Food Poisoning: An Introduction

Food poisoning is an acute gastroenteritis caused by the consumption of a food material or a drink which contains the pathogenic micro organism or their toxins or poisonous chemicals.Food poisoning is common in hostels,hotels,communal feedings, and festivel seasons.

A group of persons will be affected with same type of symptoms ,and they give a history of consumption of a common food before few hours.

Types of food poisoning...

1) Bacterial food poisoning:
Here the micro organisms called bacteria are responsible.The food material may contain the pathogenic bacteriae or their toxin and will be ingested along with the food.

2) Non bacterial food poisoning:
Due to the presence of toxic chemicals like fertilizers,insectisides,heavy metals and ect.

Since bacterial food poisoning is common it is discussed here.
Bacterial food poisoning:
All bacteria are not harmful.There are some pathogenic bacteria which secrete toxins and cause clinical manifestations.These organisms enter the human body through food articles or drinks.

How food poisoning occures:
1) Presence of bacteria in the water.
2) The raw materials for the food may contain toxins.
3) Premises where the food is prepared may contain micro organisms or toxins.
4) Food handlers may have some infectious diseases.
5) Some animals like dogs,rats may contaminate the food.
6) If prepared food is kept in the room temperature for a long time and heated again can make a chance for food poisoning.
7) Purposely some body mixing toxins in the food.

Some common bacterial food poisonings.
1) Salmonella food poisoning:
There are three different varieties of salmonella bacteria.(salmonella typhimurium,salmonella cholera suis,salmonella enteritidis) These bacteria are present in milk, milk products and eggs. Symptoms of this food poisoning include nausea, vomiting and diarrhoea. Fever is also common.

2) Botulism:
This is the dangerous type of food poisoning caused by clostridium botulinum. The spores of these organisms are seen in the soil and enters the human body through pickles and canned fish ect.Compared to other food poisonings here vomiting and diarrhoea are rare Mainly the nervous system is affected.The symptoms starts with double vision,numbness with weakness.Later there will be paralysis with cardiac and respiratory failure ending in death.

3) Staphylococcal food poisoning:
It is caused by staphylo coccus aureus. These organisms usually cause skin troubles like boils and eruptions.It causes mastitis in cow.Through the milk and milk products it enders and causes gastroenteritis.There will be vomiting,abdominal cramps with diarrhoea.

4) Closteridium food poisoning:
This is caused by closteridium perfringens.They are present in stool,soil and water. They enter the body through,meat,meat dishes and egg ect.If food articles are cooked and kept in room temperature for a long time and heated again before eating can result this food poisoning.Symptoms include vomiting ,diarrhoea and abdominal cramps.

5) Bacillus cereus:
The spores of these organisms can survive cooking and causes enteritis. Diarrhoea and vomiting is common in this infection.

How to investigate food poisoning?
1) Examine each and every person affected.
2) Water sample should be tested.
3) Kitchen, store room and food samples should be examined.
4) The cook and food handlers should be questioned and examined.
5) Samples of vomitus and stool of all victims should be tested to identify the bacteria.

How to prevent food poisoning:-
1) Only purified water should be used.
2) Hygiene should be maintained by all persons keeping contact with food.
3) Workers should use masks, cap and gloves during cooking and serving.
4) Sick individuals should not come in contact with food materials.
5) Kitchen and premises should be neat and clean.
6) Vessels should be washed with soap and hot water.
7) Should not keep the prepared food for a long time in room temperature.
8) All food materials should be kept in closed containers.
9) Animals like dog, cat, rat ect should not come in contact with food materials.
10) Vegetables should be washed before cooking.
11) Meat should be fresh and should be purchased from recognised slaughter house.

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Alcohol Effect on Membranes

The parts which first suffer from alcohol are those expansions of the body which the anatomists call the membranes. "The skin is a membranous envelope. Through the whole of the alimentary surface, from the lips downward, and through the bronchial passages to their minutest ramifications, extends the mucous membrane. The lungs, the heart, the liver, the kidneys are folded in delicate membranes, which can be stripped easily from these parts.

If you take a portion of bone, you will find it easy to strip off from it a membranous sheath or covering; if you examine a joint, you will find both the head and the socket lined with membranes. The whole of the intestines are enveloped in a fine membrane called peritoneum .

All the muscles are enveloped in membranes, and the fasciculi, or bundles and fibres of muscles, have their membranous sheathing. The brain and spinal cord are enveloped in three membranes; one nearest to themselves, a pure vascular structure, a network of blood-vessels; another, a thin serous structure; a third, a strong fibrous structure.

The eyeball is a structure of colloidal humors and membranes, and of nothing else. To complete the description, the minute structures of the vital organs are enrolled in membranous matter."

These membranes are the filters of the body. "In their absence there could be no building of structure, no solidification of tissue, nor organic mechanism. Passive themselves, they, nevertheless, separate all structures into their respective positions and adaptations."

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Alchohol Effect On Our Blood

Dr. Richardson, in his lectures on alcohol, given both in England and America, speaking of the action of this substance on the blood after passing from the stomach, says:

"Suppose, then, a certain measure of alcohol be taken into the stomach, it will be absorbed there, but, previous to absorption, it will have to undergo a proper degree of dilution with water, for there is this peculiarity respecting alcohol when it is separated by an animal membrane from a watery fluid like the blood, that it will not pass through the membrane until it has become charged, to a given point of dilution, with water.

It is itself, in fact, so greedy for water, it will pick it up from watery textures, and deprive them of it until, by its saturation, its power of reception is exhausted , after which it will diffuse into the current of circulating fluid."

It is this power of absorbing water from every texture with which alcoholic spirits comes in contact, that creates the burning thirst of those who freely indulge in its use. Its effect, when it reaches the circulation, is thus described by Dr. Richardson:...

"As it passes through the circulation of the lungs it is exposed to the air, and some little of it, raised into vapor by the natural heat, is thrown off in expiration. If the quantity of it be large, this loss may be considerable, and the odor of the spirit may be detected in the expired breath.

If the quantity be small, the loss will be comparatively little, as the spirit will be held in solution by the water in the blood. After it has passed through the lungs, and has been driven by the left heart over the arterial circuit, it passes into what is called the minute circulation, or the structural circulation of the organism. The arteries here extend into very small vessels, which are called arterioles, and from these infinitely small vessels spring the equally minute radicals or roots of the veins, which are ultimately to become the great rivers bearing the blood back to the heart.

In its passage through this minute circulation the alcohol finds its way to every organ. To this brain, to these muscles, to these secreting or excreting organs, nay, even into this bony structure itself, it moves with the blood. In some of these parts which are not excreting, it remains for a time diffused, and in those parts where there is a large percentage of water, it remains longer than in other parts.

From some organs which have an open tube for conveying fluids away, as the liver and kidneys, it is thrown out or eliminated, and in this way a portion of it is ultimately removed from the body. The rest passing round and round with the circulation, is probably decomposed and carried off in new forms of matter.

"When we know the course which the alcohol takes in its passage through the body, from the period of its absorption to that of its elimination, we are the better able to judge what physical changes it induces in the different organs and structures with which it comes in contact. It first reaches the blood; but, as a rule, the quantity of it that enters is insufficient to produce any material effect on that fluid. If, however, the dose taken be poisonous or semi-poisonous, then even the blood, rich as it is in water and it contains seven hundred and ninety parts in a thousand is affected.

The alcohol is diffused through this water, and there it comes in contact with the other constituent parts, with the fibrine, that plastic substance which, when blood is drawn, clots and coagulates, and which is present in the proportion of from two to three parts in a thousand; with the albumen which exists in the proportion of seventy parts; with the salts which yield about ten parts; with the fatty matters; and lastly, with those minute, round bodies which float in myriads in the blood (which were discovered by the Dutch philosopher, Leuwenhock, as one of the first results of microscopical observation, about the middle of the seventeenth century), and which are called the blood globules or corpuscles.

These last-named bodies are, in fact, cells; their discs, when natural, have a smooth outline, they are depressed in the centre, and they are red in color; the color of the blood being derived from them. We have discovered that there exist other corpuscles or cells in the blood in much smaller quantity, which are called white cells, and these different cells float in the blood-stream within the vessels.

The red take the centre of the stream; the white lie externally near the sides of the vessels, moving less quickly. Our business is mainly with the red corpuscles. They perform the most important functions in the economy; they absorb, in great part, the oxygen which we inhale in breathing, and carry it to the extreme tissues of the body; they absorb, in great part, the carbonic acid gas which is produced in the combustion of the body in the extreme tissues, and bring that gas back to the lungs to be exchanged for oxygen there; in short, they are the vital instruments of the circulation.

"With all these parts of the blood, with the water, fibrine, albumen, salts, fatty matter and corpuscles, the alcohol comes in contact when it enters the blood, and, if it be in sufficient quantity, it produces disturbing action. I have watched this disturbance very carefully on the blood corpuscles; for, in some animals we can see these floating along during life, and we can also observe them from men who are under the effects of alcohol, by removing a speck of blood, and examining it with the microscope. The action of the alcohol, when it is observable, is varied.

It may cause the corpuscles to run too closely together, and to adhere in rolls; it may modify their outline, making the clear-defined, smooth, outer edge irregular or crenate, or even starlike; it may change the round corpuscle into the oval form, or, in very extreme cases, it may produce what I may call a truncated form of corpuscles, in which the change is so great that if we did not trace it through all its stages, we should be puzzled to know whether the object looked at were indeed a blood-cell.

All these changes are due to the action of the spirit upon the water contained in the corpuscles; upon the capacity of the spirit to extract water from them. During every stage of modification of corpuscles thus described, their function to absorb and fix gases is impaired, and when the aggregation of the cells, in masses, is great, other difficulties arise, for the cells, united together, pass less easily than they should through the minute vessels of the lungs and of the general circulation, and impede the current, by which local injury is produced.

"A further action upon the blood, instituted by alcohol in excess, is upon the fibrine or the plastic colloidal matter. On this the spirit may act in two different ways, according to the degree in which it affects the water that holds the fibrine in solution. It may fix the water with the fibrine, and thus destroy the power of coagulation; or it may extract the water so determinately as to produce coagulation."

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Bad Bread Threatment

Bad breath is a common health problem in the society.Offenssive smell from the mouth may be due to various reasons.The main reason is the presence of anaerobic bacteria in the biofilm formed on the tongue.These bacteria degrades the proteins present in the food resulting in the production of some offenssive gases like hydrogen sulphide,skatol ect.

Bad odor from the mouth in the early morning is seen in almost all individuals.This can be controlled by maintaining oral hygiene.Even after cleaning the mouth some individuals may suffer from bad breath due to some problem in the mouth or in the nearby areas.Some general disease condition can also produce bad breath.Exact cause has to be identified and should be treated accordingly.Some common measures to cure or reduce bad breath are discussed here...

1) Oral hygiene:
Mouth should be kept clean every time to reduce the bacterial action.After food gargling with lukewarm water is very essential.Even after small food articles like snacks,sweets,buscuits cleaning with water is needed.Brushing should be done twice daily.It is said that early morning brushing is for beauty and bed time brushing is for good health.

2) Brushing techniques:
Normal brushing technique should be followed for better result.Many people brush vigorously causing damage to the gums.Brushing after every food and drink can damage the enamel .Bristles of the tooth brush should be smooth but hard enough to remove the food particles from the gaps.The direction of brushing is the most important thing.The upper teeth should be brushed in a downward direction and the lower in upward direction.This is applicable to both inner and outer surfaces.Next comes the crown of the teeth;here brushing is done in anterior and posterior direction keeping the brush in same direction.This applicable to both upper and lower set of teeth.

3) Tongue cleaning:
White or yellowish coating on the tongue can cause bad breath.This is more well marked in the morning and should be removed twice daily with the healp of a tongue cleaner. Tongue cleaner must be used gently without damaging the taste buds on the tongue.

4) Tooth pick:
Tooth pick is a small strip of wood or plastic with a pointed end.This is used to remove food particles lodged between the gaps.Very useful after eating meat and fish.Should be used gently to avoid damage to gums.

5) Gargling:
After every meal gargling with lukewarm water is useful.For better result little common salt is dissolved in the lukewarm water .Different types of mouth wash is available in the market in different trade names.Gargling with mouth wash can also reduce bad breath.

6) Food habits:
Protein containing food articles are known to produce bad breath. Example; meat, milk, fish, egg etc. If these food articles are taken proper cleaning is essential.Some food articles are known to produce particular smell which may be unpleasent for others. Raw onion is the best example.It is said that an apple a day keeps the doctor away and a raw onion a day keep every body away.Small food articles taken in between can also cause bad smell(nuts,fried items etc).Maintaining regularity in food timing is the most important thing.

7) Water intake:
Dryness in the mouth can make a favourable condition for the bacterial activity resulting in bad odor.saliva is needed to keep the mouth moist and to reduce the bacterial proliferation.Production of saliva is closely related with water balance of the body and hence sufficient quantity of water should be taken to maintain the production of saliva.

8) Mouth freshners:
Natural and artificial mouth freshners can reduce the intensity of bad breath to some extent.Spicy articles are commonly used for this purpose.Chewing spices like clove,cumin seed,cardomom,cinnamon,ginger ect are useful. All citrus fruits can reduce bad odor.Mouth freshners and chewing gums are available in the market.these products are also helpful ,but some may cause damage hence should be used with caution.

If the above things doesn't work then what to do? The Alternative can be consider the following:

1) Remove the cause:
Bad breath is common in some general and systemic diseases like diabetes,fevers,gastric disorders,liver diseases and ect.By removing or reducing the primary cause the bad breath will go automatically.

2) Modern medicine:
If bad breath is due to any infection suitable antibiotics,anti fungal or anti viral medicines will help.If it is due to any autoimmune or chronic inflamatory conditions steroids may also be used.Saliva producing tablets can also be used.

3) Dental cleaning:
Dental cleaning done by a dentist can remove the dental plaques and tartar. This can reduce the severity of bad breath.Visit your dentist atleast once in a year.

4) Filling of caries:
Since caries are one of the main cause for bad breath it should be filled by a dentist.Earlier silver amalgam was used ,nowadays it is replaced by synthetic materials.If the pulp cavity is affected by the caries root canal treatment can be done.

5) Tooth extraction:
If caries are deep with destruction of teeth with bad smell extraction is the better choice and a dental implant can be kept in the gap.

6) Tonsillectomy:
Patients with recurrent tonsillitis can have bad breath due to offenssive discharges and release of pasty materials from the crypts of tonsils.Such patients get great relief after tonsillectomy(removal of tonsils).

7) Psychological counselling:
Those who suffer from bad breath may be very much depressed and they be away from the public .This isolation hampers their daytoday activities.Such people should understand the fact that all humanbeings are having bad breath, but with slight differences in intensities.Mostly all people control it by taking personal care.Every human body has got it's own smell,that may or may not be tolerable for others.They should be adviced to do all hygienic meashures to reduce the intensity of smell.Improving the quality of life by all possible means can also help.Moral support from friends and family members are needed for such people.

Some individuals visit the doctor for bad breath without any real problem.It is included under somatisation disorder.They usually complain about pain, breathlessness,abdominal discomfort,bad smell ect.proper diagnosis is needed to rule out any real causes.These patients should be managed with a psychological approach.

8) Homoeopathy:
In Homoeopathy medicines are selected on the basis of physical ,mental,emotional,and social aspects of the diseased person.Considering the whole aspects a constitutional homoeopathic medicine is selected and given in suitable potency and dose.By this all health related problems including bad breath will be solved.On the basis of coating on the tongue,type of smell,cause for bad breath,and other associated complaints a medicine can be given to get relief from bad breath.In the homoeopathic medical repertory by Dr Robin Murphy there are 140 homoeopathic drugs mentioned for bad breath.On the basis of signs and symptoms of the individual a suitable medicine is given.Commonly used drugs are arnica, antim crud, pulsatilla, sulphur, psorinum, nux vomica, ars alb, merc sol, kreosot, hekla lava, silicea, asafoitida, graphites, kali bich, acid nitric etc.

Homoeopathic mother tinctures like cinnamon Q,kreosot Q,zingiber Q,rhus glabra Q,menthol Q and ect can be used for gargling after diluting in water.

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BAD BREATH

Bad breath is a common health problem which greately affects the daytoday activities of somany people. The offenssive odor from the mouth is unpleasent to those who come in close contact with bad breathers.

The problem will be doubled by psychological trauma leading to depression. The sufferers from this problem wil be isolated from the society. This can even lead to marital disharmony.

Literally speaking all humanbeings are badbreathres. Oral cavity contains millions of anaerobic bacteria like fusobacterium and actinomyces which acts on the protein of food materials and putrifies them. This process results in the formation of offenssive gases like hydrogen sulphide,methyl mescaptan,cadaverin,skatol,putrescine ect causing bad odor.

If oral hygiene is not maintained properly all will suffer from bad breath. Most of us control this by regular brushing,tongue cleaning and gargling. Even after maintining cleanliness in the mouth some individuals suffer from offenssive smell due to various causes which has to be diagnosed and treated properly.

Some common causes of bad breath:

1) Poor oral hygiene:
If oral hygiene is not maintained properly the mouth becomes the seat for millions of bacteria which produce offenssive gases by degrading the food debris. Bad breath is severe in those who do not brush their teeth regularly and clean their mouth after every food. Snacks taken inbetween meals can also produce bad breath because of improper cleaning.

Badbreath is common in almost all people in the morning on waking. During sleep there is less production of saliva .Saliva has got some antibacterial properties which help to keep the mouth clean. Saliva conains oxygen molecules which is needed to make oral cavity aerobic. So the reduction in it's quantity during sleep makes a favourable condition for anaerobic bacteria.

2) Food habits:
The main cause of bad smell is due to degradation of protein by the bacteria and hence all food products rich in protein favours bad breath. Meat,fish,milk products, eggs,cakes,nuts,pear and ect can cause bad breath. Some food articles can produce particular type of smell which may be unpleasent. Raw onion can produce typical bad smell. It is said that an apple a day keeps the doctor away,a raw onion a day keeps everybody away. Eating groundnuts can also produce bad smell. However if proper cleaning is done smell can be reduced irrespective of the nature of food. Irregularity in timing of food can also produce bad breath. Small food articles taken in between the meals can also produce bad smell.

3) Biofilm:
There is formation of a thin sticky coating called biofilm on the tongue and oral mucosa. This coating is thick on the posterior aspect of the tongue where millions of gram negative bacteriae are seen .The thick coating on the tongue is always associated with badbreath. Even a thin biofilm can make anaerobic condition favourable for bacterial proliferation.

4) Dental caries:
This is a destructive process causing decalcification with distruction of enamel and dentine resulting in cavitisation of the tooth. These are produced mainly by the lactobacilli . Food particles are deposited inside these cavities and are putrified by the anaerobic bacteria producing bad smell. Normal brushing will not remove the food debris easily and hence they are putrified completely. Caries are common in schoolgoing children and in those who donot maintain proper oral hygiene .Calcium and vitamin deficiency can also predispose caries.

5) Gingivitis:
Gum is a mucus membrane with supporting connective tissue covering the tooth bearing borders of the jaw .The main function of gum is protection .Gingivitis is the inflammation of the gum .Due to various causes gum tissue get infected resulting in swelling,pain and discharge. If the condition become worse the infection spread towards peridontal area leading to continuous discharge called pyorrhoea. Some times the infection goes deep producing alveolar abscess with discharge of pus. Infection can even reach the bone causing osteomyelitis.All these conditions can produce offenssive smell.

6) Gum retraction:
When the gums retract from the teeth a gap is developed which will lodge food particles and cause bad breath.

7) Dental plaques and tartar deposits; Plaques and tartar is deposited mainly in the gaps between the teeth and gum. This will provide shelter for the food debris and bacteria causing bad breath.

8) Ulcerative lesions& coatings:
Almost all ulcerative lesions of the mouth are associated with bad breath. These lesions may be caused by bacteria,viruses,food allergies or due to autoimmune disorders. Apthous ulcer is the commonest amoung ulcerative lesions. Others are herpes,fungal infections,vincents angina,infectious mononucleosis,scarlet fever,diphtheria,drug reactions and ect. Cancerous ulcers produce severe bad breath. All fungal infections produce white coating(candidiasis). Leucoplakia is a white thick patch on the mucus membrane of the mouth & tongue. It is considered as a precancerous condition. Offenssive breath is associated with these conditions.

9) Diseases of the salivary glands:
Saliva is very useful to supply oxygen to all parts of the oral cavity. Even a thin film of coating called biofilm can provide an anaerobic condition in the mouth. Saliva can wet these layers and make an aerobic condition which is unfavourable for the bacteria .Any condition which reduces the production of saliva can increase bacterial activity. Some times the salivary duct is obstructed by stones or tumors.Cancer of the salivary gland is associated with offenssive odor. In suppurative parotitis purulant dischrge in to the mouth causes bad breath.

10) Tonsillitis:
Tonsils are a pair of lymphoid tissue situated in the lateral wall of oropharynx. Inflammation of the tonsil is called tonsillitis. Bad breath is seen in both acute and chronic tonsillitis. Quinsy or peritonsillar abscess can also produce bad breath.

11) Tonsillar plaques & tonsillar fluid:
If bad breath persists even after maintaining proper oral hygeine there is possibility of this condition. Serous fluid secreated from the folds of tonsil is very offenssive. Some patients complain that they hawk some cheesy materials from the throat;which are very offenssive in nature. These are formed inside the tonsillar crypts which contain thousands of bacteriae. In such conditions tonsillectomy gives noticiable relief from bad breath.

12) Pharyngitis& pharyngial abscess:
Pharynx is a fibromuscular tube which forms the upper part of the digestive & respiratory tract. Inflmmation of the pharynx is called pharyngitis, caused mainly by bacteria and viruses. Bad breath is present in pharyngitis along with other signs like cough and throat irritation. Abscesses in the wall of pharynx can also produce offenssive discharge of pus in to the throat.

13) Dentures:
Denture users may complain about bad smell due to lodgement of small food debris in between. Proper brushing may not be possible in denture users especially fixed dentures.

14) Tobacco:
Tobacco chewing is associated with bad breath. The smell of tobacco itself is unpleasent for others. Tobacco can irritate the mucus membrane and cause ulcers and coatings. Gingivitis and pyorrhoea are common in tobacco chewers. Tartar is deposited on the teeth mainly near the gums. Tobacco chewers get gastric acidity with eructations. All these causes offenssive smell.

15) Smoking:
Smokers always have bad smell. It can also produce lesions in the mouth & lungs causing bad breath.Smoking increases carbon dioxide in the oral cavity & reduces oxygen level,causing a favourable condition for bacteria. Smoking reduses appetite & thirst hence acid peptic disease is common in chain smokers.

16) Lesions in the nose & ear:
Bad breath is occasionally seen in sinusitis(infection of para nasal sinuses). In case of post nasal dripping bad breath is common due to the presence of protein in the discharges. These proteins are degraded by the bacteria. Infection in the middle ear with discharge of pus in to the throat through the eustachian tube(passage from middle ear to the throat)can also cause offenssive odor. Chronic rhinitis(infection of mucus membrane of nose) and forign bodies in the nose can also produce bad smell in the expired air.

17) Diabetes mellitus:
Mostly all diabetic patients suffer from bad breath. Coated tongue,ulcers &coatings in the mouth ,increased sugar level in tissues ect are responsible for bad breath.Bacterial growth in diabetic patient is very faster than non diabetic individuals.

18) Fevers:
Bad breath is common in almost all fevers. Even an acute fever can produce bad breath. Severe bad breath is seen in typhoid .Other infectious diseases like Tuberculosis , AIDS ect produce bad smell.

19) Fasting & dehydration:
Dry mouth favours bacterial activity. So any condition which produce dryness in the mouth makes the breath offenssive. Eventhough the food particles are known to produce bad breath, fasting can also produce the same. Production of saliva is also reduced during fasting. Chewing and swallowing also helps to keep the mouth clean.

20) Bedridden patients:
Bedridden patients suffer from offenssive breath due to thick coating on the tongue. water intake is also limited in these patients. Regurgitation of food aggravates the condition. Since they talk less aeration in the oral cavity is reduced which favours anaerobic bacteria to become active.

21) Diseases of stomach & esophagus:
Eructation of gas and food produce unpleasent smell. Abnormality in the function of lower sphincter can allow the food to regurgitate upwards causing bad breath. Bad breath is also common in gastritis,gastric ulcer and cancer of stomach.

22) Intestinal diseases:
Bad breath is common in patients suffering from ulcerative lesions of intestine like ulcerative collitis..Other diseases are malabsorption syndrome intestinal tuberculosis, peritonitis ect

23) Diseases of lungs:
Lung diseases like pneumonia, lung abscess,chronic bronchitis,bronchiectasis,tuberculosis, lung cancer ect can produce bad odor during expiration.

24) Liver disorders:
Liver diseases like hepatitis, cirrhosis,can cause bad breath.Gall bladder diseases with vomiting also causes unpleasent odor.

25) Psychiatric patients:
Bad breath is common in psychotic patients due to poor hygiene,irregular food habits,less water intake and ect.

26) Somatisation disorder:
This is a psychiatric disorder charecterised by the presence of a physical symptom that suggest a medical illness .These patients come with physical complaints like pain,nausea difficult respiration, bad smell ect. This condition is diagnosed after detailed examination of the patient with all investigations.Since this is a psychiatric disorder it has to be managed with a psychological approach.

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