Psychogenic Halitosis

In the case of psychogenic halitosis, the person persistently declares that he has bad breath and obsesses about it. However, neither the devices that measure bad breath nor a second person can feel the bad breath of that person. In this respect, psychogenic halitosis is the feeling of bad breath that an individual creates in the mind (subjective) or at the receptor level (neurogenic).

Characteristics of Psychogenic Halitosis

Having subjective bad breath with psychogenic causes is a complex situation and it is not easy to diagnose. However, this form also has some hints. Such patients use two patterns: either since they know themselves or since childhood, they say that their mouth stinks. Moreover, they do not feel this smell themselves. But there is no one else who can feel their bad breath. For these people, especially the most effective zinc compounds-containing oral care products such as mouthwash (eg, TheraBreath Plus Fresh Breath, Tom’s of Maine Natural Wicked Fresh, etc.), toothpaste (eg, TheraBreath Fresh Breath, etc.) or chewing gum (eg, CB12 Boost Sugar Free, etc.) can work.

These people perceive the actions of others towards them as a sign of bad breath. That’s why they need someone other than themselves to complain about bad breath. So the reference is outside of them. These people say that bad breath goes away when they are alone, and they say that they do not have bad breath complaints at home. However, some exaggerated patients say that they have no complaints when they are alone, but feel bad breath when they look in the mirror.

Diagnosis and Treatment of Psychogenic Halitosis

Patients with subjective halitosis with psychogenic causes say that the smell is uninterrupted. They even say that they have bad breath even while eating. Normally, bad breath is intermittent. Moreover, they say that there are many kinds of bad breath. However, objective halitosis is mostly one type and in rare cases, there may be more than one type. Generally, many of these patients also have disorders such as obsession. For example, they obsess about doing certain movements a certain number of times a day (like brushing teeth 10 times a day). For all these reasons, we usually refer these patients to psychiatrists.

Causes, Symptoms, and Treatment of Neurogenic Halitosis

In neurogenic subjective halitosis, patients perceive taste as odor. Since the tongue is a taste organ, not an olfactory organ, these patients have chemosensory dysfunction. In other words, in some people, olfactory receptor cells may be congenitally scattered on the back of the tongue and/or nasopharynx.

In cases of chemosensory dysfunction, the patient receives the odor through olfactory receptor cells scattered either on the back of the nose (retronasal) or on the back of the tongue (dorsolingual). And we usually refer these patients to neurologists.

Distinguishing Psychogenic and Neurogenic Halitosis

There are some tests to distinguish the neurogenic form of subjective bad breath from the psychogenic form. One of them is the vanillin test. The doctor tells the patient to close the nose wings with his hand and stick out his tongue. With a teaspoon, the doctor puts the vanilla powder on the back of the patient’s tongue. The doctor tells the patient not to swallow or speak so that there is no air traffic in the nasopharynx. He then asks the patient if he can feel the taste by marking. The patient answers yes or no by pointing with his nose closed.

If the patient feels the taste of vanilla left by the doctor on his tongue, he is referred to a neurologist with the suspicion of chemosensory dysfunction. Because vanillin has no flavor, only scent. Therefore, the patient who tastes the vanilla placed on the back of the tongue means that he smells it with his tongue. Because normally, under test conditions, the patient should not taste and smell the vanilla that the doctor puts on the back of the tongue.