HOW TO BEAT
Little health horrors that wreck your confidence
BAD BREATH, body odour, smelly feet, spots, boils and ‘moobs’ are just some of the conditions which, although they won’t kill you, can still get you down and affect your quality of life. In the second part of our unique series on the health problems no one likes to talk about, we help you find the right remedies . . .
BAD BREATH
BAD breath, oral malodour, or halitosis, is estimated to affect up to 40 per cent of us at some point. Dr Mervyn Druian, a dental surgeon at the London Centre for Cosmetic Dentistry, says he regularly sees patients who are totally socially withdrawn because they are so embarrassed about their breath.
‘The irony is that these sorts of problems are totally fixable, but people are too embarrassed to see anyone to ask for help,’ he says.
It’s totally normal to have ‘ morning breath’ — bad breath caused by the mouth drying out overnight and a buildup of smelly bacteria, but this will clear when you’ve had a drink and brushed your teeth.
Other causes of temporary bad breath are certain foods such as onions or garlic — which contain natural sulphur compounds — drinking alcohol or smoking.
Most cases of persistent halitosis are caused by a build-up of bacteria: there are around 100 million bacteria living in the mouth, and there are 15 types which are thought to be linked to bad breath.
‘At least 80 per cent of cases of halitosis are down to oral hygiene problems,’ says Stephen Porter, professor of oral medicine at UCL Eastman Dental Institute.
‘If you don’t remove food left in your mouth, the bacteria will break down the debris, producing volatile sulphur compounds, which are sometimes called sulphides or VSCs.’
However, sometimes bad breath can be a symptom of an underlying medical disorder, including infections of the sinus passages and also tonsillitis, where the tonsils become inflamed, as well as acid reflux.
‘Sometimes a foreign body trapped in the nose can cause obstruction, and this can manifest itself as bad breath because bacteria will grow around the obstruction,’ says Professor Porter.
‘If children have a piece of a toy stuck up their nose and this has gone unnoticed, their bad breath can be the first sign that something is wrong.’
Other causes include a condition known as dry mouth, which reduces saliva so debris sticks to the teeth — this can be a result of age or as a side-effect of drug treatments, most commonly antidepressants, explains Professor Porter.
‘ Less common causes of halitosis include gastritis, which is caused by the bacteria infection helicobacter pylori, chest infections, cancer of the lung, and undiagnosed diabetes, or the rare instances of liver or kidney failure.’
Some people are convinced they have bad breath when they actually don’t have it, a condition called pseudo halitosis.
‘It’s quite difficult to persuade them they don’t have it,’ says Professor Porter, and indeed this can be a notably disabling disorder as the person perceives that everyone around them thinks they have bad breath.
‘As a result, they can have significant problems maintaining relationships, and may even change their jobs. It is very difficult to shift.’
Dental surgeon Mervyn Druian says halitosis treatment should focus on good oral hygiene.
‘The cells in the lining of the mouth normally break down every two to four days and the saliva you produce carries them away,’ he explains.
‘But in some people, the cells renew more quickly and they break down every six to eight hours, giving off sulphides, which build up, causing bad breath.’
Simple things you can do to prevent this happening include not skipping meals ( eating stimulates saliva flow), drinking more water, chewing sugar- free gum or mints and snacking on fruit between meals because it has a high water content and will prevent your mouth from drying out. Other steps Dr Druian recommends apart from brushing your teeth, gums and tongue and removing food with floss, are to use a mouthwash containing the chemical chlorhexidine, which neutralises sulphides, and/or a toothpaste containing a dilute form of chlorine dioxide — this breaks down sulphur compounds in the mouth rather than just masking the smell.
‘These will all help with halitosis caused by oral health problems and are available from pharmacies and dental surgeries,’ he says.
Other antibacterial ingredients to look out for in mouthwashes and toothpastes include cetylpyridium chloride, hydrogen peroxide, and zinc. The National Institute for Health and Care Excellence ( NICE) recommends cleaning the tongue with a tongue scraper, particularly the rear upper part of the tongue, where bacteria builds up.
SWEATING
WE PRODUCE two types of sweat — the watery sweat that cools us down, and an oily liquid that may be linked to sexual attraction.
Cooling sweat is produced by the eccrine glands, found on the soles of the feet, palms of the hands, forehead, cheeks and armpit. If the body becomes too hot, sweat glands in the skin produce more sweat.
The sweat itself doesn’t smell —
odour occurs when sweat stays on the skin for too long and bacteria break down proteins in it, creating an odour in the process.
The second type of sweat is produced by the apocrine glands in the armpits, genitals and nipples.
They produce an oily liquid that is full of fat and protein — it’s thought to contribute towards sexual attraction.
Though it’s odourless when released, once this sweat is on the skin it reacts with bacteria such as Staphylococcus hominis, producing malodorous by-products.
Around 4 per cent of people suffer from excessive sweating or hyperhidrosis, says Dr Adil Sheraz, a consultant dermatologist at the Royal free Hospital in London.
‘There are two types: primary hyperhidrosis, which has no underlying cause, and secondary hyperhidrosis, which is associated with thyroid gland problems and side- effects of medication,’ he says.
THESE include tri- cyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs) and opioid painkillers.
Poorly controlled diabetes can also cause hyperhidrosis because low sugar triggers a fight-or-flight response that stimulates hormone production and sweat secretion.
Hyperhidrosis most commonly affects the hands, feet, underarms, face and head — as these areas have a higher concentration of sweat glands. People sweat excessively regardless of the temperature around them.
Over-the- counter treatments include antiperspirant sprays containing aluminium which block the sweat glands and anti- bacterial agents to kill bacteria. Some products combine both.
‘for hyperhidrosis, botulinium (botox) injections are available in some places on the NHS,’ says Dr Sheraz.
‘They work by blocking signals from the brain to the sweat glands, and are particularly effective for the underarm area.
‘Around 20 to 30 injections are made in each armpit, which is anaesthetised beforehand with a local anaesthetic.
‘The effects last from four to six months. They are not so practical for the hands and feet because more injections are needed and it’s more painful.’
Other treatments include anticholinergic drugs, which suppress secretions in the body, but these can cause dry eyes and mouth.
‘Another good drug is glycopyrronium bromide, but it’s expensive and your GP needs to apply to the local health authority for funding,’ says Dr Sheraz.
A permanent treatment for underarm sweating available privately is miraDry Plus, which uses microwave energy to destroy up to 82 per cent of the sweat glands in the affected area.
Dr Sach Mohan, a cosmetic physician and chief executive of the Revere Clinic in Harley Street, says this treatment was previously available only to hyderhidrosis sufferers, but is now licensed for use in people who are just worried about sweating.
‘We treat a lot of dancers from Strictly Come Dancing, for instance,’ he explains.
Treatment is one 45-minute session under a local anaesthetic. It costs £1,200, compared with £500 for botox injections every four to six months.
Potential side- effects include temporary underarm swelling and tenderness lasting several days.