World Toilet Day takes place on November 19th and focuses mainly on the sanitation needs in developing countries. It highlights how important toilets can be and how they can truly make all the difference in the battle against disease and widespread infection. However, we’re looking at a campaign closer to home and one which has a huge impact on the lives of people living with disabilities in the UK. The Changing Places campaign is staging an event as part of a worldwide awareness raising efforts called ‘The Big Squat’.
Changing Places is a campaign which is pushing for the installation of accessible changing rooms in a range of public places across the UK. There are many reason why properly accessible changing rooms are essential and many people living with different disabilities need more support and space to be able to toilet in public places comfortably.
Currently standard disabled toilets do not meet the needs of all people living with disabilities and their carers or support staff. People living with profound and multiple disabilities including learning disabilities, spinal damage and acquired brain injury often find themselves needing additional facilities to be able to comfortably utilise public toilets.
Changing Places toilets are different and provide initial facilities and apparatus to allow for easier usage.
Changing Places Toilets
Changing Places toilets provide the right equipment, enough space and a safe and clean changing environment. The equipment provides will either be a height adjustable adult-sized changing bench and a fully functional tracking hoist system or mobile hoist where this isn’t possible.
The changing areas will also have enough space for the disabled person as well as up to two carers and the toilet will be centrally placed to allow for support from carers on either side. Curtains or screens are also fitted so the disabled person and carer can have some privacy during the change.
The safety and cleanliness is provided by tear off paper roll to cover the bench before use and a large waste bin to allow for the disposal of pads. The floors are all non-slip to avoid any other accidents or risks.
Where do we want them?
The Changing Places campaign want to see their unique and potentially life changing toilets installed in all large public places. Their list of places includes:
• city centres
• shopping centres
• arts venues
• motorway service stations
• leisure complexes
• large railway stations
They also highlight that these new changing facilities should be installed in addition to pre-existing accessible toilets and not as a replacement. We definitely agree and think accessibility to comfortable toilets should be a basic right for all. Below is a case study looking at one mother and daughter who definitely see the need for accessible Changing Places toilets in every possible location.
Bethan and Lowri – A Case Study
Bethan is the mother of two daughters, Elin and Lowri, and the youngest, Lowri, lives with Retts Syndrome. Retts Syndrome means Lowri needs support with all her daily activities as she has no independent mobility. She uses continence pads for comfort and Bethan, Elin and Lowri were all pleased to have the chance to enjoy a happy family day out thanks to a Changing Places toilet.
The mum and daughters were able to enjoy a day out in Nottingham City Centre including shopping, lunch and a show at the local theatre. Nottingham City Council had the initiative to install a Changing Places toilet which allows for Bethan to help her daughter with her toileting needs without stress or difficulty, utilising the specialist hoist and changing equipment.
Bethan highlighted that without the Changing Places toilet there days out were very different as they had to plan their days out around specific times, ensuring to be home for mealtimes as Lowri would need to go to the toilet and they simply wouldn’t be able to change her comfortably in regular disabled toilets, as it would involve lying her on the floor. My own son Joe, has Dravet Syndrome and cannot be changed in most toilets. We had our vehicle specially adapted with a bench, curtains and a small hoist because of this issue.
Changing Places have taken Bethan and Lowri’s story as a great positive and use them regularly in their campaigns to show the importance of their toilets for whole families as well as individuals. This video tells a little more about their story:
(Full Transcript Below)
Take Part In the BIG SQUAT for World Toilet Day
The Big Squat event will be at 12 noon on 19 November
The squatting exercise is highly symbolic of the problems faced by many people in the developing world, where a lack of toilets forces people to squat in fields, in the bush, along train tracks, or in other open places. Open defecation is a major problems: it spreads disease, resulting in over 1.8 million deaths from diarrhoeal disease every year. It also affects women’s wellbeing and safety: in many developing countries, women are forced to relieve themselves either before sunrise or after sunset, causing them immense discomfort and inconvenience as well as putting them at risk of rape and other attacks.
In the UK the Changing Places campaign will be using the Big Squat to help highlight the need for Changing Places toilets in public spaces in order to meet the needs of the 230,000 people who need additional support and appropriate facilities in order to use the toilet.
Some of their campaigners in London will be heading to the Queen Elizabeth II Olympic Park in Stratford to do a very public mass squat. We also think this is a great opportunity to celebrate the availability of Changing Places facilities at the park and the accessibility legacy left behind by the London 2012 Olympic and Paralymplic games.
One of our favourite products comes from Uriwell as they cater for every member of the family and can be a great aid to keep to hand if you often find yourself in situations where your bladder gives you little warning. It’s also very valuable for helping young children who are learning to use the toilet.
On the theme of toilet training for younger children we also rate the Game of Pee which adds a bit of fun to the process. The game includes a Happy Pee and the game comes with different faces for the Uriwell as well as an educational booklet that can be coloured in. A wall chart allows you to mark your child’s progress and help them feel a sense of achievement as they move up the steps. The range has even expanded to include the Happy Poo and so toilet training really can be simpler than you thought.
World Toilet Day and the UK Changing Places campaign needs your support and we’re hoping after reading this you might take part in the Big Squat! (#BigSquat or contact @CP_consortium on Twitter)
00:06 Speaker 1: My name is Bethan, and this is Lowri who is my 10-year-old daughter. Lowri is profoundly disabled. She has a condition called Rett syndrome. And she is completely dependent on us for all her activities of daily living. Lowri wears incontinence pads or nappies and so obviously, we have to change her during the day and in an ordinary disabled toilet that involves putting her on the floor because she is getting a big girl, and it’s no joke to manhandle that. You’ve got to keep her hands off the dirty floor ’cause the next place they’ll go is to her mouth. So, that’s why we need Changing Places toilets. We’ve got to get her onto this height adjustable table, so that’s either lift but ideally you want some kind of an equipment to help you with that because really you do far too much lifting. So, a ceiling track hoist is really ideal. It’s changed our life in the sense that coming to Nottingham for a day out, we can come here, we know it’s here, we can plan our whole day.
01:06 S1: When there’s a Changing Places toilet, it just increases the length of time that you can spend somewhere, and it means you are not time limited, you haven’t got that worry about how long am I going to be out? Where do I go next? If you know that there is a decent facility, then you can build that into your day, and it just takes the pressure off you. The Changing Places campaign is really important for people with profound and multiple learning disabilities and their family. I see it as being the next step. We’ve got standard accessible disabled toilets everywhere these days, everybody expects them. We’ve got baby changing everywhere and it’s expected. I think that having Changing Places toilets is the next step.
At the Museum of Liverpool there’s a small, unassuming exhibition which looks like the recreation of a normal house. When you get inside you realise it has been setup with every possible gadget and gizmo to support independence. The Mi Smarthouse is a project put together by More Independent (Mi).
More Independent is a Government-funded initiative that is being piloted across four UK regions. As there website says the scheme exists to:
enable you to take charge of your health, wellbeing and lifestyle
use technology to allow you to feel safer and live more independently in your own home
give peace of mind to yourself and your family
reduce the amount of time you have to spend on appointments, by supporting you to manage better at home
The Mi Smarthouse at the museum is kitted out with a wide range of equipment covering all the key areas of the home. Here we’re taking a look at some of the gadgets they’ve highlighted and used in their perfect, accessible home.
These gadgets could be useful at any place in your home and can make it feel more safe and secure.
A fall detector can be worn around your neck and it connected to a system which will alert your carer if you do fall even if they’re not on the premises.
Large Buttons Picture Telephone
Phone keypads can be hard to use and it can also be difficult to remember phone numbers. This phone has spaces for photographs of those people you call regularly as well as large, clear numbers for when you need to dial out.
Home Safety Alert
The Mi Smarthouse has a bonus caller panic button installed by the front door, giving the residents the chance to press the button if anyone arrives at the door who they’re not comfortable with. Similar home safety alarm system can be found elsewhere too.
The Supra KeySafe is the UK’s first police approved key safe and is the perfect place to store your emergency keys. You choose a combination number and you can share this number only with somebody you trust implicitly.
Carbon Monoxide Sensor
Carbon monoxide can kill. It’s odourless and can’t be seen so the only way to sense it before it is too late is with a dedicated carbon monoxide sensor. Sensors can be easily installed and can save your life.
A fingerprint lock is a great option if you struggle with keys. You can add the details of your carer and friends as authorised ‘pad-pressers’ so they can get in and out with ease when necessary too.
We’ve talked regularly about the importance of gadgets to make access to the kitchen easier. It’s potentially a dangerous environment so anything to make it less so is a good invention in our book. In the Mi Smarthouse they demonstrated a range of kitchen-specific gadgets.
The controls on a microwave oven can be difficult if you have difficulties with your vision or dexterity. A Talking Microwave Oven can help guide you to the buttons you need and it will also tell you when the door is open or closed and let you know whether the food needs stirring or left to stand.
An induction hob only cooks the pot upon it. There is next to no danger of being burned by it and they’re becoming a common installation in supported living environments to aid independence. This type of hob is also energy efficient and reaches top temperatures in record time. In the Mi House the hob was fitted but they can also be bought as separate electric units .
One cup Kettle
We’ve talked before about how useful the one cup kettle can be. Never worry about spilling boiling water as the kettle will dispense the exact amount you need with the simple pressing of a button.
Entertainment and Living Area
Many of these items listed below could be used all around the house but are most useful when you’re relaxing in front of the TV or lounging on the sofa.
If speech has always been or is becoming difficult then these small voice recorder switches can be used to record key phrases. They can have messages such as ‘I’m hungry’ or ‘I want to go home’ ready recorded for when you’re home or out and about when speech has become difficult.
Chair Occupancy Alert
This item is extremely useful if you have an outside care team supporting you as it allows them to monitor the time spent out of your chair. If it seems exceptionally long they may phone you or come around the check everything is OK.
Big Jack Controller
Big Jack Multi-Controller
The Big Jack can replace all your smaller, fiddly remotes and switches. It can be programmes for a whole range of jobs and can be used to change channels on the TV, switch off lights and even use the telephone.
The personal care element of the home is the most private. Both the bedroom and bathroom are places where you want to maintain as much independence as possible and some of these gadgets are designed to guarantee this as well as ensure you can get the help you need, when you need it.
Living with any form of epilepsy or convulsions can be extremely frightening – especially if you’re alone when one occurs. This epilepsy sensor will alert an outdoor care team if a seizure is taking place, allowing them to provide the right support ASAP.
Designed to fit comfortable under the top sheet, an enuresis sensor will alert your carer to the fight signs of dampness whilst in bed – ensuring you’re not left uncomfortable for a long period of time. We have looked at these aids previously for helping children but they can be equally useful later in life.
A flood detector will guarantee you never forget about another bath. It’s very easy to forget the bath is running but with the installation of a simple detector, it will be safe and you can avoid the risks of damage to your home and the even higher risk of slipping.
The Mi Smarthouse in Liverpool is one of the first examples of how all this technology can come together and successfully be used to help people remain in their own homes independently. You can take a virtual tour of the Smarthouse here. We recently visited the £D printing exhibition at the London Science Museum and will cover the potential benefits in a future post.
Bad breath can be an embarrassing issue to tackle. Most of us will feel as though we’ve had a bad breath day at some point in our lives. Usually this is fixed by a quick brushing of teeth or swill of mouth wash. However for some dealing with bad breath, or halitosis, can be a socially devastating experience.
Bad Breath or ‘Halitosis’ and its Causes
Problems with bad breath do not always start in the mouth. Although oral health is the most likely cause of bad breath, it can also depend on other issues.
Low Carb Diet Bad Breath
What we eat and drink has a huge effect on our breath. Eating foods with a strong flavour, such as garlic and spices can cause temporary bad breath. However many will find that simply cutting down on these ingredients will solve the problem quickly.
Dieting, especially low-carbohydrate based diets, can also cause bad breath. This is because as the body starts to break down fat at a fast rate, chemicals called ketones are produced. These ketones escape through urine and unfortunately, your breath. Ketone-based bad breath has a distinct odour. If you are on a low-carb diet and suffer from bad breath, it is more than likely that ketosis is to blame.
Bad breath is an unfortunate side-effect of dieting. However when the body is producing ketones, it is proof that you are actually burning fat. Products such as Ketostix can show if you are producing ketones. They are dip-sticks for testing levels of ketones in your urine. These will help you find out if your bad breath is ketosis, whilst also providing proof that you are loosing weight via fat loss.
Cigarette Bad Breath
A build up of dental plaque will cause gum disease, which causes halitosis.
Bad breath is obviously the least important health issue caused by smoking. However, as well as the damage to your lungs, smoking can cause gum disease. Gums can become irritated by smoke, causing further complications such as gum disease. Gum disease, also known as gingivitis, makes gums swollen, infected and painful.
It is mostly noticed when there is blood whilst brushing your teeth. The gum tissue is very sensitive to cigarette smoke, and is eroded over time. This is mostly caused by the extra bacteria in the mouth due to smoking. This bacteria cause plaque, which will deteriorate the gums and then cause bad breath.
The most sensible cure for bad breath due to smoking is obviously to stop smoking. However keeping up to date with dental appointments and maintaining good oral health will help stop cigarette bad breath.
The NHS provides a “Quit kit” to will help you to stop smoking.
Medicines That Cause Bad Breath
There are a number of medicines that cause bad breath. If these drugs are vital to your health, bad breath is an unfortunate yet unavoidable side effect. However if you are deeply concerned about your bad breath, talking to your GP may help. They maybe able to offer you an alternative medicine to avoid getting bad breath.
Post Nasal Drip Bad Breath
Post nasal drip is also known as upper airway cough syndrome. It is caused by an excess production of mucous in the nose. This mucous then gathers in the throat causing bad breath. Post nasal drip can be a side-effect of further health issues, such as sinusitis or swallowing disorders.
Bad Breath in Babies and Children
Children can occasionally fall foul of bad breath, too. As stated by Dr Lewis First in this article for NBC 5 News, the main cause of halitosis in children is tooth decay. Many children dislike having to brush their teeth and see it as a chore. This is why it is important to try and make cleaning their teeth a fun experience.
Make cleaning teeth fun! Photo Credit: Stuart Berry http://www.flickr.com/photos/stuartberry/
There are a range of toothbrushes available to encourage your child to brush. Finding a fun toothbrush for your child will help them take an interest in brushing. Character brushes based on cartoons and toys are a firm winner with most children. Also you will find many of these character brushes include built-in flashing lights. These Barbie and Spiderman toothbrushes light up once activated, not only to entertain, but to also act as a timer. They will flash continuously for 1-2 minutes, ensuring your child has brushed for the right amount of time.
Studies have also found that “mouth breathing” can also contribute towards halitosis in young children. Mouth breathing often takes place when a child is ill with a cold. Their noses become blocked and stuffy, leaving no option other than to breathe mainly through the mouth. The intake of air through the mouth then dries out saliva, leaving bacteria to fester. This is usually a short term problem that is solved once the child no longer has a cold. However taking extra time for brushing during this time can help lessen bad breath.
Bad Breath and Disease Symptoms
As mentioned previously, bad breath can sometimes be a symptom of an underlying health condition. Below we cover some of the more common illnesses and conditions that can include bad breath as a symptom.
Halitosis is simply the umbrella term for of all disorders that cause bad breath. This covers everything from morning breath to oral hygiene issues. Morning breath happens for the opposite reason that children suffer bad breath due to mouth breathing. At night the mouth is exposed to less oxygen than during the day time. This lack of oxygen circulating around the mouth again allows the bacteria to breed. This is why ensuring you clean your mouth, teeth and gums properly before bed is so important for oral health.
Gum disease, also known as gingivitis is the most common form of dental disease. It is caused by a build-up of plaque that then allows bacteria to grow in the mouth. This bacteria then starts to effect the gums and can lead to periodontitis. The most common symptoms of gingivitis are:
bleeding gums, especially when brushing
swelling of the gums
changes in the colour of the gums, most notably a dark red colour
It is important to spot and treat gingivitis before it leads to periodontitis. Once periodontitis sets in it can destroy the gums when bacteria travels under the tooth. Teeth can then become loose as the gums become more infected. Eventually this will lead to loss of teeth permanently.
Bad breath caused by gingivitis is easily remedied by keeping on top of oral hygiene. Making visits to your dentist for check-ups and maintaining a good brushing routine.
The kidneys are vital organs that help to cleanse the blood and keep your body chemicals balanced. Waste and toxins that are taken into the body through food, air and drink eventually end up in your blood. It is the job of the kidneys to filter the blood of these toxins and then convert them to urine. People with kidney disease will often complain of bad breath. This is because when the kidneys are not functioning properly, they fail to remove toxins from the body. One of these toxins is ammonia, which is found in urine. This build-up of toxins within the body then escapes through the digestive system to the mouth, causing a ‘fishy odour’ in the breath.
Bad breath occurs for people with type 1 diabetes due to excess ketones caused by lack of insulin.
Bad breath caused by diabetes is related to ketosis, as mentioned in our low carb diet section. However as ketosis is a temporary side-effect of low-carb dieting, diabetic ketoacidosis can be life-threating.
Generally found in people with type 1 diabetes, ketoacidosis is caused by a lack of insulin to convert blood sugars to energy. Instead the body will start metabolising fat stores rather than converting sugars from food. This rapid burning of fat causes an influx of ketones; a byproduct of fat breakdown. The body will then become overwhelmed with ketones which are highly acidic, and change the PH of the blood.
The presence of these ketones within the digestive system then cause bad breath as they escape the body via urine or the mouth. This in turn causes the breath to smell unpleasant. Some people describe this as like the smell of the sweets called ‘pear drops’.
Dogs detecting diabetes in the breath
Specially trained dogs can detect the smell of ketones and are being used to help warn people with diabetes. So called ‘Hypo dogs‘, can alert people before they notice the symptoms themselves and can be especially helpful for small children or people whose glucose levels drop very quickly.
Sinus infection, also known as sinusitis, is an inflammation of the lining of the sinuses. This is usually caused by a bacterial infection. The sinuses are located in several areas in the head. However it is the sinuses in the nose that cause bad breath when infected. Very similar to post nasal drip, the excess mucus produced can build up and allow bacteria to grow. This influx in bacteria produces a bad odour, that is noted as bad breath.
When your body fails to pass solid waste on a regular basis this is called constipation. This then slows down the digestive process of food. Undigested food will then remain in the bowls where it becomes toxic and emits gas. This gas will eventually travel back up the digestive system and into the mouth, causing bad breath.
Keeping yourself regular and avoiding constipation is key to preventing bad breath. Statistics show that unto 25% of bad breath cases are caused by constipation. A diet of high fibre, fruit, veg and at least 4-6 glasses of water a day can prevent constipation. However it is also important to remain physically fit if this is possible. Maintaining a healthy weight and exercising the middle of the body will keep bowl muscles toned. This in turn will make passing solid waste easier and more regular, avoiding bad breath.
For people who find it hard to eat enough natural fibre, a useful alternative is fybogel drinks or psyllium husks added to food.
Bad Breath Remedies
Brushing teeth for at least 2 minutes helps ensure plaque removal.
Sometimes it can be difficult to find a bad breath cure. Knowing the cause is your first step before trying to cure it. Disorders such as post nasal drip can often be cured using antibiotics or nasal steroids. However if your bad breath is due to oral hygiene rather than an underlying health condition it might be less simple to cure.
Treating and preventing bad breath should start with your daily brushing routine:
Always ensure you spend at least 2 minutes brushing with a quality toothpaste. Pastes such as Weleda’s Salt Toothpaste include natural ingredients that not only freshen but help neutralise plaque acids.
Ensure you floss between your teeth every time you brush, to further prevent plaque and tartar build-up. Plaque is the number one cause of gum disease and then bad breath.
It will help to brush your tongue as well as your teeth. Using a soft bristle brush for a longer brushing time is advised. The softer brushes cause less damage to gums and the tongue.
Use a mouth wash several times a day. It can help to carry a small bottle of mouth wash around with you for between snacks and meals. Brushing your teeth whilst at work or out and about can be difficult. However a quick swill of quality mouth wash between meals will help to dislodge particles of food until you can brush again.
Avoid brushing teeth for around 30 minutes after drinking fruit juice. Due to the acid in the juice, brushing straight away can cause further erosion of the teeth.
Once you have a solid oral hygiene routine in place, it is advised that you continue to avoid spicy foods, alcohol intake, smoking and coffee drinking. If after 2 weeks you are still suffering from bad breath, it may be time to consult your GP and dentist. They can rule out any underlying health issues that could be the cause of your bad breath.
Cognitive Behavioural Therapy for Bad Breath
Although bad breath is a very serious concern for the sufferer, it is not rare for the bad smell to be a psychological issue. Some can become convinced that they suffer bad breath when they actually don’t. In his recent interview with BBC Radio 4, Dr Tim Hodgson says up to 80% of self-referring halitosis patients don’t really have bad breath.
This paranoia of having bad breath is called halitophobia. People can become obsessed with oral hygiene and avoid social situations due to embarrassment of their bad breath. If a dental professional or GP feels halitosis is not present, the patient will be referred for cognitive behavioural therapy.
Cognitive Behavioural Therapy helps a patient with anxieties to understand the link between how they think, feel and act.
Cognitive behavioural therapy is usually referred to by the initials CBT. CBT is a therapy that involves discussing problems with a professional to find the root of your problems. CBT helps you to examine your emotions, actions and thoughts to understand how they are all interlinked.
Often those that are referred for CBT have at some time in the past suffered from bad breath. However this is usually no longer a problem yet they still think in the same way as they did during that time. Patients create a perception of themselves based on situations that occurred during the previous period of bad breath. This builds an anxiety that makes them concentrate on potential problems related to bad breath.
This is where cognitive behavioural therapy comes in. CBT sessions help the patient to see that their negative actions or negative reactions of those around them are actually caused by their own negative thoughts. This in turn helps the patient to filter all social and emotional information relating to bad breath equally. Rather than concentrating on only the negative they can see and feel, CBT helps them to interpret their apparent bad breath issue in a clearer light.
Products That May Help with Bad Breath
We have compiled a selection of over-the-counter products that are available to treat bad breath. If you have any recommendations or any experience with these products, please comment below.
This all inclusive oral hygiene kit has garnered fantastic reviews. It includes an oral rinse, tooth gel, tongue scraper and tooth brush all specifically designed to eliminate bad breath.
One of the many five star reviews on amazon comes from bumblebee:
It really does help! I ordered it for my close relative who was feeling really bad about her bad breath and although I really doubted it would help, it worked and I really do recommend that product to anyone who has bad breath! 🙂
The Tung Brush is especially designed to remove odour caused by bacteria. The unique design of the flat head and bristles keep the tongue extra clean to avoid bad breath.
This review by amazon reviewer “Me” explains how important tongue hygiene is in combating bad breath:
This product is absolutely amazing. 80% of bad breath comes from the back of your tongue. I’m surprised no one else has thought of this idea. We see tongue scrapers and mouthwashes on the market but we hardly see a good quality tongue brush to clean out tongue.
All the companies want us to buy mouthwashes to clean and freshen out breath, but the truth is that mouthwash just masks your breath for a very short period..that’s it. It won’t remove the bacteria, it won’t scrub it off, it will just stay there.
Now about this Tung Brush. There is also a special kind of zinc tongue gel sample that comes with this brush, which I think is not very good. This is how I use the brush, firstly after brushing your teeth with your toothbrush, apply a strip of normal toothpase (anything that you normally use, I use Aquafresh), then put some water onto it, and then scrub your tongue with it, but only go from back to front motions not back, front, front back etc. But most importantly remember your focus is to clean the very back of your tongue as this is where all the odour smelling bacteria is! This may make you gag a few times, but it is worth it. Afterwards spit, rinse and gargle. And now your tongue and mouth will feel so clean, that your sense of taste will change aswell, it will feel much cleaner and fresher.
You can also buy a Tung tongue scraper from Amazon to use after the Tung brush, this just adds to removing even more bacteria and foul smelling breath.
This is my first review, I wrote it because I think this Tung Brush is an absolute essential for clean and fresh breath. It really will affect your sense of taste.
Transcript from Video
00:01 Speaker 1: From bad hair, to bad breath. Halitosis is a tricky problem for us GP’s, not because we’re particularly prone to it, you understand, but because we’re often the last port of call for desperate patients. People complaining of persistent bad breath often end up coming back to their GP after their dentist has checked their mouth and various specialists who have looked at their throats, lungs and stomach. So, what can the GP add if there is no abnormality to find? Well, the first thing he or she can do is actually check that their patient has bad breath. Offering to smell someone’s breath can be embarrassing for both parties but it’s essential, as I discovered when I met Tim Hodgson, Consultant in oral medicine at the Eastern Dental Hospital in London.
00:42 Tim Hodgson: I think the most important thing to say to these individuals is, “Is it there or is it not?” And you’ve got to be very careful how you say it cause often these people are coming to you with a problem that they feel is real. And then, if you turn immediately around to them and say, “This is not real”, you can run into problems. But I think it’s very important within the first discussion to smell the breath cause that’s the gold standard test, and if they haven’t got bad breath you can say at that moment in time they don’t have halitosis but it is possible that in times previously that they had. And it’s often the case that people have halitosis, address their gum health.
01:22 S1: And gum health being the most common cause of it?
01:24 TH: Yeah. And after that they’re left with this perception that they’ve still got halitosis even though they’ve corrected the cause. And that’s sometimes reinforced by family members, friends and relatives. And often they come along with a very considered construct that people on their bus or on the Tube are turning away from them or covering their face or won’t talk to them directly because they feel they’ve got bad breath. And they look, almost looking for people who are avoiding them because of their bad breath.
01:58 S1: And that reinforces their notion that they’ve got bad breath.
01:59 TH: Yeah, it reinforces and helps build a construct in their own head.
02:03 S1: As a rough guide, what sort of proportion of people that you see here with halitosis would, in your mind, not necessarily have a real problem but have a perceived problem? Are they a significant minority?
02:14 TH: I would say probably 80% of patients referred with halitosis to our service don’t have halitosis.
02:21 S1: Do they believe you when you smell their breath and say, “Look, I can’t smell anything”.
02:26 TH: Some do, and others don’t.
02:29 S1: Working along side Tim Hodgson at the Eastern Dental Hospital is clinical psychologist, Claire Daniel.
02:34 Claire Daniel: For some of these people, they may well have had halitosis in the past so they’ve set up this way of thinking is… We work in a cognitive behavioural way which basically looks at the way in which people think, they way in which they feel, what they do and the physical symptoms and how they all interact. So, this patient in the past may well have had halitosis. They’ve set up this belief system thinking about their breath, maybe they’re focusing on their breath. And as Tim said, they’ve had past experiences of people reinforcing that they’ve got halitosis. Now, even if the halitosis disappears some patients may well remain quite anxious about that and so they will keep on focusing on the potential symptoms. And they become very biased in the way in which they see and hear information so they become very focused on the negative stuff that will reinforce their beliefs and will sort of ignore the other bits of information that may well support a more helpful, more realistic way of thinking about their situation.
03:25 S1: So, when a doctor or a dentist tells them that they haven’t got bad breath, they’ll say, “Well, that’s not true or I haven’t got my bad breath today but, trust me, I had it yesterday because I saw someone in the pub wince”.
03:36 CD: Yes, absolutely. So, it’s either, “Well yes, it’s okay today but it wasn’t yesterday or it won’t be tomorrow”. But also, some people initially will be reassured by somebody saying they haven’t got bad breath but, as we know, reassurance is for people who believe they have medical difficulties can only be short-lived for most people. So, they’ll feel very reassured in the consulting room and then will go home and their whole belief system will trigger again, maybe reinforced by the people. So, their anxiety maintains.
04:02 S1: Looking at this from the outside, Tim’s got perhaps the easy part of the job when he says, “Look, I don’t think you have halitosis”, and he then does the referral to you.
04:09 CD: Absolutely.
04:09 S1: And you’ve got to do something about it. It’s quite a complex problem so what can you do and how successful might you be?
04:14 CD: Yeah, it’s very complex. Cognitive behavioural therapy is an anxiety about health in general, we don’t set out to tell people that they’re wrong. We set out to try and help people understand what’s going on. So, we don’t just talk about their physical reported symptoms. We’ll talk about the way in which they’re interpreting things, they way in which they’re thinking about things, and how those interpretations actually may be unhelpful. They might seem helpful to the patients, like go to the doctor, go to the dentist, focus on their breath to check, maybe clean their teeth, but in the long term they can be very unhelpful and maintain the problem. So, we help people to take a broader outlook on their situation. We don’t tell them what it’s not, we help them to understand what it could be and then we help them to develop evidence to support what it could be rather than maybe what it’s not.
05:01 S1: And practically, what is involved and how often do you see them?
05:04 CD: So, we’d see people maybe every week, every two weeks.
05:08 S1: Is this one-on-one?
05:09 CD: Yes, one-on-one, for this particular condition. One-on-one, so one patient with one psychologist for about 50 minutes about, on average about eight times.
05:17 S1: And in terms of success rate, how effective is it?
05:20 CD: I would say, we do help… With particularly halitosis, we probably help about 80-90% of people.
05:28 S1: That’s pretty good.
05:28 CD: But I wouldn’t… But then it’s a continuum, we might help some people just a little bit. And I think with things like anxiety about health, it’s a life-long issue. We’re not just going to suddenly stop people’s anxieties. It’s about helping them to live with uncertainty and live with a degree of anxiety about their condition. So, they’ll still have times when they think their breath smells.
05:46 S1: Clinical psychologist Claire Daniel. Just time to tell you about the next Inside Health when I will be investigating the side effect of cancer treatment…