Tonsil Stones: Symptoms, Causes, and How to Remove

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Hi, I’m Dr. B, practicing functional dentist for 35 years. I graduated from the Dugoni School of Dentistry in San Francisco, CA in 1987 and am a member of the American Academy of Dental Sleep Medicine (AADSM), Academy of General Dentistry (Chicago, IL), American Academy for Oral Systemic Health (AAOSH), and Dental Board of California. I'm on a mission to empower people everywhere with the same evidence-based, easy-to-understand dental health advice that my patients get. Learn more about Dr. B

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: Adobe Stock

Causes of Tonsil Stones

Causes of tonsil stones include:

  • Poor dental hygiene
  • Chronic mouth breathing (during the day or at night)
  • Deep crevices (crypts) in the tonsils (where food particles can become lodged)
  • Large tonsils
  • Chronic tonsillitis (inflammation of the tonsils)
  • Hormonal changes (like during pregnancy)
  • Too much calcium in the blood without enough vitamins K2 and D3

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:

  • Persistent bad breath (halitosis)
  • Visible yellowish or white stone on the tonsils (on one or both sides)
  • Sore throat
  • Difficulty swallowing
  • Feeling like you constantly need to swallow
  • Ear pain
  • Persistent cough
  • Swollen tonsils

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:

  • Strep throat
  • Sinus infections
  • Tonsillitis/tonsil infection

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:

  • Vigorously gargle with warm salt water
  • Use an oral irrigator (water flosser) to gently spray water to dislodge the calcified stone
  • Very gently nudge tonsil stones with a cotton swab 
  • Make yourself cough

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!

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Treatment for Recurring Tonsil Stones

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

  • Anti-inflammatory drugs: Over-the-counter or prescription anti-inflammatories, such as ibuprofen, may help reduce tonsil swelling and make tonsil stones easier to remove. They can also improve discomfort and difficulty swallowing.
  • Antibiotics: Antibiotics can wipe out bacteria in your gut, where most of your immune system lives, to reduce the symptoms of a severe tonsil stone flare-up. However, this isn’t a long-term option and should be used infrequently, due to the risk of antibiotic resistance.

Surgical treatments for recurring tonsil stones include:

  • Laser tonsil cryptolysis: This procedure involves the use of a laser to get rid of tonsil crypts that can contribute to tonsil stone development. Only local anesthesia is used and most cases require only one visit. There are no major risks or side effects associated with laser tonsil cryptolysis. You should expect to miss no more than 2 days of work while you recover.
  • Coblation cryptolysis: Coblation, or the use of radio waves to alter salt solution to charged ions, destroys tonsil crypts without using heat. Like laser cryptolysis, only local anesthesia is used and surgery and recovery are minor. Coblation cryptolysis is a relatively new procedure, introduced in 2012. Its major benefits are the lack of a “burning sensation” caused by laser procedures and no risk of facial burns or damage to the eyes.
  • Tonsillotomy: In this tonsil surgery, only the palatine tonsils (where tonsil stones occur) are removed. It is also known as a partial tonsillectomy and requires general anesthesia. However, a tonsillotomy is less invasive than a full tonsillectomy and has a shorter, less painful recovery for both children and adults. Tonsillotomy is equally as effective as a full tonsillectomy — and preferred more by patients — to treat recurring tonsil stones.
  • Tonsillectomy: The most drastic surgical option for tonsil stone flare-ups is a tonsillectomy. This surgery involves removing all three types of tonsils (palatine, pharyngeal, and lingual). If your dentist or doctor has identified enlarged adenoids as a trigger for nighttime mouth breathing or sleep-disordered breathing, your adenoids may also be removed during this surgery.

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:

  • Brush your teeth twice each day and 45 minutes after eating any sugary, acidic, or processed foods/drinks
  • Use a remineralizing toothpaste like Boka or RiseWell
  • Scrape your tongue every day
  • Floss every day
  • Eat a diet rich in nutrient-dense foods and low in sugar and processed foods
  • Use oral/dental probiotics if you notice signs of dental problems like bleeding gums (gingivitis) or bad breath
  • See your dentist and dental hygienist at least every 6 months for regular teeth cleanings
  • Avoid alcohol-based and/or antibacterial mouthwash, which are like an antibiotic for the mouth that disrupt the oral microbiome
  • Mouth tape at night if you show any signs of sleep-disordered breathing (such as snoring, waking up in the middle of the night, or dry mouth in the morning)
  • Stop smoking, vaping, or using any form of tobacco
  • Don’t abuse alcohol
  • Address chronic tonsillitis or sinus infections with your ENT and/or primary care doctor

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:

  • Tonsils of different sizes
  • Blood in your saliva
  • Problems swallowing, speaking, or breathing
  • Pain, swelling, or lumps in the neck
  • Severe pain in your mouth or throat

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/