Tonsil stones are stones which can form at the back of the throat within the tonsils. They are not serious but can cause problems with a sore throat or bad breath.
What are tonsil stones?
Tonsil stones, or tonsilloliths, are a white or yellow accumulation of debris at the back of the throat. They tend to occur in people who have large or craggy tonsils.
Tonsils are the soft lumps at the back of your throat. You may be able to see them if you shine a torch in your mouth and say 'aah' to yourself in the mirror.
Not everyone has visible tonsils - if the back of your throat looks quite flat, you are unlikely to develop tonsilloliths. If on the other hand you can see red soft lumpy areas at the back of your throat, with nooks and crannies in them, these are tonsils in which stones may form.
What do tonsil stones look like?
By Glacko2021 at English Wikipedia, via Wikimedia Commons
What causes tonsil stones?
The tonsil stones are made up of minerals - mainly calcium salts. Debris from surrounding cells, tissues and germs (such as bacteria) gets stuck in the crevices of the tonsils and then hardens (becomes calcified).
They can be hard, like tiny rocks, or quite soft. They usually look white, or a cream or yellow-ish colour. They are usually quite small, but can get bigger.
They are not cancerous growths, and are not attached to the tissues around them, but instead are stuck in them. In fact, tonsil stones form to help the immune system by blocking bacteria and viruses from entering the body.
Tonsilloliths can occur at any age but are more common in adults than in children. Some people just develop one, whereas others can have more than one at a time. In some people, even when they get rid of one, another one forms somewhere else on their tonsils.
Why do I keep getting tonsil stones?
Some people are more prone than others to developing tonsil stones. Risk factors include: smoking, poor oral hygiene, recurrent tonsil infections and having tonsillar crypts.
Tonsillar crypts are the folds, gaps and crevices found in some people's tonsils. They are more common in larger or craggy-looking tonsils.
What are the symptoms of tonsil stones?
Often there are no symptoms of tonsil stones at all, though when there are they may include :
- A feeling of something being stuck at the back of your throat, or irritating your throat.
- Bad breath (halitosis).
- A sore throat or discomfort when you swallow.
- Difficulty swallowing.
- A bad taste in your mouth.
- An irritating cough.
- Earache (sometimes a problem in the mouth can 'radiate' to the ear due to the way that the pain signal is carried along nerves).
Are any tests needed for tonsil stones?
Usually tonsil stones (tonsilloliths) can be seen at the back of the mouth and no special tests are needed. Sometimes they are seen coincidentally on X-rays or scans which have been done for other reasons.
How to get rid of tonsil stones
In many cases you can remove and manage tonsil stones at home and treatment is not necessarily needed, especially if there are no symptoms.
Try gargling with mouthwash or a salty water solution. This may dislodge the tonsil stones.
This involves gently shooting water at the back of the mouth to try to dislodge tonsil stones. It is possible to buy a syringe specially for this purpose, which has a curved tip, or an irrigation kit.
However, you should follow the instructions carefully, as it is possible to damage the tonsils if too much force is used. You may then have pain and bleeding if this happens.
Try gently massaging around your tonsils with a cotton swab to push the tonsil stone loose.
An ear, nose and throat (ENT) surgeon can remove tonsil stones which are causing problems if you are unable to dislodge them yourself. This is usually done if the tonsil stone is:
- Large in size.
- Causing repeated bacterial infections and sore throats.
See your dentist or GP who can refer you if necessary. This is usually done by scraping out the stone, with local anaesthetic.
How to prevent tonsil stones
Good oral hygiene helps to prevent tonsil stones. Brush your teeth twice a day as advised by your dentist, including the spaces in between them, to stop any debris accumulating.
Consider a tongue scraper to keep your tongue clear of any gunk or germs which might contribute to a stone forming.
Regular gargling with a mouthwash or salt water solution may also help. Avoid smoking and excess alcohol which can cause your mouth to be dry and may make tonsilloliths or tonsil stones more likely to build up.
For some people, an operation to flatten the surfaces of the tonsils may help to stop persisting problems with tonsilloliths recurring. This is called cryptolysis and can be done either by laser treatment or another type of treatment called coblation cryptolysis.
This may need a general anaesthetic or sometimes a local anaesthetic. Occasionally, removal of the tonsils (tonsillectomy) is recommended to prevent ongoing problems with tonsil stones.
Further reading and references
Shikino K, Ikusaka M; Tonsillolith. Clin Case Rep. 2021 Jun 229(6):e04243. doi: 10.1002/ccr3.4243. eCollection 2021 Jun.
Bamgbose BO, Ruprecht A, Hellstein J, et al; The prevalence of tonsilloliths and other soft tissue calcifications in patients attending oral and maxillofacial radiology clinic of the university of iowa. ISRN Dent. 2014 Jan 222014:839635. doi: 10.1155/2014/839635. eCollection 2014.
Halitosis; NICE CKS, September 2019 (UK access only)