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Tonsil stones are harmless for the most part but may require treatment in some cases. Practicing good oral hygiene is the best way to prevent tonsil stones. Please keep reading to find out what causes tonsil stones and how to prevent and treat them.

What Are Tonsil Stones?

The tonsils are glands at the back of the mouth and top of the throat. They filter out germs and prevent infections. Tonsil stones are small, hardened, whitish-yellow, pebble-like lumps that form in the tonsils. The technical term for tonsil stones is tonsil calculi or tonsilloliths. 

Tonsil stones are common in teenagers and are usually harmless. However, they can sometimes cause problems such as bad breath, earache, and sore throat, making it necessary to have them treated or removed surgically. 

There can be one or more tonsil stones. Most tonsil stones are small, but in rare cases, large tonsil stones can occur. Large tonsil stones that are over 5 millimeters (mm) in size are more likely to cause problems. Tonsil stones can have overlapping symptoms with the following conditions:

• Gum disease 

• Tonsil cancer, such as squamous cell carcinoma 

• Strep throat 

• Tonsilitis 

If you experience severe pain or fever, you should have your tonsil stones diagnosed and further evaluated by a healthcare professional.

Common Tonsil Stone Symptoms: From Bad Breath to Sore Throat

Symptoms of tonsil stones include:

• Halitosis (oral health problems causing bad breath)

• A bad taste in the mouth

• Difficulty swallowing

• A feeling that something is stuck in the back of your throat

• Visible white patches on the tonsils

• Sore throat

• An irritating cough

• Earache

Why Do People Develop Tonsil Stones?

Tonsil stones form when calcium deposits build up around food debris, germs, dead cells, and mucus in the tonsillar crypts (tissue folds in the tonsils). This debris then becomes calcified (hardened) and forms tonsil stones. Risk factors for developing tonsil stones include:

• Teenage years

• Enlarged tonsillar crypts

• Frequent tonsil infections (tonsillitis)

• Dehydration

• Smoking

• Poor dental hygiene

Find out how to treat swollen tonsils.

Key Factors in Tonsil Stone Formation

Bacteria and Debris Accumulation

Tonsil stones form when harmful bacteria, food particles, and other debris become entrapped in the tonsil crypts (folds or crevices in the tonsillar tissue). This can also trigger infections. 

Poor Oral Hygiene

Poor oral hygiene allows bacteria to flourish in the mouth, increasing the risk of getting tonsil stones when the bacteria become trapped in the tonsillar crypts. However, people who brush and floss regularly can also develop tonsil stones.  

Diet and Hydration

Certain foods such as nuts, seeds, and popcorn tend to leave debris in the mouth, increasing your chances of getting tonsil stones. Also, not drinking enough water can lead to a dry throat and increased mucus production, which can trap debris. This can lead to tonsil stone formation and tonsil infection. 

Medications such as antihistamines can increase the risk of dry mouth, contributing to the development of tonsil stones. Antihistamines include medication used to treat seasonal allergies, acid reflux, and vertigo/seasickness. Examples include Benadryl (diphenhydramine), Zyrtec (cetirizine), Pepcid (famotidine), and Dramamine (dimenhydrinate). 

How to Get Rid of Tonsil Stones and Prevention Strategies

Good Oral Hygiene

Brushing Techniques to Clean Tonsillar Crypts

If you have tonsil stones, you can try the following tactics:

• Gently press them out with the back of your toothbrush or a cotton swab. 

• Wash them out with a low-pressure water flosser or irrigator. 

Flossing and Tongue Scraping

Maintaining good oral hygiene keeps your mouth and tonsillar crypts clean to help prevent tonsil stones from forming. Brushing your teeth regularly (at least in the morning and before bed, after every meal if possible) and flossing at least daily is recommended. Scraping your tongue with the back of your toothbrush or using a tongue cleaner is also recommended. 

Gargling Fights Off Bacteria in the Throat

Gargling with warm, salty water can help to loosen tonsil stones that have formed in the pits and craters in your tonsils. You can make a gargling solution at home by mixing one teaspoon of salt in a glass of warm water.

Warm Salt Water vs. Medicated Mouthwash for Tonsil Stones

If you do not want to gargle with warm, salty water, an alcohol-free mouthwash can also help prevent bacteria and debris from being trapped and hardened.

Dietary Adjustments and Hydration

Foods to Eat 

Probiotic foods such as yogurt and naturally acidic fruits such as apples, grapes, and pomegranates can help fight bacteria and prevent tonsil stone formation. In addition, chewing raw vegetables such as carrots can increase saliva production, which can prevent tonsil stones from forming or dislodge stones that have formed. 

Foods to Avoid to Prevent Tonsil Stones

Avoid eating nuts, seeds, and popcorn, which can leave debris in your mouth. Reduce sugary food and alcohol intake since they promote bacterial growth. Quit smoking if you are a smoker.

Stay Hydrated

Drinking plenty of water helps to limit the buildup of debris in the tonsils and prevents the formation of tonsil stones.

Advanced and Professional Interventions

Removal at Home: Using Cotton Swabs and Water Picks Safely

Use a cotton swab carefully to remove a visible tonsil stone. Aggressive use may cause damage to the tonsillar tissues or trigger an infection. Gargle with salt water immediately after you remove a tonsil stone with a cotton swab to lower the risk of infection.

Use a water flosser such as Waterpik at the lowest pressure setting to remove a tonsil stone. Higher pressures may cause discomfort or even choking. Do not use the Waterpik for more than 30-60 seconds at a time.

When to See a Doctor for Tonsil Stones: Otolaryngologists and Tonsillectomy

You should see a doctor if you have:

• Persistent tonsil soreness 

• Red or bleeding tonsils 

• Severe pain in the throat that extends to the ear

Your doctor can diagnose tonsil stones with a physical exam. Sometimes, an imaging scan is necessary if the stones are not easily visible. If your provider is unable to dislodge the stones in their office, they may refer you to an otolaryngologist (throat doctor).

Find out When to See an Ear, Nose, and Throat Doctor.

New Technologies in Tonsil Stone Treatment

Pain Medications, Antibiotics, and Surgical Removal of Tonsil Stones

Over-the-counter pain relievers can provide temporary relief from throat pain. Your healthcare provider may prescribe antibiotics if you have a bacterial infection. However, these are not long-term solutions. 

If your tonsil stones keep coming back and cause symptoms, your doctor may recommend surgery to have your tonsils removed. This surgery is called a tonsillectomy and is done under general anesthesia. Surgery is sometimes recommended if you have  a larger-size tonsil stone. Surgical intervention is the only way to permanently prevent tonsil stones.

Laser Cryptolysis

Laser cryptolysis is done under local anesthesia. It uses a laser to vaporize tonsillar tissue in which recurrent tonsil stones form. The treatment is associated with less pain and faster recovery (1 week) compared to traditional surgical options to have the tonsils removed. Most patients can eat regular food within 24 hours of laser cryptolysis. However, this tonsil stone treatment carries a risk of burns from the laser and eye damage from the vapors.

Coblation Cryptolysis

Coblation cryptolysis uses non-heat radiofrequency energy to destroy tonsillar tissues in which tonsil stones are present while leaving surrounding healthy tissue intact. It is done under local anesthesia and is less risky and less expensive than laser cryptolysis. However, more than one session may be required.

Living with Tonsil Stones: Management and Symptom Relief

Temporary Relief for Tonsil Stone Symptoms

Self-care steps and home remedies for relief from throat pain and other symptoms include:

• Practice good oral hygiene to remove bacteria from your mouth.

• Stay hydrated.

• Gargle with warm salt water.

• Use a cotton swab to gently dislodge a visible tonsil stone that is causing you to feel pain.

• Use a water flosser such as Waterpik to loosen tonsil stones.

The Importance of Prevention and Good Oral Health

Maintaining good oral hygiene and staying hydrated are the best ways to prevent tonsil stones, as well as promote overall good oral health. These practices prevent the overgrowth of bacteria in your mouth which can become entrapped in the nooks and crannies in your tonsillar tissues, harden, and form tonsil stones.

Consult Healthcare Providers for Persistent Issues

Tonsil stones may cause problems for some people. Consult your healthcare provider if you have persistent symptoms or the tonsil stones keep coming back. You may need surgery to remove your tonsils. Recurrent tonsil stones can put you at risk of infections and other health complications.

Learn about Tonsilitis: Is it contagious?

Frequently Asked Questions About Tonsil Stones

Why do I keep getting stones in my tonsils?

It is possible you keep getting stones in your tonsils because your tonsillar crypts are enlarged. These are crevices and folds in your tonsillar tissue in which debris and bacteria can become entrapped and harden to form tonsil stones.

What increases the chances of tonsil stones?

Known risk factors for tonsil stones include teenage years, dehydration, enlarged tonsillar crypts, smoking, and frequent tonsil infections. Taking medications that can cause dry mouth can also increase the risk of developing tonsil stones. 

Can tonsil stones go away on their own?

Tonsil stones can go away on their own. They may dislodge and you may swallow them without realizing it.

Does mouthwash prevent tonsil stones?

Gently swishing alcohol-free mouthwash can help to kill bacteria in the mouth and prevent tonsil stones. It can also help to loosen any tonsil stones that have already developed.

Does salt water stop tonsil stones?

Gargling with warm salt water is an effective way to dislodge tonsil stones. It can also provide relief from a sore throat and reduce bad breath. However, salt water does not stop tonsil stones from forming.