Tonsil Stones: Symptoms, Causes, Treatments How to Remove

Tonsil stones, also known as tonsilloliths, are small, hardened material formations that develop in the tonsils. They can cause a range of symptoms and are often associated with bad breath and throat discomfort. Understanding how tonsil stones form, their symptoms, and treatment options is essential for maintaining good oral health.

Key Facts

Tonsil stones are medically referred to as tonsilloliths

They form in the crevices of the tonsils and are composed of calcified material

They often contain calcium, but can also have magnesium, phosphorus, and ammonia

Bad breath, throat discomfort, and difficulty swallowing are common symptoms

Tonsil stones are a common condition but are more prevalent in adults than in children

Depending on size and symptoms, tonsil stones can be removed at home or may require professional medical intervention

What are Tonsil Stones?

Tonsil stones are small, calcified deposits that form within the crevices of the tonsils. They develop when debris, such as food particles, dead cells, and bacteria, become trapped in the nooks and crannies of the tonsils. Over time, this debris can harden, or calcify, forming tonsil stones.
They vary in size and can be as small as a grain of rice or as large as a pea. Though they can sometimes be uncomfortable, they are not generally considered harmful. However, their presence can contribute to bad breath and may sometimes cause discomfort or pain.

What are Tonsils?

The tonsils are small, soft tissues located at the back of the throat on either side. They are part of the lymphatic system and play a role in the body’s immune response. Tonsils act as the first line of defense against airborne pathogens such as bacteria and viruses, trapping them before they can go further down the respiratory tract. They contain lymphocytes, which are white blood cells that help to fight infections.

There are three sets of tonsils:

Palatine tonsils: These are what most people refer to when they say tonsils. They are located at the back of the throat.
Pharyngeal tonsils (adenoids): These are located behind the nose and the roof of the mouth.
Lingual tonsils: Located at the base of the tongue.

What do Tonsil Stones Look Like?

Tonsil stones are typically whitish or yellowish in color. They are irregularly shaped – often resembling tiny rocks or pebbles. Due to their color, they can sometimes be difficult to see within the tonsils, which are typically pink or flesh-colored. When they are small, they may not be visible at all, or may look like tiny specks within the crevices of the tonsils.
Larger tonsil stones may be more easily visible and can sometimes be seen protruding from the tonsils. They may also be detected through symptoms such as bad breath, a sore throat, or the feeling of having something stuck in the back of the throat.

What’s the Difference Between Tonsil Stones and Tonsillitis?

Tonsil stones and tonsillitis are two distinct conditions that affect the tonsils but have different causes and symptoms.

Tonsil Stones (Tonsilloliths)

Cause: Tonsil stones are formed by the accumulation and calcification of debris such as food particles, dead cells, and bacteria in the crevices of the tonsils.
Symptoms: They often cause bad breath, a sensation of something being stuck in the back of the throat, and sometimes mild discomfort or pain, especially if they are large.
Appearance: Tonsil stones are visible as small, whitish or yellowish, hard masses within the tonsils.
Treatment: Depending on the size, tonsil stones can sometimes be removed at home by gentle pressure or gargling, or may require professional removal by a healthcare provider.

Tonsillitis

Cause: Tonsillitis is an infection of the tonsils usually caused by viruses or bacteria.
Symptoms: Common symptoms include a sore throat, swollen tonsils, difficulty swallowing, fever, and swollen lymph nodes in the neck. The throat and tonsils may appear red, and there might be a white or yellow coating on the tonsils.
Appearance: The tonsils are often enlarged, red, and may have white patches of pus when infected.
Treatment: Tonsillitis caused by bacteria is usually treated with antibiotics. Viral tonsillitis does not respond to antibiotics and is usually managed with pain relief and rest.

Who’s at Risk of Tonsil Stones?

Certain factors can increase the risk of developing tonsil stones:

Large Tonsils: Individuals with larger tonsils or with more crevices in their tonsils are more likely to develop tonsil stones.
Chronic Tonsillitis: Those who have repeated episodes of tonsillitis or chronic inflammation of the tonsils are at higher risk.
Poor Oral Hygiene: Not maintaining good oral hygiene increases the likelihood of tonsil stones.
Dry Mouth: A lack of adequate saliva can lead to the accumulation of debris in the tonsils.
Diet: Certain diets high in dairy or sugar may contribute to the formation of tonsil stones.

How common are tonsil stones?

Tonsil stones are relatively common, although the exact prevalence is not well-documented. Many individuals may have small tonsil stones without even realizing it. Tonsil stones are more common in adults than in children and are often discovered accidentally during dental exams or X-rays.

What Causes Tonsil Stones?

Tonsil stones are caused by the accumulation of debris in the tonsillar crypts.
This debris can include:

Food Particles: Small bits of food can become lodged in the tonsils
Dead Cells: Naturally shedding epithelial cells can accumulate
Mucus and Saliva: These can combine with other debris in the crevices of the tonsils
Bacteria: The tonsils can harbor bacteria, which can contribute to both the formation and the bad smell associated with tonsil stones

Over time, this debris hardens or calcifies, forming tonsil stones. Factors such as poor oral hygiene, chronic tonsillitis, dry mouth, and diet can contribute to the development of tonsil stones.

What are the Symptoms of Tonsil Stones?

Tonsil stones may sometimes not cause any symptoms, especially when they are small. However, as they grow in size, they may cause various symptoms, including common symptoms (bad breath, throat pain, trouble swallowing) and additional signs like ear pain. Here’s the full list:

Bad Breath (Halitosis): Tonsil stone symptoms often include bad breath or tonsil caseum induced halitosis due to bacterial growth. The bacteria and decaying material in tonsil stones can produce a foul smell.
Sore Throat Pain: Tonsil stones can cause discomfort or pain in the throat, sometimes resembling strep throat or other throat infections.
Difficulty Swallowing: Depending on their size and location, tonsil stones can make swallowing food and liquids uncomfortable. Larger stones can cause a sensation of obstruction, leading to difficulty swallowing.
Ear Pain: Because of the close proximity of the ear, nose, and throat systems, stones can sometimes cause referred ear pain due to shared nerve pathways between the ears and the throat.
Swollen Tonsils: The tonsils may appear swollen, and this can sometimes be mistaken for tonsillitis.
White or Yellow Debris: Small, white or yellow lumps on the tonsils are usually tonsil stones.
Metallic Taste in Mouth: Some people report a metallic taste in the mouth when they have tonsil stones.
Sensation of Something Stuck in the Throat: People with tonsil stones often feel like they have something stuck at the back of their throat.
Frequent Tonsil Stones: Some individuals may experience many tonsil stones, indicating chronic issues.

How are Tonsil Stones Diagnosed?

Diagnosing tonsil stones typically involves a physical examination. A healthcare provider or dentist will use a light to look into the throat and may use a tool to press down the tongue for a better view. The characteristic appearance of white or yellowish lumps in the tonsil area usually confirms the diagnosis.
In some cases, especially if tonsil stones are deep within the tonsils or the symptoms are not typical, additional diagnostic tools such as X-rays or CT scans may be used to confirm the presence of tonsil stones.

How are Tonsil Stones Treated?

Treatment for tonsil stones depends on the size and symptoms they are causing:

No Treatment: Small tonsil stones that do not cause symptoms may not require any treatment.
At-Home Removal: For smaller, accessible stones, some individuals use a non-sharp object like a cotton swabs or the back of a toothbrush to carefully nudged out of the tonsil crypts until the stone dislodges. Gargling with warm salt water can also sometimes help to remove tonsil stones.
Oral irrigation: A warm salt water gargle or using a water flosser can also help dislodge small stones.
Antibiotics: In cases where there is significant swelling and pain associated with tonsil stones, antibiotics may be prescribed to address any underlying infection.
Surgical Removal: For very large stones or recurrent tonsil stones causing significant symptoms, a healthcare provider may recommend surgically removing the stones.
Tonsillectomy: In extreme cases, particularly if a person has chronic issues with tonsil stones or tonsillitis, the healthcare provider might recommend a tonsillectomy, which is the surgical removal of the tonsils.

It is important to approach tonsil stone removal with care as the tonsil tissue is delicate and can bleed easily.

Can I Remove the Tonsil Stones Myself?

It’s possible to remove tonsil stones at home if they are small and easily accessible. However, one must be extremely careful when attempting to do this, as the tissue around the tonsils is delicate and can be easily injured.
Here are steps to remove tonsil stones at home:

Wash your hands: Before attempting to remove tonsil stones, ensure your hands are clean to prevent infection.
Use a Light: Stand in front of a mirror in a well-lit area so you can clearly see the back of your throat.
Use a Cotton Swab or the Back of a Toothbrush: Gently press or massage the area around the tonsil stone with a moistened cotton swab or the back of a toothbrush. Be gentle and don’t use force, as this can injure the tonsil tissue.
Gargle with Warm Salt Water: After attempting removal, gargle with warm salt water to help clean the area and soothe the throat.

If you experience pain, bleeding, or if the tonsil stone is lodged deeply or difficult to reach, it’s advisable not to force it and instead consult a healthcare provider.

Are Medications Used to Treat Tonsil Stones?

Medications are not typically used to treat tonsil stones directly, but they can be used to address symptoms or contributing factors. For instance:

Antibiotics: In cases where there is significant swelling, redness, or pain associated with tonsil stones, antibiotics may be prescribed to treat any underlying bacterial infection.
Mouthwashes: Therapeutic mouthwashes that help reduce bacteria in the mouth can sometimes help to manage and prevent tonsil stones.

Remember that it’s essential to use medications responsibly and under the guidance of a healthcare provider.

Is There a Way to Remove Tonsil Stones Surgically?

Yes, there are surgical options for the removal of tonsil stones, particularly when they are large or recurrent and cause significant symptoms.

Curettage: This involves using a curette to scoop out the calcified tonsil stone. It can be done under local anesthesia.
Laser Tonsil Cryptolysis: This is a procedure in which a laser is used to eliminate the crevices in the tonsils where stones can form.
Tonsillectomy: In extreme cases, particularly for individuals who have chronic issues with tonsil stones or tonsillitis, the healthcare provider might recommend a tonsillectomy, which is the surgical removal of the tonsils. This is typically considered a last-resort option.

These surgical procedures should be discussed with a healthcare provider who can provide information on the risks, benefits, and suitability based on the individual’s health status and history.

Will I Need a Tonsillectomy Because of Tonsil Stones?

The necessity for a tonsillectomy due to tonsil stones varies from person to person and is usually considered a last resort.
A tonsillectomy may be considered if:

There are recurrent episodes of tonsil stones that cause significant symptoms such as pain, difficulty swallowing, or chronic bad breath.
The tonsil stones are exceptionally large or recur frequently despite other treatments.
There is an underlying chronic tonsillitis that might be contributing to the formation of tonsil stones.

It’s important to discuss the risks and benefits of tonsillectomy with a healthcare provider, who will consider the severity of your symptoms, your health history, and the potential impact on your quality of life.

How Can I Prevent Tonsil Stones?

While it might not be possible to prevent tonsil stones entirely, certain measures can be taken to reduce the likelihood of their formation:

Maintain Good Oral Hygiene: Brush your teeth at least twice a day and floss daily. Use a tongue scraper to clean the back of your tongue as well.
Stay Hydrated: Drink plenty of water to help keep the mouth moist and to prevent the accumulation of debris in the tonsils.
Gargle with Saltwater: Regular gargling with a saltwater solution can help to remove debris from the tonsils and reduce inflammation.
Avoid Excessive Dairy: Some people find that reducing dairy intake can decrease the formation of tonsil stones.
Regular Dental Check-ups: Visit a dentist regularly for oral check-ups.

What’s the Outlook for People with Tonsil Stones?

For many individuals, tonsil stones are a minor and temporary inconvenience. They may occur occasionally and either fall out on their own or be easily removed at home. For others, they can be a recurring problem that requires more proactive management.
The outlook for people with tonsil stones is generally good, especially if proper oral hygiene is maintained. For those with recurrent or troublesome tonsil stones, removal techniques and possibly tonsillectomy can provide relief.
In general, tonsil stones are not harmful in themselves, but the symptoms can be bothersome for some. It’s important to address any concerns with a healthcare provider to determine the best course of action for your specific situation.

How Do I Take Care of Myself if I Have Tonsil Stones?

If you have tonsil stones, taking care of yourself involves managing symptoms and trying to prevent future occurrences.
Here are steps you can take:

Maintain Oral Hygiene: Brush your teeth at least twice a day, floss regularly, and use a mouthwash to reduce bacteria in your mouth. Consider using a tongue scraper to clean your tongue as well.
Gargle with Saltwater: Mix 1/4 to 1/2 teaspoon salt in 8 ounces of warm water. Gargle the saltwater in your mouth for a few seconds before spitting it out. This can help dislodge tonsil stones and reduce tonsil swelling.
Stay Hydrated: Drink plenty of water to keep the throat moist and to prevent the accumulation of debris in the tonsils.
Eat a Balanced Diet: Avoid excessive consumption of dairy products and include more fibrous foods which can help in cleaning the oral cavity.
Don’t Use Sharp Objects: Avoid using sharp objects to try to remove tonsil stones, as this could cause injury.

When Should I See a Healthcare Provider About Tonsil Stones?

You should see a healthcare provider about tonsil stones if:

You experience severe pain or discomfort in your throat
The tonsil stones are very large or you are unable to remove them yourself
You have symptoms of infection such as fever, chills, or persistent sore throat
You experience difficulty swallowing or breathing
The tonsil stones keep coming back despite self-care measures

What Else Should I Ask My Provider?

When consulting a healthcare provider about tonsil stones, consider asking the following questions:

What is the cause of my tonsil stones?
Are there specific foods or habits that could be contributing to their formation?
What treatment options are available for tonsil stones?
Is there any medication that might help manage symptoms or prevent tonsil stones?
What are the risks and benefits of surgical removal or tonsillectomy?
Are there any lifestyle changes you would recommend?

Are Tonsil Stones Contagious?

No, tonsil stones are not contagious. They form from debris within an individual’s own tonsils.

Why do Tonsil Stones Smell so Bad?

The unpleasant smell from tonsil stones comes from the sulfur-producing bacteria that are part of the debris in the tonsil crypts. These bacteria produce volatile sulfur compounds, which are responsible for the bad smell.

How Long do Tonsil Stones Last?

Small tonsil stones may dislodge and dissolve on their own in a few days. Larger stones can persist for longer periods and may require removal.

Tonsil Stone Home Remedies

Gargling with warm salt water can help dislodge small tonsil stones and soothe the discomfort associated with them. Oral irrigators, like water flossers, can also be effective at dislodging stones. A healthy diet, good oral hygiene, and staying hydrated can all contribute to preventing tonsil stones.

Tonsil Stone Complications

While generally harmless, tonsil stones can cause discomfort, bad breath, and potential complications like chronic tonsillitis or infection. They can also lead to emotional distress due to persistent bad breath. In rare cases, very large tonsil stones can cause difficulty breathing or swallowing. If tonsil stones frequently recur, it can lead to chronic discomfort and surgical intervention might be considered.

Bottom Line

Tonsil stones are relatively common and often don’t cause significant problems. However, in cases where they cause discomfort, bad breath, or recur frequently, it is important to seek the advice of a healthcare provider. Maintain good oral hygiene and a healthy lifestyle to minimize the chances of tonsil stone formation. When consulting a healthcare provider, ensure you understand the cause, available treatment options, and any preventive measures you can take.

This article is complete and was published on June 1, 2023, and last updated on December 21, 2023.

Key Facts