Halitosis and its management

Patients with halitosis may seek treatment from dental clinicians for their perceived oral malodour. In this article,
an examination protocol, classification system and treatment needs for such patients are outlined. Physiologic halitosis, oral pathologic halitosis and pseudo-halitosis would be in the treatment realm of dental practitioners.
Management may include periodontal or restorative treatment or both, as well as simple treatment measures such
as instruction in oral hygiene, tongue cleaning and mouth rinsing. Psychosomatic halitosis is more difficult to
diagnose and manage, and patients with this condition are often mismanaged in that they receive only treatments
for genuine halitosis, even though they do not have oral malodour. A classification system can be used to identify
patients with halitophobia. Additionally, a questionnaire can be used to assess the psychological condition of
patients claiming to have halitosis, which enables the clinician to identify patients with psychosomatic halitosis. In
understanding the different types of halitosis and the corresponding treatment needs, the dental clinician can bettermanage patients with this condition.
The prevalence of halitosis has been reported to be as high as 50%. However, only a few patients visit dental clinicians to seek help for halitosis. This fact suggests that the patients who do visit clinicians may have different psychological characteristics or values concerning their own breath than other individuals. Since the biochemical
pathogenesis of oral malodour was elucidated by Tonzetich, simple treatment measures have proven very effective in controlling halitosis. Nevertheless, halitosis treatments are generally unsuccessful in halitophobic patients because clinicians are unable to find any signs of bad breath. Patients with psychosomatic halitosis frequently receive only treatment for genuine halitosis and do not receive care from a psychological specialist.
Occasionally, patients with no oral malodour have been given metronidazole and/or chlorhexidine mouthwash,  which might involve side effects, rather than referral to a psychological specialist. Patients’ persistent complaints about malodour are often ignored by dental clinicians. Consequently, these patients may start “doctor shopping.” Many patients with psychosomatic halitosis are not able to obtain proper treatment for their condition because of a clinician’s mistake