Tonsilloliths

Also known as "Tonsil Stones."

We have selected the following expert medical opinion based on its clarity, reliability and accuracy. Credits: Sourced from the website Patient UK, authored by Dr Mary Harding, reviewed by Prof Cathy Jackson (see below). Please refer to your own medical practitioner for a final perspective, assessment or evaluation.

Overview

Tonsilloliths are stones which can form at the back of the throat within the tonsils. They are not serious but can cause problems with a sore throat or bad breath.

What is a tonsillolith?

Tonsilloliths, or tonsil stones, are an accumulation of debris at the back of the throat. They tend to occur in people who have large or craggy tonsils. Tonsils are the soft lumps at the back of your throat. You may be able to see them if you shine a torch in your mouth and say 'aah' to yourself in the mirror. Not everyone has tonsils - if the back of your throat looks quite flat, you are unlikely to develop tonsilloliths. If on the other hand you can see red soft lumpy areas at the back of your throat, with nooks and crannies in them, these are tonsils in which stones may form.

Tonsil stones

By Glacko2021 at English Wikipedia, via Wikimedia Commons

The stones are made up of minerals - mainly calcium salts. Debris from surrounding cells, tissues and germs (such as bacteria) gets stuck in the crevices of the tonsils and then hardens (becomes calcified). They can be hard, like tiny rocks, or quite soft. They usually look white, or a cream or yellow-ish colour. They are usually quite small, but can get bigger. They are not cancerous growths, and are not attached to the tissues around them, but instead are stuck in them.

Tonsilloliths can occur at any age but are more common in adults than in children. Some people just develop one, whereas others can have more than one at a time. In some people, even when they get rid of one, another one forms somewhere else.

Symptoms

What are the symptoms of a tonsillolith?

Often there are no symptoms at all.

Possible symptoms of tonsil stones (tonsilloliths) include:

• A feeling of something being stuck at the back of your throat, or irritating your throat.
• Bad breath (halitosis).
• A sore throat or discomfort when you swallow.
• Difficulty swallowing.
• A bad taste in your mouth.
• An irritating cough.
• Earache (sometimes a problem in the mouth can 'radiate' to the ear due to the way that the pain signal is carried along nerves).

Diagnosis

Are any tests needed?

Usually tonsil stones (tonsilloliths) can be seen at the back of the mouth and no special tests are needed. Sometimes they are seen coincidentally on X-rays or scans which have been done for other reasons.

Treatment

What is the treatment for tonsilloliths?

Treatment is not necessarily needed if there are no symptoms.

If there are symptoms, options for tonsil stone treatment include:

• Regular gargling (then spitting out) with mouthwash or a salt water solution. This may dislodge the stones.
• Gentle irrigation. This involves gently shooting water at the back of the mouth to try to dislodge stones. It is possible to buy a syringe specially for this purpose, which has a curved tip, or an irrigation kit. However, you should follow the instructions carefully, as it is possible to damage the tonsils if too much force is used. You may then have pain and bleeding if this happens.
• Surgery - tonsil stone removal. An ear, nose and throat (ENT) surgeon can remove tonsil stones which are causing problems if you are unable to dislodge them yourself. See your dentist or GP who can refer you if necessary. This is usually done by scraping out the stone, with local anaesthetic.

Prevention

How can I prevent tonsilloliths from forming?

Good dental hygiene helps to prevent tonsil stones. Brush your teeth twice a day as advised by your dentist, including the spaces in between them, to stop any debris accumulating. Consider a tongue scraper to keep your tongue clear of any gunk or germs which might contribute to a stone forming. Regular gargling with a mouthwash or salt water solution may also help. Avoid smoking and excess alcohol which can cause your mouth to be dry and may make tonsilloliths more likely to build up.

For some people, an operation to flatten the surfaces of the tonsils may help to stop persisting problems with tonsilloliths recurring. This is called cryptolysis and can be done either by laser treatment or another type of treatment called coblation. This may need a general anaesthetic or sometimes a local anaesthetic.

About the Author

Dr Mary Harding

BA, MA, MB BChir, MRCGP, DFFP

Mary qualified at Cambridge in 1989. She joined EMIS as an author in 2013. Mary is a part-time, salaried GP at The Village Surgery, Wheathampstead and previously for 12 years in Welwyn Garden City. Mary is also an appraiser and Senior Appraiser for NHS England, in the Central Midlands area team.

Prof Cathy Jackson

BSc (Hons) (Physiology), MB ChB, MRCGP, MD

Cathy qualified in 1983 and has been a member of the EMIS (patient.info) team since 2002 (the first 5 years as an author, now a peer-reviewer). Cathy is Dean of the Faculty of Clinical and Biomedical Sciences at UCLan and Head of the School of Medicine. She is a Professor of Primary Care Medicine with a research interest in asthma, COPD and inflammatory airway disease. She is passionate about providing remote and rural educational experiences for  health care students and also in ensuring CPD opportunities for graduates in the skills required to practice in these areas e.g. urgent and pre- hospital emergency care, leadership and the use of digital technology.

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