Doc, my breath smells bad. What do I do?

Dear Healthy Nation,
My breath smells bad even though I brush my teeth twice a day. I am uncomfortable when I am with other people because I think they can smell it, which makes me try to cover my mouth when I am talking. What can I do about it?
Molly

Dear Molly,
Bad breath, also known as halitosis, can be caused by problems with dental hygiene due to the bacteria in the mouth. It can also be due to gum disease or food particles retained in the mouth. You should brush and floss your teeth after meals, at least twice a day, and also brush your tongue or use a tongue scraper. You can also use a mouth wash or gargle after brushing your teeth. It is also advisable to visit a dentist to have your teeth checked, cleaned and treated because plaque, tooth decay and cavities can contribute to bad breath.
Having a dry mouth can also lead to bad breath. This is because saliva helps wash away food particles and bacteria. During sleep, the production of saliva slows down, allowing multiplication of bacteria.

This is what causes bad breath in the morning. To deal with this, in addition to brushing your teeth in the morning, you should also eat a meal in the morning. You may still have bad breath even after brushing your teeth if you do not eat. Prolonged hunger and fasting can also lead to bad breath.
Diet can also contribute to bad breath - some foods like onion and garlic, so reduce their intake.

Take a lot of water, about two litres per day, and lots of vegetables and fruits.
Other health conditions that can contribute to bad breath are sinusitis, recurrent throat infections, tonsil stones, recurrent heart burn and stomach infections, diabetes, liver or kidney failure.

Other causes of bad breath are smoking, consumption of alcoholic drinks, snoring, dieting and hormonal changes. If any of these are the cause of the bad breath, dealing with the underlying problem should get rid of the issue.

Hey Doc,
Thanks for the good work you are doing.
My problem is that when I sit for long, I feel pain on my left joint of the pelvic joint on the left buttock. But when I am standing I am okay. This pain has persisted for some time now. What might be the problem?
Wellington

Dear Wellington,
There is a small muscle within the gluteal (buttock) region called the piriformis muscle. It helps to rotate the hip by turning the leg and foot outwards.

Right beneath it is the sciatic nerve, which is a big nerve that starts at the lower spine and passes through the buttocks and down the leg, with branches all the way to the toes. What you are describing is most likely piriformis syndrome, where the piriformis muscle spasms, causing buttock pain. The spasms can also irritate or compress the sciatic nerve, causing pain, starting either in the lower back or at the hip or buttocks, spreading down the leg, even to the toes.
The piriformis muscle may spasm due to injury, irritation, inflammation, bleeding or swelling of the muscle or due to inflammation in the nearby structures such as the joints.

The pain may be worsened by sitting for long or climbing, and there may be difficulty moving the hip.
It is advisable for you to be on follow-up by an orthopaedic specialist. The diagnosis is made from what you tell the doctor and from a physical examination because unfortunately, there is no laboratory or radiological test to diagnose piriformis syndrome and irritation of the sciatic nerve.

Treatment includes medications for pain, both oral and injections; heat or cold therapy, stretching exercises and physiotherapy including physical exercises, deep massage and transcutaneous electrical nerve stimulation. Surgery may be done in extreme cases.

You also need to get a comfortable chair and to stand and stretch, or do some exercises after sitting for some time.

Dear Doc,
For two weeks now, my finger nails have been chipping and I am worried because this has weakened them. What could be causing this problem?
Njeri

Dear Njeri,
Nails are made of a protein called keratin and they have several layers that can peel. The causes of this damage are either external or internal.

Nails take about six months to grow, so the damage you see today may have been caused by a trauma several months ago. If the finger nails are chipping and the toe nails are healthy, then the cause is most likely external.

This may be due to having your fingers in water frequently or for prolonged periods, peeling off nail polish, use of nail polish removers, using acrylic nails, pressing on the nails for long or using the nails as a tool for example to open, lift or remove something. Internal causes of nail chipping are rare and may be due to iron deficiency, deficiency of a vitamin or thyroid disease. These will affect both the finger and toe nails.

To protect your nails, avoid exposing them to water frequently or for a prolonged period of time, apply lotion or cream to hands before swimming, wear cotton-lined rubber gloves when doing water-based household chores, take iron supplements if necessary, take biotin supplements, remove nail coatings gently, without pulling or scraping, file your nails to achieve curved edges and avoid using your nails as tools.
 

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