Visiting the dentist is not high on most people’s list of favourite things to do. The NHS website has a page dedicated to ‘fear of the dentist’ while the British Dental Health Foundation offers leaflets and information on overcoming dental phobia and anxieties. But whatever level of confidence a patient may have regarding visiting their dentist, they may find another concern equally troubling.
Bad breath has long been something of a taboo subject in society. In a recent survey of 2024 people only 29 per cent of respondents said they would tell someone if they had bad breath, while 71 per cent wanted to be told if they were suffering.
Halitosis’ effects can be far-reaching and research in the Netherlands in 2005 revealed that it constituted “one of the 100 biggest human overall exasperations” and further, that it causes “embarrassment and affects their social communication and life.”
Just how badly a patient can be affected by the condition is evident from a retrospective study conducted over a seven-year period (February 2003-February 2010) by the University of Basel in Switzerland.
Of 451 patients included in the study, the study reports: “In 83.4 per cent (n=376) bad breath took its toll on one’s social life, manifested to varying degrees of inhibition, insecurity, isolation, withdrawal, reduced social contact, problems in relationships, less talking by an unwillingness to speak or by keeping a distance to others.”
The study observes that: “long time sufferers can be marred from deep psychological stress. Because nine out of 10 cases have an oral cause, the initial inquiry should be with a dentist.”
In nearly 85 per cent of cases, the cause for halitosis lies in the oral cavity and so it is perhaps not surprising that the dentist is a professional from whom sufferers will seek help. With an estimated one in four people suffering from bad breath on a regular basis and up to around 50 per cent of the population suffering from it in varying degrees at any one time, it would therefore seem likely that most dentists will see sufferers amongst their patients.
Because of the intensely personal nature of the problem, patients may also be reserved about discussing halitosis and their dentist may find themselves in the position of having to advise those who are unaware.
A study conducted at La Sapienza University of Rome by Nardi et al comments that “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 main, but not the only, cause of halitosis lies in the generation of volatile sulphur compounds (VSCs) caused by bacteria in the oral cavity. The actual detection of bad breath can pose a problem for sufferers as most individuals cannot smell their own breath.
Curd, Bollen and Thomas Beikler (Netherlands research) describe the ‘gold standard’ for detection as “ the organoleptic scoring, ie, smelling the odour of the patient. A more objective method is the analysis of breath samples by gas chromatography or by means of portable VSC analysers.” If organoleptic scoring is used, the authors detail samples, and certain precautions are taken prior to the examination to enable optimal test results.
Some patients may have suffered from bad breath for a considerable time – in the University of Basel study, 32.3 per cent of the 451 patients claimed to have suffered for more than 10 years. The personal, social and psychological aspects of the condition, which may be potentially debilitating for an individual and something they are apprehensive to talk about, may therefore need to be borne in mind alongside treatment of the physical condition, which will depend upon the professional’s assessment.
Bad breath is an emotive subject and, as with patients who have concerns about stepping over the threshold of their dental practice, may need a considerate and sensitive approach. The implications for a patient may go beyond those of simply addressing a physical problem and move into the realms of their personal and social life with possible psychological effects.
In the Basel study “almost every patient (94.5 per cent) tried selfremedies to combat bad breath. These included chewing gum, sweets or mouthwashes which had a masking effect but no influence on the cause of bad breath (Quirynen et al 2002).”
With halitosis largely arising “from intra-oral causes” and the formation of VSCs, preventing these gases forming and their neutralisation – rather than masking the problem – for a prolonged period, can aid this distressing condition. CB12 is one such product that can be recommended to sufferers, it uses a combination of low concentrations of zinc acetate and chlorhexidine to neutralise and prevent the production of VSCs combating bad breath and offering relief for up to 12 hours.
Treatment of, and relief from, bad breath can have implications that extend beyond addressing the physical cause of the problem. Although a visit to the dentist is unlikely to ever rise to the top of the ‘favourite things to do’ list, it may make an important difference to a patient’s enjoyment of life.
References available on request.