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Suggest Treatment For Chronic Halitosis
Question: I have severe case of chronic halitosis. Going back 16 years or so. Initially I chewed trident gum for 6 to 7 years to mask the bad breath and it was sufficient. But after a while it didnt work anymore, and i would have severe stomach pain, gas and would feel light headed. I think it might"ve been a reaction to the artificial sweeteners due to prolonged use. I then switched to profresh mouthwash (with Chlorine Dioxide), that helped somewhat for 2 to 3 years... After that my nightmare started about 7 years back. Thats when nothing worked, I removed my wisdom teeth, went to dentists after dentists, tried dr katz mouthwash, got an edoscopy.... Hpylori test, ppi medicine...ect. Now I am very food sensitive and make a room smell up. People can smell my breath from a few feet away and my body also smells. I tried antibiotics but that made the situation worse, I tried fungus medicine and that helped a little but drained me out. Recently a doctor in Canada gave me tecta PPI, it reduced my body odor, stomach pain, but now if I open my mouth my coworkers began to cough from distance away. I assume ppi reduced the symptoms but allowed the bugs in my stomach to overgrow without hydrochloric acid... I need help as this is impacting my livelihood, my work, and personal life. My father described the smell as smelly feet, others have said it smells like gutter, rotten fish... I want to know what tests I can do to identify the issue and who can administer these test, also any other advice is welcomed
Brief Answer:
? Fish odor syndrome
Detailed Answer:
Hi,
Thank you for your query. I can understand your concerns.
Halitosis most commonly originates from the oral cavity or nasal passages.
Periodontal disease, caries,acute forms of gingivitis, poorly fitting dentures, oral abscess, and tongue coating,sinusitis are common causes. Since you have visited dentists many times without any permanent relief,these oral and nasal causes are reasonably ruled out.
Pockets of decay in the tonsillar crypts, esophageal diverticulum, esophageal stasis (e.g., achalasia, stricture)account for some instances. However you have already undergone endoscopy and taken ENT consultation,as I understand.
Helicobacter pylori gastritis can also produce ammoniacal breath but you have undergone test for H.Pylori.
Since the common causes of foul breath have been ruled out and as your father had said that your breath smells like rotten fish, you have to look for a rare cause like Trimethylaminuria (TMAU), an endocrine disorders also called fish odor syndrome or fish malodor syndrome. Individuals with this condition do not have any physical symptoms, and typically appear healthy.
Measurement of urine for the ratio of trimethylamine to trimethylamine oxide is the standard screening test,which you can undergo.
Meanwhile avoid foods such as egg yolks, legumes, wheat germ,red meats, fish, beans and other foods that contain choline, carnitine, nitrogen, sulfur and lecithin.
Regards
Dr. T.K. Biswas M.D. XXXXXXX
? Fish odor syndrome
Detailed Answer:
Hi,
Thank you for your query. I can understand your concerns.
Halitosis most commonly originates from the oral cavity or nasal passages.
Periodontal disease, caries,acute forms of gingivitis, poorly fitting dentures, oral abscess, and tongue coating,sinusitis are common causes. Since you have visited dentists many times without any permanent relief,these oral and nasal causes are reasonably ruled out.
Pockets of decay in the tonsillar crypts, esophageal diverticulum, esophageal stasis (e.g., achalasia, stricture)account for some instances. However you have already undergone endoscopy and taken ENT consultation,as I understand.
Helicobacter pylori gastritis can also produce ammoniacal breath but you have undergone test for H.Pylori.
Since the common causes of foul breath have been ruled out and as your father had said that your breath smells like rotten fish, you have to look for a rare cause like Trimethylaminuria (TMAU), an endocrine disorders also called fish odor syndrome or fish malodor syndrome. Individuals with this condition do not have any physical symptoms, and typically appear healthy.
Measurement of urine for the ratio of trimethylamine to trimethylamine oxide is the standard screening test,which you can undergo.
Meanwhile avoid foods such as egg yolks, legumes, wheat germ,red meats, fish, beans and other foods that contain choline, carnitine, nitrogen, sulfur and lecithin.
Regards
Dr. T.K. Biswas M.D. XXXXXXX
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Thank you. This seems like good advice... but I have a few more facts below. Maybe that may provide more direction:
Mondays through Fridays, during the workweek, I am having the following: for breakfast: Oatmeal, banana, & Yogurt. For Lunch: Quinoa, Grapefruit, carrots, celery, apple, cranberry, cucumber salad. For dinner: Chicken, Rice, lentil, Spinach. This seems to be reducing my symptom, but I still have people backing away a bit, and coughing, sniffing their nose... not wanting to work near me.
There were a few times when I felt normal I think: it was the first time I took antibiotics and acid blocker...that lasted for 5 to 7 days...then my symptom was back... when I took antibiotics again the second time, my situation got worse... Also, the first time I used colgate toothpaste which has triclosan, I think that helped but I would get cramps in stomach and get tired quickly and later it didn't work and mint and artificial sweetener would leave a bad taste in my mouth. There was a period of 3 months when I chewed on Organic Ceylon cinnamon, and I was doing very well then but then I went back to having problems. it was like the bug in my body adapted to whatever was suppressing it.
When I eat red meat, tea/coffee, tomato, sugar, milk, fish, chickpeas, pasta my situation is the worst I think... as in people cough, sniffle their nose, I get stomach pain at night, my mouth tastes bitter, very low energy, mental fog...etc...
I also had severe case of Dandruff, gas, skin cracking on my feet... when I applied antifungal medicine on my hair it contained the dandruff but it came back 3 months later. if I apply anti fungal cream on my feet the cracks get smoother but I don't care too much about my feet problem and there is steroid in the foot cream, so I don't use it much.
My follow up questions are: are there any systematic relevance to the symptoms I have stated above. Do you think I have TMAU + other issues or does it sound like 1 systematic issue causing all the symptoms above
you mentioned what to avoid, but what should I be eating? what are the top 10 best food for me?
I plan to do the TMAU test, also, should I get my stool test done? do you know of any company that is providing these test at cheaper cost? ie. can I send my samples to an XXXXXXX company and have you or another doctor at this website analyze it?
thank you in advance...
Mondays through Fridays, during the workweek, I am having the following: for breakfast: Oatmeal, banana, & Yogurt. For Lunch: Quinoa, Grapefruit, carrots, celery, apple, cranberry, cucumber salad. For dinner: Chicken, Rice, lentil, Spinach. This seems to be reducing my symptom, but I still have people backing away a bit, and coughing, sniffing their nose... not wanting to work near me.
There were a few times when I felt normal I think: it was the first time I took antibiotics and acid blocker...that lasted for 5 to 7 days...then my symptom was back... when I took antibiotics again the second time, my situation got worse... Also, the first time I used colgate toothpaste which has triclosan, I think that helped but I would get cramps in stomach and get tired quickly and later it didn't work and mint and artificial sweetener would leave a bad taste in my mouth. There was a period of 3 months when I chewed on Organic Ceylon cinnamon, and I was doing very well then but then I went back to having problems. it was like the bug in my body adapted to whatever was suppressing it.
When I eat red meat, tea/coffee, tomato, sugar, milk, fish, chickpeas, pasta my situation is the worst I think... as in people cough, sniffle their nose, I get stomach pain at night, my mouth tastes bitter, very low energy, mental fog...etc...
I also had severe case of Dandruff, gas, skin cracking on my feet... when I applied antifungal medicine on my hair it contained the dandruff but it came back 3 months later. if I apply anti fungal cream on my feet the cracks get smoother but I don't care too much about my feet problem and there is steroid in the foot cream, so I don't use it much.
My follow up questions are: are there any systematic relevance to the symptoms I have stated above. Do you think I have TMAU + other issues or does it sound like 1 systematic issue causing all the symptoms above
you mentioned what to avoid, but what should I be eating? what are the top 10 best food for me?
I plan to do the TMAU test, also, should I get my stool test done? do you know of any company that is providing these test at cheaper cost? ie. can I send my samples to an XXXXXXX company and have you or another doctor at this website analyze it?
thank you in advance...
Brief Answer:
Halitosis and systemic diseases
Detailed Answer:
Since the malodor makes your colleague repulsive, you are having true halitosis and not pseudo-halitosis.
Apart from Trimethylaminuria (TMAU), another rare cause is unknown metabolic condition ( Dimethylsulphidemia) resulting in systemic presence of dimethyl sulphide in blood and alveolar breath (odor like rotting meat or cabbage).
Few systemic disease can also cause foul breath e.g Fetor hepaticus i.e dead mousy breath caused by chronic liver failure,Lower respiratory tract infections by anaerobic organism (e.g lung abscess).chronic renal insufficiency (ammoniacal smell in breath) but it seems that you are otherwise healthy (at least what I can make out from whatever informations you have provided) and you are not having any of these systemic diseases accounting for your foul breath.
Trimethylaminuria (TMAU) being a rare condition test facility will be available with selected laboratories only.In XXXXXXX Dr Lal PathLabs can be approached.
What should be the best foods can be decided once a firm diagnosis is reached.
Since your foul odor emanation gets worse on red meat,fish& peas ,you need to avoid these food items as these are sources of choline and sulfur.
Low doses of antibiotics such as neomycin and metronidazole reduces the amount of bacteria in the gut and often helps in TMAU,albeit temporarily ( you felt normal when first time on antibiotics ).
HCM has panel of experts and a second opinion is always welcome.
Regards
Dr. T.K. Biswas M.D. XXXXXXX
Halitosis and systemic diseases
Detailed Answer:
Since the malodor makes your colleague repulsive, you are having true halitosis and not pseudo-halitosis.
Apart from Trimethylaminuria (TMAU), another rare cause is unknown metabolic condition ( Dimethylsulphidemia) resulting in systemic presence of dimethyl sulphide in blood and alveolar breath (odor like rotting meat or cabbage).
Few systemic disease can also cause foul breath e.g Fetor hepaticus i.e dead mousy breath caused by chronic liver failure,Lower respiratory tract infections by anaerobic organism (e.g lung abscess).chronic renal insufficiency (ammoniacal smell in breath) but it seems that you are otherwise healthy (at least what I can make out from whatever informations you have provided) and you are not having any of these systemic diseases accounting for your foul breath.
Trimethylaminuria (TMAU) being a rare condition test facility will be available with selected laboratories only.In XXXXXXX Dr Lal PathLabs can be approached.
What should be the best foods can be decided once a firm diagnosis is reached.
Since your foul odor emanation gets worse on red meat,fish& peas ,you need to avoid these food items as these are sources of choline and sulfur.
Low doses of antibiotics such as neomycin and metronidazole reduces the amount of bacteria in the gut and often helps in TMAU,albeit temporarily ( you felt normal when first time on antibiotics ).
HCM has panel of experts and a second opinion is always welcome.
Regards
Dr. T.K. Biswas M.D. XXXXXXX
Above answer was peer-reviewed by :
Dr. Prasad
Thank you. One last item my current doctor in Canada prescribed tecta ppi and have been taking it for about 2 months. First few weeks my stomach ache went away and odor reduced a bit. But now odor is very strong and noticable. This is similar to what happened last time I took ppi. Can you think of any reason why ppi would make my halitosis/ odor worse from the mouth/stomach?
Brief Answer:
Halitosis and use of Tecta PPI (Pantoprazole)
Detailed Answer:
A variety of gastrointestinal disorders have been associated with bad breath but there is little evidence to substantiate this.
Tecta PPI (Pantoprazole) is a powerful antacid and neutralizes gastric acid . However Anti reflux drugs (proton pump inhibitors, e.g. Pantoprazole )can cause xerostomia (dry mouth) which results in increased microbial growth in the mouth and consequent increase in foul odor in breath. That could be the possible explanation.
Regards
Dr. T.K. Biswas M.D. XXXXXXX
Halitosis and use of Tecta PPI (Pantoprazole)
Detailed Answer:
A variety of gastrointestinal disorders have been associated with bad breath but there is little evidence to substantiate this.
Tecta PPI (Pantoprazole) is a powerful antacid and neutralizes gastric acid . However Anti reflux drugs (proton pump inhibitors, e.g. Pantoprazole )can cause xerostomia (dry mouth) which results in increased microbial growth in the mouth and consequent increase in foul odor in breath. That could be the possible explanation.
Regards
Dr. T.K. Biswas M.D. XXXXXXX
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Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
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