Bad breath is one of the rare occurrences after bariatric surgery. It is a condition characterized by an unpleasant odor emanating from the mouth when the individual talks, yawn, belches or breathes through the mouth. Although not a severe health issue, its negative impact on self-esteem and quality of life makes it a source of concern for the affected person. The good news, however, is that it is transient and can be suppressed.
Gastric sleeve surgery is an effective and most commonly performed bariatric (weight loss) surgery in the United States. It is a restrictive surgery where the stomach is reduced in capacity with a reduction in the production of ghrelin (an appetite-stimulating hormone). This is followed by a decrease in appetite and calorie intake resulting in weight loss and improvement in comorbid conditions.
Bad breath common is more with gastric bypass surgery and extremely rare after gastric sleeve surgery.
Nevertheless, it is not impossible in patients with gastric sleeve. Many factors have been associated with bad breath following bariatric surgery. These include; dehydration, stasis of food within the stomach/pouch, and ketosis.
After weight loss surgery (gastric sleeve inclusive), the calorie intake is reduced, and amount of energy-given foods the body gets from a daily meal is reduced. The energy deficit is expected to be generated by the body from the stored fat by a process known as fatty acid oxidation. This is the final pathway of all bariatric surgery. This process of fatty acid breakdown is accompanied by ketogenesis: formation of ketone bodies which also serve as sources of energy to somebody organs. Formation of ketones can occur following any significant weight loss, but it is more pronounced following weight loss surgery due to rapid mobilization of stored fat.
The excretion of these ketones from the body is through the kidneys and the lungs. Acetone, one of the ketones, is excreted through the lungs given the breath a characteristic fruity smell. This smell may not be perceived as unpleasant by some people while others may find it unbearable.
Stasis of food within the stomach is another cause of bad breath after bariatric surgery. The inability of the ingested food to move from the stomach into the small intestine will allow acidic contents to regurgitate from the stomach into the esophagus and at times into the mouth, a condition known as water brash. This condition would be accompanied by a burning chest pain due to irritation of the esophagus by the acidic contents of the stomach. Food stasis in the stomach can be prevented by adhering to the post-op dietary plan and habits
Gastroesophageal reflux disease (GERD) is a common problem among obese people. The acidic contents of the stomach regurgitate into the esophagus, especially when in the supine position. This results in heartburn and occasionally bad breath. Gastric sleeve surgery has been shown to increase the severity of reflux in obese patients, and this may be one of the reasons for experiencing bad breath after gastric sleeve surgery.
Dehydration may be a cause of bad breath even in people without bariatric surgery. It is however common after bariatric surgery because most patients ignorantly reduce their fluid intake. Gastric sleeve surgery shouldn’t be a reason to reduce fluid intake. It is therefore recommended that patient should take adequate amount of fluid after gastric sleeve surgery to prevent dehydration and in small quantity at a time to avoid stomach stretch.
In summary, the following tips may help suppress bad breath after gastric sleeve surgery:
- Improve your oral hygiene by brushing at least twice daily if not after each meal
- Drink plenty of water at least 64 ounces a day, though small quantity at a time
- Adhere to your post-op dietary plan to prevent stasis in the stomach
- Antacids for gastroesophageal reflux
- You can chew gum (sugar-free gum) as it increases saliva production and reduces the mouth’s bacterial load.
- You may need to consult a dentist to be sure you are not suffering from tooth decay or gum disease.
In conclusion, bad breath is not a common condition following gastric sleeve surgery but may occur. It may be due to ketone formation, in which case is a pointer to ongoing weight loss or dehydration. Though not much can be done to prevent this, it is a transient problem that often resolves by the end of the second month after surgery when solid foods with carbohydrate contents must have been commenced.