Delusional halitosis: Treatment outcome of a multidisciplinary approach

Objective: This study aims to validate a protocol for a multidisciplinary management of delusional halitosis and to assess their outcome of treatment. Method: A prospective study of 61 patients with complaint of chronic bad breath and initial diagnosis of psychological halitosis after assessment with halitosis questionnaires and clinical examination. A final diagnosis of pseudo halitosis or delusional halitosis was made based on the patients’ response to oral hygiene prophylaxis, antimicrobial treatment and counseling for 2 weeks. The delusional halitosis patients were treated in a ‘Joint Clinic’ of oral medicine physician and mental health experts, using a 5-step treatment protocol over a 4-week period. Treatment outcomes for the delusional halitosis patients were evaluated using patient’s self-assessment, WHO well-being index, psychological score and other mental health instruments. Results: There were 33 (54.1%) delusional halitosis patients among the psychological halitosis patients. Twenty (60.6%) patients out of the 33 (100%) delusional halitosis patients attended the ‘joint clinic’. Six (30.0%) of the 20 treated patients had improved self-esteem, while only 1 (5.0%) and 3 (15.0%) showed improvement in state anxiety and trait anxiety respectively. Normal psychological score was found in 1 (25.0%) out of 4 (100%) patients that claimed to be ‘cured’, and 3 (50.0%) out of 6 (100%) patients had ‘improved’ final self-assessment. Conclusion: Preliminary findings suggest early signs of recovery, with improvement in self-esteem, anxiety and psychological problems in delusional halitosis patients.