Q: My wife complains that my breath has smelled terrible for a long time. Can anything be done about bad breath?
A: Bad breath most commonly results from dental problems or smoking. Retention of smelly food particles on or between the teeth, acute infections of the gum, chronic gum disease, tooth decay or abscesses, and unclean dentures can lead to foul-smelling breath. Infections in the nose, sinuses, tonsils or lungs also can cause bad breath.
First steps toward improving bad breath are to stop smoking and to regularly brush and floss your teeth. If these measures do not lead to improvement, a trip to the dentist is in order. A chronic cough, sore throat, postnasal drip or sinus pain suggests an infection needing medical attention. Mouthwashes may mask the odor without solving the problem.
Q: I am worried about my wife's memory. She is 72 and often forgets our telephone number or the names of our children. Is there anything that can be done to help her, or is she just getting senile?
A: It sounds like your wife's problems with memory are so great she may be suffering from the early stages of dementia. The dementias, diseases that affect the parts of the brain associated with intellectual skills, lead to progressive loss of memory, personality changes, declining ability to think and learn, poor judgment, disorientation and confusion.
While "senile" is derived from a Latin word meaning merely "to grow old," it is used to describe a loss of mental faculties associated with old age. As a result, people too often assume such loss of mental powers is a natural and inevitable consequence of aging. While frequency of dementia increases with age, it is estimated only 5 percent of people in the United States over 65 are severely demented and another 10 percent are mildly or moderately demented.
The most common causes of dementia -- Alzheimer's disease and multiple strokes due to disease of blood vessels supplying the brain -- are neither curable nor reversible. Less common causes of irreversible dementia include multiple sclerosis, advanced Parkinson's disease and Huntington's disease.
But it is important for your wife to have a thorough medical evaluation because she may be suffering from a treatable or reversible problem that mimics the symptoms of dementia.
Depression is probably the most frequent culprit. Drug reactions also produce symptoms of dementia, particularly in the elderly who often take multiple medications and have a slowed metabolism that may delay the clearance of drugs from the body.
Other treatable causes of symptoms akin to dementia are pernicious anemia, hypothyroidism, hypoglycemia, abnormal blood level of sodium or calcium, and a shortage of the oxygen supply to the brain as a result of disorders of the heart or lung.
Dr. Margolis is professor of medicine and biological chemistry at the Johns Hopkins School of Medicine and associate dean for faculty affairs at the school.