Bad Breath (Halitosis) and Tonsil Stones

Author: Op. Dr. Javidan Asafov · ENT / Otolaryngology Specialist · Last medical review: 04.10.2026

What is it?

Bad breath (halitosis) is an unpleasant odour of the breath that other people also notice. The odour comes mainly from sulphur gases produced by bacteria in the mouth and throat as they break down food debris and shed cells. Morning breath, which disappears after breakfast or brushing, is normal; it occurs because saliva decreases at night. The temporary odour caused by garlic, onions or alcohol is not a disease either. Odour that lasts all day despite brushing, however, needs its cause investigated.

Causes

The most common source of bad breath is the mouth itself: the whitish coating at the back of the tongue, gum disease, tooth decay and inadequate oral hygiene. Assessing and treating these causes is the field of the dentist. When the mouth and teeth are healthy, the source is usually in the ear, nose and throat region:

• Tonsil stones and chronic tonsillitis: debris collecting in the small pits on the surface of the tonsils turns into foul-smelling particles.
• Sinusitis and postnasal drip: thick, infected mucus running from the back of the nose into the throat causes odour.
• Nasal blockage and dry mouth: mouth breathing, snoring, drinking too little water and some medicines dry the mouth; with less saliva, bacteria multiply.
• Reflux and silent reflux: stomach contents rising into the oesophagus, and even up to the throat and larynx, can contribute to the odour, together with a sour or bitter taste, a burning throat, constant throat clearing and a feeling of postnasal drip. Reflux that reaches the throat (laryngopharyngeal reflux) often causes no heartburn, which is why it is also known as “silent reflux”.
• A foreign body in a child’s nose: in children, a foul-smelling discharge from one nostril may be a sign of an object stuck in the nose.

Apart from reflux, bad breath caused by stomach disease is much rarer than is commonly believed. General conditions such as diabetes and kidney or liver disease can also, rarely, cause a characteristic breath odour.

What are tonsil stones?

The surface of the tonsils has small pits called crypts. Food debris, shed cells and bacteria collect and harden in these pits, forming white or yellowish particles about the size of a grain of rice that smell very bad when crushed. These are called tonsil stones (tonsilloliths). They sometimes drop into the mouth on their own when coughing. As well as bad breath, they can cause a feeling of something stuck in the throat, a bad taste and mild pain on swallowing. Tonsil stones are not dangerous, but they can be treated if they recur often and cause symptoms.

How can I tell if I have bad breath?

People often cannot notice the smell of their own breath; breathing into your hand and smelling it is not a reliable method. The most practical way is to ask someone close whom you trust. Some people, on the other hand, are sure their breath smells even though no one else notices any odour. This is called halitophobia; showing on examination that there is no odour, and treating any real cause, also brings relief to these people.

Examination

At the examination you will be asked how long the odour has been present, how it changes through the day, and about nasal blockage, postnasal drip, snoring, reflux symptoms such as heartburn or a sour taste, and the medicines you use. The mouth, tongue, gums and tonsils are examined, checking the tonsil pits for stones or infection. The nose, the back of the nose and the larynx are assessed endoscopically with a thin camera, also looking for signs of irritation caused by reflux in the larynx. A CT scan may be requested if sinusitis is suspected, and blood tests if a general condition is considered.

Treatment

Treatment is planned according to the cause. Good oral hygiene is the basis in every case: brushing twice a day, flossing, gently cleaning the back of the tongue with a tongue scraper and drinking enough water during the day. Alcohol-based mouthwashes can dry the mouth and so increase the odour in the long run; mouthwashes only mask the odour temporarily.

For tonsil stones, gargling with warm salt water after meals reduces their build-up. Trying to remove stones with a toothpick, cotton bud or fingernail is not recommended, as it can cause bleeding and infection of the tonsil. If stones recur often, cause constant odour and a feeling of something stuck in the throat, or if the tonsils become infected often, removing the tonsils (tonsillectomy) provides a permanent solution. Sinusitis and postnasal drip are treated with medicines, and nasal blockage with medicines or surgery depending on its cause. If reflux is present, diet and lifestyle are adjusted and, if needed, medicines that reduce stomach acid are used on medical advice.

When to see a specialist

See an ENT specialist if your bad breath persists despite good oral and dental care, or if you often have white particles on your tonsils, a constant feeling of something stuck in the throat, postnasal drip, a sour taste in the mouth or nasal blockage. Seek examination without delay if one tonsil is enlarged, a sore in the mouth or throat does not heal, you bring up blood or have difficulty swallowing, or a child has a foul-smelling discharge from one nostril.

This article is for general information; please consult your physician for diagnosis and treatment.