Tonsil Stones Explained: Causes, Symptoms, And Treatments

Perhaps you've been having trouble passing food down your throat, or maybe you've suddenly (or inexplicably) started to have bad breath (via the Cleveland Clinic). If you've been noticing some small, whitish substances coming from the back of your mouth lately, then this likely explains your digestion and hygiene woes.

You might be suffering from tonsil stones, making you part of a small group of people — about a tenth of the population, per the experts at Thera Breath – who develop these tiny troublemakers every year. If left untreated, tonsil stones may bring about tooth decay, tonsil inflammation and infection, and other nasty health consequences (via Healthline).

Thus, it's important to understand what the condition entails, the individual factors that contribute to it, how to prevent it from happening, and how to treat it properly. Here are the critical bits of information about tonsil stones that you need to know, in order to spare yourself and your loved ones from the complications that they may bring.

What brings about tonsil stones

While the specific cause of tonsil stones isn't quite clear, medical experts have already established that tonsil stones consist of biofilm, a substance that forms after microorganisms build up on any surface (per Healthline). When fungi and bacteria in your mouth come into contact with other substances, they combine and change to form biofilm.

Biofilm settles on moist areas such as your tonsils (the two masses located around the section where your lower jaw meets the throat, from the inside). Tonsils consist of tissue that can produce antibodies and lymphocytes, which typically help deal with oral infections (per the American Academy of Otolaryngology). They capture viruses, bacteria, and other foreign objects that enter your mouth, and they work with your immune system to get rid of them. Normally, these substances get swept away by saliva. 

However, since the tonsils have unevenly shaped tissue, some crypts and openings of varying sizes form(via Medical News Today). Bacteria, mucus, and dead cells sometimes find their way into these deposits, forming whitish or yellowish rock-like substances. Depending on the number of substances that collect in the tonsils' fissures, the resulting tonsil stones may be massive or tiny (per WebMD).

Risk factors

There are a number of risk factors for tonsil stones. For starters, folks between 20 and 40 years old have a higher risk of developing tonsil stones (per Lumineux Oral Essentials). According to ENT (ear, nose, throat) surgeon Aaron Trinidade, if you're within this age bracket, chances are you have long-standing tonsillitis (inflamed tonsils) or had it in the past, a condition that doubles your odds of getting tonsil stones. 

If you take medication that dries your mouth, you're also at risk of tonsil stones (via Lumineux Oral Essentials). The Checkup by Singlecare mentions several medications that have dry mouth as a possible side effect, including antidepressants, decongestants, and medication for your heart and blood pressure. Per Lumineux Oral Essentials, if you also have infections or experience nose secretions that affect your throat, you may get tonsil stones as well. 

Moreover, if you're a huge lover of alcohol and refined foods, you sit on the edge of getting the condition. Having highly active salivary glands, having excess food particles getting held up in the mouth instead of being swallowed, or having larger tonsils (via MedicineNet) also make tonsil stones more likely to happen.

Tonsil stones are not tonsillitis

There's some confusion when it comes to differentiating tonsil stones from tonsillitis. Tonsil stones are also referred to as tonsilloliths, which some tend to mistake for tonsillitis (per the Cleveland Clinic). Tonsillitis is a health condition that targets the tonsils and causes inflammation, leaving them swollen (via WebMD).

Something that tonsil stones and tonsillitis have in common is that they both affect the throat. However, tonsillitis tends to affect young people, while tonsil stones are more commonly observed in adults (per Smiles on Queen Dentistry). Additionally, while tonsil stones only bring about effects that make you feel uneasy, the effects of tonsillitis can cause pain. Tonsillitis also brings about fever, which you won't experience with tonsil stones.When you address the infection that's causing tonsillitis, the health condition goes away immediately. Meanwhile, tonsil stones may still hang around up to the point where they're knocked out of position. 

Plus, more often than not, when you have tonsil stones, you won't be aware of them (unlike tonsillitis, which can cause noticeable effects). Lastly, while tonsillitis can be caused by bacterial and viral infections and becomes more common during colder months, tonsil stones are the result of biofilm, and occur regardless of season.

Tonsil stones and breath

Halitosis (commonly known as bad breath) can be an extremely embarrassing experience for anybody, especially if it's someone who's always interacting with other people. Chances are that if you suffer from halitosis, people will perceive you as someone with poor oral hygiene, regardless of the actual reason behind your breath odor woes. 

As it turns out, tonsil stones can cause bad breath in the same way eating onions or garlic and having a dry mouth can (per Scripps). Tonsil Tech describes the bad breath that tonsil stones bring as a strong sulfur-like smell that can be easily mistaken for eggs that have gone bad.

However, it's worth keeping in mind that not all people who have tonsil stones will have bad breath. Some folks with tonsilloliths don't show any kind of symptoms, and it's people like these who end up having tonsil stones for a long time without realizing it (via Colgate). 

Symptoms to expect

Apart from halitosis, another common symptom of tonsil stones is pain in your ears (per the Cleveland Clinic). Since your tonsils and ears have the same nerve pathways, when you get tonsil stones, the pain may reach your ears as well (via WebMD). 

The tonsil stones can also become too big, and may end up in a position that interferes with the smooth flow of food from your mouth to your stomach, affecting your ability to swallow. Also, tonsil stones may painfully rub against your throat and have you coughing up constantly. This causes the throat to become sore after some time. And if you have tonsillitis and tonsil stones all at once, your throat may become painful as well. Moreover, when the biofilm bulks up over time, your tonsils will get infections and inflammation, which may cause swollen tonsils.

The Cleveland Clinic adds that you may also find yourself ejecting tiny stones together with your saliva. Plus, you may get infections that are antibiotic-resistant, and some white spots may appear on your tonsils. Healthdirect Australia also says that those who have tonsil stones but don't have any visible symptoms may only find out about them after x-rays or dental exams.

Tonsil stones diagnosis

It's important to get a diagnosis when you think you have tonsil stones, so that you are sure you actually have the condition. This is because there are quite a few health issues that may explain your symptoms.

Collin County Ear Nose and Throat also says that you should consider visiting your local health center to get diagnosed when you get tonsil stones that are slowly growing in size, or if they persist even after you've tried to get rid of them. When you notice that your tonsil stones are beginning to affect your normal feeding, talking, and breathing patterns, that's a hard indication you should go for diagnosis. 

According to the Cleveland Clinic, when you finally visit a health center for a check-up, your health specialist will perform a physical examination on your throat and mouth to look for evidence of tonsil stones. They may also do imaging scans on you if your tonsil stones are hard to see, or if they're situated in hard-to-reach places. The doctor may even get a dental pick and try to extract some of the stones for further scrutiny.

Receiving treatment

As far as treating tonsil stones goes, several options can work for you. This can depend on various factors, such as the severity of your case and the size and location of your tonsil stones. There are two main approaches: Home remedies and surgical operations (per Healthline). After your doctor diagnoses you, they will tell you how much the tonsil stones have affected you and the best possible treatment plans specific to your case. 

Sometimes, you may be prescribed antibiotics to treat the condition, but this approach typically doesn't work in the long term as it only addresses the symptoms without dealing with the root cause. Antibiotics can help reduce the bacteria affecting you and making your case worse by the day. According to Everyday Health, your doctor may recommend corticosteroids to reduce severe inflammation. The antibiotics may also be useful if you get bacterial infections while having tonsil stones (via the Cleveland Clinic). In some cases, however, biofilm may persist even after antibiotic treatment (via Healthline).

Surgical procedures for tonsil stones

Treating tonsil stones using surgical procedures (tonsillectomy, laser tonsil cryptolysis, or coblation cryptolysis) is only reserved for special and advanced cases, such as when the tonsil stones raise your chances of getting tonsillitis (per Everyday Health). 

Tonsillectomy involves getting rid of your tonsils entirely. Once they're removed, the biofilm in your mouth will no longer have places where it can solidify and become tonsil stones. Tonsillectomy is for people who don't want their tonsil stones to come back later in life. However, this procedure is permanent, as tonsils won't regrow after they're removed. Moreover, there's a risk of getting infections and bleeding when you get the surgery. Worse still, since tonsillectomy works with general anesthesia, you may have to live with considerable pain for a couple of weeks after the surgery. Medical News Today also warns of the danger that may occur if your body reacts severely to the anesthesia used in the procedure. 

Coblation cryptolysis appears to be the best surgical option for tonsil stones, according to a study published in the Egyptian Journal of Otolaryngology. It uses saline and radiofrequency energy to eliminate the tonsil crypts and openings that allow stones to thrive (per Everyday Health). Meanwhile, laser tonsil cryptolysis also targets tonsil crypts, but (as the name suggests) with a laser. Both procedures require local (not general) anesthetic, which means reduced pain and a shorter healing period.

Home remedies

Tonsil stones can also be dealt with at home, as Medical News Today notes.

Coughing is perhaps the simplest technique, as it produces enough force to potentially loosen tonsil stones from your tonsils, allowing you to easily expel them. You should try it before exploring other treatments. For best results, take a mouthful of salt water and gargle it for a while. From there, cough harder than you normally do. Low-pressure irrigators (e.g., water flossers) can also help with tonsil stone displacement. While flossers are good for adults, you should never use them on your kids, as they can obstruct the airways and choke them. 

Cotton swabs are also effective, though they come with negative effects (like the risk of injuries). You can make the swab slightly wet, place it behind your throat, and softly push out the stones without hurting yourself. Warming water, adding some salt to it, and then gargling the mixture not only helps with removing tonsil stones, but also soothes an itchy throat. Apple cider vinegar and alcohol-free mouthwash are possible options as well. 

Lastly, according to Healthline, consuming yogurt, onions, carrots, and apples can prevent you from developing tonsil stones, due to their bacteria-fighting abilities.


Tooth decay (dental caries) is a common complication of tonsil stones, and may be a heavier burden to carry for someone who's already dealing with swallowing difficulties, ear pain, and other symptoms. This is because it brings a host of issues along with it, including pain when you sink your teeth into any hard edibles or sweets (regardless of temperature), teeth holes, and stained teeth (via the Mayo Clinic). Tooth decay may also lead to more severe health problems like pus-filled teeth, tooth loss, and changes in the position of your other teeth after losing a tooth. It may even make you lose weight, because you'll experience eating difficulties.

Healthline says that when you get infections while having tonsil stones, you may end up needing surgery. As with most surgeries, certain complications (such as extremely low blood pressure, lung issues, rapid loss of blood, and infected wounds) may occur after the procedure (per Johns Hopkins Medicine). Also, when your tonsil stones begin affecting your tonsil tissue, you may suffer from infections, inflammation, and swelling around the throat (via Healthline).

Tonsil stones prevention

MedicineNet recommends maintaining high oral health standards by brushing your teeth and flossing them frequently. Tongue scrapers can also help deal with the bacteria on your tongue that contributes to the formation of biofilm. General Dentistry Aubrey Bauden, DDS says that you can use your toothbrush for the same purpose. 

Frequent hydration also helps wash away the bacteria in your mouth and leads to increased saliva production, reducing your risk of developing tonsil stones. Avoid smoking cigarettes or consuming any products that contain tobacco, as the tobacco increases the bacteria in your body that allows the formation of tonsil stones. Cutting back on dairy products and carbonated drinks are other reliable prevention measures (per MedicineNet). Oladoc explains that consuming dairy products, spicy foods, and egg yolks can cause mucus buildup, which accelerates tonsil stone formation. 

Per MedicineNet, if you have an allergic reaction or sinus infections, you should have them treated as soon as possible, as they can also influence tonsil stone development. Moreover, avoid alcohol, or at least limit your alcohol consumption — alcohol dries up your mouth, which makes it easy for tonsil stones to form (via Thera Breath). You're also advised to keep your nasal passages tidy and clear in order to reduce post-nasal drip (which can reach your throat and also facilitate tonsil stone formation).