Why do I have bad breath and white spots on my tonsils?

Dear Dr. Katz,

I sometimes wake up with bad breath, the uncontrollable urge to clear my throat and, weirdest of all, white spots on my tonsils! What are those things? And are they what gives me bad breath? My girlfriend says she gets them too, and we can't figure out where they come from. Please help!

- Mark M., Juneau, AK

Good question! I gather you haven't had a tonsillectomy, Mark. For people who still have their tonsils, these little white flecks can be quite problematic. They're called tonsil stones, and they are some of the most potent causes of bad breath out there.

While they may look like white spots on your tonsils, these tiny objects are actually small, rounded balls of gunk lodged in your tonsils. And yes, they are definitely what is giving you and your gal pal a raging case of halitosis.

Here's how they form. As you eat and drink, bits of food and dead skin cells naturally get caught in the folds of your tonsils. This can be exacerbated if you've ever had tonsillitis, which can make the glands larger, permanently swollen or covered with deep pits and wrinkles.

As you might imagine, bacteria immediately go to work on these bits of gunk, digesting them and emitting foul-smelling compounds that leave you with terrible bad breath. The trouble with tonsil stones, also called tonsilloliths, is that they tend to grow as more and more food and microbes adhere to them.

Over time, these white spots on the tonsils can get pretty big! Case studies have recorded tonsil stones as large as an inch and a half across. This is very rare, but even a moderately sized tonsil stone can leave an uncomfortable sensation in your throat and a rank smell on your breath.

Your best bet for getting rid of tonsil stones is to look into specialty breath freshening mouthwashes, especially those that oxygenate your mouth and neutralize odors. By gargling these products at least twice a day, you can gradually loosen and dissolve tonsilloliths, leaving your tonsils white-spot-free and your breath as fresh as can be.

If you're unsure whether you have a tonsil stone, open your mouth in front of the mirror and shine a small flashlight into your throat. Do you see small white spots on your tonsils or adenoids? Can you spot a pebble-like object lodged to one side of your uvula, that little thing that hangs down over your tongue?

If the answer is yes, then it's high time you and your girlfriend invested in a quality specialty breath freshener. Good luck, Mark!