10 common questions about tonsil stones

What do tonsil stones look like?

Tonsil stones, also called tonsilloliths, look like little white or yellow spots on your tonsils. They are made of bits of food, bacteria, or minerals such as calcium which get stuck in the folds and gaps of the tonsils - a pair of small, oval-shaped bits of tissue at the back of your throat.

Tonsil stones are soft but can harden. On rare occasions, tonsil stones can grow larger if they aren’t removed. You’ll probably need a mirror to see them as your tonsils are at the back of your throat.

However, they may also be so small or embedded so deeply in the tissue of the tonsils that they cannot be seen.

Patient picks for Tonsils

Ear, nose and throat

What do tonsils do?

The main function of tonsils is to trap germs (bacteria and viruses) which you may breathe in. Proteins called antibodies produced by the immune cells in the tonsils help to kill germs and help to prevent throat and lung infections.

by Dr Mary Harding, MRCGP

Ear, nose and throat

Tonsillectomy

A tonsillectomy is an operation to remove the tonsils from the back of the throat. Other leaflets explain more about tonsils, sore throats and throat infections. This leaflet covers risks and benefits of the operation and what to expect before, during and after a tonsillectomy. Note: the information below is a general guide only. The arrangements often vary between different hospitals. Always follow the instructions given by your doctor or local hospital

by Dr Hayley Willacy, FRCGP

What are the symptoms of tonsil stones?

• Yellowish bumps or spots at the back of the throat.

• Tonsil redness or swelling.

• An itch or irritation in the back of your mouth or throat.

• Bad breath.

• Cough.

• Difficulty swallowing.

• Sore throat.

• Earache.

Can you get tonsil stones without tonsils?

Normally, tonsil stones form in the crevices of the tonsils, called tonsillar crypts. However, it’s possible to get them after having your tonsils removed. This could happen if not all the tonsil tissue is removed - and stones may also form in cracks in the scar tissue that develop after surgery.

What causes tonsil stones?

Not everyone gets tonsil stones. You’re more likely to get them if you have large tonsils and bigger gaps in your tonsils, if you have long term (chronic) sinus problems, or if you have inflamed tonsils (tonsillitis).

Poor dental hygiene can also increase the risk of getting tonsil stones, as not brushing and flossing your teeth can lead to the build up of food and bacteria in your mouth.

Can dehydration cause tonsil stones?

Not drinking enough water can lead to tonsil stones. This is because a dry throat can lead your body to produce more mucus, which can trap bits of food food and bacteria.

Can tonsil stones make you sick?

Tonsil stones are usually harmless. However, sometimes tonsil stones can lead to tonsillitis - long term inflammation or infection of your tonsils. Tonsillitis symptoms can include a sore throat, feeling sick, swelling of the tonsils and a high temperature.

Why do tonsil stones smell?

There are several reasons why tonsil stones smell. One study found that tonsil stones cause bad breath because they have bacteria and microbes¹. Food bits stuck in the mouth can also smell.

What happens if you swallow a tonsil stone?

If you swallow a stone, it will likely pass through your digestive system without any issues. A larger stone has the potential to cause a blockage, although this is rare. If you are concerned, you should speak to your doctor.

How do you remove tonsil stones?

One way to remove a tonsil stone is to use a water flosser. This can help dislodge a stone without making you gag, which can make you sick or feel nauseous. You can also try gargling with salt water to help loosen stones.

Some people try to push or squeeze out stones using a cotton swab, but this might make you gag. If you do try to remove a stone yourself, don’t use a sharp object as this may cause serious injury.

If you’re struggling to remove a tonsil stone, it is best to speak to your doctor or dentist who will be able to provide advice.

How do you prevent tonsil stones?

You cannot always prevent tonsil stones - and some people are prone to getting them. However, good oral hygiene can help reduce the likelihood of them developing.

To help prevent tonsil stones, you should:

• Brush your teeth after every meal, or at least twice a day.

• Floss your teeth at least once a day.

• Brush or scrape your tongue regularly.

• Rinse and gargle regularly with an alcohol-free mouthwash or warm salt water.

• Avoid or quit smoking.

• Drink plenty of water, aiming for 8 to 10 glasses of water daily.

Further reading

1. Yellamma Bai et al: Tonsillolith - A polymicrobial biofilm.