What Causes Bad Breath? Sometimes It’s a Weird Kind of Stones!
The accumulated wisdom of helpful hints on controlling halitosis seems pretty straightforward. You brush, you floss, and you use mouthwash. Brushing and flossing are what you need to do keep your mouth healthy and free of the bacteria that putrefy proteins in ways that cause bad breath and mouth odors. You use mouthwash when you can’t do your oral hygiene routine.
Or maybe controlling bad breath really boils down to diet and lifestyle issues. All you have to do is never to eat garlic and onions or stinky cheese. Asian “rotted fish” and “rotted oyster” sauces probably should be on the list, too. Stinky foods are what causes odors in your mouth.
Or maybe it’s really all about oral hygiene, but you need to do more to stay on top of bad breath. Make sure you see your dentist at least twice a year to remove the plaque on your teeth beneath the gum line. Make sure fillings and crowns don’t come lose. See your dentist at the first sign of bleeding gums. Stop smoking tobacco in any form and especially don’t let cigarette tar accumulate on your tongue and teeth, avoid tongue piercing and keep sinus infections under control.
But sometimes the real cause of overwhelming mouth odor isn’t any of these things. It can be a medical condition for which medications don’t really provide a good solution. There isn’t a nutritional supplement that works very well, either.
Sometimes the cause of bad breath is not periodontal disease or particles of food you don’t wash away. Really difficult halitosis is often caused by tonsil stones, also known as tonsoliths. And most of the world might not know this except for the extended efforts of a blogger and lay expert named Meghan Swann.
Meghan Swann’s Tonsil Stones
All through her childhood Meghan Swann suffered recurrent colds and influenza. She had sore throat so many times she lost count.
But one time when she was a teenager her there was something about her umpteenth case of sore throat that felt very different. The back of mouth was sore, but the pain seemed to be coming from inside the deep tissue of her throat rather than the lining of her throat. The pain was more akin to a muscle ache than to strep throat or the kind of sore throat you get with a cold. She had a feeling that something was stuck in her throat, not at the Adam’s apple where you get a lump in the throat, but higher up, almost in the mouth. Mouthwash and gargling and coughing didn’t bring relief.
Finally Meghan decided to take her treatment literally into her own hands. She pressed hard on the back of her throat. In a few seconds a sulfurous, smelly mass passed out. It was about the size of a small pebble or a piece of gravel. it smelled terrible.
And it was not alone. Ms. Swann developed a personal ritual that anytime she felt a “sore throat” coming on, she’d take a cotton swab and press out the debris. But her condition continued for years and years.
About ten years ago, when Meghan had reached age twenty-five, Meghan’s mother commented that she had heard of a something like Meghan’s condition called tonsillolithiasis, which is a technical term for the formation of tonsoliths, also known as tonsil stones. These are collections of dead cells and mucus that accumulate in crevices in the back of the mouth.
What Causes Tonsil Stones?
Bacteria feed on cells killed by throat and sinus infections. The process of digestion gives rise to a quite noticeable bad smell that mouthwash and breath mints cannot completely disguise. The odors emitted by the putrefaction of human tissues in the throat are chemically identical to the odors associated with sewer gas and rotten eggs. They are so potent that they kill still more cells that feed more bad breath bacteria and release more odor-causing gases.
Tonsil stones accumulate pockets of debris and digestive waste products that start smaller than the size of a pin and that can grow from the size of a pencil eraser to about 1 inch (25 mm) or in some cases 1.5 inches (38 mm) across. The decay process can be aggravated by eating lots of sugary foods and by diabetes, and also by anything that dries out the mouth, such as alcohol-based mouthwashes or drinking extremely hot coffee or tea. But before Meghan started searching on the Internet, she did not know that she was not the only person who had the condition, or that she didn’t even have the worst case on record.
A typical posting on a site for rare conditions like wrongdiagnosis.com might read, “Whew. So I’m actually not the only person on earth who gets rocks falling out of the back of her throat. I’m not such a weirdo after all. Finally I know what caused and continues causing my fearsome halitosis.” Another poster might write, “I thought I had cancer, but I really had bad breath!” The fact is, tonsil stones are getting more and more common.
An Epidemic of Tonsil Stones?
Until about 1980, it was common for children who got recurrent sore throats to have operations to have their tonsils removed. Now, under the pressure of insurance rules and risk of malpractice liability, plus the reluctance of insurance companies to approve hospital stays, it’s increasingly rare for a child to undergo the operation.
Doctors prefer to handle sore throats with antibiotic treatment, even when breathing and swallowing are impaired—and even when antibiotics won’t work, when the infection is viral! Make matters even more complicated, antibiotic drugs are a “whole body” remedy, with various potential side effects in lungs, liver, and kidneys. In children, antibiotics frequently cause skin reactions. In women, how well antibiotics work may be influenced by hormone levels the connective tissue holding the stone in place thickening when progesterone levels are higher, during the second half of the menstrual period. But the most significant predisposing factor for tonsil stones is antibiotic therapy.
Antibiotics, as we all know, kill bacteria. What do you suppose happens to bacteria when they die? Other bacteria have to break them down, of course.
The release of gases from the decay of bacteria itself can cause creation of tiny crevices in which dead cells can accumulate and from which infection can spread to living tissue. And even otolaryngologists often fail to realize that the stinky smell in the bad of the mouth isn’t the due to the decay of particles of yesterday’s cold pizza left behind by poor oral hygiene, it’s often a tonsil stone. That’s despite the growing number of reports about tonsil stones in the medical literature, including a study reported in 2008 from the Brazilian state of Minas that found that 75 per cent of children and teens who have tonsillitis that has not been treated by surgery have bad breath caused by tonsil stones.
Getting Rid of Bad Breath from Tonsil Stones
There’s one sure way to get rid of bad breath caused by tonsil stones. It’s tonsillectomy. You don’t get tonsil stones if you don’t have tonsils.
The reality is, of course, nobody likes to have surgery, especially parents of children who would receive surgery. And insurance companies won’t pay for it, anyway. For patients who wish to avoid (or cannot have) surgery, Dr. Lee A. Zimmer of the University of Cincinnati recommends this simple tonsil care regimen anyone can do at home:
1. Rinse twice a day with a mouthwash that does not contain alcohol. This means no regular Listerine. That stinging you feel when you use alcohol-based mouthwash isn’t bacteria dying. It’s the lining of your tongue and mouth dying!
2. Rinse the back of your mouth at least once a day with a cleaning jet of high-pressure water from oral irrigation products such as Hydrofloss or the Oxycare 3000. You still need to use the device on your gums (and it does not help if you point the stream of water at your teeth).
3. Chew gum. The saliva released by chewing gum, especially gum sweetened with xylitol, flushes bacteria away.
Oxygenating sinus sprays and mouthwashes may also prevent problems, since the bacteria that cause the odor are killed by exposure to oxygen. All oxygenating remedies will probably help.
It’s always possible that surgery would be the best way to handle this problem. As of the date of this article, however, Meghan Swann is still getting good results from her tried-and-true oral health maintenance routine: When you feel the stones, push them out. It will get rid of bad breath for several weeks or maybe even several months.
