Current methods for halitosis diagnosis and the impact of COVID-19 pandemic: an international survey.

Halitosis specialists can be found all over the world, but very little is known about how they approach patients with halitosis complaints. Therefore, this web-based questionnaire study tried to reach as many of them to gain insight in their methods and tools used to diagnose the condition. Since this study was carried out in the aftermath of the COVID-19 pandemic, its impact was also examined. This survey encompassed 19 questions interrogating the responders' profile; their diagnostic process in general; the methods and tools used to examine the breath; and the impact of COVID-19 on them. It was accessible online from May till October 2022. Eighty halitosis professionals from 19 different countries replied. Their answers showed that the community behind the field of halitosis seems to be largely driven by oral health professionals. The respondents had been active in this niche for on average 12 years in consultations (41%), research (23%) or a combination (36%). To achieve a diagnosis 96% believed a thorough history is a must and 94% felt that a breath odor examination (instrumental and/or organoleptically) was necessary. The Halimeter® was the most common instrument used for breath odor analysis. There was a large variation in the organoleptic examination regarding the calibration and number of judges and the specific odors sources that were assessed (i.e. mouth odor versus nose odor). Less variation was noted on the rating scale used: 87% made use of the 6-point odor strength scale. For those that performed organoleptic examinations COVID-19 forced them to modify their examination (20%) or to stop performing it (67%). This international survey showed that there is not a consensus between specialists on how the diagnosis of halitosis should be carried out. However, a common thread can be noted: thoroughly interviewing the patients and examining the breath odor are of upmost importance.