Tonsil Stones and Bad Breath

The relationship between tonsil stones and bad breath is not widely understood, in fact, many people have not even heard of tonsiloliths, the small aggregations of cellular debris that can accumulate around the tonsils. The relationship is accidental: cellular debris only contributes to halitosis indirectly.

Dealing with tonsiloliths requires an understanding of what causes them and why they in turn can exacerbate halitosis. The tonsils, located at the back of the throat, play a role in immunity, fighting off infection. Though they may look quite smooth, they have tiny indentations on the surface, which can become inflamed and enlarged over time. Then debris can begin to build up in them. The source of dead cells, protein molecules and mucus that are caught in the tonsillar crypts is often postnasal drip—material washing down from the nasal sinuses. When enough has accumulated, the masses are called tonsil stones and bad breath may be an accompanying problem.

The reason that aggregates of debris in the tonsillar crypts causes a bad smell is that this material provides a rich source of food for the anaerobic bacteria that normally live at the back of the mouth. Gaining access to the tonsils, bacteria feed on the material, releasing foul smelling gases as waste products and completing the cycle of tonsil stones and bad breath. Eventually, the mass will be extruded from the tonsil and swallowed, but new ones will probably continue to form—dealing with tonsiloliths then becomes a continual challenge.

Many people suffering from tonsil stones and bad breath rely on commercially available products to keep the odor under control. Some try to physically remove the stones once they reach a certain size (take care and never use a sharp object to scrape at the back of the throat—the tissues here are delicate and lie close to both blood vessels and the brain). Other resort to gargling or spraying jets of water at the tonsils. An extreme way of dealing with tonsiloliths is to have the tonsils surgically removed, an approach that should be avoided if possible.

Causes of Morning Breath

It’s typical to equate an offensive odor on the breath in the mornings with everyday halitosis: the causes of morning breath may indeed be similar; however, the problem is different and usually much easier to deal with. Essentially, the bad smell is caused by the metabolic activity of anaerobic bacteria—bacteria that live in the absence of oxygen, breaking down protein molecules to fuel their own cellular processes and giving off bad smelling gases such as hydrogen sulfide as waste products. These bacteria do well while you are sleeping.

Sleep can produce a sort of transient halitosis. During sleep, our mouths become inactive, we don’t drink liquids, and even saliva production slows down. Even if the sleeper is breathing through the mouth, this has the effect of drying out the oral tissues rather than delivering oxygen - another contributing factor. In these conditions, anaerobes flourish, multiplying, metabolizing, and releasing hydrogen sulfide and other volatile sulfur compounds throughout the night. These are the causes of morning breath.

Upon waking, though we may notice a transient halitosis at first, we get up and begin moving our mouths more. We talk, eat, drink, brush our teeth, swallow more often. Saliva production picks up and most of the offensive bacterial causes of morning breath are rinsed away or swallowed. Many people use a mouthwash upon rising, though this may not even be necessary. For the rest of the day, everything’s fine, and it’s not until we sleep once again that anaerobes have a chance to get the upper hand and start multiplying.

The transient halitosis known as morning breath is different from chronic problems with oral malodor: though many of the same bacteria may cause it, they are not present in the mouth in abnormal and unhealthy numbers. When odor persists throughout the day, it’s a sign that the offensive bacteria have somehow displaced normal oral bacteria. Unlike the bacterial causes of morning breath, these abnormal bacterial populations can be very hard to dislodge and often require a much more aggressive, long-term approach.