Differentials

Pseudo-halitosis

SIGNS / SYMPTOMS
INVESTIGATIONS
SIGNS / SYMPTOMS

May be classified as a type of olfactory reference syndrome (ORS), a condition characterised by preoccupation with the belief that one emits a foul or offensive body odour that is not perceived by others.[27][28][29] Patients can report a foul smell originating from the mouth, genitals, rectum, or skin, with variable level of insight.[28][29] This belief is often accompanied by ideas or delusions of reference; such as a belief that other people take special notice of the odour in a negative way (for example, by rubbing their nose in reference to the odour or turning away in disgust).[30] In addition, many patients perform repetitive behaviours, such as smelling themselves, brushing their teeth, or showering excessively. Manifestations of ORS are mentioned in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, text revision (DSM-5-TR) under obsessive-compulsive and related disorders, although it does not represent a separate diagnosis.[31][32]

Affected individuals usually have complex underlying psychological drivers; in extreme instances, they have an increased risk of suicide and may become socially isolated or have healthy teeth extracted.[30] Individuals with pseudo-halitosis should be reassured of the absence of local infection, inflammation, or malignancy, as well as of systemic disorders potentially associated with oral malodour. They require appropriate psychological referral for further investigation and treatment.[2]

INVESTIGATIONS

Tests for halitosis are negative.

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