Breaking paradigms: a new definition for halitosis in the context of pseudo-halitosis and halitophobia

Abstract

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.

Self-perception, knowledge, and awareness of halitosis among female university students

“…Halitosis has been associated with plaque, dental diseases, and tongue coating 2,5–6. It can be classified into several categories: genuine halitosis, which can be physiological or pathological; pseudohalitosis, in which patients think they have bad breath even though they actually do not; and halitophobia, in which people continue to fear that they have bad breath after halitosis treatment 7–11. Common etiologies of bad breath include periodontal diseases, tongue coating, caries, and decreased salivary flow 12–14.…”

Effectiveness of full- and partial-mouth disinfection on halitosis in periodontal patients

“…The halimeter was a VSC monitor that collects volatile sulfur gases from the mouths of patients and expresses VSC concentrations in parts per billion (ppb) (18). The organoleptic test is considering the gold standard for evaluation because of its clinical relevance: the human nose can inhale more than 10,000 odors, not only sulfur gases (19). In addition, organoleptic testing was performed by the same calibrated examiner, who inhaled breath from the mouths of patients and assigned a score of 0-4 (0 = no odor; 1 = natural odor; 2 = distance about 15 cm; 3 = about 50 cm; 4 = >50 cm) (19).…”

“…The organoleptic test is considering the gold standard for evaluation because of its clinical relevance: the human nose can inhale more than 10,000 odors, not only sulfur gases (19). In addition, organoleptic testing was performed by the same calibrated examiner, who inhaled breath from the mouths of patients and assigned a score of 0-4 (0 = no odor; 1 = natural odor; 2 = distance about 15 cm; 3 = about 50 cm; 4 = >50 cm) (19). The kappa coefficient of agreement was 0.930 for the organoleptic test.…”

Rhinosinusitis in oral medicine and dentistry

“…questionnaires and patient self reports. Subjective (non‐genuine) halitosis complaints may account for between 5% and 71% of all patients who complain of halitosis, and these are explained in the large part by psychologic factors, but also by retronasal olfaction or neurologic factors such as chemosensory dysfunction . A marked lack of standardization of research methodologies has led to some authors calling for greater efforts in standardizing protocols in halitosis research .…”