Effects Of Nose Picking

Dr. Pavan MurdeshwarMCh - Plastic & Reconstructive SurgeryCosmetic/Plastic Surgeon

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Hello. The scars and the pigmentation on the face are treatable. It's better to get it examined first so that we can identify the type of skin, scars and if they are hyper pigmented, atrophic or ice pick scars. The treatment are of various kind like ranging from simple scrubs and mild peels for the face to the major interventions such as laser therapy, dermaroller, subcision or peeling. These depend on the type of the scars and which kind you opt for. You can consult me online or text me with pictures for further details. 

0 person found this helpful

Dr. Pavan MurdeshwarMCh - Plastic & Reconstructive SurgeryCosmetic/Plastic Surgeon

94% (3409 ratings)

Ask Free Question

Hello. The scars and the pigmentation on the face are treatable. It's better to get it examined first so that we can identify the type of skin, scars and if they are hyper pigmented, atrophic or ice pick scars. The treatment are of various kind like ranging from simple scrubs and mild peels for the face to the major interventions such as laser therapy, dermaroller, subcision or peeling. These depend on the type of the scars and which kind you opt for. You can consult me online or text me with pictures for further details. 

0 person found this helpful

Dr. Isha MalhotraBDSDentist

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What is Halitosis (Bad Breath)? Halitosis, commonly known as bad breath, is an embarrassing health condition that affects approximately 30% of people around the world. Additional medical terms for this condition include stomatodysodia, fetor oris, and ozostomia. Regardless of the term used, this is the presence of a foul-smelling odor that seems to come from the mouth cavity. According to the Academy of General Dentistry, in more than 90% of cases, the odor originates in the mouth, throat, and tonsils. Although this is something everyone experiences at one time or another, if your case does not improve after brushing, flossing, and rinsing the mouth with an alcohol free mouthwash, it may be chronic. The foul oral odor is usually caused by a group of anaerobic, sulfur-producing bacteria that breed beneath the surface of the tongue and often in the throat and tonsil area. The term "anaerobic" literally means living without oxygen, and in fact, these bacteria do not require oxygen to live. They occur naturally in the oral environment and are essential because they assist in digestion by breaking down proteins into amino acids. Proteins are commonly found in food, mucus or phlegm, blood, and in diseased oral tissue. As these bacteria feast on proteins in your mouth, sulfur compounds are released from the back of your tongue and throat. The bacteria excrete waste as hydrogen sulfide, methyl mercaptan, and other odorous and bad tasting compounds known as volatile sulfur compounds. As long as the anaerobic bacteria feed on proteins and excrete volatile sulfur compounds unchecked, your breath will become worse and worse. Four Common Bad Breath Causes There are many underlying causes of halitosis, but four of them are very common. Dry mouth: Xerostomia, the medical term for dry mouth, provides a perfect environment for anaerobic bacteria reproduction. Long periods of speaking, smoking, drinking alcohol, and snoring are a few common underlying causes. Most people experience foul breath in the morning due to lack of saliva production while they sleep. For healthy individuals, food odors are temporary and normal salivary flow will eliminate them within several minutes. However, those who suffer from dry mouth and lack of saliva find that even minor food odors may lead to long-term issues. Foods: Halitosis can be exacerbated by certain foods such as onions and garlic because they contain smelly sulfur compounds, while dairy, meat, and fish contain dense proteins which are used as a food source by the anaerobic, sulfur-producing bacteria. Refined and processed sugars also provide a food source for bacteria. Coffee and juices can contribute to this problem because they are acidic and provide these bacteria with an ideal breeding environment. Poor dental hygiene: Inadequate oral care causes bacterial buildup on the teeth and gums. Teeth cannot shed their surfaces the way skin can, so microorganisms can easily attach to the teeth and remain there for extended periods. If they are not continuously removed by adequate brushing, these bacteria develop into something called biofilm, commonly known as dental plaque. When plaque is allowed to accumulate near the gumline, it will harden and begin destroying teeth and gum tissues due to intense bacterial activity. This leads to gum disease such as gingivitis and periodontitis, which enable proteins from bleeding gums and diseased oral tissue to fuel odor-causing bacteria. Tooth decay and poorly fitting or dirty dentures can also contribute to this problem. Illness and disease: According to studies, an estimated 10% of all halitosis cases are caused by certain illnesses. Individuals who suffer from diabetes, lung disease, kidney disease, cancer, liver disease, respiratory tract infections, or metabolic disorders often experience chronic foul breath due to dry mouth. Sinusitis, pneumonia, bronchitis, postnasal drip, and polyps affect the airways and may also contribute to the problem. Other common illnesses associated with bad breath include nasal odor and tonsil stones, yeast infections of the mouth, and gum disease. Certain drugs such as antidepressants, high blood pressure medications, and antihistamines can factor into dry mouth because they reduce saliva production. Please Note: Halitosis is rarely associated with life-threatening diseases. However, it is important that you consult your doctor or dentist as soon as you notice consistent white spots on the tonsils and sores in the mouth with or without a fever. Sometimes bad breath is triggered by severe health conditions such as throat or mouth cancers, human immunodeficiency virus (HIV) infection, digestive system disorders, or diabetes – and further, can indicate dehydration or zinc deficiency. Taking proper care of your teeth and visiting the dentist at least twice a year are the easiest ways to avoid these issues. Halitosis Symptoms Offensive breath tells us that something is out of balance. In fact, anthropologists have reported that once humans started to kiss each other, the ability to smell one another's breath became a very important way to test a partner's compatibility. If the other person didn't pass the smell test, they were not able to get to the next step towards securing a mate. Halitosis is a medical condition that lowers self-esteem and affects everyday life and personal relationships. People with chronic or recurring bad breath often lose their self-confidence. It can be difficult to know if you have this problem, because it is often challenging to pick up on one's own scent. Furthermore, family members and colleagues may not feel comfortable telling you. One of the best ways to find out if you have foul breath is to lick the inside of your wrist, wait five seconds, and then take a whiff. Most symptoms of halitosis depend on the underlying cause. The most common symptoms include postnasal drip, a bitter metallic taste, a white coating on the tongue, and thick saliva. Many individuals who have foul breath associated with dry mouth can experience difficulty speaking or swallowing, a burning sensation in the mouth, or dry eyes. Fever, sore throat, persistent cough, and swollen lymph nodes in the neck indicate respiratory tract infections, which can also be a contributing factor. Getting a Proper Diagnosis The best way to truly identify the source of chronic halitosis is to visit a dentist or doctor for a professional diagnosis. When you are ready to tackle this situation, be sure to be open and honest with the healthcare professional performing the examination. It is important for him or her to understand all the health problems you are experiencing in order to determine the underlying cause and recommend appropriate treatment. The Halimeter (also known as a portable sulfide gas monitor) is the most commonly used clinical diagnostic instrument utilized in this field. It measures the concentration of hydrogen sulfide in parts per billion (ppb) in mouth air. The Halimeter uses a patented electrochemical voltammetric sensor, which has provided reproducible results to clinicians for the past 20 years. It has been demonstrated hundreds of times on national and local television by Dr. Harold Katz on programs such as The View, Good Morning America, and CBS Morning News. Getting Proper Treatment For more than a century, pharmaceutical companies attempted to alleviate halitosis by using mouthwash that contained alcohol. This is the exact opposite of what should be done because alcohol is a drying agent. Clinicians have learned a good deal in the ensuing years, and in most cases, this condition can be successfully treated. Like the symptoms, treatment depends on the underlying cause. It is important to keep in mind that you cannot eliminate the bacteria from the tongue that cause bad breath. Consequently, scraping or brushing the tongue is a temporary remedy at best, and is typically frustrating for those who believe tongue scraping or tongue brushing is a permanent solution. The bacteria that cause this are part of your normal oral flora and are essential to breaking down proteins, a key step in normal digestion. A much simpler and clinically-proven method to treat bad breath is to interrupt the bacteria's chemical production of odors by introducing oxygenating compounds to your oral environment. Oxygen is the natural enemy of the bacteria that cause this problem because they are anaerobes and cannot function in the presence of oxygen. In general, a dentist will recommend mouthwashes and toothpastes that contain oxygenating agents such as chlorine dioxide or sodium chlorite to neutralize volatile sulfur compounds and help control odor causing bacteria found in the mouth. If you are experiencing mouth dryness, your dentist will recommend a saliva substitute to moisten the mouth throughout the day. Some effective, natural ingredients to look for in oral care products are zinc gluconate, aloe vera, green tea, tea tree oil, xylitol, CoQ10, glycyrrhizic acid and oral probiotics like K12 and M18. Six Bad Breath Home Remedies The practice of a few, simple, self-care techniques can help to minimize halitosis. There are several things you can do at home. Advanced oral care products: Use oral care products such as mouthwashes and toothpastes that have been shown to be effective in fighting bad breath. Proper oral care: Brush and floss your teeth at least twice a day. Be sure to get a toothbrush with soft bristles (as to not damage tooth enamel or gums) and also use fluoride toothpaste. Brushing and flossing helps to remove any food and plaque which can be used as a fuel source by the anaerobic, sulfur-producing bacteria that are at the root of this problem. Stimulate your salivary flow: Prevent dry mouth with chewing gum, lozenges, or mints that are sugar free. Look for Xylitol, a non-sucrose sweetener, which in recent years has been shown to have anti-cavity properties. Eat fibrous fruits and vegetables: One of the best ways to remove bacteria in the mouth is to eat an apple a day. It helps moisten the mouth, too. Take a dietary supplement: Vitamin C, Vitamin D, Vitamin E, and Vitamin B are effective at helping your body eliminate excess mucus and toxins naturally. Brush your teeth occasionally with baking soda: The bacteria that cause bad breath thrive in an acidic oral environment. Brushing your teeth with baking soda helps neutralize excess acids found in the oral cavity. 12 Easy Ways to Prevent Bad Breath Please remember, preventing halitosis is always easier than treating it. By developing the right habits, you can effectively help prevent it. Eat foods rich in fiber: High fiber foods help prevent halitosis. Avoid eating heavily processed foods that contain refined carbohydrates such as cookies, cakes, sweets and ice cream. Use mouthwash: Some mouthwashes or oral rinses are effective at preventing bad breath. However, you should never use alcohol based mouthwashes because the alcohol makes the mouth very dry, which will actually make the problem worse. Drink green and black teas: They contain polyphenols that help eliminate sulfur compounds and reduce oral bacteria. Avoid drying medication: Try not to take antidepressants, diuretics, pain relievers, and antihistamines unless it is absolutely medically necessary. These drugs inhibit saliva flow and can cause chronic dry mouth. Avoid products with sodium lauryl sulfate or alcohol: Do not use any oral hygiene products that contain sodium lauryl sulfate or alcohol because the alcohol makes the mouth very dry, one of the most common causes of bad breath. Clean your mouth after eating meat, fish or dairy products: Practicing consistent and thorough oral hygiene is an effective prevention tool. Stop smoking: Studies have shown that smokers are at higher risk of developing periodontal disease and dry mouth. Furthermore, people who smoke may also engage in other habits that promote this condition such as dieting, drinking alcohol, and suffering from chronic anxiety conditions that require exacerbating prescription medications. Breathe through your nose instead of your mouth: Try to address any snoring or sleep apnea issues that could be affecting your breath and causing dry mouth. Drink water: Keep your mouth moist by drinking plenty of water. Clean your dentures at least once a day: Practice the same, proper oral care that you would with your original teeth. Eliminate dairy products from your diet: Lactose intolerance can be an underlying cause of halitosis. Use an oral probiotic like S. Salivarius K12 and M18: Use probiotics to balance the oral cavity and prevent an overgrowth of the odor-causing bacteria involved in halitosis. 

2 person found this helpful

Dr. Abhishek VijayakumarMCh Plastic Surgery, MS - General SurgeryCosmetic/Plastic Surgeon

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Hello, There are various treatments for acne scars which include creams, chemical peels, microdermaabrasion, microneedling, radiofrequency, surgery, fat fill, laser etc. TCA peels do help with ice pick scars, CO2 laser though is a good option it cannot be used in all skin type due to risk of hyperpigmentation. The redness following the laser may last upto 3 months and usually subside. Microneedling Radiofrequency therapy is a good option for collagen induction. Only microneedling gives moderate results and derma pen is better option than dermaroller. There are some skin repair creams with growth factors which help in collagen production after microneedling. What you need to understand is no therapy is perfect a combination of treatment give satisfactory results. Tretinoin creams in long term are also good option to improve the scars but needs to be stopped prior to any procedure. A photograph would help assess you better. Consult a dermatologist. 

4 person found this helpful

Dr. Abhishek VijayakumarMCh Plastic Surgery, MS - General SurgeryCosmetic/Plastic Surgeon

91% (2318 ratings)

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Hello, There are various treatments for acne scars which include creams, chemical peels, microdermaabrasion, microneedling, radiofrequency, surgery, fat fill, laser etc. TCA peels do help with ice pick scars, CO2 laser though is a good option it cannot be used in all skin type due to risk of hyperpigmentation. The redness following the laser may last upto 3 months and usually subside. Microneedling Radiofrequency therapy is a good option for collagen induction. What you need to understand is no therapy is perfect a combination of treatment give satisfactory results. Tretinoin creams in long term are also good option to improve the scars but needs to be stopped prior to any procedure. A photograph would help assess you better. Consult a dermatologist. 

0 person found this helpful

Dr. Karun GuptaBDS, Non-Resident J.R. in Dept. of Orthodontics, Certified oral implantologist, Advanced Aesthetics, Digital Smile DesignerDentist

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this white color is due to food lodgement on the tongue furrows...make a habit of brushing twice daily,,, also start using tongue cleaner for removing tongue debris.....also bad breath should reduce as this bad breath is also due to food lodged in the tongue papillae...... 

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Dr. Isha MalhotraBDSDentist

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Four Common Bad Breath Causes There are many underlying causes of halitosis, but four of them are very common. Dry mouth: Xerostomia, the medical term for dry mouth, provides a perfect environment for anaerobic bacteria reproduction. Long periods of speaking, smoking, drinking alcohol, and snoring are a few common underlying causes. Most people experience foul breath in the morning due to lack of saliva production while they sleep. For healthy individuals, food odors are temporary and normal salivary flow will eliminate them within several minutes. However, those who suffer from dry mouth and lack of saliva find that even minor food odors may lead to long-term issues. Foods: Halitosis can be exacerbated by certain foods such as onions and garlic because they contain smelly sulfur compounds, while dairy, meat, and fish contain dense proteins which are used as a food source by the anaerobic, sulfur-producing bacteria. Refined and processed sugars also provide a food source for bacteria. Coffee and juices can contribute to this problem because they are acidic and provide these bacteria with an ideal breeding environment. Poor dental hygiene: Inadequate oral care causes bacterial buildup on the teeth and gums. Teeth cannot shed their surfaces the way skin can, so microorganisms can easily attach to the teeth and remain there for extended periods. If they are not continuously removed by adequate brushing, these bacteria develop into something called biofilm, commonly known as dental plaque. When plaque is allowed to accumulate near the gumline, it will harden and begin destroying teeth and gum tissues due to intense bacterial activity. This leads to gum disease such as gingivitis and periodontitis, which enable proteins from bleeding gums and diseased oral tissue to fuel odor-causing bacteria. Tooth decay and poorly fitting or dirty dentures can also contribute to this problem. Illness and disease: According to studies, an estimated 10% of all halitosis cases are caused by certain illnesses. Individuals who suffer from diabetes, lung disease, kidney disease, cancer, liver disease, respiratory tract infections, or metabolic disorders often experience chronic foul breath due to dry mouth. Sinusitis, pneumonia, bronchitis, postnasal drip, and polyps affect the airways and may also contribute to the problem. Other common illnesses associated with bad breath include nasal odor and tonsil stones, yeast infections of the mouth, and gum disease. Certain drugs such as antidepressants, high blood pressure medications, and antihistamines can factor into dry mouth because they reduce saliva production. Please Note: Halitosis is rarely associated with life-threatening diseases. However, it is important that you consult your doctor or dentist as soon as you notice consistent white spots on the tonsils and sores in the mouth with or without a fever. Sometimes bad breath is triggered by severe health conditions such as throat or mouth cancers, human immunodeficiency virus (HIV) infection, digestive system disorders, or diabetes – and further, can indicate dehydration or zinc deficiency. Taking proper care of your teeth and visiting the dentist at least twice a year are the easiest ways to avoid these issues. Halitosis Symptoms Offensive breath tells us that something is out of balance. In fact, anthropologists have reported that once humans started to kiss each other, the ability to smell one another's breath became a very important way to test a partner's compatibility. If the other person didn't pass the smell test, they were not able to get to the next step towards securing a mate. Halitosis is a medical condition that lowers self-esteem and affects everyday life and personal relationships. People with chronic or recurring bad breath often lose their self-confidence. It can be difficult to know if you have this problem, because it is often challenging to pick up on one's own scent. Furthermore, family members and colleagues may not feel comfortable telling you. One of the best ways to find out if you have foul breath is to lick the inside of your wrist, wait five seconds, and then take a whiff. Most symptoms of halitosis depend on the underlying cause. The most common symptoms include postnasal drip, a bitter metallic taste, a white coating on the tongue, and thick saliva. Many individuals who have foul breath associated with dry mouth can experience difficulty speaking or swallowing, a burning sensation in the mouth, or dry eyes. Fever, sore throat, persistent cough, and swollen lymph nodes in the neck indicate respiratory tract infections, which can also be a contributing factor. Getting a Proper Diagnosis The best way to truly identify the source of chronic halitosis is to visit a dentist or doctor for a professional diagnosis. When you are ready to tackle this situation, be sure to be open and honest with the healthcare professional performing the examination. It is important for him or her to understand all the health problems you are experiencing in order to determine the underlying cause and recommend appropriate treatment. The Halimeter (also known as a portable sulfide gas monitor) is the most commonly used clinical diagnostic instrument utilized in this field. It measures the concentration of hydrogen sulfide in parts per billion (ppb) in mouth air. The Halimeter uses a patented electrochemical voltammetric sensor, which has provided reproducible results to clinicians for the past 20 years. It has been demonstrated hundreds of times on national and local television by Dr. Harold Katz on programs such as The View, Good Morning America, and CBS Morning News. Getting Proper Treatment For more than a century, pharmaceutical companies attempted to alleviate halitosis by using mouthwash that contained alcohol. This is the exact opposite of what should be done because alcohol is a drying agent. Clinicians have learned a good deal in the ensuing years, and in most cases, this condition can be successfully treated. Like the symptoms, treatment depends on the underlying cause. It is important to keep in mind that you cannot eliminate the bacteria from the tongue that cause bad breath. Consequently, scraping or brushing the tongue is a temporary remedy at best, and is typically frustrating for those who believe tongue scraping or tongue brushing is a permanent solution. The bacteria that cause this are part of your normal oral flora and are essential to breaking down proteins, a key step in normal digestion. A much simpler and clinically-proven method to treat bad breath is to interrupt the bacteria's chemical production of odors by introducing oxygenating compounds to your oral environment. Oxygen is the natural enemy of the bacteria that cause this problem because they are anaerobes and cannot function in the presence of oxygen. In general, a dentist will recommend mouthwashes and toothpastes that contain oxygenating agents such as chlorine dioxide or sodium chlorite to neutralize volatile sulfur compounds and help control odor causing bacteria found in the mouth. If you are experiencing mouth dryness, your dentist will recommend a saliva substitute to moisten the mouth throughout the day. Some effective, natural ingredients to look for in oral care products are zinc gluconate, aloe vera, green tea, tea tree oil, xylitol, CoQ10, glycyrrhizic acid and oral probiotics like K12 and M18. Six Bad Breath Home Remedies The practice of a few, simple, self-care techniques can help to minimize halitosis. There are several things you can do at home. Advanced oral care products: Use oral care products such as mouthwashes and toothpastes that have been shown to be effective in fighting bad breath. Proper oral care: Brush and floss your teeth at least twice a day. Be sure to get a toothbrush with soft bristles (as to not damage tooth enamel or gums) and also use fluoride toothpaste. Brushing and flossing helps to remove any food and plaque which can be used as a fuel source by the anaerobic, sulfur-producing bacteria that are at the root of this problem. Stimulate your salivary flow: Prevent dry mouth with chewing gum, lozenges, or mints that are sugar free. Look for Xylitol, a non-sucrose sweetener, which in recent years has been shown to have anti-cavity properties. Eat fibrous fruits and vegetables: One of the best ways to remove bacteria in the mouth is to eat an apple a day. It helps moisten the mouth, too. Take a dietary supplement: Vitamin C, Vitamin D, Vitamin E, and Vitamin B are effective at helping your body eliminate excess mucus and toxins naturally. Brush your teeth occasionally with baking soda: The bacteria that cause bad breath thrive in an acidic oral environment. Brushing your teeth with baking soda helps neutralize excess acids found in the oral cavity. 12 Easy Ways to Prevent Bad Breath Please remember, preventing halitosis is always easier than treating it. By developing the right habits, you can effectively help prevent it. Eat foods rich in fiber: High fiber foods help prevent halitosis. Avoid eating heavily processed foods that contain refined carbohydrates such as cookies, cakes, sweets and ice cream. Use mouthwash: Some mouthwashes or oral rinses are effective at preventing bad breath. However, you should never use alcohol based mouthwashes because the alcohol makes the mouth very dry, which will actually make the problem worse. Drink green and black teas: They contain polyphenols that help eliminate sulfur compounds and reduce oral bacteria. Avoid drying medication: Try not to take antidepressants, diuretics, pain relievers, and antihistamines unless it is absolutely medically necessary. These drugs inhibit saliva flow and can cause chronic dry mouth. Avoid products with sodium lauryl sulfate or alcohol: Do not use any oral hygiene products that contain sodium lauryl sulfate or alcohol because the alcohol makes the mouth very dry, one of the most common causes of bad breath. Clean your mouth after eating meat, fish or dairy products: Practicing consistent and thorough oral hygiene is an effective prevention tool. Stop smoking: Studies have shown that smokers are at higher risk of developing periodontal disease and dry mouth. Furthermore, people who smoke may also engage in other habits that promote this condition such as dieting, drinking alcohol, and suffering from chronic anxiety conditions that require exacerbating prescription medications. Breathe through your nose instead of your mouth: Try to address any snoring or sleep apnea issues that could be affecting your breath and causing dry mouth. Drink water: Keep your mouth moist by drinking plenty of water. Clean your dentures at least once a day: Practice the same, proper oral care that you would with your original teeth. Eliminate dairy products from your diet: Lactose intolerance can be an underlying cause of halitosis. Use an oral probiotic like S. Salivarius K12 and M18: Use probiotics to balance the oral cavity and prevent an overgrowth of the odor-causing bacteria involved in halitosis. 

0 person found this helpful

Dr. Isha MalhotraBDSDentist

93% (7863 ratings)

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Four Common Bad Breath Causes There are many underlying causes of halitosis, but four of them are very common. Dry mouth: Xerostomia, the medical term for dry mouth, provides a perfect environment for anaerobic bacteria reproduction. Long periods of speaking, smoking, drinking alcohol, and snoring are a few common underlying causes. Most people experience foul breath in the morning due to lack of saliva production while they sleep. For healthy individuals, food odors are temporary and normal salivary flow will eliminate them within several minutes. However, those who suffer from dry mouth and lack of saliva find that even minor food odors may lead to long-term issues. Foods: Halitosis can be exacerbated by certain foods such as onions and garlic because they contain smelly sulfur compounds, while dairy, meat, and fish contain dense proteins which are used as a food source by the anaerobic, sulfur-producing bacteria. Refined and processed sugars also provide a food source for bacteria. Coffee and juices can contribute to this problem because they are acidic and provide these bacteria with an ideal breeding environment. Poor dental hygiene: Inadequate oral care causes bacterial buildup on the teeth and gums. Teeth cannot shed their surfaces the way skin can, so microorganisms can easily attach to the teeth and remain there for extended periods. If they are not continuously removed by adequate brushing, these bacteria develop into something called biofilm, commonly known as dental plaque. When plaque is allowed to accumulate near the gumline, it will harden and begin destroying teeth and gum tissues due to intense bacterial activity. This leads to gum disease such as gingivitis and periodontitis, which enable proteins from bleeding gums and diseased oral tissue to fuel odor-causing bacteria. Tooth decay and poorly fitting or dirty dentures can also contribute to this problem. Illness and disease: According to studies, an estimated 10% of all halitosis cases are caused by certain illnesses. Individuals who suffer from diabetes, lung disease, kidney disease, cancer, liver disease, respiratory tract infections, or metabolic disorders often experience chronic foul breath due to dry mouth. Sinusitis, pneumonia, bronchitis, postnasal drip, and polyps affect the airways and may also contribute to the problem. Other common illnesses associated with bad breath include nasal odor and tonsil stones, yeast infections of the mouth, and gum disease. Certain drugs such as antidepressants, high blood pressure medications, and antihistamines can factor into dry mouth because they reduce saliva production. Please Note: Halitosis is rarely associated with life-threatening diseases. However, it is important that you consult your doctor or dentist as soon as you notice consistent white spots on the tonsils and sores in the mouth with or without a fever. Sometimes bad breath is triggered by severe health conditions such as throat or mouth cancers, human immunodeficiency virus (HIV) infection, digestive system disorders, or diabetes – and further, can indicate dehydration or zinc deficiency. Taking proper care of your teeth and visiting the dentist at least twice a year are the easiest ways to avoid these issues. Halitosis Symptoms Offensive breath tells us that something is out of balance. In fact, anthropologists have reported that once humans started to kiss each other, the ability to smell one another's breath became a very important way to test a partner's compatibility. If the other person didn't pass the smell test, they were not able to get to the next step towards securing a mate. Halitosis is a medical condition that lowers self-esteem and affects everyday life and personal relationships. People with chronic or recurring bad breath often lose their self-confidence. It can be difficult to know if you have this problem, because it is often challenging to pick up on one's own scent. Furthermore, family members and colleagues may not feel comfortable telling you. One of the best ways to find out if you have foul breath is to lick the inside of your wrist, wait five seconds, and then take a whiff. Most symptoms of halitosis depend on the underlying cause. The most common symptoms include postnasal drip, a bitter metallic taste, a white coating on the tongue, and thick saliva. Many individuals who have foul breath associated with dry mouth can experience difficulty speaking or swallowing, a burning sensation in the mouth, or dry eyes. Fever, sore throat, persistent cough, and swollen lymph nodes in the neck indicate respiratory tract infections, which can also be a contributing factor. Getting a Proper Diagnosis The best way to truly identify the source of chronic halitosis is to visit a dentist or doctor for a professional diagnosis. When you are ready to tackle this situation, be sure to be open and honest with the healthcare professional performing the examination. It is important for him or her to understand all the health problems you are experiencing in order to determine the underlying cause and recommend appropriate treatment. The Halimeter (also known as a portable sulfide gas monitor) is the most commonly used clinical diagnostic instrument utilized in this field. It measures the concentration of hydrogen sulfide in parts per billion (ppb) in mouth air. The Halimeter uses a patented electrochemical voltammetric sensor, which has provided reproducible results to clinicians for the past 20 years. It has been demonstrated hundreds of times on national and local television by Dr. Harold Katz on programs such as The View, Good Morning America, and CBS Morning News. Getting Proper Treatment For more than a century, pharmaceutical companies attempted to alleviate halitosis by using mouthwash that contained alcohol. This is the exact opposite of what should be done because alcohol is a drying agent. Clinicians have learned a good deal in the ensuing years, and in most cases, this condition can be successfully treated. Like the symptoms, treatment depends on the underlying cause. It is important to keep in mind that you cannot eliminate the bacteria from the tongue that cause bad breath. Consequently, scraping or brushing the tongue is a temporary remedy at best, and is typically frustrating for those who believe tongue scraping or tongue brushing is a permanent solution. The bacteria that cause this are part of your normal oral flora and are essential to breaking down proteins, a key step in normal digestion. A much simpler and clinically-proven method to treat bad breath is to interrupt the bacteria's chemical production of odors by introducing oxygenating compounds to your oral environment. Oxygen is the natural enemy of the bacteria that cause this problem because they are anaerobes and cannot function in the presence of oxygen. In general, a dentist will recommend mouthwashes and toothpastes that contain oxygenating agents such as chlorine dioxide or sodium chlorite to neutralize volatile sulfur compounds and help control odor causing bacteria found in the mouth. If you are experiencing mouth dryness, your dentist will recommend a saliva substitute to moisten the mouth throughout the day. Some effective, natural ingredients to look for in oral care products are zinc gluconate, aloe vera, green tea, tea tree oil, xylitol, CoQ10, glycyrrhizic acid and oral probiotics like K12 and M18. Six Bad Breath Home Remedies The practice of a few, simple, self-care techniques can help to minimize halitosis. There are several things you can do at home. Advanced oral care products: Use oral care products such as mouthwashes and toothpastes that have been shown to be effective in fighting bad breath. Proper oral care: Brush and floss your teeth at least twice a day. Be sure to get a toothbrush with soft bristles (as to not damage tooth enamel or gums) and also use fluoride toothpaste. Brushing and flossing helps to remove any food and plaque which can be used as a fuel source by the anaerobic, sulfur-producing bacteria that are at the root of this problem. Stimulate your salivary flow: Prevent dry mouth with chewing gum, lozenges, or mints that are sugar free. Look for Xylitol, a non-sucrose sweetener, which in recent years has been shown to have anti-cavity properties. Eat fibrous fruits and vegetables: One of the best ways to remove bacteria in the mouth is to eat an apple a day. It helps moisten the mouth, too. Take a dietary supplement: Vitamin C, Vitamin D, Vitamin E, and Vitamin B are effective at helping your body eliminate excess mucus and toxins naturally. Brush your teeth occasionally with baking soda: The bacteria that cause bad breath thrive in an acidic oral environment. Brushing your teeth with baking soda helps neutralize excess acids found in the oral cavity. 12 Easy Ways to Prevent Bad Breath Please remember, preventing halitosis is always easier than treating it. By developing the right habits, you can effectively help prevent it. Eat foods rich in fiber: High fiber foods help prevent halitosis. Avoid eating heavily processed foods that contain refined carbohydrates such as cookies, cakes, sweets and ice cream. Use mouthwash: Some mouthwashes or oral rinses are effective at preventing bad breath. However, you should never use alcohol based mouthwashes because the alcohol makes the mouth very dry, which will actually make the problem worse. Drink green and black teas: They contain polyphenols that help eliminate sulfur compounds and reduce oral bacteria. Avoid drying medication: Try not to take antidepressants, diuretics, pain relievers, and antihistamines unless it is absolutely medically necessary. These drugs inhibit saliva flow and can cause chronic dry mouth. Avoid products with sodium lauryl sulfate or alcohol: Do not use any oral hygiene products that contain sodium lauryl sulfate or alcohol because the alcohol makes the mouth very dry, one of the most common causes of bad breath. Clean your mouth after eating meat, fish or dairy products: Practicing consistent and thorough oral hygiene is an effective prevention tool. Stop smoking: Studies have shown that smokers are at higher risk of developing periodontal disease and dry mouth. Furthermore, people who smoke may also engage in other habits that promote this condition such as dieting, drinking alcohol, and suffering from chronic anxiety conditions that require exacerbating prescription medications. Breathe through your nose instead of your mouth: Try to address any snoring or sleep apnea issues that could be affecting your breath and causing dry mouth. Drink water: Keep your mouth moist by drinking plenty of water. Clean your dentures at least once a day: Practice the same, proper oral care that you would with your original teeth. Eliminate dairy products from your diet: Lactose intolerance can be an underlying cause of halitosis. Use an oral probiotic like S. Salivarius K12 and M18: Use probiotics to balance the oral cavity and prevent an overgrowth of the odor-causing bacteria involved in halitosis. There are many causes of a white tongue ranging from benign to potentially serious. It is important to see your dentist every six months or sooner if you are concerned. A healthy tongue is pink, painless, and covered with tiny bumps called papillae. These can become irritated and appear white in color. Waking up with a a white tongue in the morning might just be due to poor hygiene. Make sure to brush your teeth and tongue twice a day. Another common reason for a white tongue in the morning is if you have been breathing through your mouth instead of your nose the night before which will dry out your mouth. This is commonly due to allergies or a cold. Dehydration, smoking, and medications that cause dry mouth can also cause a white tongue. If your symptoms resolve after getting a drink in the morning it is likely due to one of the above mentioned causes of dry mouth. Another cause of white tongue is thrush, which is a yeast infection in the mouth and requires treatment. Other less likely conditions which cause a white tongue are leukoplakia which is a potential precursor to cancer and oral lichen planus which causes a lacy white pattern on your tongue and its cause is often unknown. As it is not possible to diagnose your condition without an exam please see your dentist or primary care provider. 

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Dr. Isha MalhotraBDSDentist

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Four Common Bad Breath Causes There are many underlying causes of halitosis, but four of them are very common. Dry mouth: Xerostomia, the medical term for dry mouth, provides a perfect environment for anaerobic bacteria reproduction. Long periods of speaking, smoking, drinking alcohol, and snoring are a few common underlying causes. Most people experience foul breath in the morning due to lack of saliva production while they sleep. For healthy individuals, food odors are temporary and normal salivary flow will eliminate them within several minutes. However, those who suffer from dry mouth and lack of saliva find that even minor food odors may lead to long-term issues. Foods: Halitosis can be exacerbated by certain foods such as onions and garlic because they contain smelly sulfur compounds, while dairy, meat, and fish contain dense proteins which are used as a food source by the anaerobic, sulfur-producing bacteria. Refined and processed sugars also provide a food source for bacteria. Coffee and juices can contribute to this problem because they are acidic and provide these bacteria with an ideal breeding environment. Poor dental hygiene: Inadequate oral care causes bacterial buildup on the teeth and gums. Teeth cannot shed their surfaces the way skin can, so microorganisms can easily attach to the teeth and remain there for extended periods. If they are not continuously removed by adequate brushing, these bacteria develop into something called biofilm, commonly known as dental plaque. When plaque is allowed to accumulate near the gumline, it will harden and begin destroying teeth and gum tissues due to intense bacterial activity. This leads to gum disease such as gingivitis and periodontitis, which enable proteins from bleeding gums and diseased oral tissue to fuel odor-causing bacteria. Tooth decay and poorly fitting or dirty dentures can also contribute to this problem. Illness and disease: According to studies, an estimated 10% of all halitosis cases are caused by certain illnesses. Individuals who suffer from diabetes, lung disease, kidney disease, cancer, liver disease, respiratory tract infections, or metabolic disorders often experience chronic foul breath due to dry mouth. Sinusitis, pneumonia, bronchitis, postnasal drip, and polyps affect the airways and may also contribute to the problem. Other common illnesses associated with bad breath include nasal odor and tonsil stones, yeast infections of the mouth, and gum disease. Certain drugs such as antidepressants, high blood pressure medications, and antihistamines can factor into dry mouth because they reduce saliva production. Please Note: Halitosis is rarely associated with life-threatening diseases. However, it is important that you consult your doctor or dentist as soon as you notice consistent white spots on the tonsils and sores in the mouth with or without a fever. Sometimes bad breath is triggered by severe health conditions such as throat or mouth cancers, human immunodeficiency virus (HIV) infection, digestive system disorders, or diabetes – and further, can indicate dehydration or zinc deficiency. Taking proper care of your teeth and visiting the dentist at least twice a year are the easiest ways to avoid these issues. Halitosis Symptoms Offensive breath tells us that something is out of balance. In fact, anthropologists have reported that once humans started to kiss each other, the ability to smell one another's breath became a very important way to test a partner's compatibility. If the other person didn't pass the smell test, they were not able to get to the next step towards securing a mate. Halitosis is a medical condition that lowers self-esteem and affects everyday life and personal relationships. People with chronic or recurring bad breath often lose their self-confidence. It can be difficult to know if you have this problem, because it is often challenging to pick up on one's own scent. Furthermore, family members and colleagues may not feel comfortable telling you. One of the best ways to find out if you have foul breath is to lick the inside of your wrist, wait five seconds, and then take a whiff. Most symptoms of halitosis depend on the underlying cause. The most common symptoms include postnasal drip, a bitter metallic taste, a white coating on the tongue, and thick saliva. Many individuals who have foul breath associated with dry mouth can experience difficulty speaking or swallowing, a burning sensation in the mouth, or dry eyes. Fever, sore throat, persistent cough, and swollen lymph nodes in the neck indicate respiratory tract infections, which can also be a contributing factor. Getting a Proper Diagnosis The best way to truly identify the source of chronic halitosis is to visit a dentist or doctor for a professional diagnosis. When you are ready to tackle this situation, be sure to be open and honest with the healthcare professional performing the examination. It is important for him or her to understand all the health problems you are experiencing in order to determine the underlying cause and recommend appropriate treatment. The Halimeter (also known as a portable sulfide gas monitor) is the most commonly used clinical diagnostic instrument utilized in this field. It measures the concentration of hydrogen sulfide in parts per billion (ppb) in mouth air. The Halimeter uses a patented electrochemical voltammetric sensor, which has provided reproducible results to clinicians for the past 20 years. It has been demonstrated hundreds of times on national and local television by Dr. Harold Katz on programs such as The View, Good Morning America, and CBS Morning News. Getting Proper Treatment For more than a century, pharmaceutical companies attempted to alleviate halitosis by using mouthwash that contained alcohol. This is the exact opposite of what should be done because alcohol is a drying agent. Clinicians have learned a good deal in the ensuing years, and in most cases, this condition can be successfully treated. Like the symptoms, treatment depends on the underlying cause. It is important to keep in mind that you cannot eliminate the bacteria from the tongue that cause bad breath. Consequently, scraping or brushing the tongue is a temporary remedy at best, and is typically frustrating for those who believe tongue scraping or tongue brushing is a permanent solution. The bacteria that cause this are part of your normal oral flora and are essential to breaking down proteins, a key step in normal digestion. A much simpler and clinically-proven method to treat bad breath is to interrupt the bacteria's chemical production of odors by introducing oxygenating compounds to your oral environment. Oxygen is the natural enemy of the bacteria that cause this problem because they are anaerobes and cannot function in the presence of oxygen. In general, a dentist will recommend mouthwashes and toothpastes that contain oxygenating agents such as chlorine dioxide or sodium chlorite to neutralize volatile sulfur compounds and help control odor causing bacteria found in the mouth. If you are experiencing mouth dryness, your dentist will recommend a saliva substitute to moisten the mouth throughout the day. Some effective, natural ingredients to look for in oral care products are zinc gluconate, aloe vera, green tea, tea tree oil, xylitol, CoQ10, glycyrrhizic acid and oral probiotics like K12 and M18. Six Bad Breath Home Remedies The practice of a few, simple, self-care techniques can help to minimize halitosis. There are several things you can do at home. Advanced oral care products: Use oral care products such as mouthwashes and toothpastes that have been shown to be effective in fighting bad breath. Proper oral care: Brush and floss your teeth at least twice a day. Be sure to get a toothbrush with soft bristles (as to not damage tooth enamel or gums) and also use fluoride toothpaste. Brushing and flossing helps to remove any food and plaque which can be used as a fuel source by the anaerobic, sulfur-producing bacteria that are at the root of this problem. Stimulate your salivary flow: Prevent dry mouth with chewing gum, lozenges, or mints that are sugar free. Look for Xylitol, a non-sucrose sweetener, which in recent years has been shown to have anti-cavity properties. Eat fibrous fruits and vegetables: One of the best ways to remove bacteria in the mouth is to eat an apple a day. It helps moisten the mouth, too. Take a dietary supplement: Vitamin C, Vitamin D, Vitamin E, and Vitamin B are effective at helping your body eliminate excess mucus and toxins naturally. Brush your teeth occasionally with baking soda: The bacteria that cause bad breath thrive in an acidic oral environment. Brushing your teeth with baking soda helps neutralize excess acids found in the oral cavity. 12 Easy Ways to Prevent Bad Breath Please remember, preventing halitosis is always easier than treating it. By developing the right habits, you can effectively help prevent it. Eat foods rich in fiber: High fiber foods help prevent halitosis. Avoid eating heavily processed foods that contain refined carbohydrates such as cookies, cakes, sweets and ice cream. Use mouthwash: Some mouthwashes or oral rinses are effective at preventing bad breath. However, you should never use alcohol based mouthwashes because the alcohol makes the mouth very dry, which will actually make the problem worse. Drink green and black teas: They contain polyphenols that help eliminate sulfur compounds and reduce oral bacteria. Avoid drying medication: Try not to take antidepressants, diuretics, pain relievers, and antihistamines unless it is absolutely medically necessary. These drugs inhibit saliva flow and can cause chronic dry mouth. Avoid products with sodium lauryl sulfate or alcohol: Do not use any oral hygiene products that contain sodium lauryl sulfate or alcohol because the alcohol makes the mouth very dry, one of the most common causes of bad breath. Clean your mouth after eating meat, fish or dairy products: Practicing consistent and thorough oral hygiene is an effective prevention tool. Stop smoking: Studies have shown that smokers are at higher risk of developing periodontal disease and dry mouth. Furthermore, people who smoke may also engage in other habits that promote this condition such as dieting, drinking alcohol, and suffering from chronic anxiety conditions that require exacerbating prescription medications. Breathe through your nose instead of your mouth: Try to address any snoring or sleep apnea issues that could be affecting your breath and causing dry mouth. Drink water: Keep your mouth moist by drinking plenty of water. Clean your dentures at least once a day: Practice the same, proper oral care that you would with your original teeth. Eliminate dairy products from your diet: Lactose intolerance can be an underlying cause of halitosis. Use an oral probiotic like S. Salivarius K12 and M18: Use probiotics to balance the oral cavity and prevent an overgrowth of the odor-causing bacteria involved in halitosis. 

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Dr. S.K. TandonM.D. Consultant Pathologist, CCEBDM Diabetes, PGDS Sexology USA, CCMTD Thyroid, ACDMC Heart Disease, CCMH Hypertension, ECGSexologist

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H1N1 influenza is sometimes called "swine flu" because it is usually found in pigs. You cannot become infected with H1N1 influenza from eating pork products. The injectable form of H1N1 influenza virus vaccine is a "killed virus" vaccine and will not cause you to become ill with the flu virus that it contains. View Slideshows Natural Cold & Flu Remedies Slideshow Anatomy of a Sore Throat Slideshow Flu Slideshow: 10 Foods to Eat When You Have the Flu Related Diseases Images & Quizzes Index Natural Cold & Flu Remedies Slideshow Anatomy of a Sore Throat Slideshow Flu Slideshow: 10 Foods to Eat When You Have the Flu Patient Comments: Swine Flu - Concerns and Risks Patient Comments: Swine Flu - Symptoms and Signs Patient Comments: Swine Flu - Treatment Swine flu (H1N1 and H3N2v influenza virus) facts What is the swine flu? How is swine flu transmitted? Is swine flu contagious? What is the incubation period for swine flu? What is the contagious period for swine flu? How long does the swine flu last? What causes swine flu? Why is swine flu now infecting humans? What are swine flu symptoms and signs? What tests do health care professionals use to diagnose swine flu? What types of health care professionals treat swine flu? What is the treatment for swine flu? What is the history of swine flu in humans? What are the risk factors for swine flu? Is it possible to prevent swine flu with a vaccine? Is it possible to prevent swine flu if the swine flu vaccine (or other flu strain vaccines) is not readily available? Are there home remedies for swine flu? Was swine flu (H1N1) a cause of an epidemic or pandemic in the 2009-2010 flu season? What is the prognosis (outlook) and complications for patients who get swine flu? Where can I find more information about swine flu (H1N1 and H3N2v)? Swine flu (H1N1 and H3N2v influenza virus) facts Swine flu is a respiratory disease caused by influenza viruses that infect the respiratory tract of pigs and result in a barking cough, decreased appetite, nasal secretions, and listless behavior; the virus can be transmitted to humans. Swine flu viruses may mutate (change) so that they are easily transmissible among humans. The April 2009 swine flu outbreak (pandemic) was due to infection with the H1N1 virus and was first observed in Mexico. Symptoms of swine flu in humans are similar to most influenza infections: fever (100 F or greater), cough, nasal secretions, fatigue, and headache. The incubation period for the disease is about one to four days. Swine flu is contagious about one day before symptoms develop to about five to seven days after symptoms develop; some patients may be contagious for a longer time span. The disease lasts about three to seven days with more serious infections lasting about nine to 10 days. Vaccination is the best way to prevent or reduce the chances of becoming infected with influenza viruses. Primary-care specialists, pediatricians, and emergency-medicine doctors usually treat the disease, but other specialists may be consulted if the flu is severe and/or complicated. Two antiviral agents, zanamivir (Relenza) and oseltamivir (Tamiflu), have been reported to help prevent or reduce the effects of swine flu if taken within 48 hours of the onset of symptoms. Some researchers disagree and suggest the antiviral agents have no effect. There are various methods listed in this article to help individuals from getting the flu. Home remedies are available, but patients should check with their doctors before use; over-the-counter medications may help reduce symptoms. The most serious complication of the flu is pneumonia. What is the swine flu? Swine flu (swine influenza) is a respiratory disease caused by viruses (influenza viruses) that infect the respiratory tract of pigs, resulting in nasal secretions, a barking cough, decreased appetite, and listless behavior. Swine flu produces most of the same symptoms in pigs as human flu produces in people. Swine flu can last about one to two weeks in pigs that survive. Swine influenza virus was first isolated from pigs in 1930 in the U.S. And has been recognized by pork producers and veterinarians to cause infections in pigs worldwide. In a number of instances, people have developed the swine flu infection when they are closely associated with pigs (for example, farmers, pork processors), and likewise, pig populations have occasionally been infected with the human flu infection. In most instances, the cross-species infections (swine virus to man; human flu virus to pigs) have remained in local areas and have not caused national or worldwide infections in either pigs or humans. Unfortunately, this cross-species situation with influenza viruses has had the potential to change. Investigators decided the 2009 so-called "swine flu" strain, first seen in Mexico, should be termed novel H1N1 flu since it was mainly found infecting people and exhibits two main surface antigens, H1 (hemagglutinin type 1) and N1 (neuraminidase type 1). The eight RNA strands from novel H1N1 flu have one strand derived from human flu strains, two from avian (bird) strains, and five from swine strains. How is swine flu transmitted? Is swine flu contagious? Swine influenza is transmitted from person to person by inhalation or ingestion of droplets containing virus from people sneezing or coughing; it is not transmitted by eating cooked pork products. The newest swine flu virus that has caused swine flu is influenza A H3N2v (commonly termed H3N2v) that began as an outbreak in 2011. The "v" in the name means the virus is a variant that normally infects only pigs but has begun to infect humans. There have been small outbreaks of H1N1 influenza since the pandemic; a recent one is in India where at least three people have died. Quick Guide Common Respiratory Illnesses Common Respiratory Illnesses What to Do if You Think You Have H1N1 Swine Flu Virus If you've got fever, cough, or one of the other symptoms of the flu, you may be wondering if you have contracted the H1N1 swine flu virus. The reality is that it isn't possible to know unless specialized testing is ordered, and for uncomplicated cases of the flu in non-hospitalized patients, routine testing for the H1N1 virus is not being carried out. Learn when to seek medical care for H1N1 swine flu symptoms » What is the incubation period for swine flu? The incubation period for swine flu is about one to four days, with the average being two days; in some people, the incubation period may be as long as about seven days in adults and children. What is the contagious period for swine flu? The contagious period for swine influenza in adults usually begins one day before symptoms develop in an adult and it lasts about five to seven days after the person becomes sick. However, people with weakened immune systems and children may be contagious for a longer period of time (for example, about 10 to 14 days). How long does the swine flu last? In uncomplicated infections, swine flu typically begins to resolve after three to seven days, but the malaise and cough can persist two weeks or more in some patients. Severe swine flu may require hospitalization that increases the length of time of infection to about nine to 10 days. What causes swine flu? The cause of the 2009 swine flu was an influenza A virus type designated as H1N1. In 2011, a new swine flu virus was detected. The new strain was named influenza A (H3N2) v. Only a few people (mainly children) were first infected, but officials from the U.S. Centers for Disease Control and Prevention (CDC) reported increased numbers of people infected in the 2012-2013 flu season. Currently, there are not large numbers of people infected with H3N2v. Unfortunately, another virus termed H3N2 (note no "v" in its name) has been detected and caused flu, but this strain is different from H3N2v. In general, all of the influenza A viruses have a structure similar to the H1N1 virus; each type has a somewhat different H and/or N structure. Why is swine flu now infecting humans? Many researchers now consider that two main series of events can lead to swine flu (and also avian or bird flu) becoming a major cause for influenza illness in humans. First, the influenza viruses (types A, B, C) are enveloped RNA viruses with a segmented genome; this means the viral RNA genetic code is not a single strand of RNA but exists as eight different RNA segments in the influenza viruses. A human (or bird) influenza virus can infect a pig respiratory cell at the same time as a swine influenza virus; some of the replicating RNA strands from the human virus can get mistakenly enclosed inside the enveloped swine influenza virus. For example, one cell could contain eight swine flu and eight human flu RNA segments. The total number of RNA types in one cell would be 16; four swine and four human flu RNA segments could be incorporated into one particle, making a viable eight RNA-segmented flu virus from the 16 available segment types. Various combinations of RNA segments can result in a new subtype of virus (this process is known as antigenic shift) that may have the ability to preferentially infect humans but still show characteristics unique to the swine influenza virus (see Figure 1). It is even possible to include RNA strands from birds, swine, and human influenza viruses into one virus if a single cell becomes infected with all three types of influenza (for example, two bird flu, three swine flu, and three human flu RNA segments to produce a viable eight-segment new type of flu viral genome). Formation of a new viral type is considered to be antigenic shift; small changes within an individual RNA segment in flu viruses are termed antigenic drift (see figure 1) and result in minor changes in the virus. However, these small genetic changes can accumulate over time to produce enough minor changes that cumulatively alter the virus' makeup over time (usually years). Second, pigs can play a unique role as an intermediary host to new flu types because pig respiratory cells can be infected directly with bird, human, and other mammalian flu viruses. Consequently, pig respiratory cells are able to be infected with many types of flu and can function as a "mixing pot" for flu RNA segments (see figure 1). Bird flu viruses, which usually infect the gastrointestinal cells of many bird species, are shed in bird feces. Pigs can pick these viruses up from the environment, and this seems to be the major way that bird flu virus RNA segments enter the mammalian flu virus population. Figure 1 shows this process in H1N1, but the figure represents the genetic process for all flu viruses, including human, swine, and avian strains. Picture of antigenic shift and antigenic drift in swine flu (H1N1). Figure 1. What are swine flu symptoms and signs? Readers Comments 7 Share Your Story Symptoms of swine flu are similar to most influenza infections: fever (100 F or greater), cough (usually dry), nasal secretions, fatigue, and headache, with fatigue being reported in most infected individuals. Some patients may also get a sore throat, rash, body (muscle) aches or pains, headaches, chills, nausea, vomiting, and diarrhea. In Mexico, many of the initial patients infected with H1N1 influenza were young adults, which made some investigators speculate that a strong immune response, as seen in young people, may cause some collateral tissue damage. The incubation period from exposure to first symptoms is about one to four days, with an average of two days. The symptoms last about one to two weeks and can last longer if the person has a severe infection. Some patients develop severe respiratory symptoms, such as shortness of breath, and need respiratory support (such as a ventilator to breathe for the patient). Patients can get pneumonia (bacterial secondary infection) if the viral infection persists, and some can develop seizures. Death often occurs from secondary bacterial infection of the lungs; appropriate antibiotics need to be used in these patients. The usual mortality (death) rate for typical influenza A is about 0.1%, while the 1918 "Spanish flu" epidemic had an estimated mortality rate ranging from 2%-20%. Swine (H1N1) flu in Mexico had about 160 deaths and about 2,500 confirmed cases, which would correspond to a mortality rate of about 6%, but these initial data were revised and the mortality rate worldwide was estimated to be much lower. Fortunately, the mortality rate of H1N1 remained low and similar to that of the conventional flu (average conventional flu mortality rate is about 36,000 per year; projected H1N1 flu mortality rate was 90,000 per year in the U.S. As determined by the president's advisory committee, but it never approached that high number). Fortunately, although H1N1 developed into a pandemic (worldwide) flu strain, the mortality rate in the U.S. And many other countries only approximated the usual numbers of flu deaths worldwide. Speculation about why the mortality rate remained much lower than predicted includes increased public awareness and action that produced an increase in hygiene (especially hand washing), a fairly rapid development of a new vaccine, and patient self-isolation if symptoms developed. What tests do health care professionals use to diagnose swine flu? Swine flu is presumptively diagnosed clinically by the patient's history of association with people known to have the disease and their symptoms listed above. Usually, a quick test (for example, nasopharyngeal swab sample) is done to see if the patient is infected with influenza A or B virus. Most of the tests can distinguish between A and B types. The test can be negative (no flu infection) or positive for type A and B. If the test is positive for type B, the flu is not likely to be swine flu. If it is positive for type A, the person could have a conventional flu strain or swine flu. However, the accuracy of these tests has been challenged, and the U.S. Centers for Disease Control and Prevention (CDC) has not completed their comparative studies of these tests. However, a new test developed by the CDC and a commercial company reportedly can detect H1N1 reliably in about one hour; the test was formerly only available to the military. In 2010, the FDA approved a commercially available test that could detect H1N1 within four hours. Most of these rapid tests are based on PCR technology. Swine flu is definitively diagnosed by identifying the particular antigens (surface proteins) associated with the virus type. In general, this test is done in a specialized laboratory and is not done by many doctors' offices or hospital laboratories. However, doctors' offices are able to send specimens to specialized laboratories if necessary. Because of the large number of novel H1N1 swine flu cases that occurred in the 2009-2010 flu season (the vast majority of flu cases [about 95%-99%] were due to novel H1N1 flu viruses), the CDC recommended only hospitalized patients' flu virus strains be sent to reference labs to be identified. H3N2v flu strains and other flu virus strains are diagnosed by similar methods. What types of health care professionals treat swine flu? Almost all uncomplicated patients with swine flu can be treated at home or by the patient's pediatrician, primary-care provider, or emergency-medicine doctor. For more complicated and/or severe swine flu infections, specialists such as critical-care specialists, lung specialists (pulmonologists), and infectious-disease specialists may be consulted. What is the treatment for swine flu? Readers Comments 1 Share Your Story The best treatment for influenza infections in humans is prevention by vaccination. Work by several laboratories has produced vaccines. The first H1N1 vaccine released in early October 2009 was a nasal spray vaccine that was approved for use in healthy individuals ages 2-49. The injectable vaccine, made from killed H1N1, became available in the second week of Oct. 2009. This vaccine was approved for use in ages 6 months to the elderly, including pregnant females. Both of these vaccines were approved by the CDC only after they had conducted clinical trials to prove that the vaccines were safe and effective. A new influenza vaccine preparation is the intradermal (trivalent) vaccine is available; it works like the shot except the administration is less painful. It is approved for ages 18-64 years. Almost all vaccines have some side effects. Common side effects of H1N1 vaccines (alone or in combination with other flu viral strains) are typical of flu vaccines used over many years and are as follows: Flu shot: Soreness, redness, minor swelling at the shot site, muscle aches, low-grade fever, and nausea do not usually last more than about 24 hours. Nasal spray: runny nose, low-grade fever, vomiting, headache, wheezing, cough, and sore throat Intradermal shot: redness, swelling, pain, headache, muscle aches, fatigue The flu shot (vaccine) is made from killed virus particles so a person cannot get the flu from a flu shot. However, the nasal spray vaccine contains live virus that have been altered to hinder its ability to replicate in human tissue. People with a suppressed immune system should not get vaccinated with the nasal spray. Also, most vaccines that contain flu viral particles are cultivated in eggs, so individuals with an allergy to eggs should not get the vaccine unless tested and advised by their doctor that they are cleared to obtain it. Like all vaccines, rare events may occur in some rare cases (for example, swelling, weakness, or shortness of breath). About one person in a million who gets the vaccine may develop a neurological problem termed Guillain-Barré syndrome, which can cause weakness or paralysis, difficulty breathing, bladder and/or bowel problems, and other nerve problems. If any symptoms like these develop, see a physician immediately. Two antiviral agents have been reported to help prevent or reduce the effects of swine flu. They are zanamivir (Relenza) and oseltamivir (Tamiflu), both of which are also used to prevent or reduce influenza A and B symptoms. These drugs should not be used indiscriminately, because viral resistance to them can and has occurred. Also, they are not recommended if the flu symptoms already have been present for 48 hours or more, although hospitalized patients may still be treated past the 48-hour guideline. Severe infections in some patients may require additional supportive measures such as ventilation support and treatment of other infections like pneumonia that can occur in patients with a severe flu infection. The CDC has suggested in their guidelines that pregnant females can be treated with the two antiviral agents. Some researchers suggest the data on Tamiflu and Relenza is not correct and suggest the antivirals are not effective. On Dec. 22, 2014, the FDA approved the first new anti-influenza drug (for H1N1 and other influenza virus types) in 15 years, peramivir injection (Rapivab). It is approved for use in the following settings: Diarrhea, skin infections, hallucinations, and/or altered behavior may occur as side effects of this drug. Adult patients for whom therapy with an intravenous (IV) medication is clinically appropriate, based upon one or more of the following reasons: The patient is not responding to either oral or inhaled antiviral therapy, or drug delivery by a route other than IV is not expected to be dependable or is not feasible, or the physician decides that IV therapy is appropriate due to other circumstances. Pediatric patients for whom an intravenous medication clinically appropriate because: The patient is not responding to either oral or inhaled antiviral therapy, or drug delivery by a route other than IV is not expected to be dependable or is not feasible. What is the history of swine flu in humans? In 1976, there was an outbreak of swine flu at Fort Dix. This virus was not the same as the 2009 H1N1 outbreak, but it was similar insofar as it was an influenza A virus that had similarities to the swine flu virus. There was one death at Fort Dix. The government decided to produce a vaccine against this virus, but the vaccine was associated with rare instances of neurological complications (Guillain-Barré syndrome) and was discontinued. Some individuals speculate that formalin, used to inactivate the virus, may have played a role in the development of this complication in 1976. One of the reasons it takes a few months to develop a new vaccine is to test the vaccine for safety to avoid the complications seen in the 1976 vaccine. Individuals with active infections or diseases of the nervous system are also not recommended to get flu vaccines. Early in the spring of 2009, H1N1 flu virus was first detected in Mexico, causing some deaths among a "younger" population. It began increasing during the summer 2009 and rapidly circulated to the U.S. And to Europe and eventually worldwide. The WHO declared it first fit their criteria for an epidemic and then, in June 2009, the WHO declared the first flu pandemic in 41 years. There was a worldwide concern and people began to improve in hand washing and other prevention methods while they awaited vaccine development. The trivalent vaccine made for the 2009-2010 flu season offered virtually no protection from H1N1. New vaccines were developed (both live and killed virus) and started to become available in Sept. 2009-Oct. 2009. The CDC established a protocol guideline for those who should get the vaccine first. By late December to January, a vaccine against H1N1 was available in moderate supply worldwide. The numbers of infected patients began to recede and the pandemic ended. However, a strain of H1N1 was incorporated into the yearly trivalent vaccine for the 2010-2011 flu season because the virus was present in the world populations. As stated in the first section of this article, a new strain of swine flu, (H3N2) v, was detected in 2011; it has not affected any large numbers of people in the current flu season. However, another antigenically distinct virus with the same H and N components (termed H3N2 (note no "v") has caused flu in humans; viral antigens were incorporated into the 2013-2014 seasonal flu shots and nasal spray vaccines. In India in 2015-2016, a large outbreak of swine flu has been ongoing; there are some researchers who claim the strain of virus has mutated slightly and has become able to cause more severe infections. What are the risk factors for swine flu? Readers Comments 32 Share Your Story Vaccination to prevent influenza is particularly important for people who are at increased risk for severe complications from influenza or at higher risk for influenza-related doctor or hospital visits. When vaccine supply is limited, vaccination efforts should focus on delivering vaccination to the following people since these populations have a higher risk for H1N1 and some other viral infections according to the CDC: All children 6 months to 4 years (59 months) of age All people 50 years of age and older Adults and children who have chronic pulmonary (including asthma) or cardiovascular (except isolated hypertension), renal, hepatic, neurological, hematologic, or metabolic disorders (including diabetes mellitus) People who have immunosuppression (including immunosuppression caused by medications or by HIV) Women who are or will be pregnant during the influenza season Children and adolescents (6 months to 18 years of age) who are receiving long-term aspirin therapy and who might be at risk for experiencing Reye's syndrome after influenza virus infection Residents of nursing homes and other long-term-care facilities American Indians/Alaska natives People who are morbidly obese (BMI ≥40) Health care professionals (doctors, nurses, health care personnel treating patients) Household contacts and caregivers of children under 5 years of age and adults 50 years of age and older, with particular emphasis on vaccinating contacts of children less than 6 months age Household contacts and caregivers of people with medical conditions that put them at higher risk for severe complications from influenza. The CDC recommends for the 2014-2015 flu season that everyone 6 months old and older should get a flu shot to prevent or reduce the chance of getting the flu. The best way to prevent novel H1N1 swine flu is vaccination. 

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