Doc, why does my breath stink?

Dr Flo, my breath stinks, yet I brush my teeth twice a day. I feel uncomfortable and self-conscious around other people because I worry that they can smell my bad breath. I always cover my mouth when I’m talking to other people. What can I do to make my breath smell fresh? WK

Dear WK,

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 have your teeth checked, cleaned and treated by a dentist every six months, 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 e.g. some foods like onion and garlic, so reduce your intake of such foods. Take a lot of water, about two litres a day, and eat a lot of vegetables and fruits. Other health conditions that can contribute to bad breath include sinusitis, recurrent throat infections, tonsil stones, recurrent heartburn 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 sort out the smell of your breath.

Dr Flo, I am in my early twenties and I experience lower abdominal pain around my waist, and sometimes I feel as if something is pulling the organs in my lower abdomen, accompanied by itching that is sometimes unbearable. Sometimes the pain spreads to my testicles. What is causing this? Boniface

Dear Boniface,
There are several conditions that can lead to testicular pain, discomfort and itching together with abdominal pain. These include infection or inflammation of the testicle (epididymitis, orchitis), testicular torsion (twisting of a testicle leading to reduced blood supply to that testicle), inguinal hernia, injury, kidney stones or testicular tumour. For a proper diagnosis, you need to get a urine test and scans of the testicles and abdomen at a hospital.

Depending on the diagnosis, you may need antibiotics if you have an infection, or surgery. The diagnosis and treatment should be done as soon as possible since some of the causes of testicular pain can lead to permanent damage to the testicles and infertility.

Dr Flo, I have recurrent pain from my waist, through my right leg all the way to the toes. It is accompanied by inflammation. I went for a medical check-up and was diagnosed with arthritis and treated, but the condition keeps recurring and at times my leg swells. Kindly help me. Musa, Marsabit

Dear Musa,
Arthritis means there is inflammation at a joint. It can affect one or more joints in the body, including the upper or lower limbs and even the bones of the spine. Arthritis can result in pain, swelling, stiffness and/or warmth at the joint. It may be caused by wear and tear of a joint, infection, injury, gout or an autoimmune illness (where the body’s own immune system attacks some parts of the body, in this case, the joint).

The pain from the waist radiating to the right leg and toes means that most likely the arthritis has affected the sciatic nerve. The sciatic nerve is a big nerve that starts at the lower spine, and passes through the buttocks/pelvic area and down the leg, with branches all the way to the toes. When the sciatic nerve is compressed, you feel pain starting in the lower back, the waist, at the hip or at the buttocks, sometimes spreading down the leg to the toes.

You are more likely to suffer from arthritis if someone in your family also has arthritis, or if you are older in age, or if you have had injury to that joint before, or if you are overweight. Arthritis symptoms are recurrent and never fully go away.

Treatment is aimed at reducing the symptoms and reducing further damage to the joint. Treatment also depends on the cause of the arthritis. This includes medication to relieve pain and inflammation, physiotherapy and surgery if necessary.

If the cause of arthritis is autoimmunity, then steroids and other medications that affect the immune system and reduce inflammation are used. If there is gout, then medicine to reduce uric acid levels is used.
Other measures that can help include massage, weight loss if you are obese, exercise, use of hot or cold packs or the use of assistive devices like a cane and additional seat cushions and pillows.

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