Tonsil stones are small, hard lumps that form on the surface of the tonsils due to a buildup of debris. Treatment typically involves surgery to remove the tonsils.

In this article, we will explain what tonsil stones are, how to remove them, what causes them, and how to prevent them. We will also look at any possible complications that may require medical intervention.

Awareness of tonsil stones seems to be growing. Recently, tonsil stones were a trending topic on social media, and some doctors have reported an increase in clinic visits about them.

However, there is no data yet to indicate how widespread this increase in awareness and prevalence of tonsil stones may be.

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Tonsil stones form when debris, such as food, dead cells, bacteria, and other substances, becomes trapped on the tonsils.

The debris hardens as calcium builds up around it, forming tonsil stones. These stones are also called “tonsil calculi” or “tonsilloliths.” They are usually visible as white or yellowish lumps.

Tonsil stones are generally easy to extract, and some people remove them when they cough. Gargling with salty water may also dislodge them. A person may need to gargle vigorously if the stones are well established.

People with tonsil stones may be able to loosen them by gently pressing on the surrounding tissue with a cotton swab. It is better to push the stone forward by positioning the swab behind the stone. The tonsil stone then falls into the mouth instead of into the throat.

People with tonsil stones often pick them out. Some people can feel their tonsil stones, while others cannot. This seems to be related to the size and volume of the tonsil stones.

The tissues of the throat are delicate. To avoid injury, a person with tonsil stones should be careful not to push too hard.

A water flosser can work well to flush out tonsil stones in a clean way without introducing bacteria to the mouth and tonsils. Some people will water floss after meals or daily to prevent debris from accumulating to prevent tonsil stones.

A person should see a doctor if:

  • they have symptoms of tonsil stones but cannot see them
  • they cannot remove the tonsil stones at home or can only remove a portion of the stones
  • their tonsils are red, swollen, or painful
  • they feel pain after removing a tonsil stone at home
  • their throat is so swollen that breathing becomes difficult

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

The tonsils are two small mounds of tissue that sit at the back of the throat, one on either side. The American Academy of Otolaryngology explains that tonsils help fight infections that enter through the mouth.

As tonsils are made of lymphoid tissue, they can have crypts, which are holes in their surface. Tonsil crypts are a normal part of human anatomy. Some people’s tonsils may have more or larger crypts than others, making the person more likely to develop tonsil stones.

Tonsils trap bacteria, viruses, and other foreign invaders and then “teach” the immune system how to fight these germs. The debris is usually swallowed or washed away by saliva.

Most tonsil stones are small, and a person is unlikely to experience symptoms.

According to a study published in the journal Oral and Maxillofacial Surgery Cases, if symptoms do occur, they may include:

  • halitosis, or bad breath (tonsil stones provide a home for anaerobic bacteria, which produce foul-smelling sulfides)
  • a sense that something is caught in the back of the mouth or throat
  • an irritating cough
  • a bad taste in the mouth
  • swollen and inflamed tonsils

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 to jut out of the tonsils, resembling tiny rocks trapped in the mouth.

If home treatments do not work or the stones are particularly large, a doctor may recommend surgery.

In most cases, the first-line surgery in the United States to prevent tonsil stones from recurring is a tonsillectomy, which is the surgical removal of the tonsils.

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

According to the United Kingdom’s National Health Service (NHS), these risks include bleeding, dehydration secondary to pain, infection, swelling-related breathing difficulties, and, very rarely, life threatening reactions to anesthesia.

If a person is not eligible for a tonsillectomy, a doctor may suggest treating tonsil stones with laser resurfacing.

A paper published in the American Journal of Otolaryngology explains that this process, called coblation cryptolysis, smoothes the surface of the tonsils, reducing the number of crevices in which tonsil stones can grow.

Surgeons can perform the procedure using a local anesthetic, and patients can resume a regular diet and activity after one week. A 2021 study claims this treatment may be superior to other surgeries, though tonsillectomy remains the most common treatment for tonsil stones in the U.S.

However, tonsil stones may still develop again in the future.

Several other conditions can cause pain in or near the tonsils. The doctor will likely eliminate these causes before recommending surgery.

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. A fever often accompanies tonsillitis.
  • Strep throat: This type of tonsillitis 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 throat. Untreated infections in the teeth and gums can spread throughout the mouth and to other areas of the body.
  • Tonsil cancer: Lymphoma, a form of cancer that can be found in the tonsils, may 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.
  • Oropharyngeal squamous cell carcinoma: Squamous cell carcinoma is also a common form of tonsil cancer. It is linked to drinking alcohol, smoking, and HPV infection.

An otolaryngologist, or ear, nose, and throat doctor, can treat most tonsil and throat conditions.

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

An article published in the journal Oral and Maxillofacial Surgery Cases highlights a link between tonsil stones and tooth decay in one patient. However, there is insufficient data to tell whether poor dental hygiene is generally a risk factor for tonsil stones.

People who do not brush their teeth or floss regularly may be more susceptible to tonsil stones. The bacteria that cause tonsil stones can also cause tooth decay, gum disease, and oral infections.

The only way to permanently prevent tonsil stones is to remove the tonsils via tonsillectomy. In very rare cases, tonsils have grown back following this procedure.

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 of surgery might outweigh the benefits.

Practicing good oral hygiene, including frequent brushing and flossing, may reduce the risk of tonsil stones.

Irrigating the tonsils and mouth with a water flosser may also help by washing away debris and bacteria.

Tonsil stones are small, hard lumps that form in crevices on the surface of the tonsils. They are usually harmless, although they can cause bad breath.

Many people can dislodge them with a cotton swab or by gargling. A person should always make sure they use clean cotton swabs to help prevent harmful bacteria from entering the mouth.

If a person cannot remove their tonsil stones at home, a doctor may recommend surgery to remove them.