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Tonsil Stones - Also Known As Tonsilloliths


Written By Sharon Boyd, RDH, BS.       |       Reviewed by Lara T. Coseo, DDS

Contents
 1   What are Tonsil Stones
 2   Causes of Tonsil Stones
 3   Signs and Symptoms of Tonsil Stones
 4   Progression of Tonsil Stones
 5   Dangers and Health Risks
 6.  Links to other oral health conditions
 7   How to Prevent Tonsil Stones
 8   Treatments for Tonsil Stones
 9  Home Remedies
 10 Your Questions About Tonsil Stones Answered
 11 References


What are Tonsil Stones?

Tonsils lateral view

What is a tonsil stone? Tonsil stones are also called tonsilloliths, and are a buildup of hardened or calcified material in the tonsils or crevices around the tonsils. Made up of extremely odorous material, tonsil stones often cause severely bad breath. (1) The tonsillolith comes from bacteria or dead cells that have built up in pits or fissures around enlarged tonsils.

What Causes Tonsil Stones

What causes tonsil stones? Many factors can contribute to the development of a tonsil stone. Sometimes debris such as food becomes entrapped around the tonsils and begins to accumulate and harden over time with other bacteria. Mucous secretions from the nose may also contribute to this bacterial buildup. Tonsil stones are usually found in adults, and are typically associated with people that have enlarged tonsils.



Signs And Symptoms
tonsil-stones

Signs and symptoms that accompany tonsil stones include:

  • Bad breath
  • Trouble swallowing
  • Visible white film or stones on the tonsils
  • Swollen tonsils
  • Throat discomfort

Here’s 7 natural ways to avoid bad breath.

Progression

Tonsil stones begin as small, softer areas of bacterial accumulation. Over time they can calcify, while also enlarging in size. Most tonsil stones develop in cracks or crevices on top of, behind or around tonsils. As bacteria accumulate, the tonsil stone begins to put off a very foul odor. If the stones become severe enough they may cause pain in the throat, during swallowing, or in the ears. (2) If tonsil stones become severe enough to cause constant discomfort they may require professional removal. Chronic tonsil stones may require a tonsillectomy.

Dangers And Health Risks

Tonsil stones usually are not serious, but they do often accompany tonsillitis and sore throat symptoms. Severe tonsil stones can cause difficulty swallowing or ear pain. The most significant problems associated with tonsil stones are due to the malodor that they put off, which may inhibit social relationships.

Links To Other Conditions That Correlate

Tonsilloliths are an accumulation of bacteria and dead skin cells that build up and calcify in the area of the tonsils. They are often linked with:

  • Halitosis
  • Poor oral hygiene
  • Nasal drainage
  • Tonsillitis
  • Sore throat

Bad-breath-cure

Declining oral health linked to major health issues.

How To Prevent Tonsil Stones

The best way to prevent tonsil stones is to practice good oral hygiene and manage nasal-allergy symptoms that might cause mucus accumulation in the back of the throat. Keeping the mouth free of gum disease, plaque buildup and rinsing thoroughly (gargling) can help remove loose debris and prevent buildup that might cause tonsil stones. Maintaining a healthy diet that is low in sugar and processed food and using 100% pure toothpaste and mouthwash daily will help reduce the amount of active bacteria in your mouth.

Treatments for Tonsil Stones

Tonsil stones are usually left alone by professionals unless they are severe. Most health professionals will recommend increased oral hygiene and healthy lifestyle choices to reduce the buildup accumulating in the back of the throat.

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If the stones are severe enough to cause discomfort and pain, they may require surgical extraction and/or a tonsillectomy.

Antibiotics may be prescribed to reduce the bacteria as well as subsequent infections associated with the tonsil stones.

Home Remedies

Many people are able to remove tonsil stones on their own. A common tonsil stones remedy involves homemade rinses or gently removing them with a smooth-ended device such as a cotton swab. To cure tonsil stones or eliminate tonsil stones, cutting back on the levels of bacteria in the mouth is key.

Your Questions About Tonsil Stones Answered

How do you get tonsil stones?

Tonsil stones are an accumulation of bacteria and dead skin cells in and around the surfaces of tonsils. Most tonsils with tonsil stones are swollen and the person experiences some nasal drainage. They may also be due to poor oral hygiene.

How do you get rid of tonsil stones?

Tonsil stones can fall off alone. Using proper oral hygiene and home rinses can help the bacteria to dislodge and fall off. If severe enough, tonsil stones may require surgical removal.

Are tonsil stones contagious?

No, tonsil stones are not contagious. However, the bacteria from tonsil stones may be spread to loved ones through saliva.

Do tonsil stones cause bad breath?

Yes. Tonsil stones can cause severe halitosis.

How to remove tonsil stones yourself.

Many tonsil stones fall off alone, but some people also remove them with a toothbrush or cotton tip applicator. Home rinses are a safe way to help loosen and remove tonsil stones. If severe, they may need to be surgically removed as well as accompanied by a tonsillectomy. You should never attempt removing a tonsil stone with any type of metal instrument in your mouth. This is very dangerous and can cause severe damage to the delicate tissues of your throat.

Is it okay to leave tonsil stones in my mouth?

You should never want to leave calcified or large amounts of bacteria buildup in your body. These bacteria could cause problems or dislodge and travel to other areas of the body.

What causes tonsil stones?

Tonsil stones are one of those odd anomalies that some people get and others don’t. If you’re someone who has enlarged tonsils with deep pits in them, it’s possible for oral bacteria, food particles, and sinus drainage to collect inside of those crevices and calcify, just like the tartar that builds up on your teeth. 

How many tonsil stones are too many?

Just a single tonsil stone is one too many. Also called “tonsilloliths,” these calcified areas of debris can lead to serious halitosis (bad breath) and make you more prone to issues like a chronic sore throat.

Are tonsil stones and tonsillitis the same thing?

No. It’s possible to have tonsillitis without any tonsil stones. It’s also possible to have tonsil stones without having tonsillitis. FYI: Most people call them tonsil stones, but tonsillolith is the technical term.

Do tonsil stones cause tonsillitis?

Usually tonsil stones come after tonsillitis, due to the swelling and enlarged voids (tonsil crypts) left behind from repeated infections. Since your tonsils are a lymph node, they become inflamed when your immune system flares up. However, having tonsil stones wedged into tonsil crypts can lead to ongoing irritation even if you don’t have classic tonsillitis.

Do they go away with a tonsillectomy?

Usually, but there are exceptions. Since most tonsil stones form inside of your tonsil crypts, having your tonsils removed means there’s nowhere for those stony deposits to settle. However, there’s always a slight possibility that the tonsilloliths form around the scar tissue just between your soft palate (roof of your mouth) and back of your throat, where the tonsils were removed.

Are they a sign of anything?

Having tonsil stones usually means that someone has significant scarring or a history of repeated/chronic tonsillitis or post-nasal drips from sinus infections. They’re also an indication of poor oral hygiene, since they’re made up of oral bacteria and food debris.

Where are they – are they in my throat?

As the name suggests, tonsil stones look and feel like little rocks that are nestled inside of the various crevices of your tonsils. They’re similar to the rocky substance called tartar, which builds up on your teeth if they aren’t cleaned properly. Usually, they’re only in and around your tonsils (but not other parts of your throat).

Where do they come out when removed?

If you’ve ever made the mistake of googling “tonsil stone removal” you’ll see that tonsil stones come out of small openings (crypts) in your tonsil’s surface. It’s similar to what you would see if you were pressing on a pimple, except the drainage isn’t fluid.

Do they mean you are sick?

A lot of the time, people who have tonsil stones are so used to the irritation in their throat that they don’t “feel” sick. But the truth is that the added bacteria inside of their mouth means they aren’t as healthy as they ought to be.

How long do they last?

A tonsil stone can stay in place for months or years. Some people are able to remove them, while others have to go to a doctor to have them cleaned out. In most cases, people with chronic tonsilloliths will have them for as long as their oral hygiene is inadequate, chronic nasal/sinus drainage exists, or until their tonsils are removed.

Will they come back?

Tonsil stones will keep coming back if the cause isn’t treated or the tonsils aren’t removed. Poor oral hygiene or chronic tonsillitis must be addressed. Otherwise, it will only be a matter of time before new tonsil stones form.

Why do they come back?

Just like tartar buildup on teeth, tonsil stones start out through the accumulation of soft bacteria. Gradually – if not removed – those bacterial particles will start to calcify and build up into larger areas of deposit. If you have an area that’s hard to clean, such as deep tonsil crypts, recurring tonsilloliths are more common.

Will they ever stop?

Excellent oral hygiene is key, including thorough toothbrushing and use of an antimicrobial mouthwash. However, tonsil crypts may still be prone to accumulating bacteria. If they continue, you may want to consider having your tonsils removed.

How do you prevent them?

First, make sure you’re cleaning your mouth thoroughly at least 2-3 times per day. Eliminating dental plaque with brushing and flossing is the first step. Then, use an alcohol-free antimicrobial mouthwash to gargle with for several seconds. Some people also find that drinking lemon water helps, but this could be too acidic on your teeth over the long term. Additionally, work with your physician to manage chronic allergies and sinus drips to minimize bacteria in the back of your throat. Or, consider getting your tonsils taken out.

How do you get them out?

Tonsil stone removal is a delicate process, due to sensitive gag reflexes in some people. Additionally, you need to be careful not to harm the delicate mucosal linings of your tonsils and throat. Some people remove their tonsil stones by pressing against their tonsils with a cotton swab or their finger; others may simply rinse them out. Tenacious stones can be scooped or suctioned out by a healthcare provider.

Will they leave holes?

Since tonsil stones form in the crypts (crevices) or pits on your tonsils’ surfaces, you’ll likely notice a “hole” there once your tonsillolith is removed. The tonsil stone itself didn’t create the hole, but instead took advantage of forming in them in the first place. Larger tonsil stones may cause the crypts to become stretched or enlarged, widening their original size.

Can they get stuck?

Yes. The reason there are tonsil stones to begin with is because bacteria and food debris has gotten stuck (lodged) inside of your tonsil crypts. Once they grow to a significant size, removing them can be difficult. However, the stone itself won’t “fuse” to your tonsil.

Where do you go to get them removed?

Most people have their tonsil stones removed by an ENT or their primary care physician. An oral surgeon can also remove tonsil stones.

Is there blood when removing them?

Not usually. However, if the tonsil is raw or infected in the area just around or under the stone, you might see minimal bleeding or redness once the tonsillolith is removed.

Can they hide?

Absolutely. Sometimes tonsil stones aren’t visible but still form because of a tiny opening on the tonsil’s surface. If there’s a deep crevice or crypt below the opening – due to chronic tonsil infections or past tonsilloliths – you may never see the new one while it’s forming.

Where are they located?

Most tonsil stones are located within tonsil “crypts” on the tonsil’s surface, which are deep crevices. However, you can also get stones between your tonsil and the soft tissues draped down either side of your soft palate, near the back of your mouth.

Who removes them?

Some people remove their own tonsil stones, but it can be difficult to do if you have a sensitive gag reflex or the tonsilloliths are wedged deep inside of your tonsils. Usually, you’ll want to see a doctor, ENT, or dental specialist like an oral surgeon to have them removed.

What do they look like?

The majority of tonsil stones are white or yellowish in color. They tend to have a rough surface or smooth side, depending on the area they formed in. It’s possible for tonsilloliths to accumulate stain from drinks, food, or tobacco, causing them to take on other colors as well.

Are they always visible?

Tonsil stones are hard to see, since they’re located so far back in your mouth. Additionally, the largest portion of the stone tends to be tucked inside of your tonsils, making them difficult if not impossible to see. You may never even realize that they’re there.

What makes them?

All a tonsil stone is, is a collection of calcified bacteria and food debris. So, if you don’t clean your mouth well, those particles will gradually start to accumulate in and around your mouth.

Since I have them what does that mean?

If you’re one of the people “lucky” enough to get tonsil stones, it means there’s a high level of bacteria in the back of your mouth and throat. You’re probably also someone who has had a history of frequent tonsillitis, leaving scarred crevices and crypts in your tonsils’ surfaces for the bacteria to accumulate inside of.

When will they become a big problem?

Some people never realize that they have tonsil stones. Others suffer from frequent sore throats and halitosis (bad breath). There’s also the chance that the added bacterial colonies inside of your throat make you more prone to other types of infections (such as pneumonia, oral cancer, strep throat, or tonsillitis.)

Are they contagious?

No. You can’t “catch” tonsil stones from other people, just like you won’t get tartar buildup simply by sharing food with or kissing someone that has tartar. It boils down to your body’s individual biology and individual hygiene habits.

Do they hurt?

Sometimes tonsil stones can cause irritation or sore tonsils. You’re more likely to hurt if you try to remove your tonsilloliths on your own, as the mucosal lining around them is quite delicate.

Do they bleed?

Your mouth is highly vascular, meaning it can bleed easily if you cut it somewhere. If you’re not careful, it’s possible to cause bleeding while you remove your tonsil stones. But usually they won’t bleed on their own.

Are they dangerous?

Not necessarily. However, there’s always the slight risk of accidentally inhaling a tonsil stone, which can lead to a respiratory infection.

How do they form?

Anytime there’s bacterial accumulation, it’s simply a matter of time before those colonies start to multiply. In the case of tonsil stones, those accumulations gradually calcify and build upon themselves layer after layer, growing larger with time for as long as the bacteria isn’t removed.

Are they normal?

No. It’s not normal or natural for people to get tonsil stones. If you notice that you or your child has tonsil stones (tonsilloliths) it’s best to schedule an exam with your physician, ENT, or an oral surgeon to discuss removal and prevention.

Are they common?

Approximately 1 in 10 people get tonsil stones. They’re most common in people who have bad breath (halitosis) and chronic tonsillitis.

Are they bad to have?

It’s not good to have tonsil stones. They can significantly raise your risk of bad breath and a sore throat.

Are they a sign of cancer?

People who have cancer often see changes in their body’s immune system. Since tonsils are lymph nodes, it’s normal for people with autoimmune diseases or conditions like cancer to see flare-ups from time to time. However, tonsil stones themselves are not a sign of cancer.

Will they make you sick?

Chronic infections and bacterial colonies can suppress your immune system. Going extended periods of time with tonsil stones can potentially put you more at risk for infections like strep throat. When your body is working “overtime” on one infection, it makes it more difficult to control other ones at the same time. So essentially, having tonsil stones may mean you’re more at risk of getting sick.

Will they cause a sore throat?

People with tonsil stones tend to either be used to them, or more prone to having a sore throat due to the constant irritation and bacterial buildup. It can also depend on what part of your tonsil is involved and if the stone is scratching at your throat.

Will they give you bad breath?

Yes. Halitosis – or chronic bad breath – is a common symptom of tonsil stones.

Can they cause infection?

Tonsil stones are the result of bacterial buildup, so they are essentially an ongoing area of infection inside of your mouth.

Can they get infected?

Your tonsils may get infected if the tonsil stones are large or have been there for an extended period of time. Changes in oral hygiene or a recent illness may also cause your tonsils to flare up and become irritated in those areas.

Can they cause ear pain?

Since your ear, nose, and throat are all closely related, it’s common for people who have infected tonsils or tonsil stones to experience irritation or pain in the areas around them.

Will they affect your ears in any way?

Other than referred pain or irritation caused by swollen tonsils, tonsilloliths don’t affect your ears.

Can they cause headaches?

If you have strep throat or sinus infections (which are both common in people who have tonsil stones) it can cause headache symptoms.

Can they cause coughing?

Yes. Especially if they’re irritating the back of your throat or trying to work their way out of your tonsils.

Can they cause dry mouth?

No. Tonsil stones are not related to saliva production, as salivary glands are located in other areas of your mouth.

Can they cause strep throat?

Although tonsil stones don’t cause strep throat, they can raise your risk of getting it (and vice versa.)

Can they cause fever?

The stones themselves won’t necessarily cause a fever, but if your tonsils are infected or inflamed it means you probably have some type of illness that can, in turn, give you a fever.

Can they cause white tongue?

White hairy tongue or black hairy tongue are both associated with high levels of bacteria and poor oral hygiene, as are tonsil stones. So, it’s only natural for them to coexist.

Can they cause swollen lymph nodes?

Yes. Since your tonsils are lymph nodes, having tonsil stones inside of them can trigger irritation and inflammation.

Can they cause vertigo?

No. Vertigo is typically related to inner ear problems. However, they can make you feel nauseous if you have a sensitive gag reflex.

Can they make you tired?

No. If you’re tired and have swollen tonsils, it’s likely that you have some type of systemic illness and need to see a doctor.

Can they cause swelling?

Yes. Since tonsil stones are made up of bacteria and debris, having them wedged inside of your tonsils can lead to swelling in those immediate areas.

Can they cause swollen glands?

Yes. Your tonsils are a set of lymph nodes/glands, which can become inflamed and swollen when they’re invaded by bacteria (which is exactly what tonsil stones are).

Are they a sign of HIV?

Not necessarily, but someone with HIV may be more prone to getting swollen tonsils and thus tonsil stones.

Do they feel soft?

Sometimes. Tonsil stones tend to be firm, hard, or squishy. There may even be some oozing or pus around them. Although the stones themselves are solid, they can have a soft or slimy texture to them.

Can they be hard?

Yes. Most tonsil stones are hard, similar to tartar deposits across your teeth. Hence why they’re referred to as “stones.” They are essentially calcified colonies of bacteria.

Can they dissolve?

Not inside of your mouth. However, some people do claim that DIY treatments used for issues like kidney stones – such as drinking lemon water – help reduce their size. Please consult with a dentist or physician first, as long-term acidic diets can be harmful (and cause erosion in tooth enamel).

Will they go away on their own?

Some tonsilloliths work their way out on their own or when you cough them out. Others “pop” out if you press against the tonsil with your finger or a cotton swab. Left alone, the tonsil stone will not go away by itself.

Will they come out on their own naturally?

Sometimes, especially if you’re coughing or accidentally rub the area when you’re swallowing food. If the area gets too swollen, it could potentially force the tonsil stone out. But usually they won’t come out until you forcefully remove them.

Do they smell?

Yes. Tonsil stones are known to cause moderate to severe bad breath. If you suffer from halitosis but brush and floss routinely, ask your dentist about possible tonsil stones.

Are they hereditary or genetic?

Since tonsil stones tend to have a lot to do with oral hygiene and ongoing infections, it’s not uncommon to see them run in families (since germs and hygiene habits are frequently shared between family members).

Are they contagious through kissing?

No. Tonsil stones are not something you can catch by kissing or sharing food with someone else.

Are they related to kidney stones?

Tonsil stones and kidney stones have several similar characteristics but are both caused by different factors. The two are unrelated. Having one does not necessarily mean you will get the other.

Are they an STD?

No. Tonsilloliths can occur in anyone, even those who are not sexually active.

Are they more common in pregnancy?

No. Chances are that if you’re prone to tonsil stones, you’ll experience them well before ever getting pregnant.

Will they go away after pregnancy?

No. Tonsil stones are calcified areas of buildup and not affected by hormone levels.

Did I get them from sneezing?

If you’re prone to sinus infections and chronic allergies, you might find that you get tonsil stones more frequently. The sneezing is just a coincidence.

Do any foods cause them?

The type of foods you eat doesn’t usually have a significant impact on the number or size of tonsil stones that you get. That being said, certain types of foods – such as processed carbs – may tend to accumulate more than whole grains or fresh produce.

Are they a bacteria?

Basically, yes. Just like tartar on teeth, tonsil stones are hardened deposits of bacterial accumulation (combined with food debris).

Are there antibiotics for them?

An antibiotic won’t make the tonsil stone go away; it will have to be physically removed by either yourself or a medical provider. Antibiotics will only address co-existing infection in and around the tonsils.

Is there a tonsil stones remedy?

The best remedy for tonsil stones is to have your tonsils removed. Having your tonsils professionally cleaned out is usually the next best treatment, followed by improved oral hygiene (including a daily mouthwash/gargle) and addressing allergy or sinus issues.

Can they kill you?

It’s highly unlikely. A large tonsillolith coming out and being inhaled is probably the most dangerous risk, but even the chances of that happening are extremely low.

Will they affect my singing?

Singers often notice changes in their voice patterns if they have oral infections, strep throat, upper respiratory issues, or sinus inflammation. Since tonsil stones frequently co-exist with many of these health conditions, you might find that your singing voice changes as the tonsilloliths grow larger.

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References:

  1. Rio AC, Franchi-Teixeira AR, Nicola EM.; Relationship Between The Presence Of Tonsilloliths And Halitosis In Patients With Chronic Caseous Tonsillitis.; Br Dent J. 2008 Jan 26;204(2):E4. Epub 2007 Nov 23.
  2. Babu TA, Joseph NM.; Persistent Earache Due To Tonsillolith.; Indian Pediatr. 2012 Feb;49(2):144-5.

    Article Written By Sharon Boyd

    Sharon has been a Registered Dental Hygienist since 2001. She also holds a Bachelor of Science degree in Human Relations and Business. In 2011, she began implementing her dental knowledge into freelance writing services that aided dentists, product designers, continuing education providers and web marketing firms for their online and distribution purposes. She has since bridged her services into the medical and cosmetic surgery fields.

    Website

     Lara T. Coseo, DDSArticle Reviewed by Dr. Lara Coseo

    Lara T. Coseo, DDS, is a 2004 graduate of Baylor College of Dentistry.  She has 13 years of experience practicing general dentistry.  She currently serves as a part-time faculty instructor at Texas A&M College of Dentistry and writes dental website content and blog material.

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