Are tonsil stones causing your bad breath?

Your tonsils have pits and folds called crypts. Food debris, dead cells, mucus and bacteria can collect there and harden into small whitish or yellowish lumps called tonsil stones, or tonsilloliths. Cleveland Clinic describes them as being made of hardened minerals such as calcium, food debris and germs. They are usually harmless, and many fall out on their own.

Besides bad breath, they can cause a bad taste, a sore throat, a cough, earache, trouble swallowing or the feeling that something is stuck in the back of your throat. Some people have no symptoms and only learn about them on a scan.

Lab work on tonsil stones has found anaerobic bacteria such as Fusobacterium, Porphyromonas and Prevotella, groups associated with producing volatile sulfur compounds. Those are the same rotten-egg gases that tongue bacteria make.

The clinical link is fairly strong. In a 2008 study of people with chronic tonsil problems, a tonsil stone was present in 75% of those with abnormal breath readings, compared with 6% of those with normal readings. The authors calculated about a tenfold higher risk of abnormal breath tests when a stone was present.

Tongue coating and tonsil stones often go together, since both thrive on the same bacteria and debris. If cleaning your tongue daily for two weeks fixes most of the smell, the tongue was the bigger factor.

Tonsillitis is an infection, usually with a sore throat, fever, swollen tonsils and sometimes white patches or pus. The NHS lists bad breath among tonsillitis symptoms too. The difference: tonsillitis makes you feel unwell and usually settles in 3 to 4 days, while tonsil stones are painless or mildly uncomfortable lumps that come and go without fever.

Cleveland Clinic suggests these home measures:

• Gargle with warm salt water, especially after eating.
• Use a water flosser on a low setting, or gently press with a cotton swab, to dislodge visible stones.
• Brush and floss regularly, and clean your tongue too.
• Stay hydrated and, if you smoke, stop.

Do not dig at your tonsils with sharp or hard objects, which can injure the tissue. For a step-by-step routine, see our guide to tongue scrapers and tonsil stones. To be clear, a tongue scraper does not reach or remove tonsil stones. What it does is clear the tongue coating that adds to the same smell.

Talk to a doctor if home care is not working, the stones keep coming back, or they cause pain or trouble swallowing. A provider can remove stubborn stones and will treat any infection. Cleveland Clinic notes that people who get stones repeatedly usually have enlarged tonsil crypts, often from frequent tonsil infections, and that if stones keep causing symptoms, an ear, nose and throat specialist may discuss surgery, including removing the tonsils (tonsillectomy).