Bad Breath

Have you ever encountered a situation where you smell something unpleasant when someone is talking to you ? or you are the one that having this problem and feeling embarrassed to communicate with people? It is not a very serious health issue, but it definitely affects us as it could bring down our self-esteem to socialise with others. 

What is bad breath ?

Bad breath, medically known as halitosis, is a condition in which a person emanates unpleasant odour from their mouth. 

Why do I have bad breath? 

Bad breath can result from various reasons, can be due to poor oral hygiene habits, a sign of underlying health conditions, foods u consume, unhealthy lifestyle etc.

Poor oral hygiene:

If someone fails to brush and floss teeth daily, remaining food particles in the mouth provide a perfect environment for bacteria to grow between teeth, around the gums and on the tongue. This odor-causing bacteria growth will lead to bad breath. This explains why all mouthwash products in the market have antibacterial properties to limit their growth. 

Health Problem associated with bad breath: 

Persistent bad breath could be a warning sign of periodontal/ gum disease. Gum diseases occur when bacterial plaque is formed on the teeth, releasing toxins which irritate the gums. If left untreated, it can damage both the gums and jawbone. 

Another possible contributor of bad breath is having dry mouth/xerostomia. Lack of saliva production makes us unable to remove dead cells that accumulate on our tongue, gums and cheeks. As the dead cells decompose, it leads to bad breath problem. 

Respiratory tract infections (eg: pneumonia, bronchitis), diabetes, chronic acid reflux, liver and kidney diseases may also cause bad breath. For these cases, you will need to go to see your primary healthcare provider.

Foods: 

After you eat foods with strong odours (eg: garlic or onions), they start to be broken down in your mouth, causing bad breath. Brushing may cover up the odour but only temporarily, as the odour will only go away completely as the foods have passed through your body. 

Unhealthy lifestyle: 

Smoking will not only stain your teeth, but also cause bad breath problem. 

What can I do? 

For sure, the first thing that you must do is to practice good oral hygiene. Brush twice daily with fluoride-containing toothpaste to remove all sorts of food debris / plaque. Pay attention to the tongue , as a large amount of bacterias do grow on our tongue, too. Scrape the tongue, then floss and rinse. Replace toothbrush every 3 months as what the dentists always recommend us to do so. Rinse mouth with antibacterial mouthwash twice a day will help to control the bacterial growth as well as the bad breath. 

Listerine Antiseptic Mouthwash
Sourced from Google image.

Undeniably, antiseptic mouthwash kills both the good and bad bacterias in your mouth, some people may doubt of its actual benefit in long term. If that is a concern for you, there is a product that helps to promote and maintain fresh breath. It is called BLIS K12, which is a probiotic for the mouth and throat. Mouthwash from BLIS K12 Freah Breath Kit also contains a high strength anti-bacterial mouthwash that does not distinguish between the good or bad bacteria. However, their probiotic lozenges, which should be taken after the use of mouthwash, contains high amount of the beneficial oral bacteria Streptococcus salivarius K12 that helps to repopulate and restore the normal balance of bacteria in the mouth, thus providing long term effective control of halitosis, rather than temporarily masking the problem odours. 

BLIS K12 Fresh Breath Kit

For bad breath due to smoking, stop smoking is the only way out. There are nicotine replacement products available in the pharmacy, which include chewing gums, lozenges and patches, to suit your different levels of craving and therefore assist you in successful cessation.  If the bad breath happens due to dry mouth, keep the mouth moist by drinking more water is always helpful. Click here to see more products that can relieve dry mouth. 

You can also consider to keep a log of the foods/medicines you eat and review it with your dentist during your next visit. It is advisable to see your dentist regularly, at least twice a year, so that he/she can detect and treat problems that causing the bad breath. If the bad breath is due to gum disease, you will need to meet up with a gum specialist/periodontist to have professional cleaning to remove the bacterias that hide in the deep pockets near the gums. 

References

http://www.webmd.com/oral-health/guide/bad-breath#1

http://www.mayoclinic.org/diseases-conditions/bad-breath/symptoms-causes/dxc-20192379

https://www.listerine.co.nz/fresh-breath/what-is-halitosis?
utm_source=Google&utm_medium=CPC&utm_term=halitosis&utm_campaign=GO-NZ-ENG-PS-LISTERINE-X-CS-BM-RN-EDUCATE&gclid=CIGL_cCmpM8CFcGVGwod6KkNzA

http://blis.co.nz/conditions/bad-breath-halitosis.html#.V-SFWTuiaFI

Gum diseases

It is not uncommon for us to have gum disease, even in a developed country. The prevalence of gum diseases normally leap to higher number after childhood when the dental fees are not subsidised by the government. Not to mention those people in the countries whereby health care is not funded at all.

A beautiful boost your confidence. Healthy teeth is one of the keys to guarantee that. On top of that, healthy teeth is also important in maintaining a good oral health, enable us to be able to enjoy the foods and drinks.

sourced from Google search

Therefore, it is important to increase the awareness of oral care even in a community pharmacy setting.

What is gum disease ? 

It is an infection that caused by bacterial growth owing to the accumulation of dental plaque ( a sticky film of bacteria) on the teeth.

There are two main stages of gum disease:

1. Gingivitis (Gum inflammation)

 - usually no obvious sign (painless)
- the gum looks red
- the gum could be inflamed, irritated and reddened
- the gum may bleed when you brush your teeth too hard

2. Periodontitis ( Periodontal disease )
- means inflammation around the teeth
- usually is a progression from untreated gingivitis
-involve soft tissue and bone that support the teeth
- in worse case scenario, the loosened teeth have to be removed

Most of the time, plaque formation is the main cause for gum disease, however, there are also other factors contributing to this disease, including :

1. sensitive gum due to hormonal changes eg. pregnancy and menopause

2. chronic disease whereby the immune system is weakened e.g. diabetes, immunosuppressed disease such as HIV/AIDS

3. dry mouth e.g. medication use that reduce the amount of saliva production

4. smoking

What are the signs and symptoms ?

- bleeding gums when or after you brush your teeth

-swollen, tender gum (may look more red than normal)

- receding gums (tooth become loose or shifting) - make the teeth look longer

receding gums(inflamed)
(sourced from Google search) 

- teeth become sensitive

- persistent bad breath

- sleeping issues e.g. grinding teeth (damage the teeth's supporting tissues )

if the conditions deteriorate, tooth may have to be extracted due to the tissue damage.

How do we prevent gum disease ? 

Controlling the growth of plaque is the key to prevent gum diseases : 

1. Correct brushing technique is important. Use the soft tooth brush. Brush your teeth at least twice daily.  Do not brush your teeth too hardly, it may cause the deterioration of your gum.

2. Flossing is crucial in preventing periodontal disease by making sure the plaque is not accumulatein between the teeth and the gumline.

Dental floss
(sourced from Google search ) 

3. Regular check-up with dentist for overall oral health and early detection of periodontal disease (as it is quite hard to detect gum disease) at least every 6 months.

4. Use antibacterial mouth wash. ( NOTE: do not overuse mouth wash, as it may disturb your mouth microflora and lead to oral thrush. )

Mouth wash
(sourced from Google search) 

5. Quit smoking if you are a smoker. Join smoke cessation program e.g. Quitline for support.

References 

1. http://www.webmd.com/oral-health/guide/gingivitis-periodontal-disease#1

2. http://www.healthysmiles.org.nz/default,284,gum-disease.sm

3. http://www.nidcr.nih.gov/oralhealth/Topics/GumDiseases/PeriodontalGumDisease.htm

Dry Mouth

Do you ever feel like your mouth is so dry that you hardly swallow your food ? Not to mention the bad breath that affect you socially, dry mouth could be a real problem, especially when it comes to eating and drinking.

What is dry mouth ? 

Dry mouth, medically also known as xerostomia, refers to any situation in which your mouth is unusually dry. Dry mouth happens when your body does not make enough saliva to lubricate or wet the inside of your mouth. 

Saliva is produced by several types of salivary glands. Each type of salivary gland makes slightly different form of saliva at different positions of the mouth to perform different functions. Saliva can clean the mouth, lubricate it, help maintain the correct acidity levels (act as buffer), remineralise the teeth and have antimicrobial properties. Therefore, dry mouth problem can have a major impact on our general health. 

How do I know if I have dry mouth?

Most of the time, the symptoms could be mild, which includes :

1. Dry, rough and sore tongue

2. Sore and cracked lip

3. Changes in sense of taste

4. Thick saliva

5. Waking at night with your tongue stuck to the roof of the mouth

6. Difficulty in chewing, swallowing & speaking

7. Burning sensation in your mouth

8. Difficulty wearing denture

If dry mouth is being ignored, it may lead to other complications including bad breath, oral thrush, mouth ulcers and tooth decay. 

Why does it happen?

Dry mouth itself is not a disease, it is rather a sign of an underlying disease. It could be possibly owing to the side effects of the medications such as anticholinergics that you are taking or have just taken.

Numerous causes of dry mouth:-

1. Being unwell. Some autoimmune diseases eg: Sjogren's syndrome; parkinson’s disease, diabetes, anxiety disorders can present preception of dry mouth

2. Radiation therapy. This occurs particularly in those who have radiation to their head and neck that can damage the salivary gland.

3. Chemotherapy. Chemotherapy drugs will thicken the saliva so your mouth feels dry, but is usually temporary, with normal salivary flow returning after the treatment ceases. 

4. Medications.  Drugs to treat depression, nerve pain, anxiety, as well as antihistamine, muscle relaxants could bring dry mouth as their side effect.

5. Nerve damage. Head or neck injury or stroke can damage the nerves of your salivary gland which leads to insufficient saliva being produced.

6. Dehydration.

7. Smoking.

8. Menopause.

To diagnose if you have dry mouth, your doctor or dentist is likely to examine your mouth and review your medical history and all medications (including over-the-counter products, OTC) that you are taking. Sometimes, blood tests and imaging scans of your salivary glands are used to identify the cause of dry mouth too. Small sample of cells/biopsy may be taken from the patient if Sjogren's syndrome is suspected. 

How to prevent/treat dry mouth ? 

When you are experiencing dry mouth, these tips may help relieve the symptoms:-  

1. Sip water or suck crushed ice regularly to moisten your mouth

2. Avoid commercially prepared drinks e.g.: juices, energy drink due to their acidity which can damage the teeth.

3. Avoid acidic fruit and veg eg: kiwifruit, fresh tomatoes.

4. Avoid spicy or salty food eg: chilli. curry as they may cause irritation. 

5. Avoid dry coarse foods eg: toast, grainy break and cereals, scones (can consider to soften he cereals and muesli by adding milk or soak overnight)

6. Avoid sugary sweet or foods —> risk of tooth decay

7. Do not use mouthwash that contains alcohol which can lead to dryness and irritation. 

Nevertheless, if it is the medications that causing dry mouth, talk to your doctor and he or she may change the medication or adjust the dosage for you. It is also highly recommended to use fluoride toothpaste when brushing your teeth in order to protect your teeth from the complications of dry mouth. Last thing to remember is that, it is very important to visit your dentist regularly.

If the lifestyle and home remedies do not help much with your condition, the following OTC products may be useful for you.

Xerostom Anticavity Toothpaste

Sourced from google image.

Xerostom toothpaste is specially formulated to not only replenish moisture in the mouth, but also to clean and protect the mouth from cavities and bacterial plaque. It is useful in relieving pain and dryness in the mouth while stimulating saliva production. Simply brush teeth for about 3 minutes, 3 times daily.

Biotene Dry Mouth Mouthwash

Sourced from google image.

With its gentle, pH balance formula, Biotin moisturising dry mouth mouthwash is excellent in soothing the mouth from oral irritation/dryness and fighting bad breath by cleaning the mouth. Pour approximately 15 ml and gargle for 30 seconds before spitting it out. May use up to 5 times daily. 

Xerostom Mouth Spray

Sourced from google image.

Pocket-sized Xerostom mouth spray provides a more convenient alternative to relieve dry mouth problems. It is specially formulated to be alcohol, sodium laurel sulphate and sugar-free to minimise irritation to dry mouth. It lubricates dry mouth, soothes the tissues while cleans and protects the teeth from cavities or bacterial plaques. Simply shake well before use, then spray directly into the mouth (1 to 2 sprays) as you feel is required to replenish moisture. 

Biotene Oral Balance Gel

Sourced from google image.

For moderate to severe dry mouth, Biotene oral balance mouth gel would be an option for them. It is specially formulated to provide rapid and long-lasting symptoms relief (up to 8 hours) by soothing and protecting mouth tissues from minor irritations, itching and burning sensations. Apply as frequent as needed for relief, especially at night, about 1 to 2 cm directly onto the tongue and spread thoroughly. 

References 

http://www.mayoclinic.org/diseases-conditions/dry-mouth/basics/definition/con-20035499

http://www.healthnavigator.org.nz/health-a-z/d/dry-mouth/

http://www.healthinfo.org.nz/patientinfo/74891.pdf

http://www.toothshop.co.nz/shop/Brands/Biotene/x_cat/00352.html

http://www.smilestore.co.nz/dry-mouth-products/