Tonsil stones are formed when debris, such as food, dead cells, and other substances, become trapped on the tonsils.

The debris turns hard, forming tonsil stones. Sometimes called tonsil calculi or tonsilloliths, tonsil stones can sometimes irritate the tonsils and the throat.

They appear as a white or yellowish hard mass, ranging in size from very small to very large. The largest recorded tonsillolith, at 14.5 centimeters (cm) was recorded in 1936.

People with tonsil stones may not know what they are. Tonsil stones can become a home for bacteria and may have an unpleasant smell.

The tonsils are two small mounds of tissue that lie at the back of the throat, one on either side.

They help fight infections that enter through the mouth. They trap bacteria, viruses, and other foreign invaders and then “teach” the immune system how to fight these germs.

tonsil stone: image credit tonsilolithShare on Pinterest
A tonsil stone can resemble a small rock: Image credit tonsilolith

Tonsil stones develop when bacteria and other debris get trapped in tiny crevices on the tonsils.

Because tonsillectomies are less common now than they once were, more people have tonsils and therefore more people are vulnerable to tonsil stones.

Removing tonsils to prevent tonsillitis used to be a very common procedure.

Now tonsillectomies are considered a treatment of last resort.

Many people with tonsil stones have no symptoms.

If symptoms occur, they include:

  • a very bad smell when the stones appear, because tonsil stones provide a home for anaerobic bacteria, which produce foul-smelling sulfides
  • a sense that something is stuck in your mouth or in the back of your throat
  • pressure or pain in your ears

Tonsil stones can look like small white or yellow flecks at the back of the throat. A large stone may be visible. Some are large enough that they jut out of the tonsils, resembling tiny rocks trapped in the mouth.

Tonsil stones are mostly harmless, even when they cause discomfort.

They may, however, signal problems with oral hygiene. People who do not brush their teeth or floss regularly are more vulnerable to tonsil stones. The bacteria that cause tonsil stones can also cause tooth decay, gum disease, and oral infections.

Occasionally, tonsil stones can become a breeding ground for bacteria. One study has found that tonsil stones are similar to the dental plaque that causes cavities and gum disease.

Tonsil stones can usually be treated at home. They often detach during vigorous gargling.

However, if you see tonsil stones in the back of your throat but do not have any symptoms, you do not have to try to remove them.

People can use a cotton swab to loosen the stone and gently press on the tissue immediately surrounding it. They should position the swab behind the stone and push forward, pushing the tonsil stone toward the front of the mouth instead of into the throat.

Be careful not to push too hard, as you risk injuring the back of your throat. Do not use your finger or anything pointed or sharp to try to remove a tonsil stone.

If tonsil stones hurt or make it difficult to swallow, people can try gargling with warm salt water.

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A doctor may recommend treatment to remove tonsil stones.

A doctor should be consulted if:

  • a person has symptoms of tonsil stones, but no stones are visible
  • removing the tonsil stones at home is not possible, or only a portion of the stone can be removed
  • the tonsils are red, swollen, or painful
  • pain is felt after removing a tonsil stone at home

The doctor may treat tonsil stones with laser resurfacing.

A process called coblation tonsil cryptolysis involves reshaping the tonsils and reducing the number of crevices in which tonsil stones can grow.

The procedure can be completed using a local anesthetic, and patients can resume a normal diet and activity after one week.

However, tonsil stones may grow back again.

The only way to permanently prevent tonsil stones is to have the tonsils removed via tonsillectomy. It is possible, although very rare, that the tonsils will grow back.

A tonsillectomy is safe, but it can cause throat pain for several days after surgery. Like all surgeries, tonsillectomy carries some risks.

These include bleeding, infection, swelling-related breathing difficulties, and, very rarely, life-threatening reactions to anesthesia.

If tonsil stones are only a minor irritation, the risks and stress of surgery might outweigh the benefits.

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Good oral hygiene may help to prevent tonsil stones.

Preventing the growth of tonsil stones completely is almost impossible. For people who have chronic tonsillitis, a tonsillectomy may be the only way to prevent tonsil stones.

However, good oral hygiene, including frequent brushing and flossing, can help. Irrigating the tonsils and mouth with a water sprayer can remove debris and bacteria, reducing the risk of tonsil stones.

Other conditions affecting the tonsils

A number of other conditions can cause pain in or near the tonsils. A doctor can help determine what causes tonsil stones.

Other conditions that can mimic the symptoms of tonsil stones include:

  • Tonsillitis: If the tonsils are red and swollen and it is difficult to swallow, there may be an infection in the tonsils. Tonsillitis is often accompanied by a fever.
  • Strep throat: This is one type of tonsillitis that can cause intense pain in the throat or at the back of the mouth. Like tonsillitis, strep throat often causes a fever.
  • Gum disease and tooth decay: Pain in the teeth and gums can radiate to the jaw, ear, or even the throat. Untreated infections in the teeth and gums can spread throughout the mouth, and even to other areas of the body.
  • Tonsil cancer: Tonsil cancer, also known as tonsil lymphoma, can cause a sore in the back of the mouth that does not heal. Other symptoms include pain in the ears and throat, difficulty swallowing, and blood in the mouth.

An otolaryngologist, commonly known as an ear, nose, and throat doctor, can treat most tonsil and throat conditions.