At least 99 times in 100, a person complaining of oral odor will really have bad breath, as your nose can confirm easily enough. However, in rare cases, someone who says they have dragon breath - especially someone who is excessively anxious or obsessive - may have nothing at all. In these instances, just the idea of halitosis causes a phobia of oral odor, one that can be almost paralyzing.
It's called halitophobia. Before we talk about it any further, remember: Except in the most extreme and unusual cases, if you think you have bad breath, you probably really do. Fortunately, the remedy is simple. Specialty breath freshening products can wet the mouth, oxygenate the palate, neutralize odor and cleanse away bacteria. It's that simple!
For folks with halitophobia, though, it's not so easy. Their fear of halitosis causes them to suspect they have it when they don't - which means even the freshest of breath fresheners couldn't possibly make a difference.
How many people have halitophobia? Experts are unsure, since the subject hasn't been investigated all that much. Of course, plenty of people worry that their breath smells bad, but the true halitophobic is very different.
He or she will almost constantly worry about bad breath. As you'd expect, such a person usually has some serious anxiety! Likewise, these folks tend to obsessively or repetitively use mouthwash or toothpaste, often to a point that is unhealthy.
In a broader sense, halitophobia is part of a mental condition called olfactory reference syndrome (ORS), in which people believe that some part of their body (mouth, armpits, feet) perpetually stinks. At best estimate, about one in every 200 Americans suffers from ORS, according to a study published in the Journal of Postgraduate Medicine.
The condition may be related to obsessive-compulsive disorder, especially considering the fixed ideas, repetitive actions and crippling anxiety. Mental health experts have suggested adding ORS to the fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a.k.a. the psychiatrist's bible. This edition comes out in about a year.
Until then, what can be done about ORS? Most researchers recommend (a) cognitive behavioral therapy, (b) treatments to reduce anxiety, and (c) using evidence to prove that the halitosis just isn't there.
One physician wrote to the British Dental Journal recommending the use of a resealable plastic bag. He suggested having a patient breathe into it, closing it tightly, and then, in calmer and more lucid moments, asking them to take a quick sniff.
The author, one S. Setty of Manipal, India, also noted that you can collect breath from a friend or relative (which is much more likely to have an odor) and allow the patient to smell the difference.
Where is ORS the biggest problem? Not the U.S., and not in Mr. Setty's home country, either. Believe it or not, halitophobia is most common among Japanese young adults. According to Psychiatric Times, the rate might be as high as 2 percent - or one in 50 Japanese people!
Why is this problem so common in the Land of the Rising Sun? No one knows, but scientists there take it very seriously. In fact, they even have a scientific journal dedicated to it, with the weirdly specific title "The Japanese Journal of Psychosomatic Dentistry."
Here in the U.S., we take halitophobia seriously, too. But we don't sniff at bad breath, either. You see, oral odor - real halitosis - can be a sign of gum disease, tooth decay and periodontitis, and those diseases usually aren't just in your head. So keep your mouth clean and healthy with a specialty toothpaste, tongue scraper or alcohol-free mouthrinse.