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cured.. for now?
cured.. for now?
anyway, i find the antibiotic (they call it FM4 and i believe it is a mix of metronidazole and nystatin, but not sure.. i just recall that vaguely) helps for some time and then after a few months to a year or so, the bb worsens again (i.e. the maintenance rinses of chlorhexidine & smarthmouth or closys) no longer help at all) and so that is when i go back and get another prescription for the antibiotic rinse. anyway, gargled and swished with this morning and night for almost 2 weeks. it seemed to sort of help, but not fully (like i had experienced in the past). it created a coating on my tongue and sometimes i felt a sour taste in my mouth so i didn't think it was working very well (like the last time i used the rinse), but i went through the full course anyway. anyway, after that (about 12 days use of antibiotic), i decided (of my own volition) to try the Blis K12 oral probiotics.. it's a month's worth and i figured since i had cleared out much of my gram negative bacteria, it might be a good time to try the probiotics again (which had not worked for me in the past). i got as far as two days.. then went back to the oravital clinic to get checked out again as per my appointment schedule (they scheduled me for exactly 2 weeks after i got the initial FM4 antibiotic rinse). anyway, i learned i was supposed to use the chlorhexidine rinse morning and night for 2 weeks, before switching to the regular maintenance rinse schedule (which iss using chlorhexidine on mon & thu only, and using smartmouth or closys all the other days). anyway, i decided to do this 2 week course of chlorhexidine first and then go on the probiotics after this, as i do my regular maintenance rinse routine. anyway, while i felt that after the 2 weeks antibiotic rinse thing improved things (though not 100%), i have been finding that now using the chlorhexidine rinse has been working for me! i have been using it now for 2.5 days morning and night, and my breath has been totally neutral for the past 1.5 days. even today, i rinsed with it this morning after brushing, then went without eating for 2 hours which is usually a no-no for bb (i went to yoga class), then had a meal.. it's now been about 2 hours after my meal and i haven't brushed yet (which i usually do after eating because eating usually makes my bb worse) and i feel like my breath is still pretty neutral. it's amazing. i even had somewhat garlicky guacamole in my food! anyway, i am gonna go brush now but i feel excited about having what seems like neutral breath in a really long time. i had been getting a bit depressed about my situation because i just felt like i had bb all the time, no matter what i did. it made me feel really insecure.
i hope this lasts but for today at least, i am cured. i don't believe this is a permanent cure at all (i am pretty sure i have a bacterial imbalance) but even if it can last awhile, i am happy. i am going to finish the 2 week course of chlorhexidine and then switch to the regular maintenance rinse schedule. then i am going to use the probiotics for a month and see if that helps to restore good bacteria in my mouth.
i will keep you posted.
http://www.oravital.com/web/patient/index.html
(the clinic - i know some people have tried them and it doesn't work for all, but it's worth at least trying if you feel like your problems stem from within your mouth.. mine comes from the back of my tongue and between my teeth, i think.. and i have an issue with gum disease, and think i have some PND as well.. but even when these are not active issues, i still get bb so it's not just those issues)
the probiotics kit i got was this one.. i forget where i got it but i ordered it from new zealand where they make it:
http://www.pharmacyexpress.com/blis-k12 ... h-kit.html
i tried it once before and it didn't work, but i hadn't used the FM4 antibiotic rinse then, so i thought it is worth a try to try it again after having that course of treatment.
i don't have any vested interest in either of these companies, but i just wanted to share what i have been doing in case it helps others. also, it hasn't always worked for me, but i have found this has given me some relief over the past 7-8 years (although off and on relief.. but still better than no relief at all).
other things i do:
-brush with a regular manual toothbrush in the morning and after meals as much as possible (i always carry a travel sized toothbrush and toothpaste with me).
-brush with an Oral B electric toothbrush and floss at night.
-use a BreathRX tongue scraper everytime i brush (i like these plastic, ridged tongue scraped best.. i have tried tung brush which i know people have raved about on here, but i have a problem with gagging when i use it on the back of my tongue).
-Irrigate between teeth and along gumline with Hydrofloss at night and/or before going out (i miss a day here or there sometimes). i was also using chlorine dioxide in it (about 100mL of that, and 500mL of water) but i am a bit nervous about the longterm safety of using this.
-go for teeth cleanings at my dentist every 3 months. they also treat me for any active gum disease with deep cleanings after applying a medicated pack to my gums to clear out the bacteria whenever needed.
-i am supposed to be massaging my gums everyday (or at least a few times a week) with a Stim-u-dent pick and/or Proxi-Tip brush but i get lazy about that so i rarely use them, though i know i should.
none of the above bulletpoints have helped get rid of my bb, but i figure that keeping my mouth as clean as possible in addition to using whatever other methods (i.e. the FM4 and chlorhexidine rinses, BLIS K12 probiotics and the maintenance rinses)
![Sad :(](./images/smilies/icon_sad.gif)
but i don't know what else to do. sigh.
> Note: This is an Ask An Expert enquiry submitted through the Oravital patient website.
>
> Inquiry: I have been a patient with Oravital for many years. Over the past year, I have found the antibiotic rinse no longer works for me. It used to work but then about a year ago, I was prescribed the antibiotic for 2 weeks, during which time it helped but did not eliminate my bad breath (I would often gave a sour taste in my mouth after using it, and my tongue remained very coated throughout the 2 weeks). After I finished this rinse and switched to maintenance rinses, my bad breath returned as usual. The same thing happened recently (about 11 months after the last time I was prescribed the antibiotic): I used the antibiotic for 2 weeks (again, sour taste and coated tongue, and not complete elimination of bad breath). After, I used chlorhexidine morning and night for 2 weeks as prescribed by the hygienist. During the first week, my bad breath disappeared. However, during the second week, it came back again, even when I used the chlorhexidine. This was a few weeks ago and I am now on maintenance rinses, but I find they are not working. As soon as the minty flavour is gone after about 20 minutes, I can detect that my bad breath has returned. It is rather distressing that I have no way to effectively get rid of my bad breath.
>
> It seems that the antibiotic + maintenance rinse system no longer works for me.
>
> This made me curious about what you do when the usual treatment does not work? Are there other modes of treatment that are effective, or does that case became one of the few cases that you cannot help?
>
> I should mention that I eat very healthy, have excellent oral hygiene (brushing morning, night and after meals, flossing nightly, and tongue scraping often), and I do have problems with gum disease but it is under control by my dentist (I go to the dentist every 3 months). I use a neti pot with saline solution to help deal with PND. I do feel that my bad breath comes from within my mouth, possibly from the back of my tongue (which I always try to scrape).
---
Dear ____
Thank you for your email. It is difficult to totally answer your question without some of the diagnostic details such as microbiology reports to show the types and location of the causative bacteria. It may be that the FM4 rinse has become less effective because those strains of bacteria most susceptible to the antibiotics in this preparation are not present in large numbers. Having a sour taste tells me that you may have more of the acid producing bacteria present and so a different combination may be more useful. You could see your clinician and explain the problem - this may result in a rinse with another combination of antibiotics.
Secondly, it is always possible that the biofilm has developed some resistance to the antibiotic, especially if it has been used often although the FM4 combination does not easily acquire resistance. Again, it would be worth a try with the other combination that Oravital offers.
Further, if there is considerable post nasal drip and the smell/taste at the back of the tongue is odourous or bitter, this can signal that the sinuses are infected. In this case, the rinses will not help as they cannot reach the sinus areas and a systemic antibiotic would be the most appropriate.
Let me know how this works out.
Sincerely
Anne Bosy
Oravital Inc.
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it is the only thing that has ever helped me, even though it is not working so well now. that is why i keep going back. what other options do i have that have ever proven to work longer than a month? for a few years, this treatment kept my bb under control (maybe not 100% but it was a major reduction and that is counting for something). keeping it under control is the best i can hope for since bb is a chronic problem. because it has worked for me before, i am going to take anne bosy's advice and at least try this other antibiotic. i am covered under a drug insurance plan at work so the cost is covered for me. i know not everyone is this lucky.
i know the irony is that antibiotics can make situations worse, and i believe use of antibiotics as a child is what helped contribute (or even cause) an imbalance of bacteria in my mouth in the first place... but as you know, when you are desperate to get rid of the problem or at least control it, you will try anything, especially if it's shown some success in the past...
i think a systemic antibiotic is one you take internally (not just an oral rinse). medically, it does make sense.. though is not a foolproof answer and can cause a host of other problems, as we all know.
i guess you just weigh the pros and cons of it and make your decision about what to try based on that. at this point, i will try almost anything.
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