Bad breath and tonsil stones

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BY PAUL G. DONOHUE, M.D. DEAR DR. DONOHUE: I have tonsil stones. They are little balls that come from the back of my mouth when I sneeze, cough or gargle. They resemble small pieces of garlic. Aside from being annoying, they are disgusting, because they smell and cause bad breath. I can’t get rid of them. An ear, nose and throat doctor said that the only way to get rid of them was having a tonsillectomy. I’m not opposed to that, but the doctor recommends trying other things before turning to surgery. Suggestions, please? — D.

ANSWER: Tonsil stones are aggregates of food, bacteria and the mucus of postnasal drip that find their way into tonsil crevices. They do have a revolting odor. However, they’re not usually implicated as causing bad breath. Your doctor did you a favor by tempering your desire for a tonsillectomy. The back of the tongue, where a special kind of bacteria makes its home, is where most bad breath arises. These bacteria survive without oxygen. They’re also found between the teeth. They produce sulfur-containing gases that are malodorous. Getting rid of these bacteria often rids people of halitosis.

Before you start, have a friend or relative check your breath to determine if you truly have bad breath or if you only believe you do. If you really have halitosis, brush after every meal, and floss at least once daily. Flossing dislodges the odiferous bacteria lodging between the teeth. Gently brush the far back of your tongue. A plastic tongue cleaner does the job well. You’ll gag at first, but you will get used to it. Stop drinking coffee and alcohol until your breath clears. Use a mouthwash with chlorhexidine in it. Peridex and Corsodyl are two brand names. There are others.

In rare instances, bad breath comes from problems like lung abscesses, liver disease and kidney failure. I take it your health is good. If it isn’t, explore these rare causes of foul breath.

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DEAR DR. DONOHUE: My closest friend had a beautiful, thick head of hair until five or six weeks ago, when all of a sudden, she began to lose hair in various spots, each about the size of a 50-cent piece. She has never dyed her hair, and has used the same shampoo for years. The dermatologist diagnosed this as alopecia areata and has given her some steroid shots. She is in her mid-60s. Do you have anything that can help her? — M.J.

ANSWER: Circular bald patches are the hallmark of alopecia areata, an autoimmune disease. Your friend’s immune system is waging a war on hair follicles, and hair is falling out. Her dermatologist has started standard treatment, injections of cortisone drugs into the bald patches. Often such injections have to be repeated monthly. The cortisone blunts the immune attack. Other ways of doing the same are applying DPCP (diphenylcyclopropenone) lotion to the spots. Another treatment is patience. Quite often, the hair regrows spontaneously. A good omen for her is her age. Regrowth occurs more predictably at older ages.

DEAR DR. DONOHUE: Three years ago, I had a stroke that left me with a mind that is still good. Within the past few months, I have started to develop essential tremor, and sometimes it is very bad. I take Lipitor, Toprol XL, Lotrel and Plavix. Is there anything that can help me with the tremor and not affect the other medicines I take? — R.H.

ANSWER: Essential (also called familial) tremor is a common cause of shaking hands, and sometimes shaking head and shaking voice. The tremor comes on when a person moves the hand or arm. Bringing a spoonful of soup to the mouth can be an impossible challenge. One popular remedy is Inderal (propranolol), a beta blocker. You’re taking another beta blocker, Toprol. That makes Inderal a less-than-good choice for you. Primidone, however, is a totally different medicine, and it has a good record for controlling essential tremor. It’s not off limits for you.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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