Medical Questions & Answers » Mouth and Throat

Bad Breath or Gum Infection

medicalquestions — Thu, 21 May 2009 06:00:23 +0000

I am one of those people who listen to television commercials about bad breath and try everything they suggest, but my problem persists. Help!
Bad breath, with its social implications, is one of the major problems facing Australians today, if the health content of television commercials is to be believed!
Halitosis (the technical name for bad breath) may be due to smoking—the most common cause—poor dental hygiene, periodontal (gum) disease, sinusitis, bronchitis and other infections. Fad diets that contain excess protein and not enough carbohydrates are another possibility because the breakdown products of proteins are highly volatile acids that are expelled in the breath.
Alcoholics have halitosis because the alcohol alters the balance of microorganisms in the gut, causing an increase in the number of odor-producing bacteria.
Other serious diseases that can cause halitosis include diabetes, hepatitis and cancer. Drugs such as those used to treat angina, fluid tablets and certain tranquillizers may also be responsible.
Those of you with bad breath should stop smoking, clean your teeth regularly, use dental floss, and gargle with antiseptic mouthwashes. If these measures fail, then see your doctor to have some of the more serious potential causes excluded. A dental appointment may also be necessary.

Is it necessary to spend a lot of money getting wisdom teeth out because of infection or gum growing over them? Can’t they be left to rot without affecting the body?
Wisdom teeth are removed because they cause constant pain, crowd other teeth, or become infected. Most people do not have their wisdom teeth removed, because (like the appendix) they are meant to be there.
On the other hand, if these teeth are causing discomfort or damage to other teeth, it is in your long-term interest to have them removed.
Leaving an infected tooth to rot is certainly not an option. The toxins and infection can spread throughout your body, to make you extremely ill, and possibly even cause death. Even if you recovered after several months from the infection, the tooth would still be present.
Fear of dentists is a common phenomenon, but you can arrange to have a general anesthetic, and although your jaw will be sore for a few days afterwards, the long-term relief will be worthwhile.

Fluoride Toothpaste and Fluoride Tablets

medicalquestions — Wed, 20 May 2009 06:00:22 +0000

Should children be taking fluoride supplements if they use fluoride toothpaste?
The fluoride in toothpaste acts directly on the tooth enamel from the outside, hardening it and helping it resist decay, but it can only act upon the very outermost layer of the tooth enamel.
Fluoride in tablet form does the same thing, but enters the tooth from the inside via the bloodstream, and permeates the entire tooth. Fluoride tablets can therefore protect the entire tooth far more effectively than fluoride toothpaste alone.
Many areas of Australia have adequate supplies of fluoride added to the drinking water, giving everyone protection. If you live in an area that has fluoride added to the water supply, or if the natural level of fluoride in the water is high, you do not need to give your children fluoride tablets. This information will be available by phoning your local council. If there is no fluoride in the water, it is advisable to give fluoride supplements to protect your children’s teeth.

My son obtains his water for drinking from an underground well. Do his children need to take fluoride tablets?
Some water supplies, be they from the local dam or an underground well, contain adequate amounts of fluoride to protect children’s teeth. The fact that children in some communities were noticed to have far healthier teeth than others, led to the discovery of fluoride in the water supply of the healthier children, and the subsequent development of fluoridation of many water supplies around the world to protect the teeth of children.
Your local council can tell you if your water supply contains adequate amounts of fluoride. If it does not, your children should take fluoride tablets or drops to protect their teeth from premature decay.
When using water from a well, it will be necessary to have a sample of the water analysed to determine its fluoride content. Industrial chemists undertake this work, and it is important to obtain these results, as giving fluoride supplements to children who already have adequate fluoride in their diets can lead to teeth discolouration (but not damage). The minerals in the ground around the well will determine the amount of fluoride in the water.
Water obtained from rooftops and tanks will never contain any fluoride, as this is very close to distilled water, which contains no minerals of any sort.

Bleeding Gums in Children

medicalquestions — Wed, 20 May 2009 06:00:12 +0000

My two year old is still bottle fed but has white spots on his teeth and bleeding gums. He often cries when feeding. Should he see a dentist at this early age?
This case describes the typical presentation and outcome of ‘nursing bottle decay’ or ‘bottle caries’, which is seen in young children who are not yet weaned from the bottle.
Bottle caries is caused by frequent feeding of sweetened liquids from a bottle, especially before the child goes to sleep. Sugar in the liquid mixes with bacteria in the dental plaque to form acids that attack tooth enamel. Each time a sweet liquid is taken, acids attack the teeth for at least 20 minutes. When children are awake, the saliva is able to remove some of the liquid. However, during sleep, the saliva flow decreases and the sweet liquids collect around the teeth for prolonged periods, bathing the teeth in acids.
The earliest appearance of decay is the enamel turning a chalky white colour, usually around the gum line. Then as more calcium is lost from the tooth, a hole finally appears. In severe cases of bottle caries, the cavities can ringbark the teeth and cause them to break off. At the early stages, the cavities do not cause pain, but as they enlarge, increasing discomfort may be experienced, and dental abscesses may result.
Bottle caries may be treated by fillings or extractions, but because most children are not cooperative at such a young age, they usually need to be sedated. Very often, general anaesthetics have to be given.
The best form of treatment for nursing bottle decay is prevention. Children should not be allowed to sleep with a bottle of sweet liquid. If a child needs a bottle for comfort before falling asleep, fill the bottle with plain water, milk or formula, and remove the bottle as soon as the child is asleep. Dummies should never be dipped in honey.

Abnormal Taste Sensations

medicalquestions — Fri, 01 May 2009 06:00:51 +0000

For two years I have had a strong metallic taste in my mouth that makes me feel sick. Have you any ideas as to a cause?
By far the most common cause of abnormal taste sensations is the side effects of any one of a number of medications. Differenr drugs used for arthritis, bacterial and fungal infections, psychiatric disturbances, high blood pressure and heart failure may all cause strange tastes.
Other causes include thyroid gland disease, strokes that affect the taste-sensing area of the brain, radiation treatments to the face, viral infections and degeneration of the brain with age.
Differentiating between these various causes may be quite difficult, but if you are on medication of any sort (including vitamins, minerals and over-the-counter medicines) it would be worthwhile discussing with your doctor if these can be safely ceased to see if they are responsible.

I am 68, and over the past 3 years have gradually lost my sense of smell, but can still taste sweet and sour. A specialist has told me that nothing can be done. Is that true?
The senses of smell and taste are totally independent of each other, and so it is certainly possible to lose one sense and not the other.
The sense of smell comes from tiny nerve endings that project through the thin bone at the top of the nose. These nerve endings respond to different aromas in different ways, the subtlety of which is poorly understood by physiologists. The appropriate nerve impulses are then carried to a part of the brain that interprets these as the smells we know.
Man has a relatively small part of the brain devoted to smell (it is much larger in dogs), and if the blood supply to this part of the brain, or the olfactory (smell) nerve is reduced, the sense of smell may be lost. This can occur in old age from a mild stroke or hardening of the arteries, and is relatively common in smokers. There is no treatment available. Taste results from four different types of receptors on the tongue, which can detect sweet, salty, bitter and sour (and combinations of these). Taste is a far coarser sensation, and it is only the combination of smell and taste that makes us appreciate different foods.
I regret, that with taste alone, your garlic prawns and fresh strawberries are not going to be the pleasure of years past.

Lost Sense of Taste and Smell

medicalquestions — Sun, 26 Apr 2009 06:00:56 +0000

With my usual winter cold this year, I lost both my sense of taste and smell. I worry that this may be due to my age (70) and would appreciate your advice.
It is possible to taste only four flavours—sweet, sour, salty and bitter. Our ability to smell is far more important, and the smell of the food in our mouth is most of what we perceive as taste.
The cells which sense smell are covered in fine, microscopic hairs and are situated at the top of the nasal cavity at a level that is just below our eyebrows. These nerves send appropriate signals into the brain.
When you have a cold, thick mucus may cover the fine hairs and prevent them from reacting to the odours in both the environment and the mouth. As a result, you perceive that you have lost your sense of taste, when in fact it is smell.
In most cases, the problem disappears as the cold resolves, but if there has been a severe bacterial infection of the nose, the smell cells may be damaged, and the sense of smell will not return until these cells are able to repair themselves.
To prove what I am telling you, next time you feel that you have lost your sense of taste, with your eyes closed have someone put a crystal of sugar and then salt on your tongue—you’ll immediately be able to tell which is which!

I have suffered for many months with a failure of the sense of taste and cannot distinguish one type of food from another. I am 88 years old and am wondering if this problem is due to old age or illness.
A wide range of conditions can cause a loss of taste. These include lead poisoning, a lack of saliva causing a dry mouth, an underactive thyroid gland, some forms of stroke, a condition called Sjogren’s syndrome and numerous rarer conditions.
In older people a dry mouth is a common cause of poor taste sensation.
You should get your general practitioner to give you a thorough going over to exclude any illness as a cause of your problem. If nothing specific is found, old age may have to be blamed.

Surgery For Sinuses

medicalquestions — Wed, 25 Feb 2009 06:00:59 +0000

My sinuses are always full of gunk, that is absolutely foul. None of the medicines I have been prescribed work. I am absolutely fed up with having a thick head. What type of surgery could be done for my sinuses?
An antrostomy and turbinectomy is the technical name for an operation that involves drilling additional drain holes from the nose into the sinuses, and removing the curly bones (turbinates—look like a turban) that are inside your nose.
People who have recurrent attacks of sinusitis often have small or poorly placed drainage holes from the sinuses, allowing them to fill up with foul phlegm. The turbinates are covered with a moist skin that is designed to warm and moisten the air as it enters the body, but these can swell up excessively to block the nose and the sinus drain holes. There are three turbinate bones in the top of each nostril, and normally only one or two are removed.
The operation is done under general anaesthetic, has no serious complications and is often very successful in giving relief to sinus sufferers. Ask your GP to refer you to an ear, nose and throat specialist, who will consider your problem, and its possible surgical solution.

I suffer from chronic sinusitis. My face is one big ache. I can’t breathe, and feel absolutely lousy. I need help before I go mad!
Chronic sinus infections are best prevented rather than treated. This can be done by the regular use of chemist medications to dry up excess nasal and sinus secretions. If these are not sufficient, more potent medications can be prescribed by your doctor. There are also prescription nasal sprays that will keep your nose clear and aid sinus drainage. Some people may require low-dose antibiotics on a regular basis if they are particularly bad.
Operations to improve the drainage of the sinuses and remove the phlegm-secreting lining of the nose are the best option in those who have suffered repeatedly over several years. Once a sinus infection is present, antibiotics are essential. The congestion in the sinuses may also be relieved by physiotherapists using short-wave treatment to liquefy solid phlegm, or by doctors washing out the sinuses.

Learn Some Neck Exercises

medicalquestions — Fri, 13 Feb 2009 06:00:47 +0000

I have a neck that is always stiff and sore. I work as a typist and computer terminal operator, and I believe this is the cause, as my doctor cannot find any cause. He said I should exercise my neck to make it move more freely. Can you suggest some exercises for me?
Cerrainly! The following neck exercises and positions are useful for all forms of neck stiffness and arthritis.

A. POSTURE
This is very important! Don’t slouch, shoulders back, chin in, think tall’

B. STRETCHES
1. Move neck SLOWLY in all directions every day (eg. in hot shower):
— tilt to side
— rotate
— forwards & back
2. Rotate shdulders forwards and backwards.
3. Tuck chin in and hold for 2-3 seconds.
4. Push shoulders back and attempt to bring shoulder blades together.
5. Drop one shoulder, tilt head towards opposite shoulder thus:

C. STRENGTHEN
1. Lie on back with knees bent. Tuck chin in. Lift head JUST off the floor thus: Aim to hold for 30 seconds.
2. While sitting, tuck chin in, and push shoulders back and attempt to bring shoulder blades together. Use your hand to push against the side, front and back of your head in turn, but tense the neck muscles to prevent the head from moving. Hold for 6 seconds and repeat 6 times.

My husband has had problems with his neck for eleven years, which causes pain and stiffness down his right side. The doctor says his extra pair of ribs is a problem. Can this explain his shoulder pain?
In a small percentage of people, a pair of accessory ribs grow out from the base of the neck. These are usually very short, and serve no useful purpose, but may sometimes interfere with the normal path of a nerve from the spinal cord in the neck to the shoulder and arm.
Most of these accessory ribs are only discovered when a patient complains of symptoms such as your husband’s, and an X-ray is performed.
The extra rib may be responsible for pain in the neck, shoulder and arm, but not other parts of the body.
Treatments may include anti-inflammatory medications, physiotherapy, injections around the affected nerve, and surgical removal of the additional rib.

Lump On The Neck

medicalquestions — Thu, 12 Feb 2009 06:00:26 +0000

My doctor keeps feeling my son’s neck for glands every time I take him for a cold or sore throat. He prescribes antibiotics if the glands are tender. Why do your glands get sore when you have an infection?
If you have an infected cut on a finger, the bacteria can enter the lymph ducts, and slowly move along them towards the vital organs of the body. The neck glands are not really glands at all (glands secrete hormones) but are correctly called lymph nodes.
The lymph nodes act as filters along the lymph ducts, removing unwanted bacteria and viruses from the lymphatic fluid, and preventing them from progressing further. This filtering process is occurring every second of every day, but in the process of collecting and destroying germs, the lymph nodes are occasionally overwhelmed by the vast numbers of bacteria or viruses, and themselves become hot, red, sore, enlarged and infected. Some germs can then get past the nodes, and cause the fevers and muscular pains associated with a generalised infection. Without the vital lymph nodes and their vast numbers of white cells that can engulf and destroy bacteria and viruses, severe body infections would be a regular occurrence rather than an occasional nuisance.
Once lymph nodes become infected by a bacteria, antibiotics are required to assist the body in the fight against them. If treated promptly, the nodes will soon return to normal, but delay may result in an abscess forming in the node.
After a severe infection, some nodes may remain as hard lumps due to the scar tissue within them caused by the overwhelming infection. These painless lumps may take months or years to disappear.

I have a lump on the side of my neck that seems to go up and down, and every time it goes up it causes headaches and a general feeling of being unwell. My specialist wants to remove it, but says I will be left with a sizeable scar that cannot be avoided. Aren’t there more advanced techniques such as plastic surgery that can minimise the scarring?
A neck lump that increases in size when you are unwell and decreases when you feel berter is almost certainly a lymph node. Removing it may well remove a source of chronic infection, and therefore cure the problem.
Whenever any operation is performed, a scar must remain behind. Some areas of the body heal poorly (eg. the back) and a bad scar is inevitable. Other areas heal very well (eg. the face), and scarring is usually minimal. The part of your body being cut is far more important than the surgeon in determining the type of scar you will develop. Plastic surgeons are not able to perform miracles. They have techniques that will minimise scarring, but most general surgeons are aware of these techniques also. Making the initial cut along the natural skin folds of the body, using fine stitches, using stitches under the skin rather than through the skin, and removing the stitches at just the right time are some of the tricks of the trade.
There would be no benefit from having a plastic surgeon perform your operation, as I suspect your scar will be far less noticeable than you expect. The neck is an area of the body that heals quite well, but if the scar does worry you six months or more after the operation, a plastic surgeon can be consulted about having a scar revision operation.

Tumour Of Parotid Gland

medicalquestions — Thu, 12 Feb 2009 06:00:23 +0000

My wife has had a slowly enlarging lump below and in front of her ear for months. After numerous X-rays and an ultrasound scan, she has been told that she has a tumour of the parotid gland, and it will have to be removed. Is this a dangerous procedure?
The parotid gland is one of three glands on each side of the face that produce saliva, which is discharged into the mouth through a duct that opens at the back corner of the tongue. The parotid glands are the ones that usually swell up with a mumps infection.
Rarely, a tumour can arise in the parotid gland. These tumours are usually relatively benign (not cancerous), and are called mixed parotid tumours. Their cause is unknown, but they slowly enlarge with minimal symptoms other than a vague discomfort. Eventually, they start to break down and ulcerate, at which stage they cause severe pain. If left for a long period, the tumour may press on the facial nerve to cause permanent paralysis, or become malignant.
The only treatment is removal of the affected parotid gland. This is not a serious operation, but a very technically difficult and tedious operation. The gland is not easy to reach as it is tucked underneath the angle of the jaw, and more importantly, the facial nerve runs through the gland.
As it leaves the brain, the facial nerve divides into nine smaller nerves that supply the muscles of the face, the tear gland in the outer corner of the eye, and some of the taste glands and sensation of the tongue. During the operation to remove the parotid gland, the surgeon must dissect out these tiny nerve fibres from the gland and tumour, because if any of the fibres are cut, the area of the face supplied by that nerve will be permanently paralysed.
Even if the operation is completely successful, the irritation to the nerve caused by the operation will cause temporary paralysis to the face for a few weeks. During this time, the patient will not be able to smile, close the eye, suck, whistle, frown, puff out the cheeks or produce tears on the affected side of the face.
After removal of the gland, a recurrence of the tumour is uncommon, provided it has not been left to develop into a cancer.

I have seen a chiropractor for a painful neck, but it is not getting better. What other treatments are available?
The first step is to have an accurate diagnosis made as to the cause of the neck pain. This is best done by consulting a doctor who will examine you and probably order X-rays.
Once the diagnosis is known, the appropriate treatment can be given. This may involve anti-inflammatory medications, supporting collars, heat and physiotherapy. Physiotherapists are very comperent in manipulation techniques, but can also apply many other modes of therapy to ease the pain associated with neck and back injuries.

Trouble In Swallowing And Dry Throat

medicalquestions — Mon, 09 Feb 2009 06:00:26 +0000

At 84 years of age, I am having trouble swallowing and have a dry throat. What could cause this?
The first thing that springs to mind in an older person is that the dryness is causing the difficulty in swallowing, and that side effects from medicine you are taking is causing the dryness. You should ask your doctor to review your medication to determine whether it may be responsible for your problems.
There are, of course, dozens of medical reasons for both a dry throat and difficulty in swallowing, and only appropriate investigation and examination will determine if any of these are present. Possible causes can include fungal or bactetial infections of the throat, ulcers, allergies, tumours, anaemia, liver failure, excess alcohol, several different syndromes and a number of rarer diseases. Stress and anxiety can also cause a dry mouth and difficulty in swallowing in a condition known as globus.
A dry mouth is far more common in older people than younger ones, merely because the salivary glands are not working as well as they used to. Frequent sips of water and having a sips of a drink with your meal is the simplest way to overcome this .problem.

I find that I am always hiccupping when I am nervous or anxious. What causes hiccups and how can they be cured?
The diaphragm is a sheet of muscle that stretches across the body to separate the chest from the abdomen. It has holes in it to allow the major blood vessels and the gullet (oesophagus) to pass through.
Hiccoughs are due to spasms of the diaphragm. When it contracts, a small amount of air is suddenly forced out of the lungs, causing the characteristic sound. The diaphragm goes into spasm because it, or the nerve that controls it, becomes irritated. If you swallow large chunks of food, swallow quickly, or overfill the stomach (by overeating, or swallowing air when nervous), it causes pressure on the diaphragm, and therefore irritation. The cure for the condition is to cause a counter-irritation or relieve the pressure.
Drinking water may remove a piece of food lodged in the oesophagus. Holding a deep breath causes counter pressure on the diaphragm. A fright can cause a sudden generalised muscular spasm. Burping can relieve pressure too. Most of the well-known remedies work this way.
In the rare cases where the hiccoughs are prolonged, medications can be given to relax the diaphragm muscle.