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Doc, I've Got This, Um ... Er ...

Certain embarrassing physical ailments still leave us blushing and tongue-tied. But the experts say to speak up--keeping mum could be much worse.

March 20, 2000|ROSIE MESTEL | TIMES HEALTH WRITER

There are things we'd rather not wax eloquent about with others: embarrassing things. Breath that isn't as fresh as it might be. Hair that sprouts where hair doesn't usually sprout on women. Rectal bleeding and hemorrhoids. Who, other than frat boys, giggling adolescents and possibly your ever-sharing Uncle Sid, relishes chatting about such things?

Especially when they're happening to us.

Our modesty doesn't end with the people in our lives, but extends to our doctors and dentists as well, the very people who can help us find relief. We shouldn't be so bashful, experts urge. Such reticence prolongs needless discomfort--for ourselves and sometimes those we live or work with. And sometimes it can delay identifying serious, even life-threatening, maladies.

Excessive hairiness in women, for instance, can signify a hormonal imbalance that places the sufferer at a greater risk for serious conditions such as diabetes.

Bad breath can signify a host of underlying problems requiring treatment: gum disease, chronic sinus infections, tooth-rotting dry mouth syndrome--even ulcers or diabetes.

And changes in bowel movements, while they often signify nothing more than a change in diet or lifestyle, can also be a sign of colorectal cancer.

"People come to me, and I ask them how long it's been going on. And they say, six weeks, two months, or four: 'I kept waiting for it to go away,' " says Dr. Bennett Roth, a gastroenterologist and director of the Digestive Disease Center at UCLA's School of Medicine. "If they had a big boil on their neck, they wouldn't wait two to four months for it to go away. They'd go to a doctor and fix this."

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Fixing something, of course, first requires you to recognize the complaint--and when it comes to bad breath, the word usually comes from someone else. We aren't very good at smelling our own breath, even when we cup a hand over our mouth, a fact providing a niche for businesses with names like Caring Suggestions and Gentlehints.com. In a backhanded mutation of the Hallmark card, such services--for a fee--will send an anonymous letter politely informing the offender of a problem like bad breath, including "gifts" like toothpaste or mouthwash.

More people, of course, are likely to get the news at their dentist's office or from their spouse.

"The spousal report is the gold standard," says Dr. Glenn Clark, founder of the Fresh Breath Clinic at the UCLA School of Dentistry (which hosted an international meeting on oral malodor last August). "It's like snoring. The spouse always knows."

Science still has much to learn about bad breath, but it's known that a bouquet of chemicals produced by mouth or sinus bacteria are the cause. Thus, to assess bad breath, scientists like George Preti, a human odor specialist at the Monell Chemical Senses Center in Philadelphia, sample air from people's mouths. Preti uses a machine called a gas chromatograph to measure several key gases, with odors he describes as "rotten egg" or "sewer gas smell."

For other tests, breath scientists rely on specially trained human sniffers who assess the breath or the odors wafting up from a scraping of film from the back of the tongue. Why the back of the tongue? It is a perfect breeding ground for stinky breath.

"A magnifying glass will reveal that the tongue has lots of nooks and crannies, especially at the back," Preti explains. "This area doesn't flap up against the hard palate when we talk or eat--it's a good area to lay down an undisturbed surface of plaque."

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Thus, while there are many reasons why one person has bad breath and another doesn't, poor tongue hygiene--and how many of us of really brush our tongues?--is a lead cause.

But there are other causes and contributors. Chronic sinus infections harbor smell-producing bacteria and fungi. Chronic, drippy noses coat the tongue with mucus that encourages plaque build-up. Periodontal disease can also be a cause, as can the dry mouths that often come with age--because saliva contains chemicals that inhibit the growth of bacteria. With less saliva to hold them in check, bad breath bugs can breed with wild abandon.

Sometimes, bad breath even provides clues to serious problems like kidney malfunction, stomach ulcers, hepatitis or diabetes (where the breath can have a sweet smell caused by chemicals called ketones). Some people with a rare genetic disorder called trimethylaminuria have distinct, fishy breath. (Dietary changes, such as avoiding eggs and fish, can help control this odor.)

Since periodontal disease ravages our gums, since high counts of mouth bacteria may contribute to heart disease and ulcers and since untreated dry mouth causes tooth decay, bad breath is not just a social problem, experts stress.

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