Courtesy of THIS Quarterly magazine  
 
 
Bad Breath & Embarrassing Wind  
 
   
     
 

BAD BREATH OR HALITOSIS IS NOT UNCOMMON

Usually the propagators are blissfully unaware of it and it’s the surrounding people who have to bear with it 90% of pathological bad breath is caused by oral bacteria and the other 10% is due to systemic illness like kidney failure, nose or lung cancer and gastric reflux. It is easily diagnosed by breathing in the exhaled air from a “cupped” hand, or perhaps an honest comment from another person.

Offensive breath is due to gases like volatile sulphur, cadaverine and putrescine produced by oral bacteria. Excess bacteria are found in tooth and gum disease, food debri in between the teeth and mucus at the back of the tongue. To controlthe bacteria, it is essential to maintain oral hygiene and have healthy mouth, teeth and gums. Regular brushing of the teeth is not enough, daily flossing and brushing the back of the tongue, are necessary to remove the food debri and bacteria-rich mucus. Using mouth sprays and antiseptic gargles have only temporary effect.

If bad breath is due to systemic disease, specific treatment is required. With cancers of the nose, sinus or lung, an antibiotic like Metronidazole (Flagyl) is helpful to reduce bad breath in addition to the specific therapy.

Everyone has experienced passing flatus, wind or gas and can be embarrassing in public especially if it is loud and smelly. The process of passing flatus is referred to as flatulence, the sound is due to the forceful explusion of gases through a tight anus and the malodour is due to compounds like hydrogen sulphide from bacteria in the colon.

There are three main sources of abdominal gas: air swallowed while we talk, drink or eat, gas from fizzy drinks like mineral water, soda beer or champagne; and gases generated from bacterial digestion in the colon. The colon contains both good and bad bacteria. They digest plant products and produce fatty acids for maintaining healthy colonic cells, and they detoxify ingested harmful substances and chemicals.

 

These actions produce gas such as methane which is odorless and other gases like sulphur compounds which stinks. Foods like beans, lentils, cruciferous vegetables (eg. cabbage, cauliflower, kai-lan), onions, leeks, potatoes and sweet potatoes, produce a lot of gas. Prebiotics which contain oligosaccharides and inulin also generate gas. Certain ailments like constipation, food poisoning and lactose intolerance can create gas too.

The treatment of abdominal bloatedness and flatulence starts with reduction of ingested gas by avoiding fizzy drinks and minimising swallowed air (not talking with the mouth full and not gulping down food quickly). Foods like cruciferous vegetables and fruits are important for reducing the risk of colorectal cancer and constipation. With flatulence being a problem, it is best to avoid beans, lentils, onions, leeks and sweet potatoes. If constipation is present, it needs to be treated as it tends to compress gas inside the colon and prolong bacterial decomposition.

It is preferable to release gas trapped in the stomach through the mouth rather than through the rectum. This can be stimulated by surface-tension agents like Simethicone (Colimix). To control bacterial action in the colon, antibiotic like Rifaximin, which is prescribed for liver failure, can be used. When there is excess of bad bacteria as in antibiotic or travellers diarrhoea, probiotics which contains good bacteria, are useful to restore colonic equilibrium. Activated charcoal has been tried but the amount of gas it can trap is insignificant. With food poisoning or colon infection which can produce noxious gas, treatment with Rifaximin or Ciprofloxacin (cipro) is effective. Odour from non-specific causes can be treated with Bismuth subgallate (Devrom), sometimes referred to as “colonic deodorant”, but this over-the-counter medication is not available in Singapore. Instead traditional remedies like yogurt, cumin, corriander, tumeric and Kombu kelp (Japanese seaweed from Hokkaido) can be used.

While we can control excessive flatulence, it is not possible to prevent it completely. It is still common courtesy to move away to a well ventilated side and gently pass flatus.

 
 
 
DR GOH HAK SU | Colorectal Surgeon
MBBS, FRCS, FAMS

Address
 
Goh Hak-Su Colon & Rectal Centre
6 Napier Road #04-08
Gleneagles Medical Centre
Tel : (65) 6473 0408
Website : www.gohhaksu.sg