Tonsil stones, otherwise known as tonsillar stones or tonsilloliths, are small white or yellow lumps of hardened material that can form on the tonsils.
The tonsils are small pink glands found at the back of the throat that help protect the body against infection. They are a part of the body's immune system and help it filter bacteria and viruses. Tonsils also produce disease-fighting white blood cells and antibodies.
Tonsil stones are made up of calcified accumulates of cellular debris and microorganisms. They are a common, known cause of bad breath (halitosis) that can lead to coughing, an earache, a sore throat, or a bad taste in the mouth.
Tonsil stones are more common in teenagers and adults than in children. People with lots of crevices, or crypts, in their tonsils, are more susceptible to them.
Tonsil stones are usually not harmful and may not need treatment. However, they can become a problem or lead to the development of other health issues. In that case, tonsil stones can be surgically removed if necessary by an ear, nose, and throat (ENT) specialist.1,2
Tonsil stones begin as small, soft, white, or yellow clumps on the tonsils that might not even be visible to the naked eye. Over time, however, tonsil stones can calcify and harden into stones.
They can cause a bad smell in the mouth because they provide a home for anaerobic bacteria, which produce foul-smelling sulfides.
Tonsil stones vary from small to very large, with the largest tonsilith to date measuring 14.5 cm.3
Some tonsil stones don’t produce any symptoms at all and many people who have them never realize it.
Tonsil stones are caused by debris that can build up in the tonsils, specifically in folds of the tonsils called tonsillar crypts.
When tonsillar crypts are enlarged, debris as well as minerals like calcium, can become trapped. Over time, they calcify or harden into stones. Bacteria or fungi that cause tonsillitis can also cause tonsil stones to form.
Common symptoms of tonsil stones include:
In severe cases, tonsil stones can also trigger infections and can be challenging to treat with antibiotics.
On the other hand, tonsil stones don’t always cause symptoms and sometimes are found on a scan or x-ray or during a dental examination.
If you have any of the above tonsil stone symptoms, you should schedule a dental exam as soon as possible for advice, diagnosis, and treatment (if needed).
While tonsil stones often do not cause any symptoms, they can sometimes make you sick.
Tonsil stones can make it difficult to swallow or speak, causing discomfort. They can also trigger infections and pain, and that pain can spread to the ear and cause an earache.
Tonsil stones are generally harmless, but they can sometimes be a sign of something serious, such as an infection or tonsillitis.
If you think you have tonsil stones, it’s best to seek medical attention with a general dentist to diagnose your condition, identify any other health issues present, and receive treatment.
While they can be unpleasant, there are steps you can take to prevent tonsil stones.
To avoid developing tonsil stones, maintain good dental habits like:
The only way to completely prevent tonsil stones from forming is to remove the tonsils via a tonsillectomy.
During this procedure, a surgeon will remove the tonsils from the throat, thereby preventing future stones from developing. Removal of the tonsils is entirely safe and does not weaken the immune system.
While you can easily manage the symptoms of tonsil stones (such as bad breath) at home, there is no specific treatment for them.
Some people choose to treat their tonsil stones at home by gargling with saltwater, apple cider vinegar, or mouthwash.
During vigorous gargling, the tonsil stones and debris may become detached. You can also choose to use a dental pick or a cotton swab to dislodge your tonsil stones. You should be gentle if you decide to use this method so that you do not damage your tonsils or tonsil crypts.
Large stones that cause pain or other problems may have to be removed by a doctor. And if troublesome tonsil stones keep coming back or are bothering you, your doctor may recommend removing your tonsils.5
If you want to have your tonsil stones removed, you should see a doctor called an ear, nose, and throat (ENT) specialist. This specialist will examine your tonsil stones and remove the tonsil stones or provide advice on the best course of action.
A good mouthwash will help prevent tonsil stones by treating bacteria in the mouth and removing trapped material in the tonsils.
To prevent and treat tonsil stones, many people rinse with a gargle made out of saltwater. The saltwater works by increasing the pH- balance inside the mouth, creating a much more alkaline oral environment where bacteria cannot thrive.
Other products that can be used as a natural mouthwash to treat tonsil stones include:
The American Dental Association (ADA) recommends over-the-counter mouthwashes that contain any of the following:
These ingredients are proven to be effective at eliminating harmful bacteria, reducing debris, treating gum disease, and managing bad breath.
When selecting a mouthwash, you should look for one with an ADA Seal of Acceptance that verifies that the mouthwash has been medically reviewed by scientists and doctors and is proven to be effective.
Many tonsil stones don't require professional care or surgical removal. Most tonsil stones will improve and go away through practicing good oral care habits.
Some tonsil stones, especially large tonsil stones, can cause complications and require surgical removal.
If you think you may have a tonsil stone, you should see a dentist who can diagnose your condition and provide medical advice.
"Tonsil Stones" HealthDirect
"Tonsil Stones: Care Instructions" MyHealth.Alberta.ca
"What are tonsil stones?" Keck Medicine of USC
"A giant tonsolith" U.S. National Library of Medicine
”Comparative evaluation of salt water rinse with chlorhexidine against oral microbes: A school-based randomized controlled trial” Journal of Indian Society of Pedodontics and Preventive Dentistry
"Mouthrinse" American Dental Association