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What Causes Tonsil Stones? And What Do We Do About It?

What to know about tonsil stones

If you’ve ever looked in the back of your throat and noticed creamy white lumps on your tonsils, it probably gave you quite a start. But these small deposits are actually tonsil stones—and they’re much more common than you might think. So if you’re wondering where tonsil stones come from, why you have them, and what you can do to get rid of them, you’ve come to the right place.

What Are Tonsil Stones?

To understand what tonsil stones are, it’s helpful to first have a basic understanding of the tonsils themselves.

The tonsils are small masses of lymphoid tissue that lie at the back of the mouth, on either side of the tongue. While they used to be thought of as useless holdovers of evolution that needed to be removed if they became red and swollen one time too many, people eventually came to realize that they were like sentries, guarding the rest of the body from potential infection.

And this is because the tonsils produce white blood cells and antibodies that intercept bacteria and viruses that enter through the mouth and nose before they get deeper in the body. This also explains why the tonsils tend to be larger during childhood—they help train the immune system to recognize foreign invaders.

Unfortunately, the tonsils also contain small crevices that are sometimes deep enough to trap other things as well—including food particles, mucus, and old, dead cells from the lining of the mouth.

And this is how tonsil stones start.

What Causes Tonsil Stones?

When food particles and other debris get trapped in the crevices, or crypts, in the tonsils, the digestive enzymes in saliva begin to break them down, and then white blood cells attack them. The aftermath of this process results in small calcium deposits strewn about the tonsils.

Because these deposits are generally quite tiny, most people swallow them without ever realizing it. However, in people whose tonsillar crypts are larger, the particles can get lodged inside the crevices, where they continue to grow in size.

While tonsil stones—which are also known as tonsilloliths—are most common in people with chronic tonsillitis, or inflammation of the tonsils, anyone with cryptic tonsils can potentially develop stones.

Symptoms of Tonsil Stones

As just discussed, most people who have tonsil stones have no idea they’re there. And in many other individuals, the creamy white or yellowish lump that indicates a tonsil stone is the only thing they notice.

For the most part, it really depends on the size of the crypts and the quality of a person’s oral hygiene as to whether tonsil stones are mildly bothersome or downright unpleasant. In people who do experience issues, the symptoms of tonsil stones may include:

  • Ear pain (from contact with the glossopharyngeal nerve)
  • Bad breath (halitosis)
  • Foreign body sensation
  • Difficulty swallowing
  • Mild sore throat
  • Recurrent tonsillitis

But if you have tonsil stones, take heart. Most cases aren’t serious enough to warrant surgery and are easily taken care of with some simple home remedies.

Treating and Preventing Tonsil Stones

Unless you frequently check the back of your throat for stones, you may not notice them until they fall out on their own or cause discomfort or bad breath. And sometimes the feeling that something is rubbing against the back of your throat or tongue may be the clue that lets you know a stone needs to be manually removed. In either case, there are several tips you can try to both remove existing stones and prevent or reduce the recurrence of new ones.

If your gag reflex will allow it, you can use a moistened cotton swab, the back of your toothbrush, or even a clean finger to gently press against the tonsil, starting at the base, to push up and dislodge tonsil stones. But if your gag reflex won’t let you do that, you can also use a water flosser to irrigate the stone out of the tonsil.

And don’t be surprised by their awful odor. Tonsil stones contain high levels of sulfur-producing bacteria, which is the reason they’re infamous for causing bad breath.

In extremely rare situations, tonsil stones may become so large that they cause pain or swelling of the tonsils and may require surgical intervention. The two most commonly used procedures to treat severe cases of tonsil stones are:

  • Tonsillectomy
  • Cryptolysis

Tonsillectomy

If you’re of a certain generation, you probably remember tonsillectomy as a surgery often performed in childhood to remove the tonsils. However, while the procedure does involve the surgical removal of the tonsils, tissue is sometimes left behind, which can cause the tonsils to grow back. And if this happens, tonsil stones can grow back too.

Cryptolysis

This less invasive procedure uses various techniques, including lasers and radiofrequency energy, to resurface the tonsils so that the openings to the crypts are closed off. Like tonsillectomy, however, the complete elimination of tonsil stones can’t be guaranteed.

Tonsil stones symptoms and prevention

Tonsil Stones Remedies

If you’re like most people with tonsil stones, you’ll never need to think about surgical intervention, but finding effective ways to get rid of the stones you have and help prevent new ones from forming can make life with tonsil stones a little easier. And, thankfully, there’s actually a surprising number of techniques you can try in your own home to do just that. The most effective of these include:

  • Regular maintenance: Periodically "milking" your tonsils with a moistened cotton swab or clean finger or irrigating with a water flosser can help flush out the debris that leads to tonsil stones.
  • Good oral hygiene: Brushing your teeth (and tongue) after every meal and flossing each day can help cut down on the plaque that contributes to tonsil stones.
  • Plenty of water: Staying hydrated is important for the whole body, but it also helps prevent the dry mouth that can lead to higher levels of the bacteria that help create tonsil stones.
  • Apple cider vinegar: Gargling with a tablespoon of apple cider vinegar diluted in 8 ounces of warm water can help break down tonsil stones, and the simple act of gargling can help dislodge stones from their crypts.
  • Salt water: Gargling with salt water (a half teaspoon of salt in 8 ounces of warm water) can help reduce the level of bacteria in the mouth and flush out tonsil stones.
  • Essential oils: Many essential oils have antibacterial properties that make them highly effective at killing harmful oral bacteria. Oils with a long history of dental hygiene use include peppermint, tea tree, eucalyptus, myrrh, and cinnamon. Just remember that essential oils are extremely potent and should be diluted in oil or water before being used on the mouth’s sensitive mucous membranes. Their effectiveness can also be enhanced by using an antibacterial carrier such as neem oil to create a powerful mouthwash or gargle.
  • Probiotics: Foods that contain probiotics, such as yogurt and kefir, can help combat the harmful microbes in your mouth that help create tonsil stones.
  • Coughing: If a tonsil stone has grown large enough to be felt in the back of the throat, a little gentle coughing may be all the encouragement it needs to pop out of its crypt.

Because the tonsils are now recognized for the important role they play in healthy immune function and are no longer considered worthless bits of tissue, fewer people are having them removed, which means more people are experiencing tonsil stones.

So if you have them, take comfort in the knowledge you’re not alone, and know that it is relatively easy to remove tonsil stones on your own and help stop these smelly little bits of bacteria and debris from occurring in the first place.

However, if you’re unable to remove your stones on your own or they’re abnormally large and causing significant symptoms, you should speak with your health care provider about additional treatment options.

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