Last Updated on November 15, 2022 by Dr Gustavo Assatourians DDS
The tonsils are lymph nodes that look like cushions. Oval and soft, they are located in the back of the mouth and the upper part of the throat on both sides, serving as the first lines of defense of the immune system against bacteria, viruses, and other microorganisms that enter the mouth/They are made of tissue with lymphocytes, helping to prevent infections and other diseases in the body.
They can generate various health problems in the tonsils such as sore throat, plaque, tonsillitis, glandular fever, or tonsil stones, each with slightly a different cause and pathology while ultimately originating in the same place: the tonsils.
What are tonsil stones?
Tonsil stones are also called tonsilloliths, small lumps that grow on the tonsils consisting of hardened materials. They start as small yellowish spots and grow until they become large stones. Sometimes, they occur in people who have large and irregular tonsils. They develop “tonsilloliths” which can also occur in people with recurrent tonsillitis and in adolescence or young adulthood.
What do tonsil stones look like?
They may be large in size up to 1 cm in size, but they can also be 1-2 mm in size, making them difficult to see. Rarely, as some studies have reported, stones are larger than 4 cm. They are generally soft but harden over time. They are rough in appearance and light yellowish or white in color. When they look like stains they do not represent a health risk; however, they can cause bad breath among other symptoms. Of note, they can be easily removed when small and soft.
What causes tonsil stones?
The tonsils are made up of lymphoid tissue, which means that small indentations or crypts can be generated on their surface, deep enough to trap particles of microorganisms, cell debris, food residue, and minerals present in saliva such as phosphorus, ammonium, magnesium, and calcium as hydroxyapatite or calcium carbonate salts. Over time, the residue hardens and forms stones. Tonsillolithiasis, the formation of tonsillar stones, is thought to occur primarily due to the repeated inflammation of the tonsillar crypts with recurrent tonsillitis and calcification.
What are the symptoms of tonsil stones?
Tonsil stones may be removed by brushing your teeth or consuming food or liquid, without producing any symptoms. However, the symptoms that may occur are:
- Bad breath (halitosis): people can experience severe bad breath due to bacteria or possibly an infection.
- Cough: sensing a foreign body can cause an annoying and uncomfortable cough.
- Ear pain: can develop in any area of the tonsils/ It is possible that it will affect a nerve pathway shared with the ear. This can radiate the pain, even if it does not touch the ear itself.
- Sore throat: it is possible that the condition will cause pain, depending upon the size.
- Bad taste in the mouth
- Small white or yellow stones that you may spit out: see spots or solid white material when looking at the back of your mouth.
Other symptoms include:
- Difficulty swallowing: depending on the location, it may be difficult to swallow food or liquid, feeling that something is holding it since it is also painful.
- Feeling that something is stuck in the throat
- Small white spots on the tonsils
- Swelling and redness of the tonsils
When should you seek medical attention?
In very rare cases, it may be complicated and present an infection. Or the stone may be very large and present other symptoms; therefore, it is recommended to seek medical attention as follows:
- Severe sore throat that worsens quickly
- Difficulty opening the mouth
- Pain when opening the mouth
- Difficulty swallowing
- Drooling or difficulty swallowing
- Swelling in the face and neck, or inside the mouth or throat
- Difficulty speaking or breathing
- Swollen glands near the jaw or in the neck
How can I start treating tonsil stones?
The stones may initially be seen with a focused light after opening the mouth wide. In case it cannot be seen but the symptoms are present, you may require diagnostic tests to see the location, as indicated by the dentist or doctor.
- Gargling with mouthwash or salt water helps the bad odor and can remove lodged stones.
- Coughing: sometimes a strong cough helps remove these stones or loosens them.
- Cotton swab: be careful before you hurt your tonsils. Try massaging around the tonsils with the cotton swab to push out the loosened tonsil stone.
When home methods do not work, it is better to seek help from a health professional, who may indicate:
- Antibiotics: eventually medications can help with symptoms like an infection; however, they do not eliminate the stones.
- Surgical removal: if the stones are unusually large, they may require surgery to remove them.
- Tonsillectomy: removing the tonsils is sometimes the best way to get rid of recurring problems like stones or infections. Tonsillectomy is safe, but it can cause a sore throat for several days after surgery.
- Cryptolysis: a laser or radiofrequency wand is used to scar the tonsils, making the crypts disappear and tonsil stones less likely.
How to prevent tonsil stones
The best way to prevent them is by practicing good oral hygiene:
- Brush and floss regularly. Be sure to brush the front and back of your tongue as well.
- Avoid smoking and excess alcohol.
- Gargle with salt water after eating or use alcohol-free mouthwash.
- Use a water spout to clean your mouth and dislodge tonsil stones.
- Stay hydrated by drinking plenty of water. The consumption of sugary drinks is not recommended.
Tonsil stones may be harmless and go away on their own, but keeping your mouth clean and free of debris is a more efficient way to prevent tonsil stones from developing.
- Alfayez A, Albesher MB, Alqabasani MA. A giant tonsillolith. Saudi Med J. 2018 Apr;39(4):412-414. doi: 10.15537/smj.2018.4.21832. PMID: 29619494; PMCID: PMC5938656. (accessed Nov 01, 2022). Available in: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5938656/2
- Cleveland Clinic. Tonsil Stones. My.clevelandclinic.org (Internet). Published on Nov 05, 2021. (Accessed on Nov 01, 2022). Available in: https://my.clevelandclinic.org/health/diseases/21505-tonsil-stones
- Healthdirect. Tonsil stones (Internet). Published on Nov, 2020. (Accessed on Nov 01, 2022). Available in: https://www.healthdirect.gov.au/tonsil-stones
- Harding M. Tonsil Stones. Patient (internet). Published on Sep 13, 2018. (Accessed on Nov 01, 2022). Available in: https://patient.info/ears-nose-throat-mouth/sore-throat-2/tonsillolith-tonsil-stones
- Bussey A. What are tonsil stones—and what causes them? Healthily (Internet). Published on Aug 06, 2020. (Accessed on Nov 01, 2022). Available in: https://www.livehealthily.com/health-library/conditions/what-are-tonsil-stones-and-what-causes-them
- Hersh E. Preventing the Recurrence of Tonsil Stones. Healthline (Internet). Published on Feb 08, 2019. (Accessed on Nov 01, 2022). Available in: https://www.healthline.com/health/how-to-prevent-tonsil-stones
- Lee K. What Are Tonsil Stones? Symptoms, Causes, Diagnosis, Treatment, and Prevention. Everyday Health (Internet). Published on Aug 21, 2020. (Accessed on Nov 01, 2022). Available in: https://www.everydayhealth.com/tonsil-stones/
- Weber B. What you should know about tonsil stones. Medical News Today (Internet). Published on Dec 21, 2021. (Accessed on Nov 01, 2022). Available in: https://www.medicalnewstoday.com/articles/3150269
- Parker H. Tonsil Stones (Tonsilloliths). WebMD (Internet). Published on Nov 19, 2021. (Accessed on Nov 01, 2022). Available in: https://www.webmd.com/oral-health/guide/tonsil-stones-tonsilloliths-treatment-and-prevention