October 2002

• Bad Breath: Causes and Treatments
• Erythromycin and Pyloric Stenosis
• Stenting versus surgery for angina
• Living independently — and safely — in your later years

Bad Breath: Causes and Treatments

While it’s not a life-or-death problem, bad breath (halitosis) causes embarrassment and self-consciousness for many people. When certain bacteria in the mouth eat, they release airborne compounds that cause bad breath. The bacteria prefer anaerobic, or oxygen-free, conditions. One reason most of us wake up with bad breath is that our mouths have been closed and sealed off from a fresh supply of oxygen. For the same reason, you may have bad breath if you haven't talked or eaten in a while.

Low salivary flow — like that in people with Xerostomia, or dry mouth — can also be a factor. Sluggish saliva gives bacteria a chance to feed on peptides and proteins. One thing that can help prevent bad breath is acidic saliva, because the bacteria responsible for bad breath prefer alkaline saliva. So, while eating sweets is bad for your teeth, it might be good for bad breath because glucose makes saliva acidic.

About 90% of bad breath comes from oral bacteria, but there are other causes. Tonsillitis and sinusitis are occasional culprits. On rare occasions, respiratory tract tumors can be a source. Just how often gastrointestinal problems cause bad breath is up for question. Some experts say that the thin, tube-like esophagus that carries food from the mouth to the stomach is normally collapsed, so smelly gas from a “bad stomach” couldn't escape. That doesn't preclude foul-smelling belches, however. Fetor hepaticus, or liver breath, is the term for bad breath peculiar to people with cirrhosis, a kind of liver disease.

If bad breath persists, the culprit may be certain foods (garlic or curry, for example), tobacco, a sinus infection, or gum disease. If you think your problem may be a sinus infection, see a doctor. And if it’s gum disease, a periodontist can help recommend a course of action. Diuretics, antihistamines, and some antidepressants can cause bad breath. If you take these drugs, keep breath mints on hand.

Rinsing, flossing, and brushing your teeth, gums, inside cheeks, and hard palate (the front part of the roof of your mouth) can eliminate morning breath. Use a soft-bristle toothbrush and fine, unwaxed floss.

October 2002 Update

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Erythromycin and Pyloric Stenosis

A study published in the July 2002 issue of the Archives of Pediatrics and Adolescent Medicine confirms suspicions that a common antibiotic can cause a serious condition in very young infants.

Infantile hypertrophic pyloric stenosis (IHPS) occurs when the muscle surrounding the outlet from the stomach becomes overgrown and obstructs the passage of food into the intestines. The condition, which usually arises in the first three to five weeks of life, causes projectile vomiting. This can lead to dehydration, weight loss, and electrolyte imbalances that affect kidney function. Physicians have long believed that exposure to the antibiotic erythromycin is related to the condition.

To investigate the link, researchers tracked the antibiotic use and IHPS occurrence in over 314,000 infants between 1985 and 1997. Of the 7,138 infants given prescriptions for erythromycin within the first 90 days of life, 804 were diagnosed with pyloric stenosis. Further analysis showed that while infants younger than two weeks old were rarely given erythromycin, those who were exposed within the first two weeks of life were eight times as likely to develop IHPS as an infant who had not received the drug during this time. Babies who received erythromycin after the first two weeks did not appear to have an increased risk for the condition.

Physicians commonly use erythromycin to treat infants with illnesses such as respiratory and ear infections, whooping cough, and conjunctivitis. The results of this study suggest the risks and benefits of erythromycin need to be carefully weighed — and perhaps other antibiotics tried — before it is prescribed for use in infants younger than two weeks.

October 2002 Update

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Stenting versus surgery for angina

Patients with angina — chest pain caused by plaque build-up in the coronary arteries — have a few choices of treatment. Though that choice may bring freedom, it can also bring confusion. Should you treat it with drugs, bypass surgery, angioplasty, or stents? A study published in the August 22, 2002 issue of the New England Journal of Medicine may help you and your physician start to make that decision. This study focused on two of the treatments — minimally invasive bypass surgery and stenting.

Minimally invasive bypass surgery, a relatively new technique, involves a smaller incision than traditional bypass surgery. This offers the doctor limited access to the heart. As in traditional bypass surgery, the surgeon takes a blood vessel from another part of the patient’s body and either replaces the clogged artery with it, or uses it to reroute blood away from the blocked section, much like a detour reroutes traffic away from a blocked roadway. Using this technique, doctors don’t need to stop a patient’s heart as they do in traditional bypass surgery. Stenting involves widening the narrowed artery by temporarily inflating a tiny balloon in the blood vessel. The surgeon then places a circular wire mesh in the artery to flatten the plaque and hold the artery open.

In the study, researchers randomly assigned 220 heart disease patients to receive either the surgery or stenting. Doctors monitored the subjects following the procedures and saw them again six months later. Both treatments proved to be effective, but their success rates and longevity differed. Stenting was successful and without complication in all of the 110 patients who got it, whereas surgery was successful in 95% of the patients. Five of the 110 patients in the surgery group experienced complications during the procedure and a few required reoperation soon after their initial surgery.

While surgery had more early complications, its effects lasted longer than the effects of stenting. At six months 79% of the patients in the surgery group were free from angina, compared to only 62% of patients in the stenting group. Narrowing of the arteries reoccurred in a larger number of patients who received stents than those who underwent surgery. This caused 29 of the patients in the stenting group to require further intervention, compared to only five patients in the surgery group.

The results of this study offer perspective on two of the available treatments for angina. Of course, when making this decision, you and your doctor should also take into account your age, your medical history, and the condition of your coronary arteries.

October 2002 Update

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Living independently — and safely — in your later years

The majority of older people remain independent well into later life. Most seniors want to remain in their own homes, a goal that’s easier to accomplish if they adapt their lives and homes to accommodate their aging bodies. Some tips for independent living include:

Redecorate. The average home is riddled with obstacles that older eyes and feet might not be able to maneuver around. Removing slippery throw rugs, using night lights, putting nonskid mats in the bathroom and kitchen, not using high-gloss floor polishes, and installing handrails that extend beyond the bottom stair can all help. You can often fit your bathrooms with items like walk-in showers, grab bars, and higher toilet seats. Ramps, elevators, and other devices can help you handle stairs. Keep often-needed items in the handiest cabinets and use a grasping tool to get things that are out of reach instead of climbing on a chair or ladder.

Lifestyle changes. Wearing rubber-soled shoes and getting regular exercise can help keep you upright. Activities like tai chi or yoga especially help since they work on balance and strength, and are not jarring on muscles or bones. Limit your alcohol intake and learn whether any of your medications might cause dizziness or affect your balance.

Seek helping hands. Shopping for groceries and other essentials can be accomplished over the phone and via the Internet these days. Meal preparation, transportation, home repair, housecleaning, and help with financial or personal tasks such as paying bills and bathing might be hired out if you can afford it, shared among friends and family, or included in the repertoire of elder services offered in your community or through insurance.

Plan for emergencies. Who can check in on you regularly? Whom can you call in an emergency? What would happen if you fell and couldn’t reach the phone? Keep emergency numbers near each phone or, better still, on speed dial. Carry a cell phone or consider investing in a personal alarm system, if necessary. Look into companionship services or simple visits and phone checks from a local agency on aging or religious group. To find agencies near you, call the Eldercare Locator at 1-800-677-1116 or visit their web site at www.aoa.dhhs.gov/elderpage/locator.html.

October 2002 Update

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