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Rev. Latino-Am. Enfermagem vol.14 no.5 Ribeirão Preto Sept./Oct. 2006
Historical and social aspects of halitosis
Marina Sá EliasI; Maria das Graças Carvalho FerrianiII
IDental Surgeon, Ph.D. in Public Health Nursing
IIPh.D. in Nursing. Full Professor, e-mail: firstname.lastname@example.org. University of São Paulo at Ribeirão Preto College of Nursing - WHO Collaborating Centre for Nursing Research Development
Buccal odors have always been a factor of concern for society. This study aims to investigate the historical and social base of halitosis, through systematized research in the database BVS (biblioteca virtual em saúde - virtual library in health) and also in books. Lack of knowledge on how to prevent halitosis allows for its occurrence, limiting quality of life. As social relationships are one of the pillars of the quality of life concept, halitosis needs to be considered a factor of negative interference. Education in health should be accomplished with a view to a dynamic balance, involving human beings' physical and psychological aspects, as well as their social interactions, so that individuals do not become jigsaw puzzles of sick parts.
Descriptors: halitosis; history; health education
Bad breath or halitosis is an offensive odor exhaled by the mouth, nasal cavities or facial and pharyngeal sinuses. In 90% of cases, causes of halitosis are located in the mouth and can be attributed to: dental caries, periodontal disease, oral infections and mainly tongue coating(1-2). As coating is not contagious, it is common that only one partner has a bad breath, to the extent of bothering the other.
Smell and sight are susceptible to great adaptations. When first exposed to a very strong smell, the feeling can be very intense, but will hardly be felt within a minute. Hence, individuals are incapable of measuring their own halitosis(3).
This study aims to investigate the historical and social bases of halitosis, through a systematized search, selecting Brazilian and international articles from the database BVS (Virtual Health Library) and also in books about this theme. This subject is relevant as the presence of halitosis can affect the full range of people's quality of life.
Odors are essential clues in the creation and conservation of social bonds, as they are loaded with cultural values.
The problem of halitosis has been reported for many years. References were found in papyrus manuscripts dating back to 1550 BC. Hippocrates mentioned that any girl should have a pleasant breath, making sure always to wash her mouth with wine, anise and dill seeds(4).
The Romans used mechanisms to hide halitosis, such as perfumed tablets, chewing leaves and stalks of plants. In Antiquity, having a fragrant breath meant exhaling the sweetness of life and asserting the purity of a person's soul. During Christianity, the devil's supreme malignant odor smelled of sulfur, and it was presumed that sins produced a more or less bad smell(5). This association is complex, as the predominant smell in halitosis is often sulfur.
Archeological excavations in garbage deposits from the 19th century found earthenware pots with tooth powders. Announcements at that time disseminated the properties of "Chinese tooth powders", "tooth elixirs", "tooth opiates", confirming special interest in the elimination of bad breath and in cleanliness of the mouth(6).
During the 19th century, emanations of the body's internal activity, relatively tolerated until then, became unbearable. The ideology of cleaning forced the full domestication of odors and products deriving from metabolic processes. A new body etiquette emerged, whose motto became discretion(6).
Another example comes from the Talmud, dating back more than two thousand years, which reports that, in view of some conditions, such as one of the partner's bad odor for example, the matrimonial license, called Ketuba(2), can be legally broken.
A treaty in Islamic literature from the year 850 talked about dentistry, referring to the treatment of fetid breath, and recommended the use of siwak* when breath had changed or at any time when getting out of bed(7). This recommendation was probably aimed at minimizing the smell or morning or physiological halitosis.
The Hindus consider the mouth as the body's entry door and, therefore, insist that it be kept clean, mainly before prayers. The ritual is not limited to teeth brushing, but includes scraping the tongue with a special instrument and using mouthwash. Buddhist monks in Japan also recommended teeth brushing and tongue scraping before the first morning prayers(7). It is noticeable that oral hygiene in combination with tongue scraping has been performed for many years but that, despite its efficacy, dentists rarely prescribe and teach this scraping practice.
The only treaty about halitosis was written in 1874 by Howe. This author affirms that the importance of offensive breath derives from the fact that it becomes a constant source of unhappiness to the patient, and gets even worse when it destroys communication among friends and the pleasures of social contact(1).
Nowadays, it is known that multiple causes can produce halitosis, making it impossible to indicate one single treatment; after the diagnosis, the initial behavior adopted is the removal of possible causes.
Halitosis can be considered a social impediment(1), something that interferes in personal relations. In various tribes from distant countries, the word "kiss" actually designates smell, i.e. a prolonged aspiration of a loved person, a relative or a friend's odors(8).
The kiss is a demonstration of affection, a symbolic gesture of affirmation and bonding with another person(9).
Bad breath becomes an important factor in social relations and can cause concern, not only related to health aspects, but also to psychological changes that lead to social and personal isolation(2). People suffering from halitosis create a social barrier between themselves and their friends, relatives, partners or colleagues at work(4).
Considering quality of life as a person's perception about his/her position in life, in the context of the culture and value system (s)he lives in, and also in relation to objectives, expectations, patterns and concerns(10), it becomes relevant to assess that a full quality of life will be influenced if that person presents physical and mental restrictions that can interfere in aspects of speech, social relations and self-esteem(11).
The relation between mouth odors and social aspects has always been a source of concern to society which, in the attempt to hide them, used different tricks and substances. Bad breath has always been an obstacle to the full experience of conjugal life.
The problem of halitosis has been accompanying society for many years. Hence, it is unacceptable that knowledge advances are not adequately transmitted to the population.
Lack of knowledge about how to prevent halitosis permits its occurrence and limits quality of life. These problems could easily be solved through health education, as the causes of halitosis are basically concentrated in the mouth.
As social relations are one of the domains in the quality of life construct, halitosis needs to be considered as a factor of negative interference. Thus, health education should be realized with a view to a dynamic balance, involving the physical and psychological aspects of human beings, as well as their social interactions, so that individuals do not turn into puzzles of sick parts.
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11. Sheiham A, Steele JG, Marcenes W, Tsakos G, Finch S, Walls AW. Prevalence of impacts of dental and oral disorders and their effects on eating among older people; a national survey in Great Britain. Community Dent Oral Epidemiol 2001 June; 29(3):195-203. [ Links ]
Recebido em: 28.1.2005
Aprovado em: 11.5.2006
* Siwak - branch of a tree whose wood contains sodium bicarbonate and tannic acid, besides other astringent substances that exert beneficial effects on oral health.