Tonsil Stones: Symptoms, Causes, and How to Remove

by Fitcoachion | Last Updated: September 3, 2020


  • Pictures
  • Causes
  • Symptoms
  • Diagnosis
  • How to remove
  • Treatment
  • Prevention
  • Complications
  • FAQs

What are tonsil stones?

Tonsil stones (also called tonsil calculi or tonsilloliths) are yellowish or white calcifications that develop on the tonsils. Tonsils are a type of lymph node that line the back of the throat. 

These stones are made of hardened, impacted biofilm that builds up in the crypts (crevices) of your tonsils. They range in size between a small rice grain to as large as a grape.

Generally, tonsil stones develop on the palatine tonsils (on the sides of the back of your throat). 

Tonsil stones may be present in 5-6% of adult dental patients on average. Tonsil stones are twice as common in men than women, more common after the age of 40, and less frequent in black individuals than those of other ethnicities.

A mild case of tonsil stones may go unnoticed. However, once they make it feel like you constantly have to swallow or cause nasty halitosis (bad breath), tonsil stones can be a major inconvenience.

They often fall out on their own, but some stubborn tonsil stones must be removed by a dental professional.

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Tonsil Stones Pictures

Expand to view tonsil stones pictures (WARNING: Graphic images)

SOURCE: A giant tonsillolith. Saudi Medical Journal, 39(4), 412-414
SOURCE: Glacko2021 at the English Wikipedia / CC BY-SA
SOURCE: Adobe Stock

Causes of Tonsil Stones

Causes of tonsil stones include:

Food debris, bacteria, dead cells (skin or oral tissue), and mucus caught on the tonsils can calcify into stones when inflammation and bacterial overgrowth are present in the mouth. 

When white blood cells are sent to an area of infection, they leave microscopic calcifications behind that, over time, may lead to tonsil stones.

Why do people get tonsil stones? People get tonsil stones, in part, because of dysbiotic in their oral microbiome. The oral microbiome becomes unbalanced due to poor oral hygiene, mouth breathing, a poor diet, genetic factors, and more.

healthy tonsils and tonsil stones

Tonsil Stone Symptoms

Even if you can’t see them in the mirror, tonsil stones can interfere with your oral health. However, some small tonsil stones may cause no symptoms.

Common symptoms of tonsil stones are:

It’s uncomfortable to live with tonsil stones. The most frequently reported symptoms of tonsil stones are chronic bad breath and a feeling of being unable to swallow. They can also cause pain in the ears or throat, trouble swallowing, a cough, and other symptoms in the ear, nose, and throat.

What do tonsil stones smell like? Tonsil stones typically smell like rotting fruit. These calcifications create a unique, foul odor in your bad breath.

Diagnosing Tonsil Stones

Most tonsil stones are diagnosed by a physical examination by your dentist or doctor. They can often see the white or yellow stones formed on your tonsils, which is a dead giveaway that tonsil stones are to blame.

If you have very deep tonsillar crypts (crevices), your healthcare provider may prescribe imaging like a CT scan or MRI to locate stones. X-rays are unreliable for identifying hidden tonsil stones.

Without the presence of visible tonsil stones, your provider may rule out other conditions that cause similar symptoms, such as:

A primary care provider is likely to refer you to an ear, nose, and throat doctor (doctor of otolaryngology) for treatment or to confirm their diagnosis.

How to Remove Tonsil Stones

Tonsil Stone Removal at Home

Particularly if they make you uncomfortable, you may want to get rid of tonsil stones at home.

Proceed with caution. Tonsil stone removal can be simple and easy. Unfortunately, some home remedies used to remove tonsil stones are not safe (like tweezers or a toothbrush).

To remove tonsil stones at home, try the following home remedies:

Tonsil Stone Removal at the Doctor/Dentist

If gargling, coughing, and other manual remedies don’t work, you may need to see a healthcare provider about surgical removal of your tonsil stones.

Minor surgical procedures are commonly performed for large or particularly painful tonsil stones.

Your tonsil stones can be surgically removed by a dentist, oral surgeon, or an ENT specialist (for severe cases).

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I've discussed bad breath a lot recently, and I got SO MANY questions about tonsil stones as a potential cause. Let's discuss. • WHAT DO THEY LOOK LIKE? Tonsil stones (tonsilloliths) are yellowish or white calcifications that collect on your tonsils. Their size can be tiny, like a rice grain, or as big as a grape. • WHAT DO THEY FEEL LIKE? They are uncomfortable, though not usually painful. Tonsil stones create the feeling that you always have to swallow something. • WHAT ARE THE SYMPTOMS OF TONSIL STONES? Bad breath is the most noticeable symptom of tonsil stones. You may also notice pain in your ears or throat, some difficulty swallowing, swollen tonsils, oral inflammation, or a cough. • HOW DO I REMOVE THEM? To get rid of tonsil stones, vigorous gargling with salt water is a great place to start. Coughing may also dislodge them. Generally, though, your hygienist and/or dentist will need to remove them (it's not safe to remove them yourself, like with toothbrush or tweezers). They may use a laser device or coblation to do this. Your dentist and/or doctor may recommend a tonsillectomy or a course of antibiotics for recurring cases. • WHY DO THEY FORM? 1️⃣ Typically, I see them in people who struggle with mouth breathing. It can cause this calcification to grow on your tonsils as the air accelerates at about this point and dries the tissue. 2️⃣ It also depends much on the anatomy (folds) of your tonsils where food can get caught, and are associated with a purulent (pus-discharging) foreign body reaction to the food remains. 3️⃣ It's thought that tonsil stones are partly a result of a dysbiotic oral microbiome, though research on this is not extensive. 4️⃣ They may also happen as a result of chronic sinus problems. 5️⃣ If you take calcium supplements but are deficient in vitamins D and/or K2, you are likely at a higher risk of tonsil stones. • HOW DO I STOP GETTING THEM & FIX THE BAD BREATH? I’ll be touching on this in an upcoming post!

A post shared by Dr. Mark Burhenne (@askthedentist) on May 25, 2020 at 6:00am PDT

Treatment for Recurring Tonsil Stones

For frequent tonsil stone flare-ups, your doctor may prescribe medications such as:

Surgical treatments for recurring tonsil stones include:

Because they are associated with some risks, surgical options are typically used only if tonsil stones significantly disrupt your life. Surgery for tonsil stones is controversial and should be used as a last resort after other options have been exhausted.

How to Prevent Tonsil Stones

The most effective way to prevent tonsil stones is to maintain a healthy oral microbiome through a healthy diet, good oral hygiene, and addressing dry mouth.

There are several ways to prevent tonsil stones:

Complications of Tonsil Stones

Left untreated, large tonsil stones may cause complications including tonsillitis, peritonsillar abscess, breathing issues, or significant swallowing issues.

Most of the time, though, tonsil stones resolve on their own or can be treated by your doctor with no complications.

Seek medical attention from your dentist or doctor if you experience:

FAQs

Q: Are tonsil stones contagious?

A:
Tonsil stones are not contagious. However, you can pass bacteria from your oral microbiome to another person’s by kissing or sharing utensils.

Since tonsil stones are related to the health of your oral bacteria, kissing or sharing utensils with someone who has tonsil stones may risk sharing the microbial culprits.

Q: Why do tonsil stones smell so bad?

A:
Tonsil stones smell bad because they are home to anaerobic bacteria. These bacteria create sulfides, which give off a putrid smell.

Q: How long do tonsil stones last?

A:
Tonsil stones may last anywhere from several days to several years. Most tonsil stones clear up in 1-3 weeks on their own. Large stones may remain on the tonsils for many years if not removed by a doctor.

Q: How common are tonsil stones?

A:
Tonsil stones are somewhat common and occur in somewhere around 5-6% of adult dental patients.

Factors that increase the commonality of tonsil stones include:

  • Male gender
  • Age over 40
  • Hispanic or Caucasian ethnicity
  • Poor oral hygiene
  • Frequent tonsil or sinus infections

10 References

  1. Abdulrhman, A., Albesher, M. B., & Alqabasani, M. A. (2018). A giant tonsillolith. Saudi Medical Journal, 39(4), 412-414. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5938656/ 
  2. Aragoneses, J. M., Suárez, A., Aragoneses, J., Brugal, V. A., & Fernández-Domínguez, M. (2020). prevalence of palatine tonsilloliths in Dominican patients of varying social classes treated in university clinics. Scientific reports, 10(1), 1-7. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6997381/ 
  3. Takahashi, A., Sugawara, C., Kudoh, T., Uchida, D., Tamatani, T., Nagai, H., & Miyamoto, Y. (2014). Prevalence and imaging characteristics of palatine tonsilloliths detected by CT in 2,873 consecutive patients. The scientific world journal, 2014. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4214167/ 
  4. Balaji Babu, B., Avinash Tejasvi, M. L., CK, A. A., & Chittaranjan, B. (2013). Tonsillolith: A panoramic radiograph presentation. Journal of clinical and diagnostic research: JCDR, 7(10), 2378. Full text: https://www.jcdr.net/article_fulltext.asp?id=3530 
  5. Ansai, T., & Takehara, T. (2005). Tonsillolith as a halitosis-inducing factor. British dental journal, 198(5), 263-264. Abstract: https://pubmed.ncbi.nlm.nih.gov/15870743/ 
  6. Oda, M., Kito, S., Tanaka, T., Nishida, I., Awano, S., Fujita, Y., … & Kokuryo, S. (2013). Prevalence and imaging characteristics of detectable tonsilloliths on 482 pairs of consecutive CT and panoramic radiographs. BMC Oral Health, 13(1), 1-8. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3852777/ 
  7. Krespi, Y. P., & Kizhner, V. (2013). Laser tonsil cryptolysis: in-office 500 cases review. American Journal of Otolaryngology, 34(5), 420-424. Abstract: https://pubmed.ncbi.nlm.nih.gov/23583078/ 
  8. Chang, C. Y., & Thrasher, R. (2012). Coblation cryptolysis to treat tonsil stones: a retrospective case series. Ear, Nose & Throat Journal, 91(6), 238-254. Abstract: https://pubmed.ncbi.nlm.nih.gov/22711390/ 
  9. Smith, S. (2016). Tonsillotomy: An alternative surgical option to total tonsillectomy in children with obstructive sleep apnoea. Australian Family Physician, 45(12), 894. Abstract: https://pubmed.ncbi.nlm.nih.gov/27903040/ 
  10. Wong Chung, J. E., van Benthem, P. P. G., & Blom, H. M. (2018). Tonsillotomy versus tonsillectomy in adults suffering from tonsil-related afflictions: a systematic review. Acta Oto-Laryngologica, 138(5), 492-501. Abstract: https://pubmed.ncbi.nlm.nih.gov/29241412/ 

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