Tonsillar abscess (Quinsy)

• Tonsillar abscess (also known as “Quinsy” ) is a possible complication of tonsillitis.
• An abscess containing pus forms near the infected tonsil, often leading to severe pain and swelling, as well as fevers and chills.
• The pain will usually be worse on one side of the throat. Quinsy can be so painful that a person cannot swallow their own saliva, which can lead to drooling.
• It may be hard to open the mouth and quite difficult to speak.
• It’s a serious condition and usually requires treatment in hospital, which may involve intravenous antibiotics and surgical drainage of the abscess.

Tonsil stones  (Tonsilloliths)

• Also known as tonsilloliths, these are small hard white or yellow deposits that occur on the tonsils.
• They can be formed from a build up of food particles, mucus, calcium and dead cells- and tend to build up in the natural hollow on the surface of the tonsil.
• Quite often they cause no problems and may just be noticed when looking into the mouth.
• Sometimes they lead to bad breath (halitosis) or discomfort.
• They may be prevented by good oral and dental hygiene, not smoking, and staying well hydrated.
• It’s not recommended to remove stones yourself- if you’re having a lot of trouble with them, it may be worth speaking to your doctor.

Tonsillar Hypertrophy (enlarged tonsils)

• Tonsillar Hypertrophy means persistently enlarged tonsils.
• Some people have naturally large tonsils, and it causes no symptoms or complications. For others, large tonsils can be a sign of infection, irritation or allergy.
• Tonsillar Hypertrophy is very common in children, but most of the time there is no need to do anything about it as the problem often goes away over time.
• However, if there is recurrent tonsillitis, mouth breathing, bad snoring, sleep apnoea or glue ear, sometimes a tonsillectomy may be considered.
• Obviously if there are any underlying triggers such allergies, these should be addressed first.

Acid reflux

Some people report that acid reflux (when acid regurgitates from the stomach up to the mouth) can cause their breath to smell unpleasant. Also, the presence of certain bacteria in the stomach (Helicobacter Pylori), seems to be associated with bad breath.

Respiratory problems

If a person has long term sinus infections, or a constant drip of mucus down that back of the throat (a postnasal drip), this may lead to bad breath. Now and then a child might get halitosis from pushing a foreign body in the nose when nobody is watching- the first symptom that they have been up to mischief may be an unpleasant odour from the nose and mouth! Bad breath can be caused by certain lung conditions where there is build-up of infected mucus or sputum, such as bronchiectasis.

Other chronic diseases

If a person has significant liver or kidney disease, it can lead to bad breath, but in these cases there will usually be other more obvious symptoms. Untreated Type 1 Diabetes can also cause a strong chemical odour on the breath, which people say is a bit like nail varnish. If a person is dieting or malnourished, they may develop a similar type of breath, caused by high ketones in the bloodstream.

In addition, any condition that leads to a dry mouth can predispose a person to halitosis- including sleep apnoea, or uncommon conditions that result in too little saliva being produced, such as Sjogren’s disease.

What’s the best advice for someone with bad breath/halitosis?

• Find out if you really have a problem (ask someone to check your breath!)
• Avoid smoking, avoid strong smelling foods and reduce alcohol intake
• Stay well hydrated
• Carefully brush your teeth, tongue and gums twice a day- remembering to floss, and use mouthwash. Speak to your dentist if you think your gums or teeth are not in good shape.
• Consider whether you may have symptoms of acid reflux, sinus problems, tonsil stones or other health issues mentioned above, and speak to your GP
• If these measures don’t help or you’re worried about any of the causes of bad breath discussed in this article, you should see your doctor for an examination and appropriate investigations.