DR FLO: What are these smelly particles in my mouth?

Dr Flo, when I sleep at night, a lot of saliva accumulates in my mouth. It’s tasteless, but I have to wake up to spit it out. Sometimes I find smelly grey particles in my mouth in the morning. What’s ailing me? Sue

Dear Sue,

The foul-smelling grey balls from the throat are called tonsil stones or tonsiloliths.

Tonsils are lymphatic glands in the throat and they have an irregular surface. Bacteria, mucus, dead cells, and food particles can become trapped in the folds on the surface of the tonsils.

The trapped substances coalesce together and form the bad-smelling chunks. If these chunks harden, they are called tonsil stones or tonsiloliths.

Tonsil stones are more common in people with chronic tonsillitis, or sinusitis and post-nasal drip.

These stones may cause bad breath, bad taste in the mouth, throat discomfort, difficulty swallowing or ear pain. Other than this discomfort, tonsil stones are usually not dangerous.

Excess salivation can be a result of an infection like tonsillitis or sinusitis. It can also be due to tooth decay, gum irritation and reflux (heartburn).

To manage them, observe good oral hygiene by brushing your teeth after meals, gargle using salt water or a mouthwash to reduce excess saliva and bad breath.

You can have the stones removed by the doctor. Before brushing your teeth, remove food particles from your mouth by drinking water and by swishing water in your mouth and spitting it out.

It would be advisable to visit a dentist and an ear, nose or throat (ENT) specialist so that the underlying problem can be treated.

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Dr Flo, when I swallow food or drinks, I feel a lot of pain in my chest. It started a fortnight ago when I was drinking water and I suddenly felt a sharp pain between my breasts. The pain has been persistent even after taking anti-inflammatory drugs and antibiotics.

Secondly, there is fresh blood when I pass stool. I take a lot of fluids and greens, but the bleeding doesn’t stop. I have also used stool softeners and antibiotics, but there is no improvement. What is the problem? Please advise me on how to manage this. Thanks. Dennis

Dear Dennis,

The pain in the chest when you swallow food or drink is most likely due to irritation in the food pipe (oesophagus), which passes through the chest in its journey between the mouth and the stomach.

The pain can be caused by inflammation of the oesophagus (oesophagitis), fungal infection, hyperacidity and reflux or oesophageal strictures, which are caused by scarring of the lining of the oesophagus.

Endoscopy can be done to see the state of the oesophagus. There’s medication to reduce the acid your stomach makes and to reduce reflux, and antibiotics if you have an infection.

In some people, the disease may take long to treat, or it may keep coming back.

To reduce or prevent the symptoms, avoid alcohol and smoking; avoid some painkillers like aspirin and diclofenac and avoid long-term use of steroids. Do not skip any meals, take dinner two hours before going to bed and avoid heavy meals in the evening.

Also, stay upright after dinner and before sleep.

Bleeding after passing stool could be due to a tear in the lining of the anus or rectum, because of friction from passing large stool, hard stool, or from diarrhoea.

It could also be due to haemorrhoids, otherwise known as piles. These are veins that bulge in the lower part of the rectum and anus.

The walls of the veins stretch and get irritated, and easily get a tear and bleed. This can occur due to straining when passing stool e.g. due to constipation or diarrhoea; or any activity that causes repeated high pressure in the abdominal region e.g. a persistent cough and lifting weights.

To manage it, prevent constipation by taking a lot of fluid and a high-fibre diet every day, exercise, schedule time for a bowel movement every day and take your time; use baby wipes instead of toilet paper and take a sitz bath (sit in warm water) for about 20 minutes twice a day to soothe the injured tissue.

A doctor can prescribe stool softeners and suppositories to help heal the injured tissue.

Since the bleeding has been persistent, it would be advisable to see a surgeon, so that an examination can be done to visualise the lining of your anus, rectum and large intestines to see the cause of the bleeding and get the way forward.

Send your medical questions to[email protected] for absolutely free expert advice.