Have you been experiencing a bad taste in your mouth and bad breath that doesn’t seem related to anything you’ve eaten? Perhaps a sore throat or a feeling of something being stuck in your throat? Are there small white spots at the back of your throat that don’t look like they should be there? You might have tonsil stones, also known as tonsillar stones or tonsilliths. While usually not painful or harmful, tonsil stones can be a bit of a nuisance mainly because of the role they play in causing chronic halitosis.
Lurking in your tonsils
Your tonsils, those two oval pads of tissue in the back of the mouth, help filter out bacteria and viruses and thus serve as part of the body’s defensive immune system. A type of lymphoid tissue, these crevice-filled structures also produce white blood cells and antibodies that help fight disease.
Tonsil stones, which form as small, hard, and gritty white or yellow lumps, are calcifications within the substance of the tonsils. It’s not entirely clear how they develop, but they may result from bacteria, fungi, or other organic debris that build up within the tonsils’ folds and pockets (called crypts) in the setting of chronic inflammation brought on by infection. They may also simply form from food particles, saliva, and mucus that get lodged within the folds and craters of the tonsils and eventually harden.
Tonsil stones—which can come and go and occur at any age—tend to be more common in people whose tonsils contain more tonsillar crypts and in those who have had a lot of tonsil infections. Most are small, just a few millimeters in size, but they can also grow to be a couple of centimeters or even bigger in extreme cases.
People with smaller, asymptomatic tonsil stones may not even be aware they have them until the stones are spotted by their doctor or dentist during a physical exam of the mouth and throat or picked up as incidental findings in routine dental X-rays. In a study of 134 people, 54 (40 percent) were found to have tonsil stones upon imaging.
In addition to a bad taste in the mouth and bad breath, symptoms of larger tonsil stones include throat irritation and earaches. The stones, which might be coughed or spit up, may also trigger throat infections.
Treating tonsil stones
There’s no standard approach to treating or removing tonsil stones. Home remedies include coughing, which can help loosen and dislodge stones; manually dislodging them as gently as possible with a cotton swab or a low-pressure water irrigator (water pick); and gargling with salt water, which can dislodge stones and help prevent food and other debris from getting stuck in tonsillar crevices in the first place, as well as help with bad breath and soothe an irritated throat. But don’t use anything sharp, like a toothpick; even a fingertip or the back of a toothbrush can scratch a delicate tonsil, leaving it vulnerable to infection.
In general, antibiotics are not used to treat tonsil stones, which are not in and of themselves bacterial infections (hence, antibiotics have little if any impact on their underlying cause). If you do develop a bacterial infection related to a tonsil stone, however, a course of antibiotics is in order.
If your tonsil stones are especially problematic, an ENT (ear, nose, and throat) doctor can dislodge them with an instrument (though the stones often return over time). There are also surgical procedures, including coblation cryptolysis, that can smooth the crypts where tonsil stones form. These procedures can be done under local anesthesia without sedation. More than one session may be needed, however, and there is always the chance still that the tonsil stones will return.
If tonsil stones keep coming back and causing infections, a last resort—but one that is permanent—is to completely remove the tonsils (tonsillectomy). Although traditional tonsillectomy is generally considered safe, there is a small risk of serious complications such as bleeding. And, of course, there are risks associated with any surgery, including a reaction to general anesthesia. Tonsillectomy is usually done as an outpatient procedure, but recovery can take up to two weeks and can be a bit rough in the beginning, with throat pain that may get worse before it gets better, a low fever, hoarseness, and swelling. It’s generally recommended to refrain from work for at least 10 days after a tonsillectomy.
Heading them off
Preventing tonsil stones largely boils down to hygiene and hydration: Gargle regularly with salt water (using a teaspoon of salt per eight ounces of warm water), brush your teeth and floss regularly, drink sufficient amounts of water, and don’t smoke. If you can’t manage tonsil stones yourself or they keep coming back through no fault of your own and are distressing to you, talk to your doctor about other options.
