821
HI STORI CAL AND SOCI AL ASPECTS OF HALI TOSI S
Marina Sá Elias1
Mar ia das Gr aças Car v alho Fer r iani2
Elias MS, Fer r iani MGC. Hist or ical and social aspect s of halit osis. Rev Lat in am Enfer m agem 2006 set em br
o-out ubr o; 14( 5) : 821- 3.
Bu ccal odor s h av e alw ay s been a f act or of con cer n f or societ y . Th is st u dy aim s t o in v est igat e t h e
hist orical and social base of halit osis, t hrough syst em at ized research in t he dat abase BVS ( bibliot eca virt ual em
saúde - virt ual library in healt h) and also in books. Lack of knowledge on how t o prevent halit osis allows for it s
occur r ence, lim it ing qualit y of life. As social r elat ionships ar e one of t he pillar s of t he qualit y of life concept ,
halit osis needs t o be consider ed a fact or of negat ive int er fer ence. Educat ion in healt h should be accom plished
wit h a view t o a dynam ic balance, involving hum an beings’ physical and psychological aspect s, as well as t heir
social int er act ions, so t hat indiv iduals do not becom e j igsaw puzzles of sick par t s.
DESCRI PTORS: halit osis; hist or y ; healt h educat ion
LOS ASPECTOS HI STÓRI COS Y SOCI ALES DE HALI TOSI S
Los olor es bucales siem pr e han sido un fact or de pr eocupación par a la sociedad, y ellos t odav ía son
ah or a. El obj et iv o de est e est u dio es h acer u n a base h ist ór ica y social en la h alit osis. Fu e ef ect u ada u n a
invest igación sist em at izada en la base de dat os BVS ( bibliot eca virt ual em saúde - la bibliot eca virt ual en salud)
y t am bién en los libros. La ignorancia en cóm o prevenir la halit osis perm it e su ocurrencia, que lim it a la calidad
de vida. Siendo las relaciones sociales uno de los pilares del concept o de calidad de vida, es necesario considerar
la h alit osis u n f act or de in t er f er en cia n egat iv a. La edu cación en salu d se debe llev ar a cabo bu scan do u n
equilibrio dinám ico, involucrando los aspect os físicos y psicológicos del ser hum ano, así com o sus int eracciones
sociales, par a que los indiv iduos no se v uelv an r om pecabezas de par t es enfer m as.
DESCRI PTORES: halit osis; hist or ia; educación en salud
ASPECTOS HI STÓRI COS E SOCI AI S DA HALI TOSE
O pr oblem a r efer ent e aos odor es bucais sem pr e foi fat or de pr eocupação par a a sociedade e ainda
hoj e se m ost r a pr esent e. O obj et iv o do pr esent e est udo foi r ealizar um em basam ent o hist ór ico e social sobr e
a h alit ose. Par a t an t o, f oi f eit a bu sca sist em at izada, selecion an do ar t igos por m eio da base de dados BVS
( Bibliot eca Vir t ual em Saúde) e t am bém pesquisa em livr os. O desconhecim ent o sobr e com o pr evenir halit ose
per m it e a sua ocor r ência, lim it ando a qualidade de v ida. Sendo os r elacionam ent os sociais um dos pilar es do
const r uct o qualidade de vida, é pr eciso consider ar a halit ose com o fat or de int er fer ência negat iva. A educação
em saúde dev e ser r ealizada v isando o equilíbr io dinâm ico, env olv endo aspect os físicos e psicológicos do ser
hum ano, assim com o suas int er ações sociais, par a que os indivíduos não se t or nem quebr a- cabeças de par t es
d oen t es.
DESCRI TORES: halit ose; hist ór ia; educação em saúde
1
Dent al Surgeon, Ph.D. in Public Healt h Nursing; 2 Ph.D. in Nursing. Full Professor, e- m ail: caroline@eerp.usp.br. Universit y of São Paulo at Ribeirão Pret o College of Nursing - WHO Collaborat ing Cent re for Nursing Research Developm ent
Disponible en castellano/ Disponível em língua portuguesa SciELO Brasil w w w .scielo.br/ rlae
Art igo de At ualização
822
Hist orical and social aspect s...
Elias MS, Ferriani MGC.
Rev Lat ino- am Enferm agem 2006 set em bro- out ubro; 14( 5) : 821- 3 w w w .eer p.usp.br / r lae
I NTRODUCTI ON
B
ad br eat h or halit osis is an offensiv e odor ex h aled b y t h e m ou t h , n asal cav it ies or f acial an dp h a r y n g e a l si n u se s. I n 9 0 % o f ca se s, ca u se s o f
halit osis are locat ed in t he m out h and can be at t ribut ed
t o: dent al car ies, per iodont al disease, or al infect ions
a n d m a i n l y t o n g u e co a t i n g( 1 - 2 ). As co a t i n g i s n o t
cont agious, it is com m on t hat only one part ner has a
bad breat h, t o t he ext ent of bot hering t he ot her.
Sm e l l a n d si g h t a r e su sce p t i b l e t o g r e a t
ad ap t at i on s. Wh en f i r st ex p osed t o a v er y st r on g
sm ell, t he feeling can be very int ense, but will hardly
b e f e l t w i t h i n a m i n u t e . H e n c e , i n d i v i d u a l s a r e
incapable of m easur ing t heir ow n halit osis( 3).
This st udy aim s t o inv est igat e t he hist or ical
and social bases of halit osis, t hr ough a sy st em at ized
sear ch , select in g Br azilian an d in t er n at ion al ar t icles
fr om t he dat abase BVS ( Vir t ual Healt h Libr ar y ) and
also in books about t his t hem e. This subj ect is relevant
as t he pr esence of halit osis can affect t he full r ange
of people’s qualit y of life.
HI STORY
Odors are essent ial clues in t he creat ion and
conservat ion of social bonds, as t hey are loaded wit h
cu lt u r al v alu es.
Th e pr oblem of h alit osis h as been r epor t ed
f or m an y y ear s. Ref er en ces w er e f ou n d in papy r u s
m an u scr ip t s d at in g b ack t o 1 5 5 0 BC. Hip p ocr at es
m ent ioned t hat any girl should have a pleasant breat h,
m ak in g su r e alw ay s t o w ash h er m ou t h w it h w in e,
anise and dill seeds( 4).
Th e Ro m a n s u s e d m e c h a n i s m s t o h i d e
h alit osis, su ch as per fu m ed t ablet s, ch ew in g leav es
and st alk s of plant s. I n Ant iquit y, hav ing a fragrant
b r ea t h m ea n t ex h a l i n g t h e sw eet n ess o f l i f e a n d
a s s e r t i n g t h e p u r i t y o f a p e r s o n ’ s s o u l . D u r i n g
Ch r i st i a n i t y, t h e d e v i l ’s su p r e m e m a l i g n a n t o d o r
sm el l ed o f su l f u r, a n d i t w a s p r esu m ed t h a t si n s
produced a m ore or less bad sm ell( 5). This associat ion
is com plex , as t he pr edom inant sm ell in halit osis is
oft en sulfur.
Archeological excavat ions in garbage deposit s
f r om t h e 1 9t h cen t u r y f ou n d ear t h en w ar e pot s w it h
t o o t h p o w d e r s . A n n o u n c e m e n t s a t t h a t t i m e
d i s s e m i n a t e d t h e p r o p e r t i e s o f “ Ch i n e s e t o o t h
pow der s”, “ t oot h elix ir s”, “ t oot h opiat es”, confir m ing
special int er est in t he elim inat ion of bad br eat h and
in cleanliness of t he m out h( 6).
Dur ing t he 19t h cent ur y, em anat ions of t he
body’s int ernal act ivit y, relat ively t olerat ed unt il t hen,
becam e unbear able. The ideology of cleaning for ced
t he full dom est icat ion of odor s and pr oduct s der iving
f r o m m e t a b o l i c p r o ce sse s. A n e w b o d y e t i q u e t t e
em er ged, w hose m ot t o becam e discr et ion( 6 ).
An ot h er ex am p le com es f r om t h e Talm u d ,
d at in g b ack m or e t h an t w o t h ou san d y ear s, w h ich
r ep or t s t h at , in v iew of som e con d it ion s, su ch as
o n e o f t h e p a r t n e r ’ s b a d o d o r f o r e x a m p l e , t h e
m at r im on ial licen se, called Ket u ba( 2 ), can be legally
b r o k e n .
A t r eat y in I slam ic lit er at u r e fr om t h e y ear
850 t alked about dent ist ry, referring t o t he t reat m ent
of fet id br eat h, and r ecom m ended t he use of siw ak*
when breat h had changed or at any t im e when get t ing
o u t o f b ed( 7 ). Th i s r eco m m en d at i o n w as p r o b ab l y
a i m e d a t m i n i m i z i n g t h e s m e l l o r m o r n i n g o r
ph y siological h alit osis.
Th e Hin du s con sider t h e m ou t h as t h e body ’s
ent r y door and, t her efor e, insist t hat it be k ept clean,
m ain ly b ef or e p r ay er s. Th e r it u al is n ot lim it ed t o
t eet h br ushing, but includes scr aping t he t ongue w it h
a special inst r um ent and using m out hw ash. Buddhist
m on k s in Jap an also r ecom m en d ed t eet h b r u sh in g
a n d t o n g u e s c r a p i n g b e f o r e t h e f i r s t m o r n i n g
p r a y e r s( 7 ). I t i s n o t i c e a b l e t h a t o r a l h y g i e n e i n
c o m b i n a t i o n w i t h t o n g u e s c r a p i n g h a s b e e n
p e r f o r m e d f o r m a n y y e a r s b u t t h a t , d e sp i t e i t s
e f f i ca cy, d e n t i st s r a r e l y p r e scr i b e a n d t e a ch t h i s
scr ap i n g p r act i ce.
The only t reat y about halit osis was writ t en in
1874 by Howe. This aut hor affirm s t hat t he im port ance
o f o f f e n si v e b r e a t h d e r i v e s f r o m t h e f a ct t h a t i t
b ecom es a con st an t sou r ce of u n h ap p in ess t o t h e
p a t i e n t , a n d g e t s e v e n w o r s e w h e n i t d e s t r o y s
com m u n icat ion am on g f r ien ds an d t h e pleasu r es of
social cont act( 1).
Now aday s, it is k now n t hat m ult iple causes
can produce halit osis, m aking it im possible t o indicat e
one single t r eat m ent ; aft er t he diagnosis, t he init ial
behav ior adopt ed is t he r em ov al of possible causes.
823
SOCI AL ASPECTS
Halitosis can be considered a social im pedim ent(1),
som ething that interferes in personal relations. I n various
t ribes from dist ant count ries, t he word “ kiss” act ually
designat es sm ell, i.e. a prolonged aspirat ion of a loved
person, a relative or a friend’s odors(8).
Th e k iss is a dem on st r at ion of af f ect ion , a
sy m b o l i c g est u r e o f af f i r m at i o n an d b o n d i n g w i t h
anot her per son( 9 ).
Bad br eat h becom es an im por t an t fact or in
social relat ions and can cause concern, not only relat ed
t o healt h aspect s, but also t o psy chological changes
t h at lead t o social an d per son al isolat ion( 2 ). People
suffering from halit osis creat e a social barrier bet ween
t h em selv es an d t h eir f r ien ds, r elat iv es, par t n er s or
colleagues at w or k( 4).
Co n si d e r i n g q u a l i t y o f l i f e a s a p e r so n ’ s
percept ion about his/ her posit ion in life, in t he cont ext
of the culture and value system ( s) he lives in, and also
in r elat ion t o obj ect iv es, ex pect at ions, pat t er ns and
concerns( 10), it becom es relevant t o assess t hat a full
qualit y of life will be influenced if t hat person present s
phy sical and m ent al r est r ict ions t hat can int er fer e in
aspect s of speech, social relat ions and self- est eem( 11).
FI NAL CONSI DERATI ONS
The r elat ion bet w een m out h odor s and social
a sp e ct s h a s a l w a y s b e e n a so u r ce o f co n ce r n t o
soci et y w h i ch , i n t h e at t em p t t o h i d e t h em , u sed
d i f f e r e n t t r i ck s a n d su b st a n ce s. Ba d b r e a t h h a s
alw ay s b een an ob st acle t o t h e f u ll ex p er ien ce of
con j u gal lif e.
Th e p r o b l e m o f h a l i t o s i s h a s b e e n
accom p an y in g societ y f or m an y y ear s. Hen ce, it is
u n a c c e p t a b l e t h a t k n o w l e d g e a d v a n c e s a r e n o t
adequat ely t r ansm it t ed t o t he populat ion.
La ck o f k n o w l ed g e a b o u t h o w t o p r ev en t
halit osis per m it s it s occur r ence and lim it s qualit y of
life. These pr oblem s could easily be solv ed t hr ough
h e a l t h e d u ca t i o n , a s t h e ca u se s o f h a l i t o si s a r e
basically concent r at ed in t he m out h.
As social relat ions are one of t he dom ains in
t h e q u alit y of lif e con st r u ct , h alit osis n eed s t o b e
considered as a fact or of negat ive int erference. Thus,
healt h educat ion should be r ealized w it h a v iew t o a
d y n a m i c b a l a n c e , i n v o l v i n g t h e p h y s i c a l a n d
p sy ch olog ical asp ect s of h u m an b ein g s, as w ell as
t heir social int eract ions, so t hat individuals do not t urn
int o puzzles of sick par t s.
REFERENCES
1 . Hin e MK. Halit osis. J Am Den t Assoc 1 9 5 7 Ju ly ; 5 5 ( 1 ) : 3 7 - 4 6 .
2 . San z M, Rold án S, Her r er a D. Fu n d am en t als of Br eat h Malodour. J Cont em p Dent Pr act 2 0 0 1 Nov em ber 1 5 ; 2 ( 4 ) : 1 - 1 7 .
3. Ay er s KMS, Colquhoun ANK. Halit osis: causes, diagnosis, and t r eat m ent . N Z Dent J 1998 Decem ber ; 94( 418) : 156-6 0 .
4. Bosy A. Oral m alodor: philosophical and pract ical aspect s. J Can Den t Assoc 1 9 9 7 Mar ch ; 6 3 ( 3 ) : 1 9 6 - 2 0 1 .
5. Classen C, How es D, Synnot t A. Arom a: a hist ória cult ural dos odores. Rio de Janeiro ( RJ) : Jorge Zahar; 1996. 6. Andrade Lim a T. Hum ores e odores: ordem corporal e ordem social no Rio de Janeiro, século XI X. Hist ória, Ciências, Saúde, Man g u in h os 1 9 9 6 f ev er eir o; 2 ( 3 ) : 4 4 - 9 6 .
7. Ring ME. Hist ória da Odont ologia. São Paulo ( SP) : Manole; 1 9 9 8 .
8 . Ack er m an D. Um a h ist ór ia n at u r al dos sen t idos. Rio de Janeir o ( RJ) : Edit or a Ber t r and Br asil; 1992.
9. Cahen G. O beij o: prim eiras lições de am or - hist ória, art e e er ot ism o. São Paulo ( SP) : Mandar im ; 1998.
1 0 . W h o . Th e W o r l d Hea l t h Or g a n i za t i o n Qu a l i t y o f Li f e assessm ent ( WHOQOL) : posit ion paper from t he World Healt h Or ganizat ion. Soc Sci Med 1995 Nov em ber ; 41( 10) : 1403- 9. 11. Sheiham A, St eele JG, Mar cenes W, Tsakos G, Finch S, Walls AW. Prevalence of im pact s of dent al and oral disorders and t heir effect s on eat ing am ong older people; a nat ional survey in Great Brit ain. Com m unit y Dent Oral Epidem iol 2001 Ju n e; 2 9 ( 3 ) : 1 9 5 - 2 0 3 .
Recebido em : 28.1.2005 Aprovado em : 11.5.2006
Hist orical and social aspect s...
Elias MS, Ferriani MGC.
