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A BAD CASE OF BAD BREATH

Q: Can you please tell me how to cure halitosis and where to go for help?
-- H.P., Montreal
A: If you have halitosis, I hope it hasn't caused you a lot of discomfort or embarrassment. There are many approaches to curing it; the first place to go for help is to yourself.

Those readers with a weak stomach may not want to read the next few paragraphs. On the other hand, if you want decrease your food intake perhaps you should.

Our mouths, in some respects, resemble garbage disposals. In both cases, we put food into it, grind the stuff up and flush most of it out the bottom. And in both cases, some of the stuff remains behind.

Unfortunately, the mouth has many more small crevices where the remaining food can be stuck for a long time. This food then rots and is infested with bacteria. This often causes unpleasant odors and is the most common reason for halitosis. In the worst case, you will develop abscesses in the teeth and gums that really pump out the smell. ... I warned you.

But before telling you what you can do about it, it's important to know about other reasons for halitosis. Most importantly, it can be caused by a number of major problems such as diseases of the liver, kidney and lungs, as well as diabetes.

Some people with gastroesophageal reflux also have a problem. In this situation, the acid and sometimes undigested food contents are regurgitated from the stomach. Usually, however, the bad taste this causes is much worse than the odor of your breath.

Also, when we eat certain foods, such as garlic and onions, the chemicals that cause the odor are not trapped in the mouth. Rather they are absorbed into our body and then we blow out the chemicals when we breathe.

Before proceeding to cure your problem, make sure you actually have halitosis. Sometimes someone thinks their mouth smells bad, but others don't smell it. This can be a problem with their own sense of smell, not odors coming from the mouth.

Here are some pointers:

Make sure it's really halitosis.

Check out to see if you have any underlying medical problem.

If certain foods are causing the odor, stop eating them.

Improve your oral hygiene.

Improving oral hygiene includes brushing after eating and flossing every day. If you have removable dentures, keep them clean. Using mouthwashes may help, so check with a pharmacist to see what he or she recommends.

Good oral hygiene also includes regular visits to a dentist, which is the best place to get additional help. Your dentist will be able to find and treat abscesses, especially the tiny ones under the gums. A good professional cleaning from time to time will then allow you to continue to keep your mouth clean with daily flossing and more frequent brushing.

Update on diabetes: About 16 million people in the United States have diabetes. And more than 2 million have foot or leg ulcers as a result of their disease. These ulcers are hard to treat and all too often lead to infections, gangrene and the need for amputation.

Now there is a new medical product that helps treat these ulcers. Becaplermin, when combined with standard care, significantly improves the likelihood of complete healing. It is applied directly to the ulcers after all the dead tissue has been removed

Becaplermin is produced through recombinant DNA technology. It is derived from a naturally occurring substance in the blood. This is one of the first of many new drugs that will be produced using this technology.

If you or anyone you know has ulcers caused by diabetes, the most important line of defense is paying strict attention to hygienic and supportive care recommended by the doctor. This new product improves the outcome but does not replace that care.

Dr. Allen Douma welcomes questions from readers. Write to him in care of the Better Health & Medical Network, 585 Grove St., Herndon, Va. 20170.

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