What Are Tonsil Stones? Symptoms, Causes, Diagnosis, Treatment, and Prevention

If you’ve ever spotted yellowish-white spots on your tonsils (the oval-shaped pads of tissue that sit on both sides of the back of the mouth that you’ll have to open wide and use a mirror to be able to see), you may have a very common problem known as tonsil stones. These deposits, which are also called tonsilloliths or tonsilliths, can form, harden, and grow on and inside the tonsils. (1,2)

Tonsil stones are usually about gravel-sized, but they can also be quite small — sometimes even too tiny to be seen with the naked eye. In rare cases they can potentially grow to be as large as a golf ball or bigger if they grow for long periods of time. They’re usually soft but they can harden, and they are light yellowish or white in color. (1,2)

Usually these spots pose no serious risks to your health and often can be removed easily at home. These stones are not a sign of illness or disease, and they generally do not cause other negative effects on your health. (1,2)

They can, however, cause unpleasant symptoms, such as bad breath and discomfort in the back of the throat. They can also be a nuisance because they may repeatedly grow back after they’re removed. (1,2)

Here’s what you need to know about why tonsil stones form, symptoms they cause, and how to get rid of them.

Two common symptoms of tonsil stones are bad breath and discomfort. These symptoms, along with seeing white flecks in the back of the throat, are what usually send people to the doctor, leading to a tonsil stones diagnosis, says Aaron Thatcher, MD, a clinical assistant professor of otolaryngology at the University of Michigan in Ann Arbor. “Some patients might see spots in their mouth, and some might have chronic sore throat or pain,” he says. “Others may see a doctor or dentist for bad breath.”

It’s also possible that you won’t experience any symptoms at all. “Tonsil stones may be very common,” says Dr. Thatcher. “But in some people, they may be small and buried so deep that they might not see them.” This is one reason why doctors think the condition is underestimated, Thatcher notes. (2)

Some typical symptoms of tonsil stones include: (1,2,3)

• Persistent bad breath
• Pale yellow or white gravel-sized bumps on your tonsils
• Sore throat
• Discomfort and a sensation of something being stuck in the back of your throat
• Problems swallowing
  

If you see swelling, inflammation, bleeding in your tonsils, any asymmetry (if one side is bigger, looks different from the other, or is more painful), experience ear pain, or you have trouble swallowing or have a sore throat that lasts for more than a month, be sure to see your doctor because these symptoms may be signs of a more serious illness such as strep throat, tonsillitis, or even cancer. (1,2,3)

Learn More About the Signs and Symptoms of Tonsil Stones

In some people, the surface of the tonsils is more irregular than smooth, with crevices and pockets commonly referred to as “crypts” that are deep enough to trap food particles, bacteria, saliva, and other debris. “Food, plaque, cellular debris such as skin cells and the lining of the mouth all collect in the pits and crevices,” says Jennifer Setlur, MD, an otolaryngologist at Massachusetts Eye and Ear in Boston. Over time these materials become impacted and may eventually develop into stones. (1,2)

Tonsil stones tend to cause bad breath because the bacteria in the growths make them smell extremely unpleasant. (1,2)

There’s a common misconception that having tonsil stones means you have poor oral hygiene. But it’s usually not the case; the way your tonsils are shaped is a bigger factor. The reason that people with more crypts are usually more likely to develop growths is because those crevices allow food and debris to build up. (1,2) “It has to do with the structure of tonsils,” says Thatcher.

It should be noted, though, that poor oral hygiene can indeed contribute to the development of tonsil stones, and brushing, flossing, and gargling water in the back of your throat regularly are important ways to help prevent the problem. (1)

Learn More About Causes of Tonsil Stones

Your primary care provider may refer you to an otolaryngologist (sometimes referred to as an ear, nose, and throat doctor, or ENT) for diagnosis and treatment, notes Helena Yip, MD, assistant professor of otolaryngology at Banner University Medical Center in Tucson, Arizona. A specialist likely wouldn’t need to conduct any additional tests if they see the white, pearl-like growths in the back of the throat, Dr. Yip says. “They wouldn’t be mistaken for anything else.”

Getting rid of a tonsil stone can be very quick if you’re able to remove it yourself at home. They become a more cumbersome problem if they are difficult to remove or continue to show up.

If you start getting stones regularly, there is no set amount of time or frequency that the condition can affect someone. Some people may develop tonsil stones once or twice over years, while others may get them several times a week. They can appear as flares that last for a short period of time, or they can persist for years, says Dr. Kezirian. (2)

For most people, practicing good oral hygiene and following your doctor’s orders for managing tonsil stones quickly when they show up can help minimize the inconvenience they can cause, says Kezirian. If stones become more chronic and a bigger burden, there are surgical treatment options you can discuss with your doctor, such as removal of your tonsils, which will permanently prevent recurrence of tonsil stones.

Since tonsil stones are not a serious health problem and are generally not harmful, your doctor will probably recommend preventive measures to clear them out periodically and reduce your symptoms. If they’re not bothering you, and you’re not noticing unpleasant symptoms, your doctor may advise you to leave them alone, Yip says. (1,2)

In most cases, tonsil stones can be managed at home. Some people prefer to push these objects out themselves using a cotton swab or their finger. If that poses a problem because it triggers your gag reflex, using a water flosser usually allows you to flush out the stones may be a better option. (1,2)

Both Thatcher and Dr. Setlur recommend using a water flosser for tonsil stone removal because it’s effective and safe and doesn’t cause gagging. If you decide to use something else to dislodge the stones, do not use anything sharp (such as toothpicks or pins) to do so, Setlur says. Using these types of tools can cause injury to the tonsils or bleeding.

Medication Options

Your doctor may prescribe antibiotics or an anti-inflammatory medication such as a corticosteroid for tonsil stone flares, but these medications would only be used to help clear up an episode of stones and should not be prescribed for long-term use, Kezirian says. “These medications can help decrease swelling and make the crypts less shallow.”

Surgery Options

Another option for removal of tonsil stones is surgery. However, doctors generally do not recommend a tonsillectomy to treat tonsil stones unless a patient’s life is severely impacted in a negative way by the tonsilliths. (1,2,3) Frequent tonsil stones may also increase your risk of tonsillitis (an infection of the tonsils), which could be another reason for considering a surgical option to deal with serious cases, according to Kezirian.

Such surgical options to treat tonsil stones include:

• Tonsillectomy This is surgery to completely remove the tonsils, which means that the stones cannot grow back. While a tonsillectomy is the most effective way to prevent tonsil stones from forming, there are potentially serious risks to be aware of when considering this option. For one thing, a tonsillectomy requires general anesthesia, and it can involve a great deal of pain that may last for weeks, says Thatcher. And, as with any surgery, there is a risk of bleeding and infection. (1,2)
• Laser Tonsil Cryptolysis In this procedure, surgeons use a laser to get rid of tonsil crypts to prevent tonsil stones from forming. (4)
• Coblation Cryptolysis In this procedure, surgeons use radiofrequency energy and saline to remove tonsil crypts and crevices. Because surgeons are able to do this procedure at a lower temperature than with laser tonsil cryptolysis, there is lower risk of certain complications. (5)
  

Both methods of cryptolysis require only local anesthesia — unlike tonsillectomy, which is done under general anesthesia — so they may result in less pain afterward and faster recoveries. (4,5)

However, a review published in 2017 concluded that there’s not enough evidence yet to show that coblation cryptolysis is safer or better tolerated in patients or results in improved post-operative outcomes compared with other procedures, such as tonsillectomy or laser tonsil cryptolysis. (6)

Learn More About Treatment for Tonsil Stones: Medication, Surgery Options, and More

While poor oral hygiene is not the only reason tonsil stones develop, keeping your mouth clean and free of any food particles or bacteria plays an important role in preventing tonsil stones from showing up. Be sure to:

• Brush your teeth and floss regularly. Keeping your mouth clean and removing food particles can play an important role in preventing tonsil stones from flourishing by reducing the amount of materials and bacteria in your mouth that may contribute to tonsil stone growth. Brush your teeth after meals, as well as in the morning after you wake up and before bed. Floss daily. (1,2)
• Gargle water. In addition to brushing your teeth and flossing regularly, gargling water in the back of your throat after eating (as well as after brushing teeth and flossing) can also help clear away debris and food particles to prevent buildup of material that leads to tonsil stones, Setlur says. (1,2) Avoid gargling with mouthwashes that contain alcohol, which may cause irritation and lead to swelling in the area in which the tonsil stones occur. Gargling with salt water may provide additional benefit by helping reduce any swelling in the area and preventing buildup of food or other materials, Kezirian says.

Lifestyle choices can affect tonsil stone formation, too. To help prevent stones you can also:

• Stop smoking. Anything that causes inflammation in the mouth or throat, such as smoking, can irritate the tonsils, which can set the stage for worsening of crypts and increased risk of tonsil stones.
• Avoid sugary drinks. Steer clear of beverages that are high in sugar, such as juice and sodas, as they may act as a nutrient source for bacteria, helping it accumulate in the tonsils, Kezirian says.

In some cases, tonsil stones may increase your risk of tonsillitis (inflammation or infection of your tonsils). And in rare cases, if the growths are very large, they may cause breathing or swallowing problems. (7)

But otherwise tonsil stones rarely cause complications.

Tonsil stones can occur in anyone who still has their tonsils, regardless of age or gender. But an individual’s likelihood to develop tonsil stones may change over time, meaning that someone who once regularly got tonsilloliths may get them less frequently, or vice versa. That’s because tonsils can develop more crypts as we reach adolescence and into young adulthood, and then become smaller and less prone to tonsil stones as we age, Setlur explains. (1,2)

There is a lack of data evaluating how many people are affected by tonsil stones, largely due to the fact that in many cases, individuals may not realize they have them. Some people with tonsil stones never experience symptoms and may not seek medical attention. Even when tonsil stones are diagnosed, the condition is rarely serious, which explains why few researchers study them, Thatcher notes.

The research that does exist suggests tonsil stones may be very common with prevalence rates having been estimated to range from 25 to more than 46 percent. (8,9)

Favorite Orgs for Essential Tonsil Stones Info

ENT Health

This site from the American Academy of Otolaryngology–Head and Neck Surgery Foundation is a one-stop shop for everything ear, nose, throat, head, or neck related. You’ll find information about how your tonsils help keep you healthy, and a variety of tonsil problems that can occur. We especially love the “Find an ENT” feature, which makes it easy to find a specialist near you.

PBS Nova

Watch a two-minute video from the PBS show Nova to see what a tonsil stone looks like, how common they are, and what you can do to get rid of them.

Favorite Orgs for Essential Dental Health Info

American Dental Association (ADA)

ADA is a professional organization of dentists that seeks to advance the oral health of the public. You can find out about recent dental health research news, dental hygiene products recommended by ADA, dental health education and training, and more. Use the Find-a-Dentist feature on the site to connect with a provider near you.

Centers for Disease Control and Prevention (CDC) 

Keeping your mouth clean and debris-free is one way to prevent tonsil stones from developing. This CDC fact sheet reviews the basics of maintaining good oral hygiene and avoiding other oral health problems.

MouthHealthy

MouthHealthy features information about dental and oral health and is produced by the ADA for the general public. You’ll find information about dental health for specific age groups, dental visits, brushing your teeth, and more.