Our teeth and oral health can play a significant role in our self-confidence. The impact may be due to the appearance of the dentition, because of the colour or alignment of the teeth, or gaps caused by diastemata or tooth loss. However, halitosis, or bad breath, can also be a major contributor to decreased self-confidence.[i]
The effect of halitosis on self-confidence and self-esteem is interesting, mainly because of the fact that it is often not self-perceived.i Where aesthetic features that differ from the societal norm may be easily spotted in the mirror, bad breath may not be picked up by an individual at all.
Halitosis is a common condition, with an estimated prevalence of 10-30%.[ii] However, only approximately 5% of individuals will say they suffer from halitosis.iii This contrast indicates an inability to recognise one’s own oral malodour. However, studies show that people are far more likely to notice their own halitosis after identifying it in someone else around them.[iii]
Affecting mental health
Patients with low educational and income levels are thought to experience a greater psychological impact from halitosis.[iv] Similarly, women may be impacted more than men.v
The realisation that one has bad breath can be detrimental to a person’s mental health. A patient with untreated halitosis may experience distress and possible social isolation.[v] In some cases, an eventual over-concern about halitosis leads to negative psychological wellbeing, even lasting long after treatment if they think their halitosis is not well managed or completely cured.iv It is important to recognise how this can have a wider impact on a patient’s life. They may be impeded from reaching academic and professional goals, and experience an overall decreased quality of life.v
Communicating with care
With an understanding of how halitosis can severely affect an individual, it’s essential to recognise how clinicians can most effectively communicate a treatment plan.
Feelings of shame and embarrassment about the dentition can exacerbate dental anxiety and fears.[vi] To successfully overcome these fears, and leave a long-lasting and positive impact that can help a patient restore their overall confidence and mental wellbeing, clinicians should take a positive, patient-centred approach.
Positive communication between patient and dentist has been linked with greater patient satisfaction and reduced dental fear.[vii] In the case of halitosis and a lack of self-confidence, the clinician may act as a source of emotional support to alleviate any associated fears.
Be aware that for some individuals, the fact that their halitosis may not have an immediate resolution can be of concern. Recognising the greater impact on their quality of life, and assuring them of an overall management strategy may be beneficial for the patient,[viii] and allow them to buy into a longer-term treatment plan where necessary.
The role of the clinician
There are a variety of reasons a patient may develop halitosis, from oral health problems, to medical conditions such as tonsilitis and acid reflux, smoking, and even eating or drinking strong-smelling or spicy foods and drinks.[ix] Whilst addressing each individual cause will be helpful in improving patient confidence, effective general oral hygiene advice remains essential.
Encouraging patients to brush twice a day and implement daily interdental cleaning is very important. However, sometimes, even when periodontal health is perfect, tongue coating can be a key source of halitosis. Ensuring patients clean the tongue dorsum with an appropriate brush, tongue scraper or tongue cleaner is therefore key.
Suggesting patients implement other specially designed oral hygiene products as part of their routine will also be incredibly useful. Consider the Fresh Breath Oral Rinse solutions from The Breath Co., which are specifically designed to combat bad breath for up to 12 hours. Available in Mild Mint or Icy Mint flavours, The Breath Co. Oral Rinses bring long-lasting freshness by actively combating odour-causing bacteria. The unique formula is powered by active oxygen, and is able clean the whole mouth and neutralise bacteria in the hardest-to-reach places.
For more information about The Breath Co., please visit
Anne Symons Bio:
Anne Symons is a Dental Hygienist currently working in a Specialist Periodontal/implant practice and also a busy NHS surgery. She has previously worked in a Max Fax unit, and also taught Oral Health care to staff in Nursing and Residential homes. Anne is also a Professional Educator for Waterpik.
[i] Mento, C., Lombardo, C., Milazzo, M., Whithorn, N. I., Boronat-Catalá, M., Almiñana-Pastor, P. J., … & Zoccali, R. A. (2021). Adolescence, adulthood and self-perceived halitosis: a role of psychological factors. Medicina, 57(6), 614.
[ii] de Jongh, A., van Wijk, A. J., Horstman, M., & de Baat, C. (2016). Self-perceived halitosis influences social interactions. BMC Oral Health, 16, 1-7.
[iii] Bin Mubayrik, A., Al Hamdan, R., Al Hadlaq, E. M., AlBagieh, H., AlAhmed, D., Jaddoh, H., … & Abu Shryei, R. (2017). Self-perception, knowledge, and awareness of halitosis among female university students. Clinical, Cosmetic and Investigational Dentistry, 45-52.
[iv] Briceag, R., Caraiane, A., Raftu, G., Horhat, R. M., Bogdan, I., Fericean, R. M., … & Talpos, S. (2023). Emotional and social impact of halitosis on adolescents and young adults: a systematic review. Medicina, 59(3), 564.
[v] Aydin, M., & Harvey-Woodworth, C. N. (2014). Halitosis: a new definition and classification. British dental journal, 217(1), E1-E1.
[vi] Yuan, S., Freeman, R., Hill, K., Newton, T., & Humphris, G. (2020). Communication, trust and dental anxiety: a person-centred approach for dental attendance behaviours. Dentistry Journal, 8(4), 118.
[vii] Armfield, J. M., & Heaton, L. J. (2013). Management of fear and anxiety in the dental clinic: a review. Australian dental journal, 58(4), 390-407.
[viii] Renvert, S., Noack, M. J., Lequart, C., Roldán, S., & Laine, M. L. (2020). The underestimated problem of intra-oral halitosis in dental practice: an expert consensus review. Clinical, cosmetic and investigational dentistry, 251-262.
[ix] NHS, (2021). Bad breath. (Online) Available at: https://www.nhs.uk/conditions/bad-breath/ [Accessed March 2024]
