Are Tonsil Stones Causing Your Bad Breath?

Have you ever noticed a small, hard white or yellow lump in the back of your throat and wondered what it is? It may look or feel like a piece of popcorn got stuck in the back of your throat, but what it could be, more likely, is a tonsil stone.
Tonsil stones, or tonsilloliths, are "calcified structures that develop in your tonsillar crypts."¹ In other words, they form when bacteria, food particles, and other debris collect in the grooves (or "crypts") of your tonsils, then harden into a calcified mass.
While many people experience tonsil stones, not everyone will realize it because the stones are often too small to notice. You may simply end up swallowing the mass and never even know it was there. If it grows large enough, however, it may cause discomfort, sore throats, earache, tonsillitis, and another unpleasant symptom – bad breath.

Are Tonsil Stones Causing Your Bad Breath?

If you have unexplained bad breath, it's possible tonsil stones could be the culprit. Tonsil stones have been said to affect 16 percent to 24 percent of patients, although they seem to be detected in clinical practice far more often.
One study found tonsil stones actually occurred in close to 40 percent of patients, with the prevalence increasing with age (and occurring most commonly in those aged 50 to 69.² Patients averaged one to 18 stones each, with sizes ranging from 1-10 millimeters (mm).
Despite their prevalence, their exact causes remain a mystery, and few research studies have been conducted to find out, perhaps because the stones are not generally considered to be dangerous. However, they are known to cause bad breath, courtesy of the sulfur-containing bacteria they contain.
In a study conducted by researchers at the State University of Campinas in Brazil, tonsil stones were detected in 75 percent of tonsillitis patients who had bad breath but in only six percent of those with normal breath.³ The researchers concluded:⁴

"The presence of a tonsillolith represents a tenfold increased risk of abnormal VSC [volatile sulphur compounds] halitometry and can be considered as a predictable factor for abnormal halitometry [bad breath] …"

That being said, while tonsil stones can contribute to bad breath, they remain a relatively minor cause. Dr. Toshihiro Ansai, an associate professor at Kyushu Dental College in Japan, who has studied the connection, told The New York Times:⁵

"Most halitosis is caused by periodontal diseases and tongue coat … Tonsillolith would be a minor cause."

Tonsil Stones Are Living Biofilms

It's important to understand that tonsil stones are not simply inert masses; they're living biofilms that have been shown to respire oxygen and nitrate.⁶ Tonsil stones have even been compared to sea coral, because they're heavily composed of anaerobic bacteria. As reported by Dr. Harold Katz in The Huffington Post:⁷

"These [anaerobic bacteria] 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."

While I'm not aware of any research on this, it's likely that tonsil stones would be impacted by the health of your oral microbiome. Achieving oral health is really about promoting balance among the bacteria in your mouth.
The oral microbiome, while connected to the gut microbiome, is quite unique. Most importantly, it has a protective component that protects you from deadly viruses and bacteria in the environment. The second function of the oral microbiome is the beginning of digestion.
Interestingly, probiotics do not work in the mouth, so it's not as simple as adding more beneficial microbes. As an initial step, you need to cease killing microbes in your mouth.

This is why antimicrobial agents and alcohol mouthwashes designed to "kill bad bacteria" actually do far more harm than good. If you have tonsil stones, even the Mayo Clinic recommends against using an alcohol-based mouthwash.⁸
A better option may be to add fermented vegetables to your diet. These are loaded with friendly flora that not only improve digestion but alter the flora in your mouth as well.
And when made using the proper culture, fermented vegetables are an excellent source of vitamin K2. Since the addition of fermented vegetables to my diet, my plaque has decreased by 50 percent and is much softer, so it's possible it could benefit tonsil stones as well.

What Else Increases Your Risk of Tonsil Stones?

You're more likely to develop tonsil stones if you have large tonsils, and in some people they tend to show up after an illness, such as strep throat. If you suffer from dry mouth, which can be caused by many prescription medications, this also increases your risk because it allows anaerobic bacteria to thrive.⁹
Poor dental hygiene is also a risk factor, so practicing twice daily brushing (be sure to brush your tongue as well) and flossing, along with regular cleanings by your biological dentist and hygienist, will help ensure good oral health.
Equally important is eating a healthy diet while avoiding sugars and processed foods. If you develop tonsil stones, they can usually be removed using a cotton swab or water-flossing device. Gargling with salt water may also help to flush out the debris and dislodge the stones.
While removing the tonsils (tonsillectomy) is sometimes recommended for tonsil stones, this carries a significant risk of pain and bleeding and should only be used as an absolute last resort, if at all.

If Tonsil Stones Aren't Causing Your Bad Breath, What Is?

Halitosis, or bad breath, is typically caused by systemic diseases, gastrointestinal and/or upper respiratory tract disorders, and microbial metabolism from your tongue, saliva, or dental plaque — all of which are indicators of systemic imbalance.
As mentioned, the key to remedying it is making changes to your diet and proper dental care. By avoiding sugars and processed foods, you'll also help prevent the proliferation of the bacteria that cause decay and odor in the first place. If you need to freshen your breath in a pinch, try the seven natural options below:

1. Cucumber: Placing a cucumber slice on the roof of your mouth may help to rid your mouth of odor-causing bacteria. According to the principles of Ayurveda, eating cucumbers may also help to release excess heat in your stomach, which is said to be a primary cause of bad breath.¹⁰
2. Apple cider vinegar: Gargling with diluted apple cider vinegar can help to eliminate bad breath and whiten teeth. Keep in mind, however, that apple cider vinegar is highly acidic.
The main ingredient is acetic acid, which is quite harsh, so you should always dilute it with water before swallowing. Pure, straight apple cider vinegar could damage your tooth enamel or the tissues of your mouth and throat.

3. Peppermint: Powdered peppermint leaves have been used historically to freshen breath and whiten teeth; you can even add a drop or two of peppermint oil directly to your toothpaste for added freshening.
4. Oil pulling: Swishing coconut oil around your mouth and "pulling" it through your teeth may help freshen your breath. One study found oil pulling is as effective as mouthwash at improving bad breath and reducing the microorganisms that may cause it.¹¹
5. Chewing sticks: Chewing sticks are simply twigs from trees with antimicrobial properties. Historically, a frayed end would be used like a toothbrush to brush teeth while a pointed end would act as a toothpick. Many tree species were used for chewing sticks, including tea tree, cinnamon, mango, and dog wood, although neem is probably the most widely known. If you are so inclined, chewing sticks are widely available today, and their use is even encouraged by the World Health Organization (WHO).
6. Green tea: Green tea has been found to be quite useful for reducing bad breath. Researchers concluded, "Green tea was very effective in reducing oral malodor temporarily because of its disinfectant and deodorant activities, whereas other foods were not effective."¹²
7. Chew parsley: Parsley's bright green color and "green" grassy taste come from its high levels of chlorophyll. This compound has antibacterial and deodorizing properties. A study conducted in 1950 by Dr. Howard Westcott found that 100 milligrams (mg) of chlorophyll neutralized bad breath and odors from perspiration, menstruation, urine, and stools.¹³