Hi Amarula -
Hi - I'm female/37yo.
OK, I'm gonna go out on a limb here, so hear me out
I too have suffered all my life with bad breath. I am fastidious, like you, about my oral hygiene. I brush 3 times a day. I floss. I use those metal hooks or the little brushes to really get at the tartar. I visit the dentist for a thorough cleaning every 6 months, and she is always amazed at how little build-up I have (which is due to how much time I spend cleaning and flossing). I brush my toungue, the roof of my mouth and my gums. Everything. And, like you, I eat very well. I am borderline vegetarian, with no red meat and a diet high in fruit and veg. I drink TONS. I have no cavities. My teeth are in good shape.
Basically, I do everything right as suggested by the docs and experts and I *still* had breath like an animal crawled in there and died. In fact, I could go through the whole mouth brushing/flossing/rinsing routine and within 5 minutes I could taste my mouth was stale again. It is AWFUL, and I can so empathise with your sadness. It can be so depressing! I chew gum to help, but really that is just masking the problem. It has made me so embarrased socially and so on.
Yes, I agree, of course it is not life threatening. Not even physically painful....and yet emotionally it can really, REALLY, get you down. Occasional bad breath *everyone* gets, as we know....but to have it chronically like this is just horrible.
Anyway....the cause, I believe, for you and for I is TONSILLILTHS (sp?). Or, more commonly, tonsil stones. This would also explain the "lump" feeling you are getting (and I would get) at the back of your throat, like a little irritation or something stuck there. To describe the smell of these disgusting things I would have to envoke the visual of a dead animal combined with rotting eggs combined with 6-month old brocolli combined with old toe cheese combined with sour milk combined with sewage....you get the picture?? They STINK TO HIGH HEAVEN..and then some. It has to rank as one of the worse stenches I have ever smelt in my entire life.....and I am not exaggerating.
Basically tonsil stones are a combination of dead cell matter, nasal drip, possibly teeny food particles and other oral debris that fester and grow in the crypts of the tonsil. A crypt is like a little cave, so to speak....dark, damp and warm...and hence, the perfect breeding ground for these awful things. Many people have this issue and are aware of it because the stones will eventually work their way out and pop into your mouth...or sometimes can literally be seen hanging out of the tonsil pocket/crypt like a little white/creamy/yellowish stone. However, for some, they are not even aware of having them. Maybe the stones do drop out occasionally but are just swollowed...I don't know...but for whatever reason some folks can go years...decades...having this problem and being totally unaware of it. Apart from the awful aide effect of bad breath, of which they are keenly aware!
I would suggest gently running your finger tip (with a short nail..don't want to cause a cut) on the tonsil area, especially if you have a flap of skin that kind of goes across the front part (hard to describe, sorry). If you can pull it back a little, even better. Now sniff your finger tip....! If you feel like throwing up at the stench, then that, I would hazard a 99% correct guess, is your problem.
And honestly, even if it doesn't smell that bad, it could still be the problem if your crypts are very deep and the stones are buried well.
So - here's how I have dealt with it. For years I have manually pushed these things out using my finger or a q-tip. It would always feel SO MUCH better afterwards - cleaner, and less "full" back there. It gave me a short respite from feeling so paranoid about my stinky breath! I have read all sort sof ways to get these things out. One common way is to use the waterpik to gently hose them out. The problem is, they will always come back so it is a matter of constantly removing them. And, for me, I always felt that there were more stuck deeper in the tonsilur crypts. Plus, it was quite uncomfortable to manually extract them and I would often cause bleeding.
My tonsils have always caused me issues, and over the years the chronic tonsilitis has left them pitted and scarred and swollen to 3 times the size of what they should be. The more damaged they became from the repeated infections, the more scarred pockets and sunken crypts and other areas the tonsil stones had to grow in. UGH. Gross!!
Anyway, I finally took the plunge and had my tonsils out 8 days ago. The surgery is not cheap (even with insurance I ended up paying almost 1K), and I am going to be honest with you here...it has been AGONY in the recovery. I mean truly, gut-wrenching, brutal pain. I am going on day 9 post-Op, my throat is still covered in scabs, I can barely eat much beyond soup, the pain-Meds barely touched the agony...I have essentally barely left the couch in over a week. Thank the lord I took 2 weeks of work, because this is the recovery from h**l. There is no other way to describe it....but guess what....NO BAD BREATH!!! NADA! ZILCH! NOTHING! I even had my husband smell my breath first thing in the morning before brushing and he said "not that bad".....honestly, I am not exaggerating....the clouds zoomed away, the sun burst forth and the song "HALLELUJA" blasted out from the hilltops! After brushing, and even with these hideous scabs on my thorat, my breath stayed fresh all day....my husband has been subjected to the "sniff test" about every 2 hours, and I have passed everytime with flying colors. In fact, he described my breath as "nice and fresh" about 4pm....8 hours after brushing! ME...with nice and fresh breath! I can barely believe it!!!!
Adult tonsillectomy is not to be taken lightly. The recovery is slower and much more painful than that of a child. Kids can bounce back within 5 days sometimes...it can take literally 3 or 4 weeks to feel remotely normal again, althoughmore commonly 10-14 days. But still, that is a full 2 weeks you will essentailly be out of comission. Plus, the risks are higher for adults of post-operative bleeding. If you bleed during the Op, the doc is there to deal with it immediately of course. The next risky time is approx. 7-11 days post Op when the scabs drop off. Yeah - disgusting, I know. Anyway, at this time there is a 2-4% chance of a serious bleed which woul dbe enough to get you back to ER and into the OR again to have the area cauterized...which of ocurse means you have to start the healing all over again. However, the way I saw it was 2-4% chance meant there was a 96-98% chance of NOT bleeding, so to me the risk is worth it. Plus, I figured, even if I do have a major bleed-out, the hospital is only a 10minute drive. I am just suggesting you weigh up the risks if you decide to go this route...but that is something you can research online and discuss with your ENT.
So yes, I am in absolute torturous pain, I feel like crap (and look worse! hahaha!), my throat is so sore I can hardly stand it, I have lost 10lbs in weight (hmm...maybe a good thing??), I have hardly slept and sitting in the car for the ride to pick my kids up from school - and I'm not even the one driving - is enough to exhaust me for hours and hours.......but it has been SO WORTH IT!!!
To know that my breath problem (as well as my chronic tonsilitis problem) is a thing of the past brings me more joy than I could even express.
I really believe this may be the root of all your problems, and I strongly suggest getting off all these meds that don't address the real issue and finding an ENT who recognizes and understands the problem of tonsil stones and will work with you to resolve this rotten problem!! No, I am not a doctor, and of course I may be completely wrong, but everything you describe points to tonsil stones.
Good luck and I really hope this helps! When I saw your post I couldn't help but reply...sorry...it turned into a bit of a novel...hahahah!!