Persistent complaints of unpleasant breath in the absence of detectable malodour present a common and frustrating challenge in dental practice. Traditional labels such as ‘halitophobia’ are imprecise, potentially stigmatising, and may encourage repeated low yield investigations and ineffective cosmetic interventions. Contemporary evidence suggests that a subset of patients with subjective malodour concerns resemble olfactory reference syndrome, now termed olfactory reference disorder in DSM 5 TR, characterised by preoccupation with emitting an odour, reassurance seeking, checking, camouflaging and avoidance. These behaviours can temporarily reduce distress but may maintain symptoms and functional impairment. In this opinion paper we propose a pragmatic chairside framework that separates genuine halitosis from persistent subjective odour concern using a minimum dataset of objective assessment, red flag screening and explicit exit criteria for repeated testing. We outline a perceptual cognitive obsessive compulsive model for subjective malodour presentations and suggest a stepped management pathway that includes empathetic validation, avoidance of repeated reassurance, targeted oral health optimisation and timely referral for evidence based psychological interventions such as cognitive behavioural therapy with exposure and response prevention. Adopting a shared language and structured pathway may reduce iatrogenic harm, improve interdisciplinary care and provide patients with a clearer route to recovery.