Methods: Forty patients examined at the Breath Odor Clinic of our university hospital, were classified into the two categories, genuine halitosis (GH) and psychosomatic halitosis (PH), on the basis of the results of organoleptic measurement and gas chromatography. The PH group consisted of pseudo-halitosis and halitophobia patients. Twenty-one healthy volunteers without complaint of halitosis were involved as the control group. Resting saliva was collected and concentration of cortisol was measured by ELISA. Levels of Th1/Th2 cytokines (IL-2, IL-4, IL-5, IL-10, IL-12p70, IL-13, IFN-γ, GM-CSF, TNF-α) in saliva were simultaneously determined using Bio-plex® suspention array system.
Results: Significantly higher levels of cortisol were observed in PH group in compared to the GH group and control group (p<0.05). When comparison was made between patients with high salivary cortisol levels and those with low levels, a higher prevalence of subjects positive for a Th2 cytokine IL-5 was shown in the former group.
Conclusion: The results suggest that the level of salivary cortisol is elevated in PH patients in comparison with those in GH patients and control subjects. The anxiety for oral malodor would stimulate the cortisol production and this may, in turn, alter the balance between Th1/Th2 cytokines.