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Dr Roland obtaining saliva sample from a patient
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5th April, 2009
FINDING it hard to make eye contact, look away from the person when talking, and panic if they stand too close to you? You might be suffering from a chronic bad breath problem.
Many have found that their bad breath problem has been very debilitating and depressing. It has been hard to even get out of bed in the morning, knowing that no matter how much cleaning and mouth washing one does, he or she still has to talk to people in their jobs all day with bad breath.
But what is chronic bad breath anyway? How does it come about and is there any specific explanation and cure to it?
Sabahans should be proud to have a specialist centre that answers those questions. They can find what they want from the Bad Breath Clinic at Rafflesia Medical Centre (RMC) in Kepayan, which is the first and only treatment facility for bad breath in Malaysia as well as in Asia.
It is also one of the only four such clinics in the world. The other three are in Sydney and Melbourne, Australia, and in Manchester, United Kingdom. Officially opened in February this year, the clinic is run by its dental surgeon and also RMC executive chairman Dr Roland Chia Ming Shen.
From his observation, the dental and oral hygiene specialist says bad breath is caused by the coatings build on the tongue, teeth, gingival sulcus and throat. These coatings contain proteins which attract the bad bacteria in the mouth to react against them.
The bad bacteria break down the amino acids in the proteins and specifically produce sulphur that contains Cysteine and Methionine. The sulphur from the amino acids is released as waste products called volatile sulphur compounds (VSCs), which are the smell of bad breath.
In contradiction to the old wives tales, bad breath does not come from indigestion, constipation and even from worms. However, it is sometimes a hygiene problem.
There are seven types of gases in the mouth compound but only three are the most common to cause significant bad smells: methyl mercaptan (CH3SH) which produces faeces smell; hydrogen sulphide (H2S) – rotten eggs; and dimethyl sulphide (CH3SCH3) – cabbage, sulphur, gasoline.
Who has bad breath? Dr Roland says dental studies show that 50% of the population have bad breath sometimes, 25% have chronic bad breath, while majority of the people have morning breath – due to bacterial reaction in a dry mouth condition.
“Mostly, people who are easily affected by bad breath are those who consume less carbohydrate but more proteins – bodybuilders, models as well as those who are in food regiment.”
Three main factors that cause bad breath are illness, medicine and lifestyle.
The main illnesses are chronic nasal problems, periodontal (gum) disease and dry mouth (Sjogren’s Syndrome).
Chronic nasal problem lines the throat and dorsum of tongue with mucous, stops the nasal hairs from doing their cleaning action. Periodontal disease promotes the growth of hardy anaerobic bacteria and increases the available surface area for biofilm, below the gum line.
In the meantime, dry mouth affects the quality and quantity of saliva. Saliva is nature’s cleaning solution that stops mouth disease and helps reduce bad breath.
Dr Roland says, “Medicines through blood pressure, allergy and sinus, anti depressant, heartburn and indigestion, and sedative and relaxant medications affect saliva and cause bad breath.”
In lifestyle, excessive consumption of alcohol dries the mouth and decreases saliva, dairy products provide a food source for bad breath bacteria and thicken nasal mucous, smoking removes oxygen from the mouth and promotes bad breath bacteria, while coffee and other drinks increase acid in the mouth, directly affecting saliva and bacteria.
This issue has become a dental challenge as dentists do not view bad breath as an important health issue. This could be because the public make light of the condition or lack of undergraduate education on the problem.
Why do dentists not treat bad breath? Dr Roland opines that bad breath is not perceived as a glamorous dental treatment, whereas a cosmetic makeover is considered glamorous. It is also because dentists do not understand that bad breath is a practice builder.
At RMC Bad Breath Clinic, patients will benefit from a specialist treatment from Dr Roland himself, who is the only qualified dental surgeon treating such problem in Malaysia.
He had undergone a special training on that particular field in Australia under Dr Geoffrey Speiser, a halitosis (bad breath) expert who is also the proprietor of the Australian Breath Clinic.
Dr Speiser had also been working very closely with Professor Mark Taggart, an eminent microbiologist based at the University of Otago, where the various medical researches being carried out.
Dr Roland says the approach to the management of bad breath includes a medical diagnostic tool called the Oral Chroma (Halicheck Chromagraph) – to measure the gaseous of the mouth as well as a thorough assessment of the person’s hygiene, personal and social lifestyle, and dietary habits.
“We hope with the introduction of this innovative approach to managing bad breath, the people of Sabah will be able to benefit and will not need to seek treatment abroad.
“The Halicheck Chromagraph identifies bad breath gases such as the hydrogen sulphide, methyl mercaptan and dimethyl sulphide. It displays results graphically for easy patient interpretation in just short measuring time of eight minutes.”
Halicheck is simple to use. The dentist will insert a plastic syringe that comes with the product into the oral cavity and hold it between the lips (but to be careful to avoid touching the tongue with the syringe).
He will slowly pull the plunger, push it in again, and pull it for the second and third time before removing the syringe from the mouth.
Then he will wipe the top of the syringe dry with a tissue, attach the dedicated needle and eject the sampled oral gas to 0.5cc by exhausting half the gas.
The final action will be to insert the remaining oral gas into the inlet on the main unit of the Oral Chroma. The measurement will start automatically.
Dr Roland says a judgement graph can be seen on the computer monitor that can be given to patients as a recording of their results. A healthy reading is HS under 80, MM under 10 and DM under 20 while a non smell reading is HS under 112, MM under 26 and DM under 20.
To undergo the assessment (saliva test, x-ray and clinical examination), one only needs to spend about RM380 but in a case where the person is found to suffer from chronic bad breath and needs treatment, he or she will have to spend almost double the amount.
The treatment will involve the use of the KForce with BLIS (Bacteriocin-Like Inhibitory Substance) K12 solution. Discovered at Otago University, it contains smart weaponry which is a naturally occurring bacteria that only lives on the tongue surface and found in only 2% of the population.
BLIS K12 is a probiotic – live microorganisms which when administered in adequate amounts confer a health benefit on the host. It is a living organism and is able to respond to a threat by ramping up the production of the antibacterial proteins.
Dr Roland says the KForce with BLIS K12 works in three ways: as the passive occupier of tongue area; active defence mechanism; and host modifier.
Since its establishment last February, RMC Bad Breath Clinic has treated over 30 patients, he says, adding that the figure is still small because not many people are aware of the presence of the facility in Sabah.
On why such facility is not expanded to other places or states, especially in the peninsula, Dr Roland says it is part of their role to help the state and the government to promote medical tourism.
“It will be better if we let people from outside the state to come here in order to undergo the treatment. For sure it will help to boost our tourism industry,” he says.
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