Self-perception of breath odor

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ABSTRACT
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Background

Bad breath, also known as halitosis, is a common concern for millions of people. Yet there is almost no reliable way for people to properly assess their breath odor. While many develop faulty perceptions about having bad breath that affect their entire lives, others who have halitosis are unaware of their condition.

Overview

The authors discuss the issues affecting self-perception of breath odor in patients who complain of halitosis, as well as in a more general, “noncomplaining” population. The article presents self-perception of breath odor as a multifactorial, psychophysiological issue that is related closely to one's body image and psychopathological profile.

Conclusions

Based on their data, the authors suggest that every patient has a breath odor self-image. This self-image ranges from little or no distortion to severe psychopathology. Because treating patients with a specific complaint of oral malodor primarily is the responsibility of the dental practitioner, several treatment approaches are outlined: collecting odor samples from the mouth to increase objectivity, involving a confidant in diagnosis and follow-up, corroborating odor judges' scores with objective measurements, increasing the patient's sense of control over the problem and obtaining guidance from mental health professionals, when necessary.

Clinical Implications

Dentists increasingly are being called on to help patients with complaints of bad breath. In diagnosing and treating such cases, dentists should consider psychological and physiological factors.

Section snippets

THE BAD BREATH PARADOX

Many factors influence the way in which we generally perceive odors. Gabassi and Zanuttini8 point out that qualitative judgments of odors largely depend on a person's experience and personality traits. In this context, how we perceive our own breath odor is even more complex. Generally speaking, people appear to be unable to tell whether they have bad breath. This inability—termed the bad breath paradox9—results in millions of people who have bad breath, but are unaware of it, while

SELF-ASSESSMENT IN WORRIERS AND NONWORRIERS

During our initial investigation at Tel Aviv University, Israel, from 1992–1995, we asked subjects to actually smell and rate the odors coming from their mouths, tongues and saliva. We were able to confirm the subjectivity inherent in peoples' attempts to score their own oral malodor,20 but we were not able to find any support for the premise that adaptation (dulling of the senses) was involved. For example, subjects who worried about bad breath rated their own bad breath levels as being

BREATH ODOR IMAGE

Collectively, the data suggest that self-perception of one's own bad breath has psychological elements, not only among those preoccupied by bad breath concerns, but also among the general population. One way to examine this phenomenon is in terms of the body image concept.

The concept of body image has been expanded in recent times to refer to “the picture we have in our mind of the size, shape, and form of our bodies and to the feelings concerning these characteristics.”26 Although body

INCREASING THE OBJECTIVITY OF MOUTH ODOR SELF-ASSESSMENT

Investigations that we have conducted in recent years have led us to conclude that when the odor sample is removed from the body proper, objectivity of self-assessment increases.20, 29, 30 In our initial study, when subjects were asked to rate their whole mouth odor by cupping their hands over their mouths, their self-assessments showed no correlations with objective parameters. Similarly, when we asked them to score tongue odor using the wrist-lick test, the self-assessments were highly

TREATMENT

Collectively, the data suggest that every patient has a breath odor self-image. This self-image can range from little or no distortion to severe psychopathology. When a patient's self-image is relatively objective or only moderately distorted, the clinician has an excellent chance of treating not only the objective complaint but also the way the patient relates to the problem. In extreme cases, collaboration with a mental health professional is necessary. Many halitophobic patients,

CONCLUSION

Bad breath is a common problem that usually originates in the oral cavity. People who complain about having bad breath may harbor a self-perception that does not reflect objective findings. When treating patients who complain about having bad breath, clinicians should relate not only to physiological odor and associated parameters but also to the nature of the subjective complaint. We have found that both actual and perceived bad breath should be dealt with as continuous parameters. In

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  • Cited by (0)

    The authors thank Ms. Rita Lazar for her editorial assistance.

    1

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    Dr. Eli is the head, Department of Occlusion and Behavioral Sciences, The Maurice and Gabriela Gold-schleger School of Dental Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv 69978, Israel.

    2

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    Dr. Baht is a clinical psychologist, Department of Occlusion and Behavioral Sciences, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Israel.

    3

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    Dr. Koriat is in private practice in Israel. When the article was written, she was a senior dental student, The Maurice and Gabriela Gold-schleger School of Dental Medicine, Tel Aviv University, Israel.

    4

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    Dr. Rosenberg is a professor of microbiology, Department of Oral Biology, The Maurice and Gabriela Gold-schleger School of Dental Medicine, Tel Aviv University, Israel.

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