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Chapter I

INTRODUCTION

A. Background of the Study

Halitosis is the technical term for bad breath, thirty five percent of the

world’s population has a chronic halitosis another thirty five of the population is

borderline, meaning that their breath seems fresh sometimes but can easily reach chronic

level if they eat certain food, take certain medication, smoke, drink etc. it has been a

problem for mankind since the beginning of most recorded history. In most cases, bad

breath originates in the mouth itself. The intensity of bad breath differs during the day,

due to eating certain foods (such as garlic, onions, meat, fish, and cheese), obesity,

smoking, and alcohol consumption. Because the mouth is exposed to less oxygen and is

inactive during the night, the odor is usually worse upon awakening. Bad breath may

disappear following eating, brushing, flossing.

Bad breath may be chronic bad, which is more serious condition; it can

negatively affect the individual’s personal, social, business relationships, leading to poor

self-esteem and increased stress. In most cases, bad breath in the mouth can be traced to

sulfur gases produced by bacteria in the mouth. Factors that support the growth of these

bacteria will predispose a person to halitosis. Examples include accumulation of food

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within pockets around the teeth, among the bumps at the back of the tongue, or in small

pockets in the tonsils; sloughed cells from the mouth; and diminished saliva flow. Mucus

in the throat or sinuses can serve as a breeding ground for bacteria. Conditions are most

favorable for odor production during the night and between meals.

Guava has an antiseptic property, the bark and the leaf extracts of guava

have shown to have in vitro toxic action against numerous bacteria. The leaves of guava

are rich in flavonoids. The flavonoids have demonstrated anti-bacterial activity. This

causes benefits to the teeth and gums. The guava leaves is also rich in tannic, malic,

oxalic, and phosphoric acids as well as calcium, oxalate and manganese. Because of this

reason, the guava has been used for centuries to cure problems related to teeth and gums.

B. Statement of the Problem

The study aims to determine the efficacy of guava leaves decoction as a remedy

for halitosis.

Specifically, it seeks to find out:

1. What are the needs and concerns of persons experiencing halitosis?

2. How do clients affected by halitosis perceive their personal and

social life before and after the treatment with guava decoction?
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C. Significance of the Study

Halitosis has been a factor of concern for society. This study is relevant as

the presence of halitosis can affect the full range of people’s quality of life. Buying a

commercial mouthwash is costly. If proven effective the study provides as easily

accessible and cost effective remedy for halitosis with the use of guava decoction as

an alternative mouthwash.

D. Scope and Delimitation

This study focuses on the use of guava decoction to treat halitosis. The

participants of this study include 11 people with halitosis who are residents of

Riverside Sta.Maria, Zamboanga City, male and female ages 12-19 years old. The

participants will be instructed to use the guava decoction for 15 days.

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Chapter II

LITERATURE REVIEW AND CONCEPTUAL FRAMEWORK

A. Review of Related Literature

Halitosis is a common oral problem. Ninety percent of patients suffering

from halitosis have oral causes, such as poor oral hygiene, periodontal disease, tongue

coat, food impaction, unclean dentures, faulty restorations, oral carcinomas, and throat

infections. The remaining 10 percent of halitosis sufferers have systemic causes that

include renal or hepatic failure, carcinomas and diabetes. Modern analytical and

microbiological techniques permit diagnosis of bad breath. Management of halitosis

involves maintaining proper oral hygiene, and periodontal treatment, including tongue

brushing. It has a significant impact — personally and socially — on those who suffer

from it or believe they do (halitophobia), and is estimated to be the 3rd most frequent

reason for seeking dental aid, following tooth decay and periodontal (Spielman AI,

Biovona P.,Rifkin BR., 2006).

In most cases the etiology of the condition is from local oral causes (oral

malodour). Oral malodour is the result of the action of anaerobic bacteria in producing a

range of malodorous molecular species including volatile sulphur compounds (Hugnes,

Mcnab R. 2008).
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It is also important to deal with the effects of halitosis because those involved

either personally or intimately may feel uncomfortable by the odor of the person affected

by it. Sometimes a person may not even realize this is a concern, and perhaps people do

not know how to tell someone that is close to them that his or her breath stinks. This is

often one of the most difficult things for a person to do. Therefore, those people that feel

uncomfortable around the person with the halitosis condition begin to shy away from the

person affected.

1. Needs and Concerns of People with Halitosis

a. Personal

1.) Lack of Knowledge on Prevention of Halitosis

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 and remedy utilizing our natural resources such as herbal ingredients like

guava, as the causes of halitosis is basically concentrated in the mouth.

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2. Self-Image Consciousness

According to a German Philosopher, Schopenhauer, man can, through

self-consciousness, an awareness animal’s lack, make a choice between affirming or

denying the will. When feeling self-conscious, one becomes aware of even the

smallest of one's own actions. Such awareness can impair one's ability to perform

complex actions.

Professionally—having halitosis in the workplace can, at best, lead to

uncomfortable moments with co-workers due to self-consciousness at meetings,

luncheons and other periods of direct interaction. At worst, it can narrow

opportunities for career advancement.

3. Lack of Self-Confidence

According to a psychologist, Dr. Vincent Berger, self-confident people are

willing to risk the disapproval of others because they generally trust their own

abilities. They tend to accept themselves; they don't feel they have to conform in

order to be accepted. In contrast, people who lacks self-confident depend excessively

on the approval of others in order to feel good about themselves. They often put

themselves down and tend to discount like for example they have halitosis. They get
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paralyzed due to anxiety. The person tends to have lots of self-doubts, becomes very

critical about himself / herself and have low opinion of self (low self esteem). This

causes a vicious cycle where the anxiety cripples the person into inaction, and he / she

continues to berate herself thus creating more anxiety.

4. Emotional Anxiety

Personally-halitosis can even (and sometimes especially) hinder the personal

lives of those who suffer from it. They have been known to avoid intimate displays

of affection with spouses or children due to the discomfort the malodor of their

breath might cause. As evidenced in the myriad advertisements for mouthwash,

halitosis is a severe impediment to a rewarding love life, as it negatively affects

one’s appeal in intimate situations.

There is a pain of rejection if for example they have been refused a

goodnight kiss or have been told off about their bad breath. They will be aware of

the social concerns caused by this perennial problem and also feel guilty because

they are themselves the cause of the affront.

If they were to know that their halitosis is treatable and preventable and

they do not need to suffer from this embarrassing condition any more, they can lead
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a better social and work life. There are now many remedies for bad breath including

guava decoction. Though there are many over the counter treatments available and

others with prescription, there are some which can be got only from a natural herb.

5. Psychological Anxiety

Halitosis generally creates difficult psychological issues in the daily

affairs of those with the condition. In fact, it is on one’s psyche that presents the

greatest problem. It’s why people have sought to cure and prevent halitosis for

thousands of years.

For example, an open door may come up for communication about this

matter between a person with halitosis and a friend of one with halitosis. Maybe the

person with halitosis does not realize how powerful the smell is, and is talking to a

friend about why people do not want to get to close to that person. During this

conversation the person with halitosis might express something like "I wonder why

it seems like no one wants me around" or similar phrase.

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Once a halitosis sufferer is armed with the knowledge of his or her

condition, extreme stress and worry generally ensues, and they seek whatever

remedy might work. Until one is found, however, their daily lives are severely

affected. Halitosis can be debilitating to one’s self including psychological well-

being.

b. Social

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.

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 (Sanz M., Roldán S, Herrera D., 2005).
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1. Social Anxiety

The fear of social situations and the interaction with other people that can

automatically bring on feelings of self-consciousness, judgment, evaluation, and

inferiority is what we call social anxiety (Richards, 2009).

Socially—those afflicted with bad breath often experience heightened

anxiety in social settings, avoiding face-to-face encounters and gatherings in tight

quarters with the knowledge that their breath is off-putting. This may cause them to

avoid such occasions and restrict their ability to lead fulfilling social lives.

Halitosis is an extreme condition, and most of the time, people are aware that

they have this condition. However, in some cases, a person with bad breath is not

even aware of it. Instead, they suffer from the curse of not being socially accepted

and not knowing why. It is a major deterrent in social situations. Sufferers of this

embarrassing condition are extremely self-conscious, probably as much as the obese

are aware of their weight (Dr. Jon Richter, 2006).

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2. Social Isolation

Many people fear social situations and relationships because they know

that their bad breath will cause people to shun them. The problem is so bad that some

people give up their social life completely, because they have previously been

rejected due to halitosis. Finally they just relinquish the social scene and sit at home

alone and lonely.

2. Brief Remedy Approach for Person with Halitosis

a. Permission

In application of permission, patients often seek information from experts when

they have a concern. Patients' often simply need the reassurance that what they are

experiencing is normal and commonly occurs to others. This can be an open door if

carefully considered. For ways to tell someone that they have bad breath, a person may

start out by reassuring that person that he or she is an intelligent or talented person.

Then they can hopefully gradually slide into suggesting that they clean up a little more.

This can be a very sensitive subject for most people, that’s why we should know about

how to successfully communicate with others regarding difficult topics such as these

(Herrera D., Lenton, P, 2004)

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b. Limited Information

At the limited information level, the participant is given specific factual

information directly relevant to their specific problem. Typically, the information

provided at this level can be incorporated into existing schedules and does not require

additional appointment time. For example is stating facts to them like many halitosis

solutions involve reducing bacteria. It is important to understand that while too much

bacteria can lead to foul odor, you do not want to completely eliminate all bacteria. A

small amount of bacteria helps control the levels of harmful microorganisms such as the

yeast-like organism, Candida. (P. Lenton, 2004).

c. Specific Suggestions

When providing specific suggestions to participants, supplemental of verbal

instruction with appropriate discussions or readings may wish; resources include

published articles, patient education brochures, and other reliable source about halitosis

and herbal remedy which is guava in form of decoction. Reading materials provide both

non-intimidating information sources as well as being time saving, for the participants.
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d. Intensive Remedy

If the participants’ problem is related in those whose bad breath is

particular in nature including both oral components only, knowing the efficacy and

making use of guava decoction can serve as remedy for halitosis. But for instance,

patients with periodontal disease, who are taking medications, and/or who have medical

conditions that exacerbate bad breath, when the specific suggestions that work for the

majority of participants are not effective for a particular participants’ problem, then it is

time for highly individualized intensive remedy (B. Bakdash, 2004).

It is astonishing to learn that quite of few of the herbs can be used as a

remedy for bad breath. If participants are willing to try alternative remedies, these are

the herbs that can help with halitosis like guava.

C. Conceptual Framework

Before Treatment After

Personal and Guava Decoction Personal and

Social Life For Halitosis Social Life

Fig. 1 The Conceptual Model

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The study begins by determining the personal and social life of the selected 11

adolescent ages 12-19 years old at Riverside Sta.Maria, Zamboanga City, to identify

personal and social effects of halitosis.

It begins by observing the personal and social lives of the participants having

halitosis before the treatment. Next, is the treatment of halitosis with guava decoction and

observing the effects of the decoction on the personal and social lives of the participants.

D. Assumption

Guava decoction helps in reducing problems about halitosis, enhancing personal

and social life of clients

E. Definition of Terms

Needs and Concerns of People with Halitosis. These refers to the factors that needs

attention to which it affects the life (personal and social life) of the person

experiencing halitosis.

Personal. Characteristics of a person caused by halitosis.

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Lack of Knowledge on Prevention of Halitosis. Not enough understanding or

information about preventing halitosis.

Self-Image Consciousness. Excessively aware of being observed by others and

conscious of oneself or one's own being.

Lack of Self-Confidence. A negative emotion or delusion, as it exaggerates one's

limitations in capacity, quality and potential for growth.

Emotional Anxiety. Uneasiness of mind caused by revealing strong emotions.

Psychological Anxiety. Unpleasant feeling that is typically associated with uneasiness,

fear, or worry, affecting the mind as a function of awareness.

Social. Negative interference to the person with halitosis in dealing other

people or human society.

Social Anxiety. Experience of emotional discomfort, fear, apprehension, or worry

regarding social situations, interactions with others and being evaluated or scrutinized

by other people.
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Social Isolation. Pertains to a feeling of not being part of a group; being alone/lonely.

Brief Remedy Approach. Counseling and treating bad breath in a step-by-step approach

which includes permission (primarily concerned with reassuring about the info in

which a person is seeking), limited information (specific fact/information about

halitosis), Specific suggestion (detailed idea regarding halitosis) and intensive remedy

(involves a thorough assessment of the participant’s specific situation in order to

develop an individual comprehensive and therapeutic to them).

Efficacy of Guava Decoction. Pertains to the effectiveness and usefulness of guava

decoction as alternative mouthwash for halitosis. Halitosis which is the unpleasant

odor coming from the mouth of a person.

Chapter III
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RESEARCH METHODOLOGY

This chapter will present the research design, research locale, sampling method,

validity and reliability of the tool.

A. Research Design

This is a pre-experimental research that will investigate the efficacy of guava

decoction in the treatment of halitosis. It will utilize the one group pretest-post test. It

begins by observing the personal and social lives of the participants having halitosis

before the treatment. Next, is the treatment of halitosis with guava decoction and

observing the effects of the decoction on the personal and social lives of the participants.

For the preparation of the decoction, boil 5-10 leaves of guava in 3 glasses of

water. Reduce the volume to 1 glass. Let it cool. The decoction will be given twice a day,

one in the morning and one in the evening.

B. Sampling Design

This research will be conducted in Riverside Sta.Maria, Zamboanga City.

Guava trees are abundant and one of the depressed area in the city. It is where incidence

of halitosis is likely affecting people living there. This research will use purposive
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sampling method in selecting 11 participants ages 12-19 years old manifesting bad

breath.

C. Content Validity

Table of Specification

Research Question Data Needed Blueprint of the Tool

What are the needs Needs and concerns

and concerns of • Personal 1. Do you know the causes of

persons experiencing Lack of knowledge halitosis?

halitosis? Yes ( ) No ( )

If yes, what are the causes of

halitosis?

2. Do you know how to

prevent/treat halitosis?

Yes ( ) No ( )

If yes, what are you using to

prevent/treat this problem?

_______________________

3. How long have you been

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using it? Is It effective?

(1-3 months)_____

(4-6 months)_____

(6 & beyond)_____

_______________________

How do clients Lack of self-confidence 4. Do you perceive halitosis as

affected by halitosis Emotional anxiety a problem?

perceive their personal Psychological anxiety Yes ( ) No ( )

and social life before If yes, how does it affect your

and after the treatment personal life?

with guava decoction? _______________________

Self-image consciousness 5. How do you feel about

yourself having halitosis?

Social effect 6. How does it affect your

social life?

________________________

Social anxiety 7. Do you experience problems

Social Isolation with your relationship or

communication because of
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halitosis?

Yes ( ) No ( )

8. How is your social

relationship with other people?

________________________

9. Do you conceive that people

avoid having conversation with

you because of halitosis?

________________________

11. Do you avoid social

gathering/occasion because of

halitosis?

12. How confident are you

when attending social

gatherings?

13. Did you experience being

isolated/alone because of

halitosis?
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D. Reliability of the Tool

The researcher will be using questionnaire and interview guide in gathering data.

The research tool will be translated to tagalog and the vernacular. The questionnaire will

be validated by Dr. Susan Dela Cruz of WMSU. The questionnaire will be finalized after

comparing it to the literature.

Bibliography:

The Journal of Contemporary Dental Practice by Patricia Lenton RDH,MA,

Georgia Majerus
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RDH, BS, Bashar Bakdash DDS, MPH, MSD. Vol.2 No.2 spring issue 2004

Sanz M, Roldán S, Herrera D. Fundamentals of Breath Malodour. J Contemp. Dent.

Pract.2005

www.scielo.br/scielo.php. Revista Latino-Americana de Enfermagem.vol.14 no.5, 2006

www.PubMED.gov. N Y State Dent J. 2006 Dec.

John M, Vandana KL. Detection and Measurement of Oral Malodour. Indian Dent Res.

2006 vol.17 pp. 2-6

Journal of Medicine and Biomedical Research, December 2008. Vol. 7, No. 1 & 2, , pp.

5-11

www.pubmed.gov. Arch Oral Biol. 2008 April.

Kelvin Ho DDS. Top Confidence killer – Bad breath. January,2009

Richard Wilkins. Natural Halitosis Cures. EzineArticles.com.2009

http://www.animated-teeth.com/bad_breath/t1_halitosis.htm. Bad breath: Testing for

Halitosis.2009.
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Appendix

A. Research Tool

Name: ______________________________ Date: ______________

Address: ____________________________
Age: ___________

1. What do you know about halitosis?

2. Do you know the causes of halitosis? Yes ( ) No ( )
If yes, what are the causes of halitosis?
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____________________________________________________________
3. Do you know how to prevent/treat halitosis? Yes ( ) No ( )
If yes, what are you using to prevent/treat this problem?
____________________________________________________________
4. How long have you been using it? Is it effective?
(1-3 months)_____
(4-6 months)_____
(6 & beyond)_____
5. Do you perceive halitosis as a problem?
Yes ( ) No ( )
If yes, how does it affect your personal life?
____________________________________________________________
6. How do you feel about yourself having halitosis?
____________________________________________________________
7. How does it affect your social life?
____________________________________________________________
8. Do you experience problems with your relationship or communication because of
halitosis? Yes ( ) No ( )
9. How is your social relationship with other people?
___________________________________________________________
10. Do you conceive that people avoid having conversation with you because of
halitosis? Yes ( ) No ( )
11. Do you avoid social gathering/occasion because of halitosis?
Yes ( ) No ( )
12. Did you experience of being isolated/alone because of halitosis?
Yes ( ) No ( )