I’ve had bad breath for ages – how can I freshen it?

IT’S good that endometriosis and other gynaecological problems are getting attention.

Just last week, actress Florence Pugh opened up about her experience of endometriosis and polycystic ovary syndrome, revealing she froze her eggs at 27 to protect her fertility.

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But it’s still the reality that many women are facing long waiting lists for diagnosis and treatment, often while in pain.

On average an endometriosis diagnosis takes seven years.

Other common gynaecological issues include uterine fibroids and pelvic inflammatory disease.

Sometimes symptoms of these problems can be confused for other conditions, such as irritable bowel syndrome or a UTI.

We also can’t ignore that for a long time, taboos surrounding menstrual health and a tendency to normalise women’s pain have contributed, too.

Here are some questions readers have asked this week . . . 

Q) I’VE had bad breath for ages and tried everything. Do you have any suggestions for how to freshen it?

A) Chronic bad breath (also known as halitosis) can sometimes be the result of underlying medical conditions that have nothing to do with the oral cavity.

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Gastrointestinal or respiratory conditions or infections, such as tonsillitis, can cause offensive odours to come up and out of the mouth.

However, most commonly, halitosis is linked to oral hygiene or dental issues.

It might be worth making an appointment with your dentist.

One potential cause could be a dry mouth, also known as xerostomia.

Saliva acts like a natural mouthwash.

When you end up with reduced saliva production, sometimes caused by ageing, underlying medical conditions or some medications, it can result in bad breath which can be debilitating if left untreated.

Chewing sugar-free gum may freshen breath but, importantly, it will also do the job of stimulating oral glands to produce more saliva.

It’s worth thinking about the oral microbiome too – the bacteria and other microbes that live in the mouth.

After the gut microbiome, the second most diverse garden of microbes in the body resides in the oral cavity. No two people have the same make-up.

Studies have linked tooth and gum disease to the oral microbiome and the likelihood of halitosis.

Some studies advise that probiotic supplements may have a role in helping, but these would likely be different to the probiotics that many people use for gut health.

The advice around probiotic supplements is certainly not confirmatory, but there’s no harm in including naturally probiotic foods in your diet, such as yoghurt, miso, sauerkraut, kefir, kimchi and tempeh.

I’d also suggest a tongue scraper.

You’ll be amazed at what comes away each day.

DO I TELL DVLA OF OP?

Q) I SUFFER from atrial fibrillation. l’m a woman of 92 and I live on my own.

The attacks are really frightening and usually occur at night, lasting around nine to 12 hours.

I’ve been told I can have a pacemaker fitted but the waiting time is four months.

Also, do I have to advise the DVLA and my car insurance company that I will be having the operation?

A) Atrial fibrillation is a heart condition that causes an irregular heartbeat and sometimes it can cause the heart rate to be faster than normal.

The upper chambers of the heart, called the atria, contract randomly and sometimes too quickly so that the heart muscle cannot fully relax between contractions.

This causes symptoms in many people because the heart is less efficient and can’t perform properly.

Symptoms can include dizziness, feeling short of breath, chest tightness and palpitations.

In others, it doesn’t cause any symptoms at all, but this is also dangerous because the risk of stroke is five times greater for people with untreated AF, whether you have symptoms or not.

There are roughly one million people in the UK with diagnosed AF and the Stroke Association estimates that there could be as many as half a million with undiagnosed AF.

Your doctors have clearly decided a pacemaker is the best option for you but other treatments include medication such as beta blockers, anti-arrhythmic drugs, ablation and cardioversion.

Anticoagulant drugs are the most effective treatments to reduce the risk of stroke in people with atrial fibrillation.

To answer your question about the DVLA, you do have to inform both them and your insurance company.

If you have a pacemaker fitted, you are not allowed to drive for a week after having it fitted.

Usually, if you feel fine and are not having any symptoms such as dizziness, or extreme tiredness, most people are able to go back to driving after having a pacemaker fitted.

So, it shouldn’t deter you from going ahead with the best recommended treatment for you.

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Q) I’M a 53-year-old man, who’s become aware of the risk of prostate cancer since Olympian Sir Chris Hoy shared his diagnosis.

Is it worth me having a PSA test? I keep reading conflicting evidence about false positives.

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A) This question is pertinent right now following Chris Hoy sharing his own diagnosis and King Charles going public about his enlarged prostate surgery last year.

A PSA blood test detects a protein called prostate-specific antigen in the blood, produced by both healthy and cancerous cells.

You’re absolutely right that a PSA blood test has both pros and cons to consider.

Many people believe that there should be a prostate cancer NHS screening programme for men, using this test.

However, the test has a 75 per cent false positive rate, meaning that 75 out of 100 who get a positive result will not have prostate cancer.

A 15 per cent false negative rate also means that 15 per cent of people with prostate cancer will get a negative result.

This makes it far too inaccurate to be used to screen a whole population.

If a man has urinary symptoms, then they should see their GP to be fully assessed, and in this case, a PSA test may be helpful.

This leaves the question, should a man with no symptoms have a PSA test?

First consider your prostate cancer risk, which you can do by visitng prostatecanceruk.org/risk-checker.

There are three well-established risk factors for prostate cancer: Older age, family history, and being black – black men have double the risk and develop it younger.

Prostate Cancer UK therefore advocates for black men to have a regular PSA blood test from the age of 45.

Then consider what your actions will be if you have a positive PSA result, which can lead to further, invasive investigations such as biopsy which, for the 75 per cent of those whose PSA test gave a false positive, can cause unnecessary distress.

If you deem yourself to be at high risk it is worth talking to your GP to decide whether this test is for you.

It is worth reminding everyone of the symptoms of prostate cancer, including needing to urinate more often, difficulty going or taking a while, and blood in urine.