Self-Consciousness: A Barrier to Communication

Regardless of the source of oral malodor, chronic breath problems can be detrimental to one’s self-image and confidence causing social, emotional, and psychological anxiety. The problem of assessing and treating oral malodor is exacerbated by the personally sensitive nature of the topic. Even in close relationships, people are often reluctant to inform others their breath is offensive. Asking a trusted confidant or experienced health professional is considered the most reliable method of confirming a chronic breath odor problem. This, however, can be awkward and embarrassing for both the patient and the dental professional, who historically has been hesitant to broach the subject. Since the dental office is the most logical place to assess and treat oral malodor, it is important to develop the communication skills and knowledge base that will enable dental professionals to respond to our patients who seek information about and treatment for bad breath.
Since oral malodor can be related to certain medical conditions or medications, taking a comprehensive medical/dental history, including questions pertaining to breath concerns, can lay the groundwork for open dialogue about breath problems. When patients initiate a dialogue about their breath concerns, dental professionals need to be comfortable with explaining the etiology of and treatments for oral malodor. Think for a moment about how you would respond to the following situations:

Amy Wu is a 43-year-old married woman who has been referred to your office by a co-worker. During the appointment she tells you her husband frequently complains that she has bad breath. She tells you she has tried to assess her own breath by cupping a hand over her mouth and nose and smelling the expired breath, however, she is unable to detect a problem. She asks you for your professional opinion. How will you proceed to address her concern?

Jeff Olsen, a 22-year-old man, is being seen for his semiannual prophylaxis. Jeff is reserved and timid. When you ask if he has any other concerns or questions, he is too embarrassed to share that he has a bad breath problem and can often detect the offensiveness himself. You sense there is an unspoken concern; what can you do to encourage Jeff to be forthcoming about his problem?

Michelle Thomas is a 51-year-old woman who faithfully schedules her six-month recall appointments. She is a model patient and her home care is meticulous. While greeting Michelle, you notice her breath is very offensive, even from a distance of several feet. Will you say anything about this to her?

Carlos Suarez, a 36-year-old businessman, has scheduled an appointment specifically to discuss his bad breath. He tells you he is so self-conscious about the problem that he turns his head when talking to others to avoid breathing directly on them. He believes his breath is chronically bad and is certain he currently has bad breath. You are unable to detect any offensiveness; in fact, you detect “a pleasantness” in his breath. What will you say to him?