Evaluating the consequences of halitosis – Arifa Sultan

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  Posted by: Dental Design      17th October 2018

At least half the population suffer from some degree of oral malodour[1]and for many individuals it is regarded as a severe problem that negatively impacts on their quality of life. Many patients hold their breath if they come into contact with others or cover their mouth with their hand each time they speak. Those that suffer from halitosis or believe that they do, often change their behaviour by withdrawing from potential social situations,talking less or keeping away from others, which in turn, can lead to negative feelings, low self esteem and social and psychological anxiety.

A study conducted by the University of Basel in Switzerland for example, revealed that in 83.4% of subjects, unpleasant smelling breath took its toll on their social life, manifesting to various degrees of inhibition, insecurity, isolation, withdrawal, reduced social contact and problems in relationships brought about by an unwillingness to speak or by keeping a distance from others.[2]Certainly, a statistically significant relationship has been detected between anxiety and halitosis[3]and patients with pseudo-halitosis are particularly at risk.[4]

A study that was published recently suggests that a scale called the Halitosis Consequences Inventory (ICH) may be a valuable tool to help dental professionals to diagnose the presence of adverse halitosis consequences. It may also help to identify those individuals that may require screening for social anxiety disorder and/or psychological or psychiatric support.[5]

The ICH scale consists of a questionnaire, which was developed by analysing thousands of clinical records from patients at a halitosis clinic. It was based around the 18 most frequently reported changes in thoughts, feelings and behaviours and included questions such as: Do you speak less due to halitosis? Do you turn your face away when talking to someone? Do you believe that you will be a more spontaneous person in your social life if you stoppedhaving bad breath? Do you feel devaluated (i.e. feelings of low self esteem)? The questionnaire also presented questions to determine whether or not subjects were likely to misinterpret other peoples’ normal attitudes, comments and gestures.5TheICH scale was able to accurately discriminate between participants with and without halitosis complaintsand revealed that thoseindividuals with high scores were more likely to have social anxiety disorder.5

Social anxiety disorder (SAD) is more than shyness. It is a persistent disorder that causes intense fear of any situation that involves interaction with other people. Those with SAD overly worry about being negatively evaluated or criticised by other people and dread everyday activities such as beginning a conversation, speaking on the telephone, eating in company, working or shopping. It is a chronic disorder because it does not go away on its own, it can be extremely distressing and significantly impacts on almost all areas of a person’s life.

Therapy such as cognitive behavioural therapy (CBT) is markedly successful in changing sufferers’ thoughts, views and behaviour and some individuals may also require medication.[6]Nevertheless, the individual needs to be compliant and prepared to put in a lot of work into overcoming SAD. Certainly, learning the skills to manage social situations, control fear and gain self-esteem is vital, but also, if oral malodour is part or the main cause of concerns and anxiety, dental professionals can help these people considerably.

In the majority of cases, those that believe that they have unpleasant smelling breath attempt to mask the odour by chewing gum or sucking mints. However, this only works as a temporary solution. A trip to the dentist on the other hand, means that any untreated dental problems can be identified and addressed, which often resolves the problem. Yet, it should be noted that there is considerable evidence to indicate that dentally healthy people can still exhibit significant levels of mouth odour.1Furthermore, there is a fairly large proportion of people that suffer with pseudo-halitosis[7]and these patients too, need a reliable and effective solution to safeguard them from any adverse consequences.

Halitosis is mainly caused when foul smelling volatile sulphur compounds (VSCs) are exhaled in the breath. These odorous gases are produced as enzymes from the anaerobic bacteria living in the mouth break downamino acids.[8]Dental professionals therefore, can provide advice and guidance to ensure that an effective oral health routine is implemented, and as part of this, recommend CB12 mouthwash. CB12 has a clinically proven formula that actually targets and neutralises VSCs instead of simply masking them. Used alongside tooth brushing and interdental cleaning, CB12 can help to rinse away food debris and bacteria, inhibit the formation of biofilm and prevent unpleasant smelling breath for up to 12 hours.

Helping people to see situations and circumstances as a challenge that can be overcome, rather than a distressing threat may be something that you have not considered previously. However, by offering professional guidance, patience and understanding, you can make a substantial contribution to improve both the physical and psychological aspects of a patients’ life.


For more information about CB12 and how it could benefit your patients, please visit www.cb12.com



[1]Bosy A. Oral malodour: philosophical and practical aspects. J Can Dent Assoc. 1997 Mar 63 (3): 196-201. https://www.ncbi.nlm.nih.gov/pubmed/908668[Accessed12th June 2018]

[2]Andrea Zürcher, Andreas Filippi, Dept of Oral Surgery, University of Basel. ‘Findings, Diagnoses and Results of a Halitosis Clinic over a Seven Year Period’. Schweiz Monatsschr Zahnmed. [Swiss Monthly Journal of Dentistry] 3/2012. https://www.ncbi.nlm.nih.gov/pubmed/22418723 [Accessed 12th June 2018]

[3]Kursun S et al. Relationship between genuine and pseudohaltosis and social anxiety disorder. Journal of Oral Rehabilitation. 2014 Nov 41 (11) 822-828. https://onlinelibrary.wiley.com/doi/full/10.1111/joor.12206[Accessed 12th June 2018]

[4]Takashi Z et al. Relationship between social anxiety disorder and halitosis. International Journal of Clinical Preventive Dentistry. 2011 Mar: 7(1) 25-32. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3247091/pdf/1477-7525-9-94.pdf

{Accessed 12thJune 2018]

[5]Duarte da Conceicao M. et al. The Halitosis Consequences Inventory: psychometric properties and relationship with social anxiety disorder. BDJ Open 4: Article 18002 (2018) https://www.nature.com/articles/bdjopen20182.pdf [Accessed 12th June 2018]

[6]Thomas A. Richards, Ph.D., Psychologist. Social Anxiety Association. Social anxiety fact sheet. http://socialphobia.org/social-anxiety-disorder-definition-symptoms-treatment-therapy-medications-insight-prognosis[Accessed 12th June 2018]

[7]Quirynen M. et al. Characteristics of 2000 patients who visited a halitosis clinic. J Clin Periodontol. 2009 Nov;36(11):970-5. https://www.ncbi.nlm.nih.gov/pubmed/19811581[Accessed 12th June 2018]

[8]Bahadır Uğur Aylıkcıet al. Halitosis: From diagnosis to management. J Nat Sci Biol Med. 2013 Jan-Jun; 4(1): 14–23. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3633265/[Accessed 12thJune 2018]

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