Tonsil Stones

You can take steps to prevent tonsil stones:

Preventing the Recurrence of Tonsil Stones

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Tonsils are pieces of tissue in the back of each side of the mouth. They contain lymph nodes and help filter out bacteria and viruses.

Small calcium deposits, called tonsil stones or tonsilloliths, can build up on tonsils. These usually build up around food, dead cells, or mucus that you usually swallow, but can sometimes get caught in small pockets of the tonsils’ mucus membrane coating. This is the same substance that lines the inside of your mouth, nose, and throat.

In the U.S., healthcare spending accounts for 17.7% of the Gross Domestic Product (GDP), or the total value of goods and services produced by the entire nation for the entire year, according to the Centers for Medicare & Medicaid Services.

Tonsil stones are hard in texture and yellow or white in color. They’re usually small — about the size of a grain of rice — but can grow large, up to about the size of a grape. They’re most common in people who have repeated tonsillitis or have large tonsils.

The only way to fully prevent tonsil stones is to have your tonsils surgically removed. This procedure is called a tonsillectomy. It is usually used to treat chronic tonsillitis.

Tonsillectomies are most commonly done in childhood, but can also be done in adults. The surgery is performed under general anesthesia. Side effects usually include a sore throat and trouble swallowing for a few days. Serious side effects are rare.

For those who do not meet the criteria for a tonsillectomy (e.g. seven cases of tonsillitis or strep throat in one year), there are ways to help prevent tonsil stones on your own.

Practice good oral hygiene

This is the best way to prevent tonsil stones from forming. Be sure to brush your teeth and tongue in the morning, before bed, and after every meal. In addition, you should floss every day. This helps keep debris from building up.

Mouthwash

Mouthwash can help flush debris and bacteria out of your mouth and make tonsil stones less likely to form. Using a mouthwash without alcohol is best.

Gargling water

Gargling with warm salt water can help block bacteria or viruses from getting in your tonsils and causing issues. Additionally, it can help ease pain associated with tonsil stones.

Water pick

You can use a water pick to flush out your mouth, and help get rid of debris and bacteria.

Tonsil Stones

Tonsil stones, also called tonsilloliths, are small lumps that form in your tonsils. The main symptom of tonsil stones is bad breath. Methods for tonsil stone removal at home include using a saltwater gargle or a water pick. If the tonsil stones keep coming back or bothering you, your provider may recommend surgery.

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Overview

What are tonsil stones?

Tonsil stones are small lumps of hard material that form in the tonsils. Tonsil stones can cause bad breath though they’re usually not painful or harmful. They’re also called tonsilliths.

You can usually treat tonsil stones at home. But in some cases, you may need surgery to remove the tonsils.

What are tonsils?

The tonsils are a pair of small, oval-shaped bits of tissue at the back of your throat. They have folds, gaps and crevices called tonsillar crypts.

Tonsils are part of your immune system, which helps protect against infection. Tonsils filter bacteria and viruses that enter your body through your mouth. Removing the tonsils does not affect your immune system.

What do tonsil stones look like?

Tonsil stones look like little white or yellow pebbles on your tonsils. You may have one tonsil stone or many tonsil stones. They’re usually small, though sometimes people can get large tonsil stones.

What’s the difference between tonsil stones and tonsillitis?

Tonsillitis is a tonsil infection. Both conditions can cause bad breath and throat pain. Usually, if you have tonsillitis, you’ll also get red, inflamed tonsils along with a sore throat, fever and headache.

Who’s at risk of tonsil stones?

People who have more tonsillar crypts tend to get more tonsil stones. These are also more commonly found in people who have had a lot of tonsil infections in their life. Tonsilliths tend to happen more often in teens.

How common are tonsil stones?

Tonsil stones are common. Many people get them and may not even know they have them.

Symptoms and Causes

What causes tonsil stones?

Materials and debris can get trapped in the tonsillar crypts. The material can harden or calcify, forming stones. Trapped material could include:

Minerals such as calcium.
Food or debris.
Bacteria or fungi.

What are the symptoms of tonsil stones?

Some tonsil stones don’t cause any symptoms. If you do have symptoms, they may include:

Bad breath (halitosis).
Cough.
Earache.
Sore throat.
Bad taste in your mouth.
Small white or yellow stones that you may spit up.

Other symptoms include:

Difficulty swallowing.
Feeling that something’s stuck in your throat.
Small white patches on your tonsils.
Throat infections that are hard to treat with antibiotics.

Diagnosis and Tests

How are tonsil stones diagnosed?

To diagnose tonsil stones, your provider may:

Do a physical exam, looking inside your mouth and throat.
Perform an imaging scan if they cannot see the stones easily.
Dislodge the stones using a dental pick.

Sometimes, a healthcare provider happens to notice tonsil stones during an exam. If you don’t have any symptoms, your provider might notice a stone during a scan or X-ray for a different problem. Or your dentist may see them during a dental exam.

Management and Treatment

How are tonsil stones treated?

Usually, treatment aims to manage tonsil stone symptoms. There isn’t a specific treatment method for stones. Make sure to:

Brush teeth regularly.
Gargle with warm salt water.

Can I remove the tonsil stones myself?

You can try these at-home methods to get rid of tonsil stones:

Gargling: Vigorous gargling using salt water has a few advantages. It helps your throat feel better, plus it can dislodge the tonsil stones. It may even get rid of the bad odor. This is particularly helpful when you gargle after eating to prevent food and debris from getting caught in the tonsil crypts.
Coughing: Some people find that a strong cough can loosen stones and bring them up.
Using an object: If gargling and coughing don’t dislodge the stones, it’s tempting to use your finger or a toothbrush to get rid of tonsil stones. But you can easily scratch your delicate tonsils. They can get infected. Instead, if you want to use an object, try a cotton swab.

Are medications used to treat tonsil stones?

Your healthcare provider will tell you if you need antibiotics to treat tonsil stones. In most cases, providers don’t use antibiotics. These medicines don’t treat the underlying cause of tonsil stones. But you may need antibiotics if you develop a bacterial infection.

Is there a way to remove tonsil stones surgically?

If tonsil stone symptoms are bothering you, talk to your provider. They may refer you to an ENT — an ear, nose and throat specialist. The ENT can discuss your surgical options with you.

Healthcare providers may recommend surgical tonsil stone removal if tonsil stones are:

Large.
Causing pain or other problems.
Causing recurrent tonsil infections or sore throats.

Will I need a tonsillectomy because of tonsil stones?

In some cases, healthcare providers recommend a tonsillectomy — having your tonsils removed. This procedure may help if tonsil stones keep coming back or if they are causing repeated infections.

Prevention

How can I prevent tonsil stones?

You can take steps to prevent tonsil stones:

Brush and floss regularly. Make sure to brush the front and back of your tongue, too.
Quit smoking.
Gargle with salt water after eating.
Use a water pick to clean your mouth and help dislodge any tonsil stones.
Stay hydrated by drinking plenty of water.

Outlook / Prognosis

What’s the outlook for people with tonsil stones?

Tonsil stones are common. They rarely cause serious health problems. Many people have tonsil stones and don’t even know they have them. You can treat them at home. If tonsil stones keep coming back, you and your healthcare provider can discuss a more permanent solution.

Living With

How do I take care of myself if I have tonsil stones?

If you have tonsil stones, these at-home remedies can help:

A warm saltwater gargle helps with swelling and discomfort. Gargling can even help dislodge the stone. Try a gargle of 1 teaspoon salt mixed with 8 ounces of water.
Use a cotton swab to remove a tonsil stone that’s bothering you.
Brush and floss regularly.

When should I see a healthcare provider about tonsil stones?

Talk to your provider if:

At-home remedies aren’t working as they should.
Tonsil stones keep coming back or are bothering you.
You want to discuss other treatment options.

What else should I ask my provider?

If you have tonsil stones, ask your provider:

How can I get rid of tonsil stones at home?
What can I do to improve my symptoms?
What should I do if tonsil stones come back?
Will I need surgery?

A note from Cleveland Clinic

Tonsil stones are small lumps of hardened material that form on your tonsils, in the back of your throat. They usually don’t cause serious health problems. The main sign of tonsil stones is bad breath. You can usually try to get rid of tonsil stones using at-home methods, such as saltwater gargles. If home tonsil stone removal doesn’t work, or the stones keep coming back, talk to your provider. If the issue is recurring infections, you may need a tonsillectomy to remove your tonsils.

Last reviewed by a Cleveland Clinic medical professional on 05/11/2021.

References

Babu BB, Avinash TML,Avinash CKA, Chittaranjan B. (2013). Tonsillolith: A Panoramic Radiograph Presentation. (https://www.jcdr.net/article_fulltext.asp?id=3530) Journal of Clinical and Diagnostic Research. 7(10), 2378-2379. Accessed 11/18/2021.
Bamgbose BO, Ruprecht A, Hellstein J, Timmons S, Qian F. The Prevalence of Tonsilloliths and Other Soft Tissue Calcifications in Patients Attending Oral and Maxillofacial Radiology Clinic of the University of Iowa. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3920671/) ISRN Dentistry. 2014;2014:839635. Published 2014 Jan 22. Accessed 11/18/2021.
HealthDirect. Tonsil Stones. (https://www.healthdirect.gov.au/tonsil-stones) Accessed 11/18/2021.
Healthwise. Tonsil Stones: Care Instructions. (https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=ace4965#ace4969) Accessed 11/18/2021.
Masters KG, Zezoff D, Lasrado S. Anatomy, Head and Neck, Tonsils. (https://www.ncbi.nlm.nih.gov/books/NBK539792/) [Updated 2020 Aug 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan. Accessed 11/18/2021.

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Tonsil Stones

Preventing the Recurrence of Tonsil Stones