My brother seems to have a problem with his breath no matter how many times he brushes his teeth.  It’s a really big problem and I try to get him gum often. What could be the cause and how do we fix it? Rebecca 

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Dear RebeccaBad breath (halitosis) occurs due to multiple reasons. The most common underlying reason is poor dental and oral hygiene. After eating anything, food particles tend to stick around teeth. These tend to become a focus for bacteria to accumulate resulting in infections. Sticky food items like chocolates, foods with high sugar contents, vulnerability for these infections, is increased in conditions of reduced immunity like HIV infection, uncontrolled diabetes, among others. Infections of the mouth, nose and throat cause bad breath as one of the manifestations.

Use of tobacco, as in cigarette smoking, or even chewing causes bad breath. Certain pungent smelling substances like onion, garlic cause bad breath, particularly after being consumed raw. This happens as these substances pass in the blood stream after consumption. Saliva helps to cleanse the mouth. Hence, conditions with reduced saliva formation can result in bad breath. Drinking inadequate amount of water and dehydration also leads to bad breath. Crash dieting or intake of low carbohydrate food causes bad breath due to breakdown of fat deposits within the body to provide energy. Certain medications like those used to treat depression, high blood pressure, anti-angina, cause halitosis as adverse effect.

Halitosis is not something to be ignored. Apart from causing embarrassment, recurrent dental and gum infections tend to weaken the teeth resulting in precocious loss.

Prevention of bad breath lies in improving oral and dental hygiene. Teeth should be cleaned regularly and gums massaged. Toothbrush should not be worn out and bristles should be soft. After eating anything, mouth should be rinsed very well with copious amounts of water. Antiseptic mouth washes help in cleaning infectious germs from the mouth. Regular flossing helps to remove any food particles sticking around teeth. Stop smoking. Drink adequate amount of water.

Dr Rachna Pande  is a specialist in internal medicine at Ruhengeri Hospital