Halitosis: a new definition and classification.

BACKGROUND: There is no universally accepted, precise definition, nor standardisation in terminology and classification of halitosis. OBJECTIVE: To propose a new definition, free from subjective descriptions (faecal, fish odour, etc), one-time sulphide detector readings and organoleptic estimation of odour levels, and excludes temporary exogenous odours (for example, from dietary sources). Some terms previously used in the literature are revised. RESULTS: A new aetiologic classification is proposed, dividing pathologic halitosis into Type 1 (oral), Type 2 (airway), Type 3 (gastroesophageal), Type 4 (blood-borne) and Type 5 (subjective). In reality, any halitosis complaint is potentially the sum of these types in any combination, superimposed on the Type 0 (physiologic odour) present in health. CONCLUSION: This system allows for multiple diagnoses in the same patient, reflecting the multifactorial nature of the complaint. It represents the most accurate model to understand halitosis and forms an efficient and logical basis for clinical management of the complaint.

Dimethylsulphidemia: the significance of dimethyl sulphide in extra-oral, blood borne halitosis.

Halitosis is a symptom and not a diagnosis. Rather, the topic represents a spectrum of disorders, including intra-oral, otorhinolaryngological, metabolic, systemic, pulmonary, psychological and neurological conditions. Halitosis may be the third most common trigger for patients to seek dental care and can cause significant impact on patient quality of life. About 10% of all genuine halitosis cases are attributed to extra-oral processes. Some authorities have reported that the nasal cavity and the oropharynx are the most common sites of origin of extra-oral halitosis. However, recent evidence appears to suggest that blood borne halitosis may be the most common subtype of extra-oral halitosis. Tangerman and Winkel report that dimethyl sulphide was the main volatile implicated in extra-oral blood borne halitosis. They proposed a hitherto unknown metabolic condition by way of explanation for this finding, resulting in systemic presence of dimethyl sulphide in blood and alveolar breath. This paper reviews the knowledge base regarding the behaviour of dimethyl sulphide in physiological systems and those disorders in which blood borne halitosis secondary to dimethylsulphidemia is thought to have an aetiopathological role.

Patients' perception of the financial impact of head and neck cancer and the relationship to health related quality of life.

The aim of this cross-sectional survey was to ask patients about the financial burden of having head and neck cancer, and to explore its relation with health-related quality of life (HRQoL). In the Mersey region 447/752 eligible patients (59%) responded to the questionnaire. There was no obvious response bias. The most notable financial costs of head and neck cancer that were a moderate or large burden to patients were petrol (25%, 112), home heating (24%, 108), change in the type of food (21%, 95), and loss of earnings (20%, 88). During the previous week 15% (63/423) had lost a moderate or large amount of income because of their medical condition. In terms of taking care of their financial needs, 10% (40) were moderately dissatisfied and 15% (61) very dissatisfied. Patients with worse physical and social emotional functioning experienced more notable financial burden, more difficult life circumstances in the past month and greater financial difficulty and loss in income due to their condition in the previous week, more dissatisfaction with how well they took care of their own financial needs and were more likely to have sought statutory benefits. Cancer of the head and neck has a serious impact on financial aspects of patients' lives and seems to be associated with a poor HRQoL. Multidisciplinary teams can do much more to address the cost of having treatment by recognising need earlier, and giving advice and access to appropriate benefits.

Patients' perspective of financial benefits following head and neck cancer in Merseyside and Cheshire.

The aim of this interview study was to ask patients with head and neck cancer in the Mersey region about their need for financial benefits, the advice they were given about benefits and financial matters, and the financial burden of the disease. Stratified quota sampling was by employment status, whether work had been affected by the cancer, and by sex. Of 51 interviewees (mean (SD) age 61(8) years) 20 were retired, 11 were unemployed, 13 worked full-time, and 7 worked part-time. Cancer had affected the work status of 24. Since diagnosis 57% had suffered financially; this was particularly high in those who had retired (65%), and in those whose work had been affected by cancer (79%). Quality of life had decreased in 53% as a result of the financial impact of the disease. This was most common in the unemployed (64%), and in those whose work was affected by cancer (83%). Only a quarter had been given adequate help and information about finance; this was lowest in the unemployed (18%) and highest in those who were fully employed (39%). One third (17/51) had never claimed benefits. The most common benefits were Disability Living Allowance and Incapacity Benefit. Two-thirds (21/31) had applied for benefits after diagnosis, 18 of these were directly as a result of the disease. The median (IQR) weekly income from benefits was £88 (£60-170). Patients and carers need better access to financial advice. We suggest that each multidisciplinary team should have a designated benefits or financial advisor who is readily available to patients in the clinic and on the ward.