicals LLC.)

Background: Halitosis is an important cause of impaired quality of life in adolescents. Little is known about the prevalence of self-reported halitosis in adolescents in Nigeria and the extent to which self-reported halitosis impairs their oral health related quality of life., Objectives: To determine the prevalence and impact of self-reported halitosis on the oral health related quality of life of adolescent students in a suburban community in Nigeria., Methods: An analytical cross-sectional study. Pre-tested self-administered pro-forma was used to obtain the adolescents' demographic data and their self-perception of halitosis. The Oral Health Impact Profile (OHIP-14) was used to assess the adolescents' OHRQoL. The Mann-Whitney U test was used to compare the median OHIP-14 scores between adolescents who reported halitosis and those who did not. The level of significance was set at p < 0.05. Ethics approval for this study was obtained from the Health Research and Ethics Committee of the Lagos University Teaching Hospital., Results: A total of 361 adolescents aged 10 - 19 years (mean age 14.1 ± 1.79 years) took part in the study. Of these, 32.7% (n=118) had self-reported halitosis. The median OHIP-14 score among adolescents with self-reported halitosis was 3 (0-9) while those who did not report halitosis had a median OHIP-14 score of 0 (0 - 5). This difference was statistically significant (p < 0.0001)., Conclusion: Self-reported halitosis significantly impaired the oral health related quality of life of the adolescents., (© 2020 Alade O et al.)

Background: Perception of halitosis in patients during intubation is a common and additional stressor for anaesthesiologists and may lead to potential health risks., Objectives: We hypothesised that intubation with videolaryngoscopy could help reduce the anaesthesiologists' perception of patients' oral malodor during intubation., Design: A single-blinded, randomised controlled trial., Setting: Single centre general hospital, Guangdong Province, China., Participants: A total of 440 patients who underwent intubation under general anaesthesia for elective surgery, aged 18 to 60 years old, American Society of Anaesthesiologists class I to III, without upper airway abnormality or airway infection were enrolled., Intervention: Patients were randomly assigned to receive either UE videolaryngoscopy (UE) or Macintosh's direct laryngoscopy (Macintosh) group. All intubations were performed by one of six very experienced anaesthesiologists., Main Outcome Measures: The patient's oral odour score was measured prior to induction of anaesthesia. The anaesthesiologists' perception of the patient's oral malodor during intubation was recorded. The shortest distance from patient's mouth to the anaesthesiologist's nose (MN distance), the exertion rating and discomfort were also measured., Results: The oral malodor score did not differ in the UE and Macintosh groups prior to the induction of anaesthesia. However, the incidence of the anaesthesiologists' perception of halitosis during intubation was significantly lower in the UE group compared with the Macintosh group (P < 0.001). Similarly, the MN distance was significantly greater in the UE group compared with the Macintosh group (P < 0.001). The first-attempt success rate was higher in the UE group compared to the Macintosh group (P < 0.001). However, the exertion scores were considerably higher in the Macintosh group. After intubation, anaesthesiologists experienced more waist and shoulder discomfort with the Macintosh than the UE technique of intubation., Conclusion: Compared with direct laryngoscopy, videolaryngoscopy might reduce the anaesthesiologists' perception of the patients' oral malodor, help improve first-attempt success rate, as well as alleviate the anaesthesiologists' waist and shoulder discomfort., Trial Registration: Clinicaltrials.gov (ChiCTR-IOR-15007038).

Objective: To investigate the psychological condition of Chinese patients with or without a primary complaint of halitosis., Methods: The psychological condition of 196 Chinese patients who visited the Department of Periodontics was evaluated using the Cornell Medical Index (CMI) health questionnaire. The breath malodour of all patients was scored using the organoleptic test (OLT)., Results: More than half of patients (53.1%) complaining of halitosis actually demonstrated pseudo-halitosis. The overall scores and scores for emotional symptoms of CMI were significantly higher in patients with a chief complaint of halitosis than in those without such a complaint (P < 0.05). Females with a chief complaint of halitosis exhibited significantly higher scores for all parameters relative to females without a complaint (P < 0.05), while males with a chief complaint of halitosis exhibited enhanced emotional symptoms, particularly inadequacy, anxiety, and tension (P < 0.05) when compared with males without a halitosis complaint. Among patients complaining of halitosis, CMI scores for all parameters showed no difference between genuine halitosis female patients and pseudo-halitosis female patients, while male patients with pseudo-halitosis showed higher scores in the CMI overall score, scores for emotional symptoms and sensitivity, than males with genuine halitosis., Conclusion: There was a marked inconsistency between the complaints of patients and their actual odour status. Patients with a chief complaint of halitosis exhibited a greater level of inadequacy, depression, anxiety, sensitivity, anger, and stress. The psychological status of the patients varied with gender.

Background Halitosis is a frequently reported oral health problem worldwide with a prevalence rate of 10-30% in the general population. It is defined as the disagreeable or foul smelling breath originating consistently from a person's oral cavity. It not only effects the normal daily life activities of the patient but also bring humiliation, reduced self- esteem, ultimately resulting into decreased quality of life. Objective To determine the self-perception of halitosis among undergraduate students of different medical branches of Kathmandu University School of Medical Sciences (KUSMS); Kavre, Nepal. Method A descriptive cross-sectional epidemiological survey was conducted among undergraduate students of Physiotherapy, B.Sc Nursing, Bachelor of Nursing Sciences (BNS), MBBS and BDS program of Kathmandu University School of Medical Sciences, Dhulikhel. A self-administered questionnaire was developed and were distributed among 500 undergraduate students. Result Out of total 500 distributed questionnaires, 406 were completely filled and returned giving an overall response of 81.2%, in which 70 (89.7%) male and 280 (85.4%) female students from different medical branches were aware of the term halitosis. Among them 29 (7.14%) of students think that they suffer from halitosis. Similarly 178 (43.84%) students had severe impact of halitosis on their social life while 153 (37.68%) and 62 (15.27%) students had moderate and mild impact respectively. Conclusion Due to the multifactorial complexity of halitosis, further longitudinal studies including objective assessment of malodor are required to determine its prevalence and to further investigate the association of this problem with other etiological factors in the context of Nepal. Also, curriculum of different fields should be modified to include this simple but very necessary topic.

Halitosis is chronic, endogenous malodor that is etiologically classified. Subjective halitosis, which may appear in clinically neurologic (neurogenic) or psychologic (psychogenic) forms, cannot be confirmed by using tests or performing visual inspection despite insistent complaints of malodor by the patient. Neurogenic forms mainly consist of chemosensory dysfunctions (dysguisa, dysosmia) and self-halitosis (retronasal olfaction, bloodborne olfactory receptor responses, phantosmia); whereas psychogenic forms are olfactory hallucinations, halitophobia, olfactory obsession, and delusional halitosis. This article reports clinically important properties of subjective halitosis that may be difficult to manage and provides a tool to aid dental pracitioners. Practitioners can identify suspected subjective halitosis cases by asking patients simple questions to distinguish between subjective and objective forms.

Purpose: Halitosis is a universal affliction suffered by many individuals irrespective of age, sex and social status. Concern about oral malodor can significantly impede an individual's personal, professional and public life which can lead to the development of social anxiety. The present study was undertaken to assess the association between social anxiety with oral hygiene status and tongue coating among patients with subjective halitosis. Methods: A total of 321(n=321) subjects were self-recruited to participate in this IRB approved study. A 24- item Liebowitz Social Anxiety Scale, Self-Report version (LSAS-SR) was distributed and completed by the participants; followed by oral examination using Simpified Oral Hygiene Index and Tongue Coating Record (TCR). ANOVA, t-test and Mann Whitney U test was used for comparison among variables. Correlation was performed using Karl Pearson's correlation coefficient method. The level of significance was set as p<0.05. Results: The total LSAS for the study population of 321 was 61.41±24.09; with females having significantly higher scores (64.64±24.95; p=0.01*). Comparison of clinical oral parameters between the genders revealed that poor oral hygiene (2.45±1.06) with a higher tongue coating score (71.38±18.24) was observed among male participants. However, these scores were statistically insignificant. A significant correlation between total LSAS, majority of its subscales and the oral parameters among females and subjects with high school education was also reported. Conclusion: This study revealed that social anxiety, poor oral hygiene and tongue coating were associated with subjective halitosis. Hence, maintenance of good oral health along with the use of appropriate tongue cleaning methods is of critical importance in reducing oral malodor. In some cases, comprehensive treatment of halitosis may require a multidisciplinary approach including dental, psychology and counselling professionals., (Copyright © 2017 The American Dental Hygienists’ Association.)

Background: Pathologic subjective halitosis is known as a halitosis complaint without objective confirmation of halitosis by others or by halitometer measurements; it has been reported to be associated with social anxiety disorder. Olfactory reference syndrome is a preoccupation with the false belief that one emits a foul and offensive body odor. Generally, patients with olfactory reference syndrome are concerned with multiple body parts. However, the mouth is known to be the most common source of body odor for those with olfactory reference syndrome, which could imply that the two conditions share similar features. Therefore, we investigated potential causal relationships among pathologic subjective halitosis, olfactory reference syndrome, social anxiety, and preoccupations with body part odors., Methods: A total of 1360 female students (mean age 19.6 ± 1.1 years) answered a self-administered questionnaire regarding pathologic subjective halitosis, olfactory reference syndrome, social anxiety, and preoccupation with odors of body parts such as mouth, body, armpits, and feet. The scale for pathologic subjective halitosis followed that developed by Tsunoda et al.; participants were divided into three groups based on their scores (i.e., levels of pathologic subjective halitosis). A Bayesian network was used to analyze causal relationships between pathologic subjective halitosis, olfactory reference syndrome, social anxiety, and preoccupations with body part odors., Results: We found statistically significant differences in the results for olfactory reference syndrome and social anxiety among the various levels of pathologic subjective halitosis (P < 0.001). Residual analyses indicated that students with severe levels of pathologic subjective halitosis showed greater preoccupations with mouth and body odors (P < 0.05). Bayesian network analysis showed that social anxiety directly influenced pathologic subjective halitosis and olfactory reference syndrome. Preoccupations with mouth and body odors also influenced pathologic subjective halitosis., Conclusions: Social anxiety may be a causal factor of pathologic subjective halitosis and olfactory reference syndrome.

Background: To determine the impact of self-perceived halitosis on social interactions, and the effect of using an oral rinse for management of halitosis., Methods: A survey among a representative sample of the Dutch population (n = 1082), and a pre-post study among a sample of consecutive coming-by volunteers (n = 292)., Results: Participants of the representative sample rated their oral odor as 66.8 ± 17.2 and the consecutive volunteers as 70.9 ± 16.7 (range: 0-100). Sizable proportions (15.3 % and 38.1 %, respectively) indicated to always take into account their (bad) oral odor when meeting a person for the first time. The worse people perceived their oral odor, the more likely they were to take into account to keep a certain distance. Following the use of the oral rinse, a significant decline was found of the extent to which the participants reported to take into account their oral odor when meeting a person for the first time. Both studies identified a subgroup of individuals (9.1 % and 28.1 % respectively) who reported to keep a certain distance when meeting other people, despite a "fresh" self-perceived oral odor., Conclusion: The results suggest that self-perceived oral odor negatively affects social interactions, and that adequate management of halitosis has the potential to improve such interactions.

Background: Burning mouth syndrome (BMS) is an idiopathic disease characterized by the feeling of burning in the oral cavity. Ten per cent of patients presenting to oral medicine clinics have BMS. Anxiety and depression are common co-morbidities in BMS, but it is not known if they are associated with specific BMS symptoms., Objective: In an exploratory analysis, this study examined the association of generalized anxiety and depression with individual BMS symptoms., Methods: Forty-one patients were recruited from a dental outpatient clinic (30 with BMS and 11 with other oral conditions), evaluating specific BMS symptoms and their intensity. Anxiety and depression symptoms were assessed using a standardized measure (Clinical Interview Schedule-Revised)., Results: Taste change (p = 0.007), fear of serious illness (p = 0.011), metallic taste (p = 0.018) and sensation of a film on the gums (p = 0.047) were associated with an excess of psychiatric symptoms. More specifically, metallic taste (coefficient = 0.497, 95% CI = 0.149-0.845; p = 0.006) and sensation of film on gums (coefficient = 0.625, 95% CI = 0.148-1.103; p = 0.012) were associated significantly with higher scores for depressive symptoms; taste change (coefficient = 0.269, 95% CI = 0.077-0.461; p = 0.007), bad breath (coefficient = 0.273, 95% CI = 0.065-0.482; p = 0.012) and fear of serious illness (coefficient = 0.242, 95% CI = 0.036-0.448; p = 0.023) were associated with higher anxiety scores., Conclusion: Specific BMS symptoms are associated differentially with generalized anxiety and depression. Dental practitioners should ascertain which BMS symptoms are predominant and be mindful of the association of certain symptoms with anxiety or depression and, where necessary, consider medical consultation.

Objective: To provide baseline data about bad-breath perception and misconceptions among Nigerian adults., Methods: Multi-center cross-sectional study of individuals aged 18-64 years using examiner-administered questionnaires. Age comparisons were based on the model of emerging adults versus full adults. Data were recoded for statistical analyses and univariate and secondary log-linear statistics applied., Results: Participants had lopsided perceptions about bad-breath. While 730 (90.8%) identified the dentist as the expert on halitosis and 719 (89.4%) knew that bad-breath is not contagious, only 4.4% and 2.5% associated bad-breath with tooth decay and gum disease respectively. There were no significant sex differences but the older adults showed better knowledge in a few instances. Most respondents (747, 92.9%) would tell a spouse about their bad-breath and 683 (85%) would tell a friend., Conclusions: Participants had lop-sided knowledge and perceptions about bad-breath. Most Nigerian adults are their "brothers' keepers" who would tell a spouse or friend about their halitosis so they could seek treatment.

Background: Self-perceived halitosis could be a symptom of a psychosomatic or psychogenic disorder. The aim of this cross-sectional study was to clarify the relationship of self-perceived halitosis with psychological and oral health statuses., Methods: One hundred participants with a history of halitosis were enrolled from a teaching hospital. They were divided into the self-perceived and suggested groups if they sensed and did not sense the malodor, respectively. Demographic and socioeconomic information, smoking status, and oral hygiene practices were noted. Complete nasal, oral, and periodontal examinations with organoleptic tests (OLTs) and N-benzoyl-DL-arginine-2-naphthylamide (BANA) tests were conducted. The participants also completed the validated Arabic version of the 90-item revised symptom checklist (SCL-90R). Data were compared by analysis of variance, chi-square test, Student's t-test, and multivariate logistic regression., Results: The self-perceived group had higher OLT scores (p = 0.005) and were significantly younger (p = 0.001) than the suggested group. A significantly higher number of its participants were smokers (p = 0.004). No significant differences were observed in socioeconomic information, oral hygiene practices, oral conditions, and BANA test results. Further, no significant association was noted between self-perceived halitosis and the nine psychological dimensions of SCL-90R., Conclusions: Halitosis is a multifactorial symptom that requires multidisciplinary management. Self-reporting of the condition is unique entity and trust worthy symptom. It tends to be related to nonoral pathologies and extrinsic causes such as smoking.

The objective of this study was to determine the prevalence of and factors associated with clinical and perceived oral malodor among dental students. Clinical oral malodor was measured in 163 Malaysian dental students using organoleptic method and Oral ChromaTM and they were asked about their perception of self-oral malodor. Oral examination was performed to assess oral health status. Statistical analyses were performed using SPSS version 19.0. There were 52.7% students who had clinical oral malodor, while 19.0% students perceived they had oral malodor. The sensitivity (0.244) of self-perceived oral malodor was lower than its specificity (0.870). Tongue coating was closely associated with clinical oral malodor whereas high plaque index was closely associated with perceived oral malodor. These results showed that clinical oral malodor was prevalent among dental students, but students' perception of oral malodor did not always reflect actual clinical oral malodor. Furthermore, associating factors of clinical oral malodor differ from perceived oral malodor. The importance of controlling clinical oral malodor with proper tongue cleaning should be emphasized and dental students should be taught on the differences between clinical and perceived oral malodor in order to manage this problem.

Objectives: Subjective halitosis is a growing concern in the fields of dentistry and psychology. This study was designed to determine the association between subjective halitosis and contributing psychological factors., Methods: Data for this cross-sectional study were gathered from 4,763 participants who had answered questions on subjective halitosis and psychological factors (depression, anxiety, stress and personality traits) in the study on the epidemiology of psychological, alimentary health and nutrition (SEPAHAN). Binary logistic regression was used for data analysis., Result: The mean age of all subjects was 36.58 years; and the majority of subjects were female (55.8%), married (81.2%) and graduates (57.2%). The prevalence of subjective halitosis was 52.8%. The majority of subjects with the complaint of subjective halitosis were married (P<0.001) and young (P=0.07). Participants with subjective halitosis were significantly more anxious [odds ratio (OR)=1.76, 95% confidence interval (95% CI): 1.38-2.24], stressed (OR=1.41, 95% CI: 1.17-1.71) and depressed (OR=1.31, 95% CI: 1.09-1.57). Among personality traits, neuroticism was a risk factor (tertile 1 vs. tertile 2: OR=1.29, 95% CI: 1.09-1.51; and tertile 1 vs. tertile 3: OR=1.74, 95% CI: 1.43-2.13) and conscientiousness was revealed to be a protective factor (tertile 1 vs. tertile 2: OR=0.82, 95% CI: 0.70-0.98; and tertile 1 vs. tertile 3: OR=0.65, 95% CI: 0.53-0.80)., Conclusion: It seems that psychological factors, such as anxiety, depression and stress, as well as some personality traits, can be considered as risk factors for subjective halitosis. Multidisciplinary efforts by dental and psychological professionals must be considered to address this problem., (© 2015 FDI World Dental Federation.)

This study aimed to evaluate the impact of dental caries treatment on oral health-related quality of life (OHRQoL) among schoolchildren and the responsiveness of the Child Perceptions Questionnaire (CPQ8-10 ) instrument. Brazilian schoolchildren, 8-10 yr of age, were randomly selected and assigned to two groups--dental caries treatment (DCT) and caries-free (CF)--according to their caries experience [decayed, missing, or filled primary teeth (dmft) and decayed, missing or filled secondary teeth (DMFT) values of ≥ 0]. The CPQ8-10 instrument was administered at baseline and at 4 wk of follow-up (i.e. 4 wk after completion of dental treatment). In the DCT group, increases in CPQ8-10 scores were observed between the baseline and follow-up results. However, longitudinal evaluation of the CF group demonstrated no statistically significant difference in CPQ8-10 scores. Responsiveness of the CPQ8-10 instrument (magnitude of change in CPQ8-10 scores) in the DCT group was greater (effect size >0.7) than in the CF group. The findings of this study show that dental caries treatment has an important impact on OHRQoL of children. The CPQ8-10 was considered an acceptable instrument for longitudinal measurement of changes in OHRQoL., (© 2015 Eur J Oral Sci.)

Background: Although the use of removable dentures can improve oral function and esthetics for elderly people, compared to those who do not wear removable dentures, those wearing removable dentures could have worse oral health related-quality of life (OHRQoL). Additional information is required to assess which factors related to denture wearing influence the OHRQoL of elderly individuals. The purpose of this study is to evaluate the association between denture wearing and OHRQoL in a sample of elderly individuals in Taiwan., Methods: The study population included 277 elderly people wearing removable dentures (mean age = 76.0 years). Using face-to-face interviews, we collected data on the participants' socio-demographic characteristics, dental care service usage (regular dental checkups, treatment during toothache, dental visits in the last year), and factors related to denture wearing (perceived oral pain, perceived loose denture, perceived oral ulcer, perceived halitosis, perceived dry mouth, and perceived total denture satisfaction scores). OHRQoL was measured using the Taiwanese version of the Geriatric Oral Health Assessment Index (GOHAI-T). The location and number of remaining natural teeth and the type of denture were also recorded. Hierarchical multiple regression analysis was performed using GOHAI-T scores as the dependent variable., Results: All the predictors together accounted for 50% of the variance in GOHAI-T scores. Further, education level, number of natural teeth, denture status, perceived loose denture, perceived oral ulcer, and perceived total denture satisfaction scores had statistically significant influences on OHRQoL. When compared with other variables, factors related to denture wearing, especially perceived total denture satisfaction scores, had the greatest impact on GOHAI-T scores., Conclusions: Of the factors analyzed in this study, denture satisfaction was the strongest predictor of OHRQoL. This suggests that denture satisfaction is useful for assessing the effect of denture treatment on the OHRQoL of elderly individuals wearing removable dentures.

Objective: The objective was to report a case of olfactory reference syndrome (ORS) with several co-occurring disorders and to discuss ORS differential diagnoses, diagnostic criteria and classification., Method: Case report., Results: A 37-year-old married woman presented overvalued ideas of having bad breath since adolescence. She met current diagnostic criteria for social anxiety disorder, specific phobia, obsessive-compulsive disorder, generalized anxiety disorder, body dysmorphic disorder and major depressive disorder. ORS similarities and differences with some related disorders are discussed., Conclusion: Further studies regarding symptoms, biomarkers and outcomes are needed to fully disentangle ORS from existing depressive, anxiety and obsessive-compulsive spectrum disorders., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Halitosis is described as offensive breath caused by various factors such as periodontal diseases, bacterial coating of tongue, systemic disorders and different types of foods. Pseudohalitosis is a situation that patients complain of oral malodor even though they do not have offensive odour. The purpose of this study was to compare the relationships between social anxiety estimations and both pseudohalitosis and genuine halitosis cases. Liebowitz Social Anxiety Scale (LSAS) and questionnaire regarding halitosis were applied to 100 participants. Halitosis was determined using organoleptic method, gas chromatography and portable sulphur monitor. anova test and 2-tailed Spearman's rank-order correlation coefficient were used to determine the differences and relations between groups. With reference to LSAS, 62% of participants had anxiety. Among these patients, 98% had genuine halitosis (P < 0·05). The mean measurements of VSC values were 248·65 ppm in halimeter, 298·02 ppm of H2 S, 95·33 ppm of CH3 SH and 47·00 ppm of (CH3 )2 S in gas chromatography. Halitosis was present in 90% of participants, and it was absent in 10% by organoleptic assessment. There was a significant correlation between organoleptic and halimeter measurements. Moreover, statistically significant relationship was detected between anxiety and halitosis. Genuine halitosis patients exhibit social anxiety, so it can be said that there is a causal relationship between halitosis and anxiety. Comparison of the results of objective measurements (sulphur monitor, gas chromatography, organoleptic method) was statistically significant; therefore, it can be said that these methods can be used in diagnosis of halitosis with high accuracy., (© 2014 John Wiley & Sons Ltd.)

Background: There is no universally accepted, precise definition, nor standardisation in terminology and classification of halitosis., Objective: To propose a new definition, free from subjective descriptions (faecal, fish odour, etc), one-time sulphide detector readings and organoleptic estimation of odour levels, and excludes temporary exogenous odours (for example, from dietary sources). Some terms previously used in the literature are revised., Results: A new aetiologic classification is proposed, dividing pathologic halitosis into Type 1 (oral), Type 2 (airway), Type 3 (gastroesophageal), Type 4 (blood-borne) and Type 5 (subjective). In reality, any halitosis complaint is potentially the sum of these types in any combination, superimposed on the Type 0 (physiologic odour) present in health., Conclusion: This system allows for multiple diagnoses in the same patient, reflecting the multifactorial nature of the complaint. It represents the most accurate model to understand halitosis and forms an efficient and logical basis for clinical management of the complaint.

Aim: The aim of this study was to evaluate oral health status and oral health related quality of life (OHRQoL) in Iranian patients undergoing hemodialysis., Materials and Methods: In this cross-sectional study 145 (95 dentate and 50 edentulous) patients undergoing hemodialysis participated. Demographic information, laboratory findings and dental health status was recorded by a standard form. Oral hygiene status was obtained by simplifed oral hygiene index (OHI-S) and oral health was evaluated by decay missing flling teeth (DMFT) index, plaque index (PLI) and periodontal disease index. Oral health related quality of life was determined by means of short form oral health impact profle (OHIP-14) and general oral health assessment index (GOHAI)., Results: The mean (± SD) DMFT, PLI and PDI were 15.47 ± 7.85, 2.03 ± 0.95, 4.09 ± 1.31 respectively. OHI-S was good in 7 (7.4%), fair 25 (26.6%) and poor in 38 (26.6%) of patients. The mean OHIP-14 and GOHAI scores were 31.32 ± 12.53 and 29.07 ± 8.5 respectively. The self-perceived oral health of 58 (40%) was good, 49(33.8%) was fair and 38 (26.2%) was poor. Patients with higher scores for the questionnaires had significantly worst self-rated oral health. Besides, there was a significant positive correlation between dental and periodontal variables with OHIP-14 and GOHAI scores., Conclusion: Hemodialysis patients had a poor oral hygiene and periodontal status, weak attitudes and negligence toward oral health but they were satisfed of their oral health condition and their OHRQoL was approximately good. Therefor it should be communications between nephrologists and oral health care professionals for promoting the oral health status of the patients., Clinical Significance: The findings high light the need of comprehensive oral examinations including periodontal therapy, restorative treatment, preventive dental treatment and follow-up care in the hemodialysis patients.

Objective: To investigate the determinant factors of discomfort attributed to the use of fixed orthodontic appliance and the effect on the quality of life of adolescents., Material and Methods: Two hundred and seventy-two individuals aged between 9 and 18 years old, enrolled in public and private schools and undergoing orthodontic treatment with fixed appliance participated in this cross-sectional study. The participants were randomly selected from a sample comprising 62,496 individuals of the same age group. Data was collected by means of questionnaires and an interview. Discomfort intensity and bio-psychosocial variables were assessed using the Oral Impact on Daily Performance questionnaire. Self-esteem was determined using the Global Negative Self-Evaluation questionnaire. Statistical analysis involved the chi-square test and both simple and multiple Poisson regression analyses., Results: Although most individuals did not present discomfort, there was a prevalence of 15.9% of impact on individuals' daily life exclusively due to the use of fixed orthodontic appliance. Age [PR: 3.2 (95% CI: 1.2-8.5)], speech impairment [PR: 2.2 (95% CI: 1.1-4.6)], poor oral hygiene [PR: 2.4 (95% CI: 1.2-4.8)] and tooth mobility [PR: 3.9 (95% CI: 1.8-8.1)] remained independently associated with a greater prevalence of discomfort (P ≤ 0.05)., Conclusions: Discomfort associated with the use of fixed orthodontic appliances exerted a negative influence on the quality of life of the adolescents comprising the present study. The determinants of this association were age, poor oral hygiene, speech impairment and tooth mobility.

Halitosis, or bad breath occurs in 25 % of the population. 85% of the causes are located within the oral cavity (for example: periodontitis, pathologicaly coated tongue or poor oral hygiene). This is the reason why the dentist is often the first person, who sees patients presenting this problem. While some patients feel that their breath smells bad, people with genuine halitosis usually do not notice this fact, which has been called the "bad breath paradox". For people in whom symptoms of halitosis are not present, and yet they complain about having them, psuedohalitosis or halitophobia are described. The phenomena responsible for the increase in the number of cases of halitophobia and pseudohalitosis are advertising of oral hygiene products and the fact that patients pay more attention to the quality of mouth odour. It is important to make a correct diagnosis, identify the causes of the disease and to take appropriate steps in order to cure the patient. The paper presents, on the basis of literature, causes of pseudohalitosis and halitophobia and describes the treatment of patients who have been diagnosed with these conditions.

Many patients presenting at oral malodor clinics have psychological halitosis, which is characterized as being obsessive about having oral malodor or being distressed from a keen awareness of oral odor. We used the Tokyo University Egogram (TEG) to evaluate personality traits in patients presenting at the oral malodor clinic of this institute. The incidence of each TEG personality type was compared between a total of 600 patients presenting at the clinic and a cohort of healthy individuals. Differences were found between the malodor patient and healthy groups. Nurturing Parent (NP)-dominant, Adult (A)-dominant, inverse N (NP low, Free Child high), showed a significant decrease of 6.7, 11.3, and 3.6%, respectively; whereas N (A low) and N (NP high, Free Child low) showed a significant increase of 3.3 and 6.4%, respectively (p < 0.01).

Halitosis is the offensive or disagreeable odour that may emanate from the mouth. In 80%-90% of cases, bacterial activities especially on the dorsum of the tongue are implicated. Current studies on halitosis accessed from electronic databases were appraised in the light of prevalence, impact and control of halitosis. Halitosis has a worldwide occurrence with a prevalence range of 22% to 50%. Due to the associated social and psychological effects, it should be taken seriously in all affected patients. Oral healthcare professionals ought to be well informed, because their office(s) are usually the first points of call for the affected patients.

Bad breath is a widespread condition that has been increasingly discussed among professionals and in the mass media in the last few years. In nine of ten cases, halitosis originates intraorally; hence it has become an important topic of study in the education and training of dentists and dental hygienists. However, the de facto knowledge of professionals has never been examined until today. 750 dentists and dental hygienists from Switzerland, Germany, and France were personally interviewed. Their knowledge of halitosis was assessed using a specifically designed questionnaire. In general, considerable differences were ascertained between the German-speaking countries and France, dentists and dental hygienists, and women and men. 27.5% of the French participants believed that the underlying cause of halitosis has a non-oral nature, whereas only 8% of the Swiss and German participants believed so (p ⟨ 0.001). In contrast to dental hygienists, dentists more often considered gastrointestinal factors as a cause of halitosis (p ⟨ 0.001). Dental hygienists from Switzerland and Germany more frequently reported the use of tongue scrapers as a therapeutic method (97% and 97.3%) than did dentists of the same countries (87.3% and 89.3%). Among the French participants, only 52% mentioned the use of tongue scrapers to treat halitosis. 2.7% of French dental professionals had participated in a continuing education course about halitosis, which is much lower than the rate of attendance in Switzerland and Germany (46%). Additionally, interdisciplinary discrepancies were observed, as 65.3% of the dental hygienists frequented advanced training courses, which was twice as much as dentists. Therefore, there are clear differences between dentists in France and their colleagues from the German-speaking countries, but also between dental hygienists and dentists. Dental hygienists from Switzerland and Germany appear to be far ahead in terms of halitosis knowledge.

Aims and Objectives: The aim of this study was to determine the relationship between the concentration of volatile sulphur compounds in mouth air of young adult and their self perception of malodour and also to determine the relationship between the organoleptic assessment of young adult and their perception of malodour., Patients and Methods: A total of 400 willing participants were studied and they were grouped into two based on the health of their periodontium. Subjects were asked for self perception of malodour and organoleptic assessment was done to assess the level of malodour using the Rosenberg 0-5 scoring system. The concentration of volatile sulphur compounds (VSC) was determined objectively using the Halimeter., Results: Eighty subjects reported self perception of malodour i.e. 39 males (48.7%) and 41 females (51.3%). Only 9% of the subjects without periodontal diseases reported self perception of oral malodour while 31% of subjects with periodontal disease had similar claims. Majority (86%) of those who had VSC concentration less than 181 ppb claimed to have no self perception of malodour while 41% of those who had VSC concentration greater than 250 ppb had self perception of malodour. More than half (53.8%) of subjects with VSC concentration greater than 250 ppb had organoleptic score of 3. Half of subjects with organoleptic assessment score of 3 had self perception of malodour., Conclusion: It can be concluded from this study that a relationship exists between self-perception of oral malodour, organoleptic assessment and the concentration of volatile sulphur compounds in mouth air of subjects.

Objective: This article proposes a 'stop-gap protocol'for the initial management of delusional halitosis, which dental practitioners can apply where a multidisciplinary team of dentists and mental health experts (psychiatrist and psychologist) cannot be assembled., Methods: A 4-year prospective study of delusional halitosis patients managed with a 3-step 'Stop-gap protocol' is presented in this paper, to demonstrate our experience in applying the 'Stop-gap protocol'., Results: Twenty three (23) patients diagnosed with delusional halitosis were managed with the 'Stop-gap protocol' within the study period. There were 13 (56.5%) males and 10 (43.5%) females, giving a male to female ratio of 1.3:1.Most of the patients were in the 3rd decade of life (n=10, 43.5%), the mean duration of the bad breath complaint was 5 years, with unknown trigger factor (n=19, 82.6%) in most of the patients and a mean psychological score of 7 ± 1.8. No clinical oral malodour was observed in all of these patients. A normal oral flora was observed in 13 (56.5%) of the cases and a low level of volatile sulphur compound (VSC) was found in 12 (52.2%) of the patients, with a mean VSC level of 22.3 ± 2 ppb. Twenty (87.0%) of the patients presented for follow up /counselling and the mean duration of follow up was 13 weeks. Three (13.0%) patients responded to referral to the joint clinic with mental health experts., Conclusion: Although we do not claim that the 'Stop-gap protocol' is comprehensive, it is hoped that this paper will serve as a useful guide for dentists practising in health facilities without mental health specialists and also to encourage the formation of multi-disciplinary teams in centres where they are present.

This study examined the influence of self-perceived oral odour on social interaction. A representative sample of 1,082 people from the Dutch population of 16 years and older, were surveyed. On average, the participants graded their oral odour as 66.8 on a scale 0-100; 4.2% judged their oral odour as 'not fresh' (score < or = 30). Approximately 65% indicated that they took into account the fact that, when meeting somebody for the first time, that person might smell their oral odour. Participants judging their oral odour to be not fresh were shown to keep significantly more distance when meeting somebody than participants judging their oral odour as fresh. Noteworthy was a subgroup of participants who judged their oral odour as fresh, but indicated that they always kept a certain distance to other people. The results suggest that self-perceived oral odour is a potential barrier in social interaction.

Objectives: The aims were to evaluate the validity of patients' self-estimation and clinical diagnosis of oral malodor and to examine the relationship of oral malodor with oral health status., Methods: The subjects were 252 patients (mean age 43.7 ± 10.7 years) who complained of oral malodor. Oral malodor was assessed by patients' self-estimation, organoleptic test and Oral Chroma. Oral health status, including dental and periodontal conditions, oral hygiene status and flow rate of saliva, was examined. The N-benzoyl-DL-arginine-2-napthilamide (BANA) positive bacteria in tongue coating were evaluated by BANA test. A Spearman's correlation coefficient was used to test correlation between self-perceived and clinical oral malodor. The stepwise multiple regression analysis was used to assess predictors of patients' self-estimated and clinical oral malodor., Results: The percentage of patients who were diagnosed with pseudo-halitosis was 38.5%. Patients' self-estimated oral malodor was significantly correlated with organoleptic test (r = 0.61), H(2)S (r = 0.50) and CH(3)SH (r = 0.46). There were 47.1% of patients who estimated correctly their oral malodor's scores with those by examiner. The highest correspondence was found in patients without oral malodor (52.6%), followed by in those with moderate or strong oral malodor (46.7%) and in those with slight oral malodor (33.3%). The significant predictors of patients' self-estimated and clinical oral malodor were bleeding on probing, tongue coating, BANA test and flow rate of saliva., Conclusion: Patients' self-estimated oral malodor was found to correspond significantly with clinical oral malodor and be associated with oral health status. Current findings suggest that self-estimation can be used to judge one's own oral malodor.

Objective: This study aimed to evaluate the reliability and validity of the Chinese version of the Halitosis Associated Life-quality Test (HALT) questionnaire., Methods: A total of 106 patients with oral malodour were recruited to complete the questionnaire after its translation and cross-cultural adaptation. The reliability of the Chinese version of the HALT was evaluated using internal consistency and test-retest methods. Both construct validity and discriminative validity were adopted to evaluate the validity of the HALT., Results: The Cronbach's alpha value (internal reliability) for the total HALT score was 0.95, and the intraclass correlation coefficient (ICC) value (test-retest reliability) was 0.89 (95% CI = 0.74-0.98). The construct validity was determined by exploratory factor analysis. Four factors were extracted, which accounted for 85.18% of the variance. All items had factor loadings above 0.40, ranging from 0.53 to 0.94. In addition, the Chinese version of the HALT was found to be valid for distinguishing patients with different degrees of oral malodour., Conclusion: The results suggest that the Chinese version of the HALT has satisfactory psychometric properties and is applicable to patients with oral malodour in Chinese-speaking populations., (© 2012 John Wiley & Sons A/S.)

Using a representative sample from the Dutch population, some psychosocial aspects of halitosis were examined. The results of the survey showed that almost 90% of the Dutch population aged 16 years and older were regularly faced with halitosis. Forty percent reported to be exposed to someone with halitosis at least once a week, men significantly more frequently than women. Although less strongly than body odour, halitosis was reported as being one of the most severe 'let-downs' in social interactions. The greater the social distance between subjects, the less likely is the chance that a person's attention will be drawn to halitosis experienced. When it comes to an unknown person, the chance was no more than 7%, suggesting that it is problematic to draw a person's attention to the presence of halitosis. Considering the potential social consequences of halitosis is it important that dentists and dental hygienists draw patients' attention to the presence of halitosis, when this is the case, thereby encouraging them to seek adequate treatment.

Aim: The aim of this study was to observe and determine oral complaints of people aged 55 years or older, living in two nursing homes in Istanbul, Turkey, and their satisfaction with their complete or partial dentures by means of a simple questionnaire., Methods: Two old people's homes (one public and one private) in the district of Uskudar in Istanbul agreed to take part in this study. All residents who were available were invited to answer a piloted nine-point questionnaire with questions on age, gender, physical problems, eating, and communication, aesthetic denture wearing and psychological problems. The questions were asked in person by one investigator. The resulting data were entered into SPSS version 15., Results: Out of a total of 210 residents, 130 (61.9%) took part in the study, of whom 53% (n=71) of residents were living in the private nursing home and 60% (n=81) were female. One hundred and five (80%) were denture wearers. More than half of the residents (59%, n=79) were over 75 years old. Problems were mostly seen in older ages, especially those over 75 years old, over 60% of whom reported problems for all the variables listed in the questionnaire. Women were more aware of halitosis than men., Conclusions: The results of this study confirm those of previous studies and suggest that elderly people with dentures, and particularly complete dentures, frequently complain of a wide range of problems including: eating, social interaction and communication and these problems have a detrimental influence on their quality of life.

The origin of halitosis comes from the Latin word "halitus" meaning 'breath, exhaled air', and in the Hungarian terminology it means bad and smelly breath. The human body emits a number of volatile molecules, which have a peculiar odour. Their presence is influenced by several factors, such as genetic, nutritional and psychological factors. Since bad breath belongs to taboo subjects, halitosis can often lead to social isolation. To determine the incidence of halitosis, an exact diagnosis is needed which sometimes predestinates the possible treatment as well. Investigators estimate the incidence about 50% in the whole population. The male/female ratio is the same and the incidence is growing with age. The diagnosis can be genuine halitosis, pseudo halitosis and halitophobia. We can divide the genuine type into physiological and pathophysiological subtypes. The cause of the halitosis usually can be found in the oral cavity. The volatile sulfur compounds (VSC) produced by some of the oral bacteria are responsible for its development. Only 10% of the causes are extraoral, mostly inflammation of airways or gastrointestinal disorders. The judgment of halitosis is based on three objective methods: the organoleptic, the sulphide monitoring and the gas cromatography methods. Since the origin of the halitosis is mainly the oral cavity, dentists should treat them. Beyond the dental treatments the enhancement of the oral hygiene, the continuous motivation and monitoring are also very important, such as the use of tongue cleansing and special anti-malodour rinses.

Purpose: To translate the original English version of the Geriatric Oral Health Assessment Index (GOHAI) into Hindi and assess its validity and reliability for use among people in India., Materials and Method: After translation into Hindi, a total of 385 participants aged 55+ demonstrated acceptable validity and reliability when used for people in India. Individual GOHAI items were recorded and summed as originally recommended. The questionnaire sought information about socio-demographic characteristics and self-reported perception of general and oral health. Clinical examination included assessment of periodontal status and number of decayed teeth, missing teeth, filled teeth and crowned teeth., Result: Mean GOHAI score was 40.9 (SD, 10.6; range, 12-60). Cronbach's alpha for the GOHAI score was 0.88, indicating a high degree of internal consistency and homogeneity between the GOHAI items. The test-retest correlation coefficient for add-GOHAI scores was 0.72, indicating good stability. Add-GOHAI scores increased with poorer perceived general and oral health. Convergent validity, construct validity and discriminant validity of the GOHAI were demonstrated., Conclusion: It could therefore be used as a valuable instrument for measuring oral health-related quality of life for people in this region., (© 2012 The Gerodontology Society and John Wiley & Sons A/S.)

Aims and Objectives: To determine respondents' perception of their breath odour and their attitude to halitosis, a symptom with social, psychological and medical implications., Patients and Methods: Cross-sectional survey of 213 participants at an oral health education programme organised by a female non-governmental organization, at Ibadan, Nigeria. Socio-demographic variables, individual assessment of breath odour, attitude, experience and knowledge of halitosis were evaluated using a structured questionnaire., Results: About 67.1% (143) did not perceive foul odour from their oral cavity at any time of the day while one respondent perceived a persistently foul breath. 83.1% would like to be told if their breath smells foul and were of the opinion that such information was helpful. 25 respondents considered such remarks embarrassing/insulting, preferring not being told. Seventy-seven (36.2%) would consult the dentist, while 13% (27) would use agents such as chewing gums and candies to mask oral malodour if their breath odour was foul. 80 respondents had been in contact with individuals with foul breath but only 38.8% of them informed the individuals with malodour that their breath odour was foul., Conclusions: Most respondents had a good impression of their breath odour and would appreciate it when informed that their breath is offensive. A few individuals were reluctant to inform people with bad breath while some took exception to such information. To reduce the present stigma and reluctance to discuss bad breath, steps must be taken to re-orientate people through public enlightenment programmes on the aetiology, available remedy for halitosis and how to convey sensitive information to people.

Halitosis, bad breath or oral malodour are all synonyms for the same pathology. Halitosis has a large social and economic impact. For the majority of patients suffering from bad breath, it causes embarrassment and affects their social communication and life. Moreover,halitosis can be indicative of underlying diseases. Only a limited number of scientific publications were presented in this field until 1995. Ever since, a large amount of research is published, often with lack of evidence. In general, intraoral conditions, like insufficient dental hygiene, periodontitis or tongue coating are considered to be the most important cause (85%) for halitosis. Therefore, dentists and periodontologists are the first-line professionals to be confronted with this problem. They should be well aware of the origin, the detection and especially of the treatment of this pathology. In addition, ear-nose-throat-associated (10%) or gastrointestinal/endocrinological (5%) disorders may contribute to the problem. In the case of halitophobia, psychiatrical or psychological problems may be present. Bad breath needs a multidisciplinary team approach: dentists, periodontologists, specialists in family medicine, ear-nose-throat surgeons, internal medicine and psychiatry need to be updated in this field, which still is surrounded by a large taboo.Multidisciplinary bad breath clinics offer the best environment to examine and treat this pathology that affects around 25% of the whole population. This article describes the origin, detection and treatment of halitosis, regarded from the different etiological origins.

It is known that almost one-third of patients who seeks treatment for bad breath do not have genuine halitosis. Halitosis can occur even in cases when the malodor is not perceived by those around the patient and can neither be confirmed by organoleptic tests, nor by sulfur portable monitor readings. In such cases, these patients have been considered as halitophobic or have pseudo-halitosis. The complaint might signal the existence of a chemosensory dysfunction. Factors associated with taste and smell perception can be potentially connected to the occurrence of oral malodor. The threshold values of volatile sulfur compounds that have been used to establish the diagnosis of genuine halitosis do not take into account that the patient may perceive low levels of these and of other volatile compounds through retronasal olfaction. The current concept of halitosis requires the presence of a signal that has been based on equipment results, from the olfactory perception of the examiners and of those who interact with the patient. Nevertheless, the concept does not encompass the symptoms of halitosis. This paper addresses some of the possible causes of chemosensory dysfunction and proposes a new definition for halitosis.

Objectives: This is a clinical case of a 36-year-old Dutch male, patient in the Dr. S. van Mesdag Forensic Psychiatric Centre in Groningen. It demonstrates a short-time effect of a tailored oral hygiene self-care intervention in three sessions over a period of 3 months on halitosis and a patient's oral health-related quality of life (OH-QoL)., Methods: In addition to a dental screening and professional oral hygiene care, a semi-structured interview was conducted by the dental hygienist, and questionnaires were administered. The questionnaires included were; the Dutch version of the Oral Health Impact Profile-14 (OHIP-14-NL; used as a measurement of OH-QoL), scales for expected social outcomes for having healthy teeth, attitudes towards oral hygiene behaviour (OHB) and dental anxiety., Results: Clinical observations showed an improvement in patient's OHB, while the extreme foetor-ex-ore was reduced to an acceptable level. A retrospective assessment showed that patient's attitude towards the recommended OHB together with his self-perceived OH-QoL had positively increased., Conclusions: This case highlights the value of professional individual oral hygiene instructions performed by a dental hygienist. It also illustrates that a patient's effective OHB may play an important role in the reduction in halitosis and self-perceived OH-QoL. Finally, the retrospective version of the OHIP-14-NL may be an adequate method to assess self-perceived OH-QoL within a relative short period of time., (© 2011 John Wiley & Sons A/S.)

Objectives: The aims were to compare self-perceived with clinical oral malodor and to examine risk factors of oral malodor., Study Design: The study was performed on 565 dental patients. Information on sociodemographics, dental health behavior, and self-perceived oral malodor was collected. Clinical oral malodor, oral health status, and the proteolytic activity of the N-benzoyl-DL-arginine-2-napthilamide (BANA) test in tongue coating were assessed., Results: The sensitivity and specificity of self-perceived oral malodor were 47.2% and 59.2%, respectively. Risk factors for self-perceived oral malodor were smoking habit and alcohol consumption, whereas those for clinical oral malodor were level of education, dental visit frequency, tongue-brushing frequency, mouth rinse use, deep periodontal pockets, gingivitis, tongue coating, and a high BANA test score., Conclusions: Self-perception was considered an invalid method of judging one's own oral malodor. Factors related to self-perceived oral malodor were different from those found in clinical oral malodor., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Halitosis or bad breath is a taboo subject that is a widespread problem in the general population. Causes of bad breath can be multifactorial and long time sufferers can be marred from deep psychological stress. Because nine out of ten cases have an oral cause, the initial inquiry should be with a dentist. In a retrospective study from February 2003 to February 2010, the halitosis clinic at the University of Basel analyzed data from 465 patient medical histories. Study objectives evaluated the causes of halitosis, gender distribution and treatment success. All patients reported to have suffered from bad breath. However, 82.7% were actually diagnosed as having halitosis. Within this group, 96.2% showed an oral etiology and 3.8% showed an extra-oral cause. Women suffered significantly more from psychogenic halitosis. Success rates of 92.6% subjectively and 94.5% objectively reflect the treatment success of the diagnostic and therapeutic concepts presented at the University of Basel halitosis clinic over a seven year period.

Background: There is a possibility that genuine halitosis patients' anxiety do not recover after oral malodor treatment due to their social anxiety disorder. The objective of this study was to investigate the influence of social anxiety disorder on the level of anxiety in genuine halitosis patients before and after treatment for oral malodor., Methods: The subjects were 262 genuine halitosis patients who visited the Fresh Breath Clinic from March, 2008 to October, 2009. The subjects who had score 2 or higher by the organoleptic test were diagnosed as genuine halitosis patients. Gas chromatography (GC) was conducted before and after oral malodor treatment for the oral malodor measurement. Based on their risk of social anxiety disorder, subjects were divided into low- and high-risk groups using the Liebowitz Social Anxiety Scale (LSAS). The questions related to oral malodor and the clinical oral examination were both conducted before oral malodor treatment. The level of anxiety before and after oral malodor treatment was evaluated using the Visual Analogue Scale of Anxiety (VAAS)., Results: More than 20% of subjects had a score of 60 or more on the LSAS (high LSAS group). The mean age and the percentage of females were significantly higher in the high LSAS group compared to the low LSAS group. The high LSAS group was more likely to have problems associated with oral malodor and to adopt measures against oral malodor compared to the low LSAS group. The mean concentrations of H2S and CH3SH by GC significantly decreased after the oral malodor treatment in both LSAS groups. VAAS scores also significantly decreased after treatment in both LSAS groups. The logistic regression analysis indicated that the high LSAS group had a 2.28 times higher risk of having a post-VAAS score of 50 or more compared to the low LSAS group., Conclusions: This study revealed that genuine halitosis patients with a strong trait of social anxiety disorder have difficulty overcoming their anxiety about oral malodor. Oral malodor treatment of genuine halitosis patients requires not only regular oral malodor treatment but also attention to social anxiety disorder.

A valid measure of oral malodor (halitosis) and associated quality of life is required for the complete assessment of treatment effectiveness. The purpose of this study was to analyze the psychometric and clinimetric validity of the Halitosis Associated Life-quality Test (HALT) questionnaire, a specific 20-item quality-of-life measure for halitosis. The HALT is a de novo designed tool based on patient interviews and literature review. The University Hospital was the setting for the prospective random non-controlled study design. The comparison between the evaluator' scales on organoleptic testing and HALT scores was performed during the patient's initial visit. HALT was completed by 33 and 16 patients at the initial visit and at 3 months after treatment commencement, respectively. Two treatment arms comprising an experimental arm including Caphosol rinse for xerostomia-associated halitosis, and an established treatment arm with laser cryptolysis were compared. Cronbach's α was 0.93; coefficient alpha with deleted variables was between 0.92 and 0.94; equal length Spearman-Brown coefficient is 0.95. The Cronbach's alphas of each split questionnaire were 0.85 and 0.88, respectively, and test-retest scores were highly correlated (r = 0.85). HALT scores were significantly associated with the scales of organoleptic test (F = 118, p < 0.001; r = 0.96, p < 0.001). HALT successfully measured each treatment arm and showed improvement (p < 0.002) in both arms. Although cryptolysis was more efficacious, the encouraging results of the Caphosol arm indicate that additional investigation is warranted. HALT proved a valid outcome measure for patients with halitosis, describes its burden and is sensitive to clinical change.

Background: Halitosis is a recognized problem in dental practice. Some individuals have the belief that they have offensive mouth odour which neither the dental clinician nor any other person can perceive. This condition is known as delusional halitosis. Delusional halitosis can be classified as either Pseudo halitosis or Halitophobia depending on the response to initial treatment. Halitophobia is an olfactory reference syndrome and is a psychological condition that the dental surgeon is ill equipped to treat alone. This study aimed to analyse patients diagnosed with delusional halitosis, highlight our experiences and make suggestions for improved management of such patients., Methodology: All patients who presented at the dental clinics of University of Nigeria Teaching Hospital between January 2005 and December 2009 with a primary complaint of oral malodour were examined organoleptically. Those with obvious halitosis and known psychological conditions were excluded from the study Once a diagnosis of delusional halitosis was made, each patient was educated on the nature of halitosis, its causes and prevention. They then received oral prophylaxis and oral hygiene instructions. They were then recalled at one week, four week and six week intervals to establish a definitive classification., Result: 18 out of the 25 patients who presented were diagnosed with delusional halitosis. 61% of them male and 39% of them female with an average age of 30yrs. Pseudo halitosis comprised a majority of the cases seen (13). Halitophobia was seen in the minority (5). Reasons sited for believing that they had mouth odour by the patients studied included, peoples reaction when they were in close proximity and how people tended to avoid them (94.4%), ability to self perceive the foul odour from their mouths (55%) and 27.8 % said they had been told by another person that they had bad breath. All the patients had very good oral hygiene, with a tendency to over indulge on oral care products and tended to use mouthwash, breath mints and sweets in an attempt to mask the perceived odour with a few having excessive tooth brushing habits. Most had visited 2 or more other physicians within the year of presentation at the clinic with the same complaint. The patients were embarrassed (55.6%) frustrated (27.6%), self conscious (11.1%) or felt helpless (5.6%) by their perceived foul mouth odour, but none claimed to have suicidal thoughts., Conclusion: In all cases of delusional halitosis, there is usually an underlying psychosomatic problem, which can range from an over valued belief to a frank delusional disorder where the individual can hardly be dissuaded from their belief of mouth odour. A multidisciplinary approach to treatment between the dental surgeons and the psychological specialists may present the best approach for the patients.

Objective:   To assess the psychosomatically subjective symptoms of subjects with neurotic tendencies complaining of halitosis., Design:   Breath malodour was measured in 368 patients using organoleptic test and gas chromatography. Neurotic tendency and subjective symptoms were assessed using the Cornell Medical Index (CMI)., Results:   Of the 79 subjects who met the criteria for neurotic tendencies according to CMI scores, 58 (73.4%) had oral malodour, whereas 21 (26.6%) did not. Coated tongue, periodontal pocket, and daily drinking were significantly more common in subjects with oral malodour. On the CMI questionnaire, subjects with no oral malodour more frequently responded 'yes' to questions about fatigue and psychological problems in their families. Additionally, many answered that they had perceived their own bad breath., Conclusions:   Difficulties experienced by subjects with neurotic tendencies and oral malodour may manifest primarily in oral conditions, whereas those experienced by individuals with neurotic tendencies and no oral malodour may manifest primarily in psychosomatic symptoms., (© 2011 FDI World Dental Federation.)

Objective: To assess the influence of oral health and lifestyle on the prevalence of oral malodour among university students., Materials and Methods: Self-administered questionnaires. Chi-square test was used to detect any significant association between malodour and various variables., Results: 9% of males and 6% of females complained of malodour, while 36% of males and 31% of females did not complain of malodour. Nevertheless, 12% of the males and 6% of females were unable to decide. The highest percentage of respondents not complaining of malodour were non-smokers (55%). A significant number of respondents were free from caries (48%), gingival disease (55%) and also were not complaining of malodour. Statistically, a significant association was found between malodour and gingival disease (p < 0.05) and between malodour and the use of a toothbrush on a daily basis (p < 0.001)., Conclusions: The results highlight the influence of oral self-care and lifestyle on malodour. Public awareness, diagnosis and treatment of malodour are primarily the responsibility of dentists. Malodour can have a distressing effect and the affected person may avoid socialising., (© 2011 FDI World Dental Federation.)

Many patients visit oral malodor clinics because of malodors which are brought to their attention by friends and family, or because they note the behavior of people around them, they suspect a problem and develop a fear of having an oral malodor. However, only around 30% of such patients actually have levels of malodor high enough to bother other people. Many patients exhibit halitophobia symptoms, which present as self-perception of malodor, and thus have a strong obsession about their smell which results in distress. Here, we carried out a study on 300 outpatients who visited the Tokyo Dental College Chiba Hospital Odor Clinic. We used the Tokyo University Egogram (TEG) to elucidate character traits of affected outpatients and compared the occurrence of TEG types in these patients with those of normal individuals. We discovered that 10.4% of patients were A-dominant type, which was 10.6% lower than the 21.0% of normal individuals. On the other hand, 18.4% of patients were N-type (NP high, FC low), which was 9.9% higher than the 8.5% of normal individuals. Results revealed that very few of the malodor outpatients exhibited the trait that shows intelligence, calm judgment, and self-affirmation, and as a result enjoy their life. Instead, many of these patients tended to show high levels of kindness and appeared to be holding themselves back and exercising patience.