What causes tonsil stones and how to prevent them

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Tonsil stones, also known as tonsilloliths, form when debris and bacteria collect in the tonsils. This buildup then calcifies to form hard stones.

Tonsil stones can range in size, but they are usually small. Large tonsil stones are rare.

Tonsil stones are more common in adults than in children.

They are not harmful, but people may require treatment if they are experiencing uncomfortable symptoms.

Good oral hygiene is important in treating tonsil stones. It may also help prevent them from developing in the first place because it can help reduce bacteria and food debris in the mouth.

Steps for maintaining good oral hygiene include:

• using a toothpaste that contains fluoride
• brushing the teeth twice every day and flossing each day
• drinking fluoridated water
• having a dental appointment at least once a year or as often as the dentist recommends
• limiting or avoiding alcohol and tobacco
• replacing the toothbrush, or the head of an electric toothbrush, every 3 months
• drinking plenty of water
• limiting the intake of foods with added sugar
• chewing sugar-free gum, which can stimulate saliva flow in the mouth, especially in people with a dry mouth

A person who has experienced tonsil stones in the past can help prevent them from returning by doing the following:

Gargle with salt water

Gargling with warm salt water may help dislodge tonsil stones. It is possible that gargling with salt water may also help stop stones from coming back, although there is no specific scientific evidence for this.

Gargling with salt water may also help reduce bacteria in the mouth. A 2017 study compared the antimicrobial effects of a saltwater rinse with those of a chlorhexidine mouthwash.

The researchers divided the 30 participants, who were between the ages of 12 and 15 years, into two groups. One group used the saltwater rinse, while the other group used mouthwash.

Each group used their assigned product for 30 seconds daily for 5 days.

Although the chlorhexidine mouthwash was more widely effective in reducing oral bacteria, the saltwater rinse was as effective as chlorhexidine in decreasing plaque and microbes in the mouth. The researchers also noted that a saltwater rinse has other benefits, such as having fewer potential side effects and being easily accessible and affordable.

Another study found that gargling with salt water may help with oral wound healing.

Use mouthwash

Using an antibacterial mouthwash may help reduce oral bacteria and plaque, both of which may contribute to the formation of tonsil stones.

The American Dental Association advise people to look for a mouthwash that contains the following active ingredients:

• cetylpyridinium chloride
• chlorhexidine (only available with a prescription)
• essential oils
• fluoride
• peroxide

The ADA note that a mouthwash with these ingredients may also help reduce bad breath, gingivitis, plaque, and tooth decay.

Use a water flosser

Using a water flosser is one method for reducing plaque in the mouth and removing food debris, which may lead to tonsil stones, from between the teeth.

A water flosser is a handheld device that a person uses to spray water into the mouth to remove food debris. It may be a good option for people who find using dental floss difficult or have orthodontic appliances, such as braces.

Tonsil removal

People with severe, recurring tonsil stones may wish to consider medical treatment.

The only confirmed method for preventing tonsil stones from returning is tonsil removal, or tonsillectomy.

Tonsil stones can range in size from 1 millimeter to 1 centimeter (cm) in diameter. One 2018 case study reported a large tonsil stone measuring 3.1 cm by 2.3 cm.

Tonsil stones form on the palatine tonsils, which are the tonsils visible at the back of the throat. They are white or yellow, and people may notice them in the form of white patches on the tonsils. Larger stones may be easier to see than smaller stones.

Signs and symptoms of tonsil stones include:

• bad breath
• recurrent sore throat
• cough
• difficulty swallowing
• earache
• the feeling of having something stuck at the back of the throat, known as foreign body sensation
• a foul taste
• in rare cases, difficulty breathing

However, some people with tonsil stones may experience no symptoms.

The tonsils are glands at the back of the mouth that trap bacteria and prevent infections from entering the body.

The tonsils have multiple folds called tonsillar crypts. Food debris can build up in these parts of the tonsils and harden into stones. Enlarged tonsillar crypts can also trap calcium, which can then harden into stones.

A tonsil stone is a living biofilm. A biofilm forms when bacteria secrete a gluey substance to help them stick to a surface in a moist environment, such as the mouth.

The same bacteria and fungi that can cause tonsillitis, an inflammation of the tonsils, can also cause tonsil stones.

Tonsil stones are not harmful. However, a person may wish to consult a doctor if they have one or more tonsil stones that are:

• large
• causing uncomfortable symptoms
• recurrent
• unresponsive to home remedies

Anyone who suspects that they have tonsillitis should seek medical care.

Symptoms of tonsillitis include:

• swollen tonsils
• tonsils that are more red than usual
• a white or yellow covering on the tonsils
• changes in the voice due to swelling
• a sore throat
• earache
• swollen glands in the neck
• difficulty or discomfort swallowing
• bad breath
• fever

A doctor will typically diagnose tonsil stones by carrying out a physical examination. In some cases, they may also use imaging techniques to examine the tonsil stone more closely.

Tonsil stones are usually small, and people may be able to treat them with home remedies. Good oral hygiene is important in avoiding and preventing tonsil stones.

People with large or recurring tonsil stones may wish to speak with their doctor. In some such cases, surgery may be necessary to remove the stones or even the tonsils.