Nir Sterer and Mel RosenbergBreath OdorsOrigin, Diagnosis, and Management10.1007/978-3-642-19312-5_9© Springer-Verlag Berlin Heidelberg 2011
9. Breath Odor Diagnosis
(1)
Department of Clinical Microbiology and Immunology Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, 69978, Israel
Abstract
Unlike other complaints such as pain, discomfort, or impaired esthetics, breath odors are not sensed by the patients themselves but rather by people around them (e.g., friends, family members, coworkers). As a result, patients are unable to give a reliable report on their condition (e.g., onset, frequency, duration, intensity). Therefore, it is important to make sure that the patient brings a family member or a close friend (i.e., “confidant”) to the appointment (Rosenberg 1996).
Unlike other complaints such as pain, discomfort, or impaired esthetics, breath odors are not sensed by the patients themselves but rather by people around them (e.g., friends, family members, coworkers). As a result, patients are unable to give a reliable report on their condition (e.g., onset, frequency, duration, intensity). Therefore, it is important to make sure that the patient brings a family member or a close friend (i.e., “confidant”) to the appointment (Rosenberg 1996).
Additionally, modern society is constantly exposed to commercial advertisements stressing the importance of fresh breath, fuelling excessive anxiety surrounding this issue, also known as halitophobia (for more details, see Chap. 12). One result of this phenomenon is that about 20% of the patients complaining of breath odors present in the clinic without any appreciable odor that can be objectively detected (Quirynen et al. 2009; Seemann et al. 2006).
The first diagnostic challenge in the clinic is to confirm whether or not the patient is suffering from an objective malodor problem, referred to by some researchers as genuine halitosis (Yaegaki and Coil 2000).
Pre-appointment Instructions
In order to enable the clinician to properly diagnose breath odor problems, patients should avoid any malodor mitigating activities such as eating, drinking, or gum chewing for 2–3 h prior to their appointment (Rosenberg 1996). Avoiding eating or drinking for longer periods of time (e.g., 6–12 h) has been suggested in the literature (Murata et al. 2002; Richter 1996). However, such a restriction may be problematic in the case of small children or diabetic patients, does not imitate normal everyday life, and may lead to over diagnosis and over treatment.
In light of the fact that in most cases malodor production results from bacterial activity, malodor diagnosis should not be performed during or immediately following antibiotic treatment. If a patient is receiving antibiotics, malodor diagnosis should be postponed till 3–4 weeks following treatment. Performing malodor diagnosis during or immediately following antibiotic treatment may result in misdiagnosing a genuine halitosis patient.
On the day of examination, patients should maintain their regular everyday oral hygiene activity. However, these activities should not include mouthrinse use and should not be performed within 2–3 h prior to the appointment to avoid malodor reduction.
To avoid external effects on malodor measurements, consumption of onion, garlic, alcoholic beverages, coffee, as well as smoking should be avoided for 12 h prior to the appointment. Scented lipstick, cologne, or perfumes should not be worn on the day of examination, as they can confuse odor judge assessment.
Patient Interview
Due to the sensitive nature of the subject, patient interviewing should be done discreetly in a private setting (Lenton et al. 2001). A fruitful discussion on the subject can only be carried out in a calm, relaxed atmosphere where trust can be established.
In some cases, the patient’s chief complaint is self-perceived malodor, which often relies on two forms of sensation: oral discomfort (e.g., bad taste, dryness) and the interpretation of various human gestures (e.g., head averting, nose covering, and back stepping) of people encountered by the patient (see Chaps. 10
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