Causes of Bad Breath: Tonsils

If you have the kind of bad breath that you never notice but that practically knocks other people down, chance are that the problem is your tonsils. Tonsillitis is a frequent source of bad breath in both children and adults.

What Are Tonsils?

Everybody has heard about tonsils but most of us don’t really know what they are. The tonsils are tissues in the upper throat that release white blood cells to fight infection. The tonsils include the:

  • Adenoids, at the roof of the mouth and the back of the throat,
  • Tubal tonsils, at the roof of the mouth, just behind the opening of the Eustachian tube, which goes to the ears,
  • Palatine tonsils, at the back of the palate, and
  • Lingual tonsils, at the back of the tongue.

The adenoids and the tubal tonsils are covered with tiny hairs known as cilia. The cilia push white blood cells generated in the tonsil into the mouth and throat to protect against disease. The palatine and lingual tonsils are covered with a membrane that does not have any cilia. The white blood cells they produce are carried into the throat with the flow of saliva.

The tonsils reach their maximum size about the time a boy or girl goes through puberty. After puberty, the tonsils begin to shrink. The maximum size of the tonsils compared to the diameter of the throat occurs at ages 7 to 10, which is when many children develop tonsillitis.

What Causes Tonsillitis?

Tonsillitis occurs when the immune system attacks Streptococcus pyogenes, a strain of bacteria that lives in the tonsils of about 10% of children and in a much smaller percentage of adults. This bacterium “lives and lets live” until some other microorganism causes an active infection. Then it multiplies to ensure that its offspring continue to live in the mouth. The immune system attacks the bacteria with inflammation. In children, inflamed tonsils can make breathing difficult as they swell against the nasal passages and block off the Eustachian tube to the ears.

Bacterial tonsillitis typically comes and goes over a period of years. Children aged 5 to 15 who have tonsillitis most commonly have a Streptococcus pyogenes infection. Young children who develop tonsillitis, however, usually come down with symptoms very quickly due to viral infection.

Why Does Tonsillitis Cause Bad Breath?

When tonsillitis causes bad breath, it is usually because the enlarged tonsils have made breathing through the nose difficult or impossible. Breathing through the mouth dries out the air going into the throat, and also dries out the gums and tongue. The mucosal membranes covering the tongue, the gums, and the throat dry out and form microscopic cracks. These nooks and crannies form a haven for bad breath bacteria.

Two gases predominate in the kind of bad breath caused by tonsillitis. One is hydrogen sulfide. This is the gas associated with rotten egg odor. The other is methyl mercaptan. This is the gas associated with sewer odor. If the breath smells like an open sewer, bacteria in the lining of the mouth and throat are the cause. These are not the same bacteria that cause the tonsillitis, however, and turning the tide against tonsillitis is only the first step in curing bad breath.

What to Do When Tonsillitis Causes Especially Nasty Bad Breath

One of the problems that results from sick tonsils comes from an accumulation of dead bacteria and pus called tonsil stones. Essentially, bacteria and tonsil tissue both rot in the mouth and form pockets of hard material. The gases emitted by the decaying mass are so unpleasant that they literally can  dissolve tissues around them, releasing still more bad breath odor. Brushing the teeth will not make this odor go away, and neither will mouthwash.

If you are wondering whether you might have tonsil stones, hellacious halitosis is your best glue. But these peritonsillar abscesses may also cause:

  • Trismus (difficulty opening the mouth),
  • Changes in vocal quality (“hot potato mouth,” needing to speak quickly to avoid mouth pain),
  • Pain,
  • Fever, and
  • Sore throat.

The only way to get rid of tonsil stones is to push them out manually. Wash your hands, and feel  your  tonsils for hard lumps and knots. Then push. Some of the nastiest smelling matter you have ever experienced may pop out of your mouth—but that will also put an end to most of your bad breath problems.

Can’t I Just Take Antibiotics?

Antibiotics will help bring tonsillitis under control. Medication, however, does not reach any microorganisms living on the surface of your mouth, only the microorganisms living in tissues. Even after you are over tonsillitis, you will still have bad breath bacteria in all the tiny crevices in the mucosal membranes of your mouth and throat, and these have to be removed to stop bad breath.

It won’t be enough to brush your teeth. It won’t be enough to use mouthwash. You will also need to use oral irrigation to get rid of the bacteria in the the gaps between your gums and your teeth and scraping (with a blunt plastic instrument, never with a knife)  to to get rid of the largest reservoir of bad breath in your mouth, on your tongue. When you get the infection under control, and you remove any tonsil stones, and you remove excess bad breath bacteria from teeth, gums, and tongue, then you will finally be free of halitosis caused by your tonsils.


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