Relationship between Social Anxiety Disorder and Halitosis

Objective: There is little research on the relationship between social anxiety disorder and halitosis. The objective of this research was to investigate the social anxiety disorder of halitosis patients. Methods: The subjects were 472 patients (male: 152, female: 320, mean age: 48.0±14.5) of the Fresh Breath Clinic at the Tokyo Medical and Dental University Hospital. A self-administered questionnaire collected demographic information (gender and age) and the Liebowitz social anxiety scale (LSAS). LSAS assessed social anxiety disorder of the subjects. LSAS score of 44 or more was determine social anxiety disorder. Patient's Morning breath was assessed by the organoleptic test. They were divided into two groups: genuine halitosis patients (N=343; those with oral malodor) and pseudo-halitosis patients (N=129; those without oral malodor). T-test, chi-squared test and analysis of covariance (ANCOVA) were conducted using SPSS 17.0 software to assess statistical significance. Results: The proportions of the subjects whose score of LSAS was 44 and more did not differ significantly between genuine halitosis patients (35.0%) and pseudo-halitosis patients (43.4%). Pseudo-halitosis patients (42.3±29.4) showed significantly higher total LSAS scores compared to genuine halitosis patients (36.6±26.9). LSAS subscale scores such as fear, avoidance and performance were significantly higher in pseudo halitosis patients than genuine halitosis patients. According to ANCOVA adjusting for gender and age, pseudo-halitosis patients had significantly higher performance score compared to genuine halitosis patients. Conclusion: This study indicated that about one-third of halitosis patients suffered from social anxiety disorder. In particularly, pseudo-halitosis patients had a higher risk of social anxiety disorder compared to genuine halitosis patients. It is necessary to provide a psychological social anxiety disorder approach for halitosis patients.