Interview With Dr.Krespi - Laser Treatment To Cure Bad Breath

Thursday, November 09 2006 @ 04:25 PM MST

Here is the interview we were all waiting for. I did it over the phone and Baguio the member of our site has put it on the paper. Well he did the job perfectly. Also I am thanking Dr. Krespi, from New York. He is a nice warm person, really willing to help. So technology is here for treating bad breath, so try it, at least go for consultation or something. Get your life back. I am sure I will do it. There are some options that the insurance covers it but not sure how. If you are an American of course.
So here it is, enjoy.

Jimi: So the first question is what is the exact price of the operation?
Dr. Krespi: $2,500

Jimi: This is just for the laser surgery?
Dr. Krespi: That’s correct.

Jimi: What about the polyps in the sinuses?
Dr. Krespi: It depends on the type of polyps, how many sinuses, left side or right side or both.

Jimi:…but approximately??
Dr. Krespi: probably anywhere between $4,000and $6,000 dollars.

Jimi: What about the CT Scan?
Dr. Krespi: CT Scan is $300-400.

Jimi: Are there any additional costs?
Dr. Krespi: Consultation is about $350 and that’s about it. There is no other test that we do – unless we do it in the hospital and it involves anesthesia and the hospital fee.

Jimi: Oh, that’s expensive I guess?
Dr. Krespi: Yes.

Jimi: So is it necessary to do it in the hospital?
Dr.Krespi: No, its not necessary….majority of the patients with cryptic tonsils – providing they don’t have a strong gag reflex and they are cooperating – we can do it in the office under local anesthesia.

Jimi: What about the polyps and sinuses?
Dr. Krespi: The majority of the patients, they have to go to the hospital.

Jimi: Is your procedure covered with health insurance?
Dr. Krespi: It depends. There are many plans – ordinarily yes but it would be the patients responsibility to get involved with the insurance.

Jimi: Could the sinuses be the cause of the halitosis?
Dr. Krespi: Yes.

Jimi: What are the signs of that…how the person feels if the sinuses are causing the problems?
Dr. Krespi: If they have a colourful discharge from the nose – yellow or green discharge or significant odour coming from the discharge – from the front of the nose or from the back of the nose as opposed to the tongue or the tonsil area. The diagnosis of whats called the Rhino-halitosis is very much different from whats called the oral halitosis.

Jimi: So is the smell different or the intensity?
Dr.Krespi: It depends on the bacteria responsible for the gas formation. Each bacteria has the opportunity to develop different types of gases and you can tell which bacteria is dominant.

Jimi: Oh, you can tell that?
Dr. Krespi: Well, if you measure the gases into a gas analysis, you can identify the main bacteria that is causing the halitosis.

Jimi: So you are using Halitmeter or other tools?
Dr. Krespi: We used to use Halimeter and we use it still, but I like the gas chromatography method.

Jimi: Oh yeah that’s the new one.
Dr.Krespi: That’s brand new.

Jimi: So that is included in the examination fee?
Dr. Krespi: No its not included because we send the gases for examination to an outside laboratory. We don’t get involved with that. We just collect the gas, put it in a bag, seal it and send it to the lab. We do that only if the patient wants to do that.

Jimi: So how can the person know if he has a smelly discharge if he cannot smell his own breath?
Dr. Krespi: We measure organoleptically. I have two of my nurses including myself and we grade it down – smelling the discharge. We use the Rosenberg Classification and we grade then organoleptically and we take the average.

Jimi: So that way you can determine if the halitosis is coming from the tongue or from the back of the throat?
Dr. Krespi: That’s correct.

Jimi: Whats is more common, sinuses or tongue?
Dr. Krespi: I would say the tongue is more common. Maybe 60% is the tongue as opposed to 20-25% the nose and the rest is distrinarian area.

Jimi: So is it possible that the problem only lies in the sinuses and not in the tongue?
Dr. Krespi: Oh yes, absolutely.

Jimi: How can a person know if the tongue is the reason?
Dr. Krespi: Again, the only way you can do it is by doing a scrape testing. You scrape the back of the tongue and you measure and grade it in an organoleptic fashion.

Jimi: Oh yeah, with the person smelling it.
Dr. Krespi: Yes.

Jimi: But isn’t it that the bacteria coming from the sinuses are spreading over the tongue and causing the tongue to smell? Isn’t that possible?
Dr. Krespi: That’s possible of course. That’s why if the origin is in the nose, we do examine the nose with telescopes and endoscopes. We look for secretions. We take cultures from the nose and throat and we verify the bacteria.

Jimi: Is the breath worse when the person is talking?
Dr. Krespi: With talking your inhaling out….and the mouth gets dry. If your talking a lot your losing saliva.

Jimi: So that is the reason some people say that when they talk their halitosis is much worse.
Dr. Krespi: Yes, if they’re talking all day, their mouth is getting dry. It’s a good idea to stop talking after every ten-fifteen minutes, take a drink of water and continue.

Jimi: Oh yes, so you also advise to drink a lot of water?
Dr. Krespi: Yes, absolutely. I tell my patients to carry a bottle of water all the time and keep sipping. Hydration is very important and very easily fixable. They should avoid drying agents as well…such as coffee, hot chocolate, alcohol, spicy foods, salty foods…

Jimi: What are the physical signs a person can identify as a benefit from the operation?
Dr. Krespi: Well most people they will see the pockets in the tonsils…and the pockets they will fill up with tonsil stones – which are a combination of bacteria, food particles and sometimes nasal secreations. They form a paste-like substance – similar like a peanut butter consistency. When they sqeeze the bacteria out, obviously they can recognise the smell and you can identify it.

Jimi: What about the people that don’t have tonsils anymore and no crypts? Can they benefit from this procedure?
Dr. Krespi: No. If they no longer have tonsils or tonsil pockets, they cannot benefit from this procedure. Then we would have to look at the back of the tongue, realising that there is also remaining tonsil tissue at the back of the tongue. Its very rare that those tonsil structures - they can get enlarged and enflamed and may contain thick secretions. And the tongue Brush or tongue scrapers – they don’t reach that area. So they have to be evaluated with an endoscope.

Jimi: A lot of people…they have their tonsils removed and they are still saying that they feel like the cause is in the back of the throat.
Dr. Krespi: That’s correct – but those are rare cases. If that is the case, then they need a good ENT examination with an endoscope to determine if they have remaining tonsil tissue at the back of the tongue.

Jimi: What about the tongue crypts at the back of the tongue?
Dr. Krespi: Those are not cypts, they are slits or fissures. They similarly may contain bacteria in the depth of the fissures. The only way that you can improve the conditions if you cannot remove those fissures (or burn the fissures with a laser) is with chemical and mechanical therapy.

Jimi: With mouthwashes?
Dr. Krespi: Antiseptic mouthwashes may contain chlorohexidine, chlorinated substances, - that contain sometimes zinc, etc. Hydrogen Peroxide mixed with mouthwashes that are not alcoholic and then proper brushing and cleaning.

Jimi: Can it be that the smell is also coming from the gums?
Dr. Krespi: Absolutely. The first thing I request before they come in for an evaluation is for the patient to see a periodontal specialist to be sure they don’t have gum pockets. If they do, I request that they have that treated first as its much easier to treat the gum disease than the other areas.

Jimi: What can be done if the cause is in the tongue?
Dr. Krespi: Well as I told you there are not many choices because during surgery, it is not easy…. And a little bit more drastic than doing laser surgery on the tonsils. We start with very aggressive mechanical brushing – at least two or three times a day…and scraping …and using a variety of antiseptic products.

Jimi: And what is the level of success with these patients? How many per cent have you cured for example?
Dr. Krespi: Well, its hard to claim ‘cure’ but we can certainly – by putting this regimen, we can improve the condition in all of them. Now, if they don’t adhere to this regimen, halitosis may come back. So as soon as they’re on strict & disciplined regimen, their condition will improve.

Jimi: So what about the others – where the cause was in the sinuses?
Dr. Krespi: You have to do an examination and verify that the cause is in the sinuses and if its in the sinus, they may need a sinus lebage, cleansing of the sinuses, irrigation of the sinuses and they are making matters to treat the bacteria that are originating from the sinuses and causing the bad breath through a significantly thickened post-nasal drip.

Jimi: One guy was in your office about six months ago and now he posts on our forum that he is cured. He still has the breath when he drinks but under normal circumstances he can talk with others and work closely – and they don’t smell him anymore.
Dr. Krespi: Well that’s wonderful news. I think this is a good example of a rhino-halitosis that was treated with a sinus procedure – that his condition was seriously improved.

Jimi: Yes, he told me that he had the crypts lasered. Also he had an operation on the sinuses and after that has practically cured because he can function normally and he doesn’t have bad breath anymore you know?
Dr. Krespi: Well that’s wonderful. Maybe you should recruit this guy on your website and let him chat with other people that are suffering with similar problems.

Jimi: Yes, we are doing that right now. That’s why I am also interviewing you.
Dr. Krespi: Excellent.

Jimi: What other procedures should the patient do before he comes to your centre?
Dr. Krespi: Well, I request that they see a dentist and be sure that the halitosis is verified by other people – mainly friends or family members. Because sometimes they may have some psychological issues. We want to be sure that the halitosis is confirmed before they come here and start spending money. Then we know this is a real problem and not a psychological problem. Number two, we want it confirmed that there are no dental pocket issues – and the next stage is for us to do a full evaluation.

Jimi: Shouldn’t the person do the CT Scan or something like that?
Dr. Krespi: I wouldn’t start with that. Its not necessary to go through so many unnecessary tests. Get the proper consultations, then let the doctor order the appropriate tests.

Jimi: If a foreigner comes to the United States, can all this be done in one day?
Dr. Krespi: Yes, the work can be finished in one day – that’s no problem. In fact, even if they come in without a dental consultation, in our centre we have dental colleagues. If we suspect there are sinus problems, they can go downstairs to have a CAT Scan immediately. Those are easily performed in a matter of a couple of hours.

Jimi: What about the operation? Would it be the next day?
Dr. Krespi: Again, if they are a candidate and they are appropriately selected with a tonsil pocket, we can do the surgery the same day.

Jimi: Some of the members asked if they can get a discount as it’s expensive?
Dr. Krespi: Well, we usually take it one at a time you know. Those issue they have to discuss with our centres business manager. I’m involved with the hospital and I usually don’t get involved with negotiating the fees – and so its beyond me. We will try to help them as much as we can obviously.

Jimi: Have some patients come back and they were cured or they don’t come back even?
Dr. Krespi: If they continue having problems we tell them to come back. If they’re cured, we leave it up to them if they want to come back or not. But certainly we would like them to come back after a couple of months if the problem continues.

Jimi: But you were successful in treating some of the patients 100%?
Dr. Krespi: Everybody sees some form of improvement. We cannot say about curing halitosis but we can say everybody gets an improvement.

Jimi: Ok I guess that’s it.
Dr. Krespi: Thank you very much Jimi.

Dr. Krespi Office Number : 212 262 2929, New York

10th of November 2006
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