The delusion of halitosis: experience at an eastern Nigerian tertiary hospital.

Background: Halitosis is a recognized problem in dental practice. Some individuals have the belief that they have offensive mouth odour which neither the dental clinician nor any other person can perceive. This condition is known as delusional halitosis. Delusional halitosis can be classified as either Pseudo halitosis or Halitophobia depending on the response to initial treatment. Halitophobia is an olfactory reference syndrome and is a psychological condition that the dental surgeon is ill equipped to treat alone. This study aimed to analyse patients diagnosed with delusional halitosis, highlight our experiences and make suggestions for improved management of such patients.

Methodology: All patients who presented at the dental clinics of University of Nigeria Teaching Hospital between January 2005 and December 2009 with a primary complaint of oral malodour were examined organoleptically. Those with obvious halitosis and known psychological conditions were excluded from the study Once a diagnosis of delusional halitosis was made, each patient was educated on the nature of halitosis, its causes and prevention. They then received oral prophylaxis and oral hygiene instructions. They were then recalled at one week, four week and six week intervals to establish a definitive classification.

Result: 18 out of the 25 patients who presented were diagnosed with delusional halitosis. 61% of them male and 39% of them female with an average age of 30yrs. Pseudo halitosis comprised a majority of the cases seen (13). Halitophobia was seen in the minority (5). Reasons sited for believing that they had mouth odour by the patients studied included, peoples reaction when they were in close proximity and how people tended to avoid them (94.4%), ability to self perceive the foul odour from their mouths (55%) and 27.8 % said they had been told by another person that they had bad breath. All the patients had very good oral hygiene, with a tendency to over indulge on oral care products and tended to use mouthwash, breath mints and sweets in an attempt to mask the perceived odour with a few having excessive tooth brushing habits. Most had visited 2 or more other physicians within the year of presentation at the clinic with the same complaint. The patients were embarrassed (55.6%) frustrated (27.6%), self conscious (11.1%) or felt helpless (5.6%) by their perceived foul mouth odour, but none claimed to have suicidal thoughts.

Conclusion: In all cases of delusional halitosis, there is usually an underlying psychosomatic problem, which can range from an over valued belief to a frank delusional disorder where the individual can hardly be dissuaded from their belief of mouth odour. A multidisciplinary approach to treatment between the dental surgeons and the psychological specialists may present the best approach for the patients.