Sir,- While many patients genuinely suffer from halitosis, halitophobia, an exaggerated fear of having bad breath, should be considered if no clinical findings support the patient's complaints or if the patient persists in believing that they have halitosis after treatment for genuine halitosis or pseudo halitosis1.
At times it becomes difficult for dentists to manage such patients. Referring such patients to a clinical psychologist or psychiatrist is an option, but this is not acceptable to all patients because they believe that they have severe malodour2 and also due to the social stigma attached to visiting a psychiatrist. 'Organoleptic' or 'hedonic' assessment has been considered as a kind of reference standard3 and the most practical method4 of oral malodour measurement. Such patients can be helped by using a simple 'air bag' method.
This should be done only after the patient is diagnosed to be suffering from pseudo halitosis or halitophobia. A food grade thin transparent plastic bag (odourless) measuring approximately 8 × 12 inches is used. The halitophobic patient is asked to seal his mouth with the open end of plastic bag. They then inhale air through the nose and exhale through the mouth in short bursts, as in speaking. The procedure is continued till the plastic bag is fully inflated. The mouth of this plastic air filled bag is then held tight so that no air escapes out of it. Next, the patient is seated comfortably in a well ventilated odour free room. Air from the plastic bag should be squeezed out in front of the patients' nose while they inhale slowly. As the air is odour free, the patient should be convinced that they are not suffering from halitosis.
To further strengthen the belief, odour free air can be collected from a volunteer or relative of the patient and the procedure be repeated for comparison. The advantage of this method is that a stream of the exhaled air is available for longer duration to be sniffed by the patient.
Another advantage of this method is the way in which air is collected; which is by short bursts, similar to speaking. We generally notice bad breath while someone is talking. Hence this air bag organoleptic self-assessment method can be used as adjunct in the management of patients with pseudo halitosis or halitophobia.
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Yaegaki K, Coil JM . Examination, Classification, and Treatment of Halitosis; Clinical Perspectives. J Can Dent Assoc 2000 66: 257–266