In recent years it has been proven that halitosis causes a strong impact on the self-esteem and self-confidence of those who suffer from it, being a trigger for anxiety and continued stress. “The way in which the halitosis damages the sufferer psychologically has surprised both the health professionals and the relatives of the patients,” explains Dr. Jonas Nunes, one of the few researchers of the human breath internationally. He directs the Halitosis Unit in Milan (Columbus Clinic Center) and in Rome (European Hospital).

“In fact, the awareness of suffering bad breath triggers psychological consequences, with visible manifestations in behavior: gestures such as covering the mouth when speaking, maintaining a greater interpersonal distance or avoiding social relationships, some of which can become serious. Even though they can be questioned, there are stories of suicide whose cause has been attributed to the desperation caused by suffering from bad breath.

“The sporadic stories of patients who come to the breath consultations” – continues Dr. Nunes – “have led to numerous studies on the international scene.” One of those studies, performed in Hungary in 2006, obtained results that stood out, identifying halitosis as the condition related to the mouth that causes the greatest negative impact on the quality of life of a person. It was shown that this impact exceeds those caused by other oral health problems, such as the absence of teeth, the use of removable prostheses (dentures), or the existence of pain at the temporomandibular joint level.

Hold your breath

Another study carried out in the psychology laboratory of the ISCTE – University Institute of Lisbon – in 2010, showed that the simple belief of having bad breath causes an immediate effect on the level of happiness; in the emotions and behavior of a person with no history of halitosis. Without knowing that they were the subject of study, around 100 volunteer students (the vast majority without a history of halitosis) underwent a free tracking on their breath.

Some of the students were deceived on purpose and were informed that their preliminary results pointed towards the existence of halitosis. While awaiting the final results, these students were invited to participate in a collective activity in which a jury could observe and record how they behaved and interacted with each other. In the end, psychological measurement instruments were applied to all students.

When comparing the two groups, it was verified that the students deliberately diagnosed with halitosis showed greater presence and frequency of negative emotions (disturbance, nervousness and agitation, among others). Thus, during an activity in which they had to interact in groups, those who believed they had halitosis positioned themselves at a greater physical distance from the others (on average, two meters further than the students “without halitosis”), to avoid contact. In the questionnaires completed at the end of the test, they admitted having adopted a series of behaviors to prevent halitosis from being detected by their peers: they frequently communicated by signals and gestures, carried out shorter breaths, used chewing gum and even went so far as to smoke. ??

When the experimental nature of the activity was revealed to the students, the immediate reestablishment of the parameters affected by the experience was verified: level of happiness, emotions and behaviors. In other tests developed by the Breath Institute (*), the long-term effects that occur when there is awareness of prolonged halitosis over time have been established.

Such effects can be classified into four levels, according to their impact on the life of the patient:

Level 0

• He does not show alterations in behavior.

Level 1

• Speaks at a distance.
• Gestures with the head more than usual.
• Uses chewing gum frequently.
• Has the habit of covering the mouth with his hand.

Level 2

• Avoids talking too much.
• In meetings or group work does not usually express his opinion.
• Depends partially on products that ensure the elimination of the oral odor: chewing gum, cigars/cigarette and oral elixirs.
• Does not speak in closed places (very small rooms or public transport, among others).
• Tends to reduce intimate contact with his partner.
• Reveals phonetic alterations, less amplitude of the mouth opening and more serious vocal timbre.
• Manifests alterations of the respiratory pattern: avoids prolonged expirations and unconsciously acquires a shorter and superior / intercostal inspiration pattern.
• Reveals low self-esteem.

Level 3

• Manifests social phobia, avoiding leaving home and any intimate contact.
• Does not look the person he is talking to in the eyes; Often looks away.
• Loss of concentration (eg, while exposing a more complex reasoning, he is left thinking that the person he is talking to is sensing bad breath and he therefore loses the thread of what he was saying).
• Totally depends on products that ensure the elimination of the oral odor: gum, cigars/cigarettes and oral elixirs.
• Shows insecurity.
• Expresses self-pity.
• Is pessimistic.

Level 4

• Reveals chronic anxiety and depression.
• Has a panic attack.
• Manifests suicidal tendencies.

(*) Source: Breath Institute

Levels 1 and 2 characterize the vast majority of patients who demand halitosis treatment. The last levels that correspond to the most dramatic cases are not usual, although they can appear with very rapid progression.

Smell and emotions

The simple act of smelling carries with it an enormous emotional charge that can elicit approval or rejection, and even stimulate memory. According to Dr. Jonas Nunes, “smell has been considered not only the most emotional sense organ but also the most complex, due to the high variability of emotional responses that odors produce in human beings. The perception of an unpleasant breath generally generates the immediate increase of negative emotions, such as irritability, discomfort, nervousness and agitation. ”

Recent publications in the area of ​​neuroimagiology have interpreted the close relationship between smell and emotions as the result of the superposition of neuronal systems, since the sense of smell is located in the same area of ​​the central nervous system as emotions (the limbic system). “The key limbic structure in the interaction with the olfactory center is the cerebellar amygdala, the place where emotions are processed,” continues the breath specialist.

“Some of the recent findings have clearly shown that this amygdala is stimulated by the perception of an odor, and that olfactory stimuli (positive or negative) influence emotions related to memory, language, spatial recognition and temperament. Inevitably, in the social context, smells, emotions, body image and relationships interact dynamically and uninterrupted throughout our lives. And in this framework” – he concludes – “halitosis is a determining issue.”

Pioneers in the medical treatment of halitosis

The Breath Institute is the first center specialized in the investigation of human breath. It cooperates with professionals from different areas of medicine and psychology with whom it shares a common goal: the medical treatment of halitosis taking into account the more than 80 causes that can produce it.

His scientific contribution has consisted in the development of a novel medical protocol, the HCP Arthyaga® protocol, widely recognized by international experts and, even more importantly, supported by the growing number of satisfied patients. As a precursor in the medical treatment of halitosis, it works to increase the quality of life of patients, participating in the advancement of science, and promoting the fact that halitosis is a socially recognized and understood disease.

For more information contact:
Breath Institute
10 Harley Street, London, W1G 9PF
Tel. 020 3936 1280