What Women Need to Know
Chapter 7 pgs. 24-26
Bad Breath
Q. I have a new boyfriend and a new problem – bad breath. Recently, much to my embarrassment, my boyfriend commented that my breath was bad, and suggested that I see a dentist. My dentist told me that my teeth are fine, but my breath still isn’t. I brush regularly and use mouthwash, what more can I do?
A. Bad Breath is such a common complaint that there are actually breath clinics springing up up around the country that specialize in treating this problem. In fact, it has been estimated that about 25 million Americans have a problem with bd breath at some point in their lives.
Bad breath is a result of the accumulation of anaerobic bacteria in the mouth, teeth, or gums that can emit unpleasant sulfur fumes. This particular breed of bacteria thrive in warm, dark places, and live on plaque deposits in teeth and food debris that may linger in the mouth or on the tongue. Gum disease or tooth decay is a leading cause of bad breath, and your boyfriend was correct to suggest that you see a dentist. Bad breath may also be a result of the monthly hormonal changes women go through. At the beginning of menstruation and during ovulation, women produce more protein in their saliva, which creates more sulfur fumes.
- Based on what you are telling me, however, I suspect your breath problem may be caused by a decrease in saliva production due to stress. Saliva helps keep your breath fresh by constantly irrigating or washing out the mouth. Chronic stress can hamper the production of saliva, thus promoting bad breath. Now that you are embarking on a new romance, you may be feeling more anxious than normal, and this may be affecting your saliva flow. There are several things you can do to increase your saliva production and keep your breath fresh.
- Replace lost moisture: You will need to compensate for the decrease in saliva production by keeping your mouth moist. Try taking frequent sips of water throughout the day. Simple measures, such as sucking on sugar-free mints, may also help stimulate saliva flow and freshen your mouth.
- Use mouthwash: When the people at Consumer Reports tested popular brands of mouthwash, they found that most did freshen breath and eliminate odor, but within ten minutes to an hour they stopped working. Some of the new mouthwashes on the market, however, contain a compound called chlorine dioxide, which, according to several studies, may be more effective in controlling bad breath then some of the older mouthwashes.
- Clean your tongue: Although the tongue appears to be a smooth, slippery surface, it is actually loaded with crevices that can be a magnet for bacteria. Some dentists recommend that when you brush your teeth, you should lightly brush your tongue. Interestingly, in India and Arab cultures, people use small shovel-like tongue scrapers several times a day to keep their breath fresh. Although tongue scarpers are sold in Middle Eastern and Indian markets, I recommend that you get one form a dentist who can show you how to use it.
If these simple measures don’t help your breath problem, your problem, your physician may prescribe a medication called pilocarpine (sold as Salogen) to help improve salivary flow. Pilocarpine works well for many people but should not be used by individuals with certain medical problems.
If your breath problem persists or gets worse, you should see your doctor. Bad breath is not just embarrassing; it could be a sign of a health problem. In addition to chronic stress, there are several other conditions that can be causing your bad breath, including a throat or sinus infection. If you have a stuffy nose or a post-nasal drip, check with your physician to see if you have ana infection. Very often, a course of antibiotics can clear up both the infection and the bad breath. In addition some common physical ailments can cause a decrease in saliva flow, which will result in bad breath. For example, Sjogren’s syndrome, an autoimmune disease that primarily strikes women, can cause chronic dry mouth. Very often, people with Sjogren’s have other symptoms, including dry eye and joint pain. Certain medications, such as antidepressants and antihistamines, can also reduce salivary flow and cause bad breath. If it’s medication that is causing your problem, your physician may be able to prescribe another one.
Marianne J. Legato, MD, Ph. D. (hon. c.), FACP is an internationally renowned academic, physician, author, lecturer, and pioneer in the field of gender-specific medicine. She is a Professor Emerita of Clinical Medicine at Columbia University College of Physicians & Surgeons and an Adjunct Professor of Medicine at Johns Hopkins Medical School. Dr. Legato is also the Director of the Foundation for Gender-Specific Medicine, which she founded in 2006 as a continuation of her work with The Partnership for Gender-Specific Medicine at Columbia University. She received an honorary PhD from the University of Panama in 2015 for her work on the differences between men and women.
At its core, gender-specific medicine is the science of how normal human biology differs between men and women and how the diagnosis and treatment of disease differs as a function of gender. Dr. Legato’s discoveries and those of her colleagues have led to a personalization of medicine that assists doctors worldwide in understanding the difference in normal function of men and women and in their sex-specific experiences of the same diseases.
She began her work in gender-specific medicine by authoring the first book on women and heart disease, The Female Heart: The Truth About Women and Coronary Artery Disease, which won the Blakeslee Award of the American Heart Association in 1992. Because of this research, the cardiovascular community began to include women in clinical trials affirming the fact that the risk factors, symptoms, and treatment of the same disease can be significantly different between the sexes. Convinced that the sex-specific differences in coronary artery disease were not unique, Dr. Legato began a wide-ranging survey of all medical specialties and in 2004, published the first textbook on gender-specific medicine, The Principles of Gender-Specific Medicine. The second edition appeared in 2010 and the third edition, dedicated to explaining how gender impacts biomedical investigation in the genomic era, won the PROSE Award in Clinical Medicine from the Association of American Publishers in 2018. A fourth edition is forthcoming.
She also founded the first scientific journals publishing new studies in the field, The Journal of Gender-Specific Medicine, and a newer version, Gender Medicine, both listed in the Index Medicus of the National Library of Medicine. She has founded a third peer-reviewed, open access journal, Gender and the Genome, which focuses on the impact of biological sex on technology and its effects on human life.
Dr. Legato is the author of multiple works, including: What Women Need to Know (Simon & Schuster, 1997), Eve’s Rib (Harmony Books, 2002), Why Men Never Remember and Women Never Forget (Rodale, 2005), Why Men Die First (Palgrave, 2008), The International Society for Gender Medicine: History and Highlights (Academic Press, 2017), and most recently, The Plasticity of Sex (Academic Press, 2020). Her books have been translated into 28 languages to date.
As an internationally respected authority on gender medicine, Dr. Legato has chaired symposia and made keynote addresses to world congresses in gender-specific medicine in Berlin, Israel, Italy, Japan, Panama, South Korea, Stockholm, and Vienna. In collaboration with the Menarini Foundation, she is co-chairing a symposium on epigenetics, Sex, Gender and Epigenetics: From Molecule to Bedside, to be held in Spring 2021 in Italy. She maintains one of the only gender-specific private practice in New York City, and she has earned recognition as one of the “Top Doctors in New York.”
