Tonsil stones

What are tonsil stones?

Tonsil stones, otherwise known as 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, one at each side. They are lymph nodes which sometimes enlarge to help fight infection.

Not everyone has visible tonsils - people whose tonsils are not visible are unlikely to develop tonsilloliths. Some people have large tonsils with craggy ridges in them.

Tonsil stones

© By Glacko2021 at English Wikipedia, via Wikimedia Commons

They look like small white, yellow or pale grey pebbles, in the nooks and crannies of the tonsils.

Tonsil stones are made up of minerals - mainly calcium salts. Debris from the surrounding cells, tissues and 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 are usually quite small, but can sometimes get bigger.

They are not cancerous growths, and they are not attached to the tissues around them, but instead are stuck in the crevices of the tonsils.

Tonsil stones can actually 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, when they get rid of one, another forms somewhere else on their tonsils.

Some people are more prone than others to developing tonsil stones.

Risk factors include:

• Smoking.

• Poor oral hygiene.

• Recurrent tonsil infections.

• 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.

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 the throat.

• Bad breath (halitosis).

• Discomfort swallowing.

• A bad taste in the 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).

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.

In many cases tonsil stones can be removed at home. Treatment is not necessarily needed, especially if there are no symptoms.

• Salt water gargle. Try gargling with mouthwash or a salty water solution. This may dislodge the tonsil stones.

• Gentle irrigation. 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. It is important to follow the instructions carefully, as it is possible to damage the tonsils if too much force is used. This may cause pain and bleeding.

• Cotton swabbing. Gently massaging around the tonsils with a cotton swab can push the tonsil stone loose.

• Surgical removal. An ear, nose and throat (ENT) surgeon can remove tonsil stones which are causing problems but this will only be done if the tonsil stones are:

  • Large in size.

  • Painful.

  • Causing repeated bacterial infections and sore throats.

A dentist may be able to help with the problem and can make the referral if needed.

• Good oral hygiene helps with preventing tonsil stones. Teeth should be brushed twice a day, as advised by dentists, including the spaces in between them, to stop any debris accumulating.

• Consider a tongue scraper to keep the 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 the 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 but is not available on the NHS.

• Occasionally, removal of the tonsils (tonsillectomy) is recommended to prevent ongoing problems with tonsil stones.