Bad breath: fact and fiction
Sophie Radice

A baby’s breath is the sweetest thing you will ever smell. I was reminded of this the other day when watching a friend putting her nose nearly into her baby son’s mouth and just inhaling. It is pure olfactory perfection, better then freshly mown grass or roses or hot chocolate, or whatever else people usually say their favourite smell is. You can’t help imagining it bottled up and labelled “Innocence”, so that you could keep it for posterity. Wouldn’t that be great, so that you can sniff it years on when your teenager comes back on a Saturday night reeking of Bulmers cider and Silk Cut?

Children’s breath is usually pretty nice, too — except when they’ve got a bad cold and it smells a bit like old flower water. Unlike adult breath, it has no trace of fags, booze, curry, tooth decay or the effects of dieting, and is usually something you are pretty pleased to smell — even first thing in the morning. Which is why I was so concerned when my nine-year-old son’s breath turned from sweet to unbelievably sour overnight.

It was an almost chemical smell, which I had to force myself not to recoil from when he jumped on my bed in the morning. Kids in his class were not so kind — particularly the girl who asked him if he was “rotting”. I wondered if at his tender age some kind of hormone had kicked in, marking the end of childhood by some pungent odour. Oddly enough, my son thought the same sort of thing. Among his pals, BO under armpits is an exciting sign of becoming “manly”, and he decided to regard bad breath as the same sort of thrilling sign of a coming of age. He laughed when his sister fled from his dragon-like breath.

I turned to the web and typed in “halitosis”. Dozens and dozens of American breath clinics selling tongue scrapers and new kinds of toothpaste and mouthwash came up. Reading through them, I was advised that the most common reason for bad breath is connected with the teeth. Apparently, few people brush long enough to remove bacteria from their teeth and these bacteria feast on food particles left on our teeth, creating smelly gases.

If you don’t floss, then the odour-producing bacteria grows rampantly in the spaces between your teeth. Your tongue, too, can harbour bacteria — particularly at the back.

So, I started to supervise my son’s twice-daily brushes once again, just as I had done when he was younger. I taught him how to floss (actually surprisingly difficult) and got him to brush his tongue as far back as he could without gagging. Despite a good 10 minutes of oral hygiene, his breath still smelt of boot polish. We tried all the over-the-counter mouthwashes but they seemed to make the smell even more intense and, fearing he had a serious dental problem such as gingivitis or an abscess, I took him to our dentist, who could find nothing wrong.

My husband became convinced that the answer was masses of water and my poor son found himself having to drink glass after glass of water. I started secretly to worry. What an earth could make a child’s breath smell as rancid as this?

Surely it might be the sign of something really serious? I knew it wasn’t the diabetic pear-drop breath smell or a problem with his tonsils, as he’d had them taken out when he was four. I was deeply concerned that he might have an infection (or worse) of the chest or the stomach.

I visited the doctor, and although I saw her wrinkle her nose when she asked him to breath on her, she clearly thought I was neurotic, told me that it was just one of those things and gave me a prescription for yet another mouthwash that didn’t just mask my son’s breath but seemed to bring out the chemical smell even more. He was still being teased at school and was allowed by the teacher to carry fresh-breath capsules, spray and mints — none of which helped for more then a few seconds.

So, never having been in the slightest bit “alternative”, I went back to the homoeopath who actually took time to talk to my son about things that might be concerning him. She explained that bad breath was ¼» often stress-related, because stress dries up the mouth, and a good flow of saliva was very important. My son suffers from allergies and has to take antihistamine quite regularly, so I asked her if the two things might be related. She gave him two little pills which he said tasted nice and, a couple of weeks later, the bad breath disappeared — which coincided with a trip to Turkey.

By the time term came again, however, the terrible boot-polish smell had returned and I was ashamed of the way it made me less inclined to hug him. I went back to my GP once again and was told there was nothing they could do about breath and that they were sure I didn’t want “invasive action” for a problem that, after all, was not so serious. So it was back to the soft-voiced homeopath who my son enjoyed chatting to about the problems of homework — but this time the little pills didn’t work.

By now, I was starting to build up a bit of an e-mail relationship with a breath expert in America. I was grateful for the American ability to embrace such a problem that obviously even embarrassed GPs over here, even if I knew they were trying to sell their products and get people to come and use their halometers (machines that measure the amount of gases in the breath). I tried really hard to explain just what the breath smelt like and Dr Gary Herskovits asked if I thought it might be a reaction to milk.

I found that really hard to believe, even though my son had suffered a severe reaction to cow’s milk when he was a baby. I wrote and said that as he only had cow’s milk on his cereal and never ate cheese, I thought it pretty unlikely. I didn’t stop him from drinking milk until nearly a month later, when a friend told me her son’s breath had improved dramatically since she had started to give him toast for breakfast. We tried it and within a day the smell had gone. That was more than two months ago and explained why it had stopped smelling in Turkey - we had eaten figs and bread and honey for two weeks.

Why did this happen? I tracked down Dr Philip Stemmer, who runs one of the only centres specialising in bad breath in this country — the Fresh Breath Centre. “Allergic reaction to foods such as milk and wheat can add to what we call the post-nasal drip, where mucus falls on to the back of the tongue,” he explained. “This layer of mucus provides a protective blanket under which the bacteria hides and feeds.”

So I will keep my son off dairy products then, and if for any reason his bad breath comes back again, I think I will take him to Dr Stemmer, who understood exactly what I meant by a “boot-polish” smell. Thank goodness, though, that my son is huggable once more and not able to use his breath as a weapon to terrify and bully his sister.

Certain facts

• You can tell if you have bad breath. You certainly can’t tell by cupping your hands over your mouth. Lick the back of your hand, leave for 10 seconds and then smell.
• Brushing your teeth gets rid of bad breath. Although it is true that only a tiny minority of bad breath comes from causes other than bacteria in the mouth, many people expect a quick brush with minty toothpaste to do the trick. You need to brush for three minutes, floss and brush your tongue. Also go to the dentist to make sure you don’t have a gum disease.
• Mouthwash gets rid of bad breath. Many mouthwashes contain alcohol, which dries out the mouth and gives the bacteria even more opportunity to flourish. Try to keep your mouth moist by drinking lots of water — particularly when exercising, fasting or talking a lot. Some of the new alcohol-free mouthwashes coming on to the market are much better for keeping the breath fresh.

Copyright: Observer News Service (ONS).

Pre-marital counselling
Dr Kanwaljit Kochhar

A marriage in the family is a very important occasion, especially for the parents, the bride and the groom. It is said that marriages are made in heaven but they are solemnised on the earth. There are a number of things to be looked into before a marriage takes place. Finding a match, matching the horoscopes, knowing something about the family background, education and looks of the boy or the girl and so on....

After the search is over, there comes the preparation for the Big Day — finding the venue, the caterer, the jeweller, the florist, the best beauty parlour and drawing up a list of the guests.

We follow all these things religiously and meticulously. After all, it is our own child getting married and it does not happen everyday. So, we leave no stone unturned to make the function a success spending lakhs of rupees and at times going much beyond the budget, only hoping and praying that our child will be happy.

But during all this turmoil and excitement we forget a very important thing, or should I say, we do not give a second thought to a simple thing known as pre-marital counselling of the couple to be married? It does not cost much but it has a very important role in the life of the young couple. It is not necessary to go to a counsellor. You can go to your family doctor with whom you are at ease and can discuss everything openly. In western countries there is no taboo attached to this. But in our country it is treading on a delicate path. Even by simply asking the blood group of the boy or the girl one can cause a havoc or create an atmosphere of suspicion. How dare you ask for an HIV test of your would-be son-in-law's blood?

We should not forget that we are now in the 21st century and, if possible, we should try and give our children a healthy and happy start in married life. So many broken marriages can be prevented by a heart-to-heart talk between the partners. A knowledgeable person should guide them properly.

You can do a few simple things.

Try and avoid marrying yours child in the family of immediate blood relations to avoid certain genetic disorders in the future generation.

The girl should have the German measles vaccine before marriage. If she contacts the disease in the first three months of the pregnancy, she may have to abort as the child can have congenital abnormalities.

The HIV test should be done before marriage. We have to help our society as well as our country along with our offspring.

Try and find out if there has been a major haemophilia or thallasemia case in the family in which you are marrying your child. The blood groups of the partners can be checked though it does not have a very significant role these days because of the facilities available.

Another very important thing in counselling concerns family planning. The life partners are the ones who need proper guidance. It gives them more time to understand and adjust with each other if they postpone their first child for about a year or more. We all know that talking about sex freely is still an uncommon thing in our society. So the young persons do not know what to do. They try and get information from friends and relatives who themselves may be ignorant about such things. Some of them land up with unwanted pregnancies, which they either abort or continue half-heartedly.

There can be serious complications after abortions and all this could have been avoided if they had consulted someone who could guide them. It is better to match the blood groups rather than the horoscopes (alone,) and wish them a happy married life!

Dr Kanwaljit Kochhar is a well-known gynaecologist and medical counsellor based in Sector 21, Chandigarh.

Viagra's Indian avatars
Dr Rajeev Gupta

Viagra (Sildenafil), the money-spinning drug from the house of Pfizer has become a household name in the world. The hype created by the drug is unparrelled in the history of the drug industry. In order to make quick gains, many Indian companies have entered the fray.

Thanks to such companies, the American Viagra of 50 mg, which was available for Rs 500 to Rs 600 is now easily purchased in its Indian avatar in Rs 18 only. It is within easy reach of most of the patients of sexual dysfunction who are more than keen to resume normal sexual life. In the market the drug is available in three distinct strengths: 25mg, 50 mg and 100 mg.

There are at least half a dozen Indian brands of the drug in the market which are striving hard to strike gold. The trade or brand names with the names of the companies are given below: Progra (Torrents); Edegra (Sun); Caverta (Protect); Penegra (Cipla); Juan (Ranbaxy); Alsigra (Cadila); Silegra (Zydus Cadilla); Androz (Alembic).

Following the instructions of the Drug Controllor of India, each packet of the drug has a clearly printed instruction on it: the drug can be prescribed by psychiatrists, endocrinologists and andrologists only. But in reality most of the companies are approaching family doctors and other specialists for drug prescription. There is tremendous pressure on the medical representatives and company officials to push the sales up. To make the drug familiar with the doctors, many companies are organising regular scientific talks on the role of Sildenafil in sexual dysfunctions. A new trend, which has been noted, is that in case of some companies the drug has been introduced by two sister concerns of the parent company by different trade names. This has been possibly done to increase their share in the market.

What does Sildenafil mean to the Indian public?
Let us understand that such dysfunction is a common clinical problem faced in medical practice. It is badly surrounded by a veil of myths and ignorance. Innocent patients keep on knocking at one door after another for seeking help. Many self-acclaimed sex-specialists have been regularly misusing the media to make a fast back. In this process, many patients are getting regularly fleeced.

Until recently, in the allopathic system of medicine, there were very few medicines for treating the problem. Now, with the availability of Sildenafil with the practitioners of modern medicine, there is going to be a definite shift towards the scientific and open approach to the problem and fewer people are expected to go to quacks or unqualified "healers" for treatment.

This drug also means a bold and direct approach to the problem of handling the cases. It is commonly observed that many patients feel shy of discussing their sexual difficulties and keep on suffering silently. Viagra has helped them to throw away their inhibition.

Many people are quite willing to discuss their problems with their colleagues and family doctors. This helps them to come out of their shell of silence and take scientific and judicious treatment for the problem.

There is a great need for caution. As the basic principle of any medical treatment goes, normal and healthy individuals, who have satisfactory physical relations, should avoid using the drug as an aphrodiasic, which it is not. Only those who are in real need of the drug should start proper treatment under strict medical supervision

This medicine is strongly contraindicated for heart patients who are taking nitrates.

The author is a Ludhiana-based psychiatrist. (Phones 472822, 472899).

HEALTH BULLETIN
A married man is a healthy man

“Women in general are much better at keeping doctor and dentist appointments.” — Reuters

Protein and breast cancer survival

Scientists have identified a protein that may predict a woman’s long-term odds of surviving breast cancer.

Since levels of the protein can be easily measured as soon as a woman is diagnosed with breast cancer, the discovery should help doctors decide which women need more aggressive treatment, one of the investigators told Reuters Health in an interview.

In a study of 122 women with early-stage breast cancer, 82% of women whose tumors contained high levels of a protein called BAG-1 were still alive 10 years after being diagnosed with cancer, compared with 42% of women whose tumors contained low levels of the protein. Women with high levels of the protein were also more likely to be disease-free 10 years after diagnosis, according to the report in the February 15th issue of the Journal of Clinical Oncology. BAG-1 is involved in cell division and survival.

Low levels of the protein, even in women whose lymph nodes tested negative for cancer, were linked to poor survival odds, Dr. Bruce C. Turner, of Jefferson Medical College in Philadelphia, Pennsylvania, told Reuters Health.

The goal of the study, according to Turner, was “to identify molecular markers that would predict women who were at greater risk of developing metastatic disease.’’

BAG-1 “may be one of many important markers,’’ he said.

The researchers also tested other potential markers for cancer survival, but BAG-1 was the only one that was a statistically significant predictor. — Bruce Turner

Women account for more AIDS cases

While women represented about 1 in 20 AIDS cases in the USA in 1986, they now represent almost 1 in 5 cases of the disease, according to a report published in the March 7th issue of The Journal of the American Medical Association.

Doctors may need to reevaluate how they decide when to start HIV-positive women on antiretroviral drugs, researchers suggest. Women generally have lower levels of the virus in their blood compared with men, but they progress to AIDS just as quickly, according to new study findings. — Reuters

Q&A
Advanced gynae procedures

Dr Nirja Chawla, a former PGI consultant, answers readers' questions

Q You have been doing laparoscopy and hysteroscopy since 1993. What exactly are these procedures?

A Both of these are endoscopic procedures and in these we use a telescope to see inside the body and its organs. The laparoscope is introduced into the abdomen through a tiny puncture while the hysteroscope can be passed into the uterus through the cervix, or the mouth of the uterus for a clear and direct exploration of the mysteries inside.

Q When does a patient require hysteroscopy?

A Hysteroscopy is a powerful tool for the diagnosis of a large variety of gynae problems ranging from abnormal uterine bleeding after a pregnancy or abortion, due to hormonal imbalance or because of fibroids, polyps or cancer of the uterus. All patients, who are not able to conceive, invariably require a hysteroscopic examination of the uterus.

Q Laparoscopy is being used to perform many operations. Does hysteroscopy also offer surgical treatment in addition to diagnosis?

A Certainly. Many kinds of operations can be done inside the uterus with the help of hysteroscopy — like the removal of fibroids, polyps and foreign bodies.

Q If such advanced surgeries are done, why are laparoscopic and hysteroscopic surgeries called "minimally invasive"?

A All surgeries outside and inside the uterus traditionally require a 10 cm-long abdominal incision. Laparoscopic surgery requires minute punctures on the abdomen and the beauty of hysteroscopic surgery is that it can be passed through the natural opening of the uterus below. There is minimum handling of tissues by hands, mops, swabs and instruments with the consequent decrease of post-operative problems.

Q Do these patients require post-operative hospital stay like other kinds of "open" abdominal surgery?

A Since there are only minute or no punctures on the abdomen, patients are often discharged the same day or within 24 hours. In fact, we often do surgical procedures at the same sitting as a diagnostic hysteroscopy.

Q Can you tell us something about the complications of hysteroscopy?

A No procedure in our profession can offer a 100% cure or a 0% complication rate. The more advanced the surgery, the higher are the chances of perforation. Infection, bleeding and fluid overload may occur following a major surgery, (rare after diagnostic procedures). Importantly, since a lot many hysteroscopic surgeries can be done under local or regional analgesia, the complications due to general anaesthesia are avoided.

Q What is the place of hysteroscopic surgery?

A We are now moving beyond the uterus and using the hysteroscope to cannulate the tubes in cases of tubal obstruction causing infertility. There was a time, a few years ago, when we were recommending hysteroscopy instead of "blind" D & C. Today, hysteroscopic surgery has replaced a lot of our conventional gynae "open" surgeries for fibroids, polyps, adhesions, septa and infertility. Hysteroscopy has changed the way we approach any gynae patient today, and with newer advances now available, it is definitely a surgery of the future.

Further information with regard to the topics mentioned above can be obtained from Gynae Endoscopy Centre, 44 D, Chandigarh.