A wide range of physical indicators, as well the patent’s perception of their health, determine quality of life. People who consider themselves to have unsatisfactory oral health are less happy than the general population and have low self-esteem.
Various measurement tools have been developed, such as ‘Oral Health Related Quality of Life Measures’ (OHQoL), which is recognised by the World Health Organisation (WHO) for evaluating to what extent different oral problems affect physical and psychosocial performance and life satisfaction. The most frequently used instrument to date is the Oral Health Impact Profile (OHIP-49).
Oral Health Impact Profile (OHIP-49)
The OHIP-49 was developed in Australia and is based on the conceptual model of oral health used by the WHO in the International Classification of Impairments, Disabilities and Handicaps category. It only includes negative influences on health and uses a Likert 0-4 type scale, with patients choosing answers that range from “never” to “very often” (OHIP-49) to reply to its 49 questions. It is based on the patient’s perception of the frequency of the daily negative impact that oral conditions have on their life in general. Seven different domains are taken into account by the OHIP-49: functional limitation (9 questions), physical pain (9), psychological discomfort (5), physical disability (9), psychological disability (6), social disability (5), and handicap (6)). In the same way as the OMS model, the impacts are organised linearly, moving from the biological domain, to the behavioural, and then to the social. The conclusion that halitosis is the oral condition that causes the most significant negative impact was reached on the basis of this scale.
Awareness of one’s own breath
The OHIP-49 scale considers the non-specific impact of all of the oral problems as a whole. For the purpose of assessing the specific impact of bad breath, a scale exclusively designed for halitosis was created in 2007 by clinicians and psychologists at the Breath Institute: the Halitosis Impact Scale (Escala Impacto Halitosis® EIH). This scale makes it possible to identify what effects the awareness of having bad breath has on behaviour (for instance, using chewing gum or smoking) to provide the patient with more personalised care, support and guidance. The OHIP is also a Likert scale, measuring the frequency of a set of negative emotions and defensive behaviours. It was drawn up based on the various examples of discomfort reported by patients as a result of the impact of halitosis on their lives.
Halitosis Impact Scale (EIH)®
|My awareness of my own breath…||Never||Rarely||Sometimes||Many times||Always|
|1 …limits me when I talk.|
|2 …makes me keep a distance when having a conversation.|
|3 …limits me when I talk in small or confined spaces.|
|4 …makes me rely more heavily on gestures and signs to communicate.|
|5 …makes me cover my mouth with my hand in social situations.|
|6 …limits how much I open my mouth when I talk.|
|7 …limits the way I exhale|
|8 …provokes negations reactions from others.|
|9 …makes me chew gum or smoke to mask the odour.|
|10 …interferes with my intimate relationships.|
|11 …makes me brush my teeth ≥ 5x/day.|
|12 …restricts my social life.|
|13 …makes me nervous.|
|14 …lessens my will to live.|
|15 …makes me contemplate suicide.|
The EIH can be used during or after treatment. A number of centres specialising in the study of the breath, the Breath Institute included, have confirmed that some patients still feel insecure and keep on avoiding social contact even after their halitosis has been successfully treated. These patients continue to constantly rely on odour-masking products (chewing gum, etc.) and on other defensive behaviours. For this reason, the scale is now used to monitor whether the psychological improvement is parallel to biological improvement.
It should be pointed out that even the quality of life of non-genuine halitosis patients (pseudohalitosis) can still be seriously affected. It is the awareness, even if such awareness is mistaken, of suffering from halitosis that can have a negative impact on a person’s life. According to the data collected during the first consultation of hundreds of patients seeking treatment in the Breath Institute’s affiliated centres, it was the patients not suffering from genuine halitosis (cases of pseudohalitosis and halitophobia) for which the biggest impact was observed: 25.0 and 19.2, respectively. Patients with genuine halitosis scored 16.9. However, in all of the cases, the levels were significantly high. Following treatment, the index value decreased by around 40% for values close to 10 points (within the normal range).
The Breath Institute has discovered, on the basis of the latest international research, that there are over 80 possible causes of halitosis.
1. The composition of halitosis (bad breath)
2. Causes of halitosis (bad breath)
2.1 Oral causes
2.2 Respiratory causes
2.3 Digestive causes
2.4 Systemic causes, diet and habits
2.5 Neuropsychological causes
We identify the most effective clinical methods when diagnosing precisely the halitosis’ origin, so that you can chose the best treatment.