Halitosis: a new definition and classification

Abstract

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.

Relationships between pathologic subjective halitosis, olfactory reference syndrome, and social anxiety in young Japanese women

“…According to a report by Aydin et al [3], pathologic halitosis has been etiologically classified into five types: oral, airway, gastroesophageal, blood-borne, and pathologic subjective halitosis. Pathologic subjective halitosis (Type 5) is known as a halitosis complaint without objective confirmation by others or by halitometer measurement [3]. That is, the patient believes there is halitosis, but no odor is clinically detectable [4].…”

“…The former includes obsessive-compulsive spectrum disorder and olfactory reference syndrome; the latter includes several chemosensory disorders such as olfaction and gustation [3]. Most pathologic subjective halitosis complaints are attributed to psychological factors, but at least some are neurological [3]. To date, it has been reported that 75% of olfactory reference syndrome patients present with pathologic subjective halitosis complaints [5].…”

“…Recently, Zaitsu et al reported that patients with pseudohalitosis are at risk for social anxiety disorder [11]. Pseudohalitosis is a category of halitosis in which obvious malodor is not perceived by others, but the patient insists that it exists [12]; this is also categorized as pathologic subjective halitosis [3]. Social anxiety is defined as anxiety resulting from the prospect or presence of personal evaluation in a real or imagined social situation [13].…”

An unusual cause for halitosis

“…Both are associated with production of volatile sulfur compounds which may reach the oral cavity by either direct or blood-borne transmission 1 2 4. Where these conditions give rise to breath malodour, treatment has been shown to lead to resolution of halitosis 1 2.…”

“…Such substances include volatile sulfur compounds, diamines, indoles and short-chain fatty acids 1 2. Extraoral halitosis may be caused either by the direct passage of similar compounds from the respiratory or gastrointestinal tracts into the mouth, or odorous substances may reach the oral cavity as a result of haematogenous transmission from their site of production and alveolar gas exchange 1 2 4. The gold standard for clinical assessment of halitosis is organoleptic testing, which involves formal assessment of exhaled breath by an experienced examiner to ascertain the presence or absence of malodour.…”