THE BLOG

Tonsil Stones and Bad Breath

09/20/2011 02:35 pm ET | Updated Nov 20, 2011

Tonsil stones, also known as tonsilloliths, are often misdiagnosed and fairly common. Tonsil stones are caused by the accumulation of sulfur-producing bacteria and debris that become lodged in your tonsils. These can also lead to bad breath, but this can be countered with good oral hygiene. Sometimes people make the drastic decision to have their tonsils taken out, which will eliminate tonsils stones, but bad breath from the tonsil area can still occur. Rather than removing one's tonsils, it is possible to prevent tonsilloliths without surgery.

Tonsil stones can be somewhat allusive. It's possible that people that suffer from halitosis but do not know the source of their oral odor might have tonsil stones. They are not always visible, since they become logged in crypts within the tonsils.

Tonsil stones are very smelly because they contain a high amount of sulfur. This smell is emitted when a person with tonsil stones breathes out from the mouth. A study from the National Center for Biotechnology Information found that 75 percent of people that had unusually high amounts of sulfur in their mouths did in fact have tonsil stones. Researchers concluded that having tonsil stones can increase the risk of bad breath by up to 10 times. Tonsil stones can go away on their own, but it can help to use an oral care regimen that is designed to help prevent and eliminate these stinky stones.

Tonsilloliths are usually quite small, but one article discusses larger ones. A French study done in 2007 found that about 6 percent of people can get tonsil stones that are large enough to be detected in medical imaging scans. On rare occasions, a tonsil stone has been recorded to reach up to one inch in size! For smaller stones, the best bet to dislodge them is to gargle with an oral rinse.

Tonsillitis may also increase the risk of tonsil stones, as a study in the British Dental Journal found. In all, 75 patients that had tonsillitis had tonsil stones -- only 6 percent did not. If you cough up a tonsil stone, this odor can be extremely strong. The smell can be too much to bear, and repeated hand washings may be needed if a tonsil stone is held in one's hand. It is also important not to dissect a tonsil stone (however curious you may be), because the smell will most likely grow once the insides of the stone are exposed.

We've already discussed how tonsil stones are a buildup of leftover food particles that get lodged in the crypts of your tonsils, but now scientists think that tonsil stones might be composed of a dense film of living organisms, as stated in one article.

For some, tonsil stones may only show up after an occasional illness. They are often whitish in color, somewhat rounded in shape and sometimes compared to pearls (although definitely not as pretty). A better comparison might be sea coral, as suggested by a study published in the journal Otolaryngology -- Head and Neck Surgery. Like ocean coral, tonsilloliths are crawling with anaerobic bacteria. These thrive on sugars and food particles that are present in the mouth. This layer is called biofilm, which is a thick network of living microorganisms. Beneath this film, stones are made up of collagen and dead bacteria. Whether living or dead, these stones pack quiet a pungent smell, and the best bet to dislodging and preventing them is to gargle thoroughly with an oral rinse -- if this doesn't work, you may need something stronger.

How long have tonsil stones been aggravating people? According to one article, a very long time. Doctors have known about the tonsils for centuries, even medieval physicians new to the presence of tonsil stones. Our tonsils are glands and therefore part of the body's lymphatic system. Healthy tonsils rarely are noticed, but when an infection or sickness affecting them appears, the tonsils store up dead bacteria, allowing the body to fight through whatever illness is present. This storage often causes the tonsils to swell, as in the case of strep throat.

Tonsils that are swollen and have an appearance like a raisin (with folds and channels) are classified as "cryptic," and this is often the perfect environment for creating tonsil stones. Strathern's "A Brief History of Medicine" states that having tonsil stones was a symptom that indicated the patient was in need of a tonsillectomy (this is no longer the common form of treatment). A 10th century Arabian surgeon by the name of Abulcasis created a tonsil guillotine (a somewhat frightening name) specifically for the removal of one's tonsils. Moving ahead several centuries, in an 1800 issue of the Medical and Physical Journal (a publication of the Royal College of Physicians in London) made one of the first modern mentions of tonsilloliths. A surgeon named John Hewitt described "a case of calculous concretions in the tonsils" of his 39-year-old female patient. Similar to today, this patient had chronic throat infections, and they were often followed up by stones "of a light yellow colour, and about the size of a small field bean" stuck in her tonsils. In his detailed account, Hewitt measurements state that the tonsillolith "weighed 11 gains [0.7 grams], and was exactly the form and colour that I sent it" which indicates that he actually mailed the stone itself to one of his colleagues -- definitely not something most of us would want to receive in the mail!

While past treatments included the removal of one's tonsils, perhaps that's not quite necessary to end the appearance of tonsil stones. If you find that you are often plagued by tonsil stones, definitely speak with your dentist or doctor about it, but you might want to also explore other less-evasive options. Whatever decision you reach, hopefully these articles have help shed a little more light on tonsil stones.