Criticism of the organoleptic examination for the diagnosis of oral halitosis

Due to the fact that only a human can judge the objectionability of an odor, organoleptic examination (sniffing and scoring oral odor) was used as a reference standard of oral halitosis measurement. However, there are several problems that make the diagnostic value of organoleptic examination questionable. There is no universally accepted, precise definition, standardization or calibration in organoleptic examination, including scoring, scaling or safety protocols. Standardization, calibration, reproducibility, reliability, objectivity, specificity, accuracy and sensitivity of organoleptic measurements are doubtful. It is extremely subjective, emotional, instinctive, intuitive, speculative, hedonic and highly flexible. In addition, it is found to be repulsive, primitive and moreover even shame is experienced by patients and examiners. Non-standard protocols on pre-measurement, scoring, scaling, and training processes may cause misinterpretation or misdiagnosis since it depends on the examiner's emotional mood, gender, ethnicity, odor detection spectrum, threshold and even climatic conditions. It is not the gold standard, and not even considered standard. It is difficult to recognize, identify or focus on a particular gas among thousands in the breath. Organoleptic examination may not be necessary due to it not being a good diagnostic tool for halitosis. There may be an infection risk for sniffers or patients. Moreover, female examiners may have disadvantages in olfactory accuracy during organoleptic examination since menstruation, pregnancy and menopause may alter their odor sensation. In addition, age limits the reliability of examiners due to age-related smell loss. According to the psychophysics laws, the human nose can recognize odors logarithmically. There is no reason to think that scoring the oral malodor by sniffing the mouth of the patients obtains sufficient evidence for the diagnosis of halitosis. Portable multi-gas detectors and electronic noses, can be suggested as an alternative instead of sniffing patients. This is the first paper in the literature to criticize organoleptic examination, revalue its health risks and inconsistencies in assessment protocols.