Bad breath Sufferers may not be aware Periodontist Celi Vieira is treating a patient who, for 30 years, has been in search of a solution to his halitosis (bad breath). Only now he seems to be on the right way. However, he is an exception. Almost half of the Brazilian population has bad breath for a number of years without looking for a solution. Halitosis is a common occurrence among adults and the elderly.  According to periodontist Celi Vieira, most people are not aware of their problem because they simply get used to the odor of their own breath. They become conscious of their problem only when their attention is pointed in that direction. “Olfactory cells may suffer a fatigue process, thus getting used to the odor,” explains periodontist Denise Falcão.  Denise Falcão sees in telling other people that they have bad breath an act of kindness and a proof of neighborly love. And those who are not aware that they have halitosis end up experiencing a lengthy series of difficulties without knowing the reason why. This is true about their professional life since such people begins to be avoided and passed over by their colleagues and supervisors. Bad breath may also adversely affect the relationship between married mates, particularly during intimacies, recalls periodontist Ana Maria Ferreira.  According to Celi Vieira, when husbands have bad breath, wives usually do not call their attention to that, “for fear of being offensive.” The three above mentioned experts—all working together at Clínica Oris—agree that halitosis’ worst consequence is social restriction, especially today when interpersonal communication is of vital importance.  To have a better idea about the importance of halitosis, the American government spends a cool 10 billion dollars for treatment. In our country, those who are in search of a solution to the problem may also spend a lot of money before finding the right professional and the most adequate treatment. The three periodontists confirm that misinformation about the causes of halitosis is a major obstacle facing the population.  According to Celi Vieira, many are the taboos around the causes of this problem. Among them is the belief that this is related to stomach diseases, such as gastritis and ulcer. “Such diseases do not cause bad breath,” asserts Denise Falcão. Only 5 percent of all bad breath cases have their origin in the stomach. In 95 percent of all cases, halitosis stems from diseases in the mouth itself, such as periodontal infections on the supporting structures of the teeth—bones, ligaments, and cement. The gingivae—tissues protecting the teeth—also suffer inflammatory processes, bleeding being the most common sign of the disease. The offensive, foul odor occurs as a direct consequence of the presence of stagnant blood in the mouth. This, together with dental plaques, tartar, and the exfoliation of cells caused by the disease, ends up intensifying bad breath. Consumption of some food items may also cause temporary halitosis due to the production of sulfur-containing volatile gases. Kale, broccoli, beans, beef, cabbage, garlic, and onion are among such food items. However, there is more about it. Emotional factors, such as depression and stress, may also account for halitosis, even though temporarily. Physiological factors—severe dieting (fasting for long hours) and strenuous physical exercises—should also be considered. The worst of all possible causes, though, are periodontal diseases. In an epidemiological study, the Ministry of Health found that 92 percent of the population is affected by such diseases. Periodontal diseases are marked by the infection of the gingivae and the supporting tissues of the teeth. And it avails nothing to use mouthwash, candies, chewing gum, or cloves. Warns Ana Maria Ferreira: “Such things can only but mask the disease.” Since a patient’s mouth may not present signs of periodontitis, because the disease may be masked, the dentist is not able to make a precise diagnosis in a first moment. The disease manifests with the formation of bacterial plaques on the supporting structures of the teeth. Without adequate treatment - as soon as possible - plaques end up affecting such structures, thus making teeth loose and eventually leading to tooth loss. CAUSES   Dryness of the mouth  (xerostomia) when salivary glands are not working as they should; A coated tongue due to poor cleaning and an accumulation of food debris on the surface of the tongue; Deep cavities; Badly adjusted and/or badly cleansed prosthesis; Hepatic (liver) diseases; Diabetes; Renal (kidney) diseases; Hormonal diseases; Upper airway diseases.   LUCIENE DE ASSIS  JORNAL DE BRASÍLIA Reporter	Jornal de Brasília
(TRANSLATION) Halitosis  Best known as bad breath, halitosis affects a significant part of the population, leading to a number of serious social and family disorders. Breath odor is caused by volatile substances (called volatile sulfurated compounds, or VSC) produced by bacteria that usually live in the oral cavity—a part of the body where their concentration is among the biggest and most varied. The bacteria feed on food residue and exfoliated cells from the mucosa of the mouth and the tongue. A device called halimeter is designed to measure the amount of such substances in the expelled air, making it possible to evaluate quantitatively how serious the problem may be. Among other functions, saliva secretion accounts for constantly washing the mouth, thus cleaning it from food residue and dead cells. A decrease in saliva production may cause halitosis. It is normal to wake up with bad breath after a whole night of sleep, because of fasting and a reduction in the flow of saliva. After brushing the teeth and having breakfast, bad breath disappears. If this does not occur, there is a problem to consider and resolve. The stomach, considered the villain, usually is not the cause of halitosis, except when it is suffering from serious diseases such as cancer. The same is true about the esophagus. At times, the culprit may be obstipation (or, constipation) or diarrhea. Alcoholic beverages and a number of food items (garlic, onion, fried food, sulfur-containing elements, and so on) may change one’s mouth odor. Among the diseases causing bad breath are gingival inflammation, cavities, prosthesis that are badly adjusted and difficult to clean, chronic infections of the upper airways, sinusitis, rhinitis, tonsillitis, diabetes, major renal dysfunctions, hepatic failure, and so on. Since the causes of bad breath can be so many, treatment should be specific and personalized. Identifying the cause should be the first step, followed by its being eliminated. When it is impossible to put an end to the cause, its intensity may be reduced. A few recommendations can apply to almost all cases: daily, careful oral hygiene should be done, the teeth and the gingivae being brushed as well as the surface of the tongue being cleaned; liquid intake should increase; intervals between meals should be reduced, since chewing stimulates saliva production; food and drinks that cause halitosis should be avoided; and an expert should be consulted if such measures do not yield good results. Eugênio Bacelar Viana - Gastroenterologist	Correio Braziliense
(TRANSLATION) A network against bad breath João Luiz Marcondes A member of the Correio Braziliense staff   “A tall, sexy, tanned, handsome man,” but – Oh! What a bad breath! You can’t stand that, can you? Hygiene is vital. All the more when one’s mouth is involved. That can upset any relationship—sweethearts, friends, employers/employees. Researches by dentists worldwide reveal that this problem affects from 40 percent to 50 percent of the population. In other words, one out of each two pretty girls may have a foul odor in her mouth. If slovenliness were the only problem—like lacking a good shower—that could be easily resolved. However, physicians explain: bad breath is a disease  (or may be caused by one). In the jargon of dentists, bad breath is known as halitosis. The obvious solution would be consulting a health professional. However, believe it or not, many lack the courage to face a medical doctor or a dentist and say: “I have bad breath.” For the stubborn still there is a solution—the Internet, truly a last resource for all evils. Though timidly, dentists are beginning to display their self-promoting sites on the superhighway. Pages have plenty of information for those who like teeth, gums, papillae, and so on. They also offer hints on how to fight bad breath and suggestions to treat halitosis, a problem with many causes.   FIGHTING BAD BREATH www.abpo.com.br According to the Brazilian Association for the Study and Research on Mouth Odors (ABPO)—true, such Association is a reality—over 40 percent of the Brazilian population is affected by chronic bad breath. Based in Salvador, the ABPO’s site offers a terrific idea: “Help a friend with bad breath. The service is simple: secretly, you ‘betray’ an acquaintance with bad breath. You reveal his or her name, e-mail, and/or phone number. If you want, you may also inform the kind of relationship that you have with the person (if he or she is your sweetheart, for example) and other personal information (confidentiality is guaranteed). Tactfully, ABPO approaches the individual and “warns” the person about the problem and possible forms of treatment. Certainly this is something that many are more than anxious to do, but they fight shy of doing so.   www.halito.com.br This is the Clínica Oris site, specialized in mouth odors in Brasília. It is the most comprehensive page on the subject. The site addresses causes, consequences (change in behavior, social restriction), and how patients are treated, including an analysis of their emotional profile and feeding habits, as well as radiographic and biochemical examinations if needed. “Do I have bad breath?” is also cool. Since olfactory fatigue may prevent sufferers from being aware of their own breath, this section offers tests to help people know whether or not they have halitosis. Practical hints are missing though.   www.geocities.com/the_tropics/5129 On this site, which is under the responsibility of dentist Flávio Geraldo  Araújo, we find out that bad breath has two different causes: the mouth (teeth, tongue, oral mucosa, gingivae, and so on) and the body (hepatitis, depression). Details on how food may cause halitosis are provided. Under “Treatment,” Internet users can get acquainted with exams they may need to have before getting rid of the problem.   http://orbita.starmedia.com/~dr.jorge Those who are not dentists and yet are interested in teeth, gingivae and similar things can have fun on a site called “Dentistry for Laymen.” Under “Halitosis,” users are informed that bad breath is caused by bacteria which can be fought in three different ways: avoiding an accumulation of food through fine mouth hygiene; checking salivation, since a “dry mouth” is bound to cause bad breath; and taking care of feeding habits - odors from strong-smelling food items, such as garlic and onion, are eliminated through the lungs.   www.correionet.com./~mdc “Halitosis deprives sufferers of social contacts,” says dentist Maurício Conceição, member of the International Society of Breath Odors. On his site, Dr. Maurício explains that halitosis can have more than 50 causes, thus requiring that the first consultation lasts at least two hours for an effective gathering of facts and causes! The page explains that long intervals of fasting are sure to cause bad breath—therefore having breakfast is vital. If halitosis persists even after a meal, this is an evidence that something may be wrong.   www.svn.com.br/kolbe Dentist Ana Christina Kolbe has designed the Kolbe Tongue Cleanser, a stainless or plastic device that removes food debris from the tongue by scraping, thus eliminating bad breath. So says Dr. Kolbe. If it does not work, at least we can say it is interesting. Dr. Kolbe also informs that a survey made in Salvador among 4.670 people revealed that 42 percent of those interviewed have halitosis. The survey was done by using a device which measures in ppb (part per billion) volatile sulfurated compounds that are produced by anaerobic bacteria present in the bacterial plaque on the tongue. Wow!