Post updated Oct. 1, 2019
Tonsil stones, or tonsilloliths, are a buildup of bacteria and debris within the nooks and crannies of your tonsils. This debris hardens into small, stone-like growths.
This condition is different than tonsillitis, which occurs when the tonsils themselves become infected.
What Are Tonsil Stones?
The tonsils are gland-like tissue in the back of each side of your mouth. They contain the lymph nodes that work as a part of your immune system, filtering out viruses and other harmful particles from entering your body and making you sick.
Tonsil stones are hard white or yellow formations located within the tonsils. Tonsil stones can cause bad breath, a sore throat, and even trouble swallowing.
“Small tonsil stones are fairly common, especially for people who have repeated cases of tonsillitis,” says Jonas Johnson, MD, professor and chair of the Department of Otolaryngology at University of Pittsburgh School of Medicine and UPMC, who explains that stones can range in size from a few millimeters to several centimeters. “But we rarely see large, symptomatic tonsil stones that require medical treatment.”
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What Causes Tonsil Stones?
Typically, you swallow small particles of debris, like food, dead cells, and mucus. That debris can get caught in the crevices of your tonsils, known as the crypts.
Over time, the bacteria calcifies from a soft, gel-like state to a hardened particle – a tonsil stone.
Tonsil stones appear most often in people between the ages of 20 and 60. “Most patients who repeatedly get tonsil stones have large tonsils or repeated cases of tonsillitis,” says Dr. Johnson.
Symptoms of Tonsil Stones
The symptoms of tonsil stones can depend on how large they are. Sometimes you may experience no symptoms at all.
The most commonly experienced symptom is bad breath, also known as halitosis. Research published in the British Dental Journal found that people with tonsil stones were 10 times more likely to exhibit bad breath.
Other symptoms include:
- Chronic sore throat
- Foreign body sensation
- Painful swallowing
- Bad taste in mouth
- Ear pain
- Upper airway obstruction
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Treatment and Removal of Tonsil Stones
Tonsilloliths are generally harmless — they’re just uncomfortable, and embarrassing when they cause bad breath. Several treatments are available, both at home and at the doctor’s office. “Most people won’t need medical treatment for tonsil stones,” says Dr. Johnson, “but if they do, we now have several options for effective treatment.”
Some treatments include:
- No treatment: If you’re not experiencing any symptoms, you may not need treatment at all.
- Salt water or mouthwash: Gargling these can help dislodge your tonsil stones.
- Manual removal: You can scrape off the buildup using a toothbrush, Q-tip, or something similar.
- Antibiotics: Some doctors may prescribe antibiotics to get rid of tonsil stones.
- Surgical removal: In more severe cases, a doctor may need to surgically remove the tonsil stone. This is a simple procedure done by numbing just the area around the tonsils.
- Tonsillectomy: If tonsil stones become a chronic problem, causing repeated tonsillitis, your doctor may recommend the removal of your tonsils. This generally is done as an outpatient procedure, but you may need an overnight stay in the hospital. It also can result in a severe sore throat.
- Laser Tonsil Cryptolysis (LTC): An alternative to tonsillectomy, LTC uses a CO2 or diode laser to scar the tonsil crypts. This makes it less likely for tonsil stones to form. Potential benefits include less bleeding and pain than from a tonsillectomy.
- Coblation tonsil cryptolysis: A version of cryptolysis that uses a wand instead of a laser. This method potentially shows similar results to LTC while minimizing risks like airway fires, burns, and retinal damage.
Tonsil Stone Prevention
“Tonsil stones aren’t dangerous, but they can become uncomfortable if they are large,” says Dr. Johnson, who adds that they can generally be prevented by flossing and brushing the teeth and tongue after every meal. For people who have had tonsil stones in the past, gargling with an oral rinse at least once a day may reduce the chance of developing additional stones.
If your tonsil stones do keep coming back, a tonsillectomy might be a way to prevent them.
When Is a Tonsillectomy Needed?
Only a doctor can determine if you need a tonsillectomy or other treatment for chronic tonsil stones.
Talk to your health care provider if you experience severe or prolonged symptoms. Visit the UPMC Ear, Nose, and Throat website to learn more about throat-related ailments.
Talk to your doctor if you’re having more severe symptoms to make sure you don’t have an infection and to find ways to limit the discomfort caused by tonsil stones.
Sources reviewed for this article
Abdulrhman Alfayez, MD, Meshal B. Albesher, MBBS, Mohammed A. Alqabasani, MD, Saudi Medical Journal, A Giant Tonsillolith (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5938656/)
Balaji Babu B., Avinash Tejasvi M.L., C.K. Anulekha Avinash, Chittaranjan B, Journal of Clinical and Diagnostic Research, Tonsillolith: A Panoramic Radiograph Presentation (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3843407/?_ga=2.162075380.91142641.1566305422-555101751.1566305422#b4)
Babatunde Olamide Bamgbose, Axel Ruprecht, John Hellstein, Sherry Timmons, Fang Qian, ISRN Dentistry, The Prevalence of Tonsilloliths and Other Soft Tissue Calcifications in Patients Attending Oral and Maxillofacial Radiology Clinic of the University of Iowa (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3920671/)
Christopher Y. Chang, MD, Richard Thrasher, MD, Ear, Nose, and Throat Journal, Coblation Cryptolysis to Treat Tonsil Stones: A Retrospective Case Series (https://journals.sagepub.com/doi/full/10.1177/014556131209100605)
M. Dykes, S. Izzat, V. Pothula, Journal of Surgical Case Reports, Giant Tonsillolith – A Rare Cause of Dysphagia (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3649527/?_ga=2.133248838.91142641.1566305422-555101751.1566305422)
YP Krespi, V. Kizhner, American Journal of Otolaryngology, Laser Tonsil Cryptolysis: In-office 500 cases review (https://www.ncbi.nlm.nih.gov/pubmed/23583078)
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