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Minerva Stomatologica 2009 September;58(9):435-44


language: English, Italian

Halitosis: a stomatological and psychological issue

Nardi G. M. 1, Forabosco A. 2, Forabosco G. 3, Musciotto A. 4, Campisi G. 4, Grandi T. 2

1 La Sapienza University of Rome, Rome, Italy; 2 CLID, University of Modena and Reggio Emilia, Modena, Italy; 3 Psychologist and psychotherapist, Ravenna, Italy; 4 Department of Stomatology, University of Palermo, Palermo, Italy


It can be stated that halitosis is located on the ridge connecting dentistry, oral medicine, parodontology and psychology. It represents, at the same time, the manifestation of an organic malfunctioning of the oral apparatus, and a problematic element for the individual and his/her relational life. A smelly emanation comes into conflict with the wish to attract, to please, to seduce. The attitudes towards the possibility to suffer from bad breath have two typical opposite expressions, which share the common characteristic that many are bad judges of one’s own breath. The dentist, in fact, is frequently involved in the management of patients who believe they have bad breath problems, which in reality are non-existent (pseudo-halitosis), and, more often, of patients who are not aware they have an halitosis condition, and who are not inclined to accept it (denied halitosis). Generally, the most adequate and suitable option is that of communicating to the unaware patient the existence and the nature of the problem. What is said, and especially the way of saying it, may play an important role in patient’s acceptance of the information without producing, or reducing to a minimum, the undesirable side effects on the patient-professional relationship, and on the personal dynamics of the patient him/herself. A useful procedure is provided by employing a pre-visit questionnaire, that may suitably ask many different questions about relevant dental and mucosal aspects, for instance, dental complaints, the frequency of toothbrushing and flossing, gum bleeding, and about psychological aspects, such as dental anxiety, and degree of satisfaction as regards one’s oral condition, in order to solve or alleviate the patient’s problem, avoiding unnecessary personal discomfort and, at the same time, providing competent and effective professional help. Strategies for communicating in an effective way, in order to properly face both the somatic and the psychological aspects, are proposed. A questionnaire (Halitosis Question-naire - HQ) is also provided, to facilitate the assessment and the management of the halitosis issue.

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