To treat halitosis, clinicians must examine the psychologic condition ofa patient as well as the disease history and plausible causes of oral malodor, such as periodontal disease. However, it is not easy for a practitioner to carry out a psychologic examination other than the normal inquiry concerning oral malodor itself. Hence, a questionnaire that appears to be a normal inquiry, rather than one containing psychologic questions, was composed to survey the causes of halitosis and psychosomatic tendencies. Keywords: counseling, halitophobia, halitosis, psychosomatic dentistry, psychosomatic disease, questionnaire