Tonsil Stones: Symptoms, Causes, and Treatment Options

Nearly 6% of adults experience tonsil stones at some point. Many people who get them don’t realize they have them. Adults who’ve had tonsillitis are more likely to experience other tonsil issues, such as tonsil stones.

Common Symptoms 

The most commonly reported symptoms of tonsil stones include:

• Visible yellow or white pebbles on one or both sides of the tonsils
• Chronic bad breath (halitosis)
• Bad taste in your mouth
• Difficulty swallowing
• Feeling like you always need to swallow
• Pain when swallowing
• Swollen tonsils
• Sore throat
• Persistent cough
• Ear pain

Untreated tonsil stones may lead to bacterial infections, including throat infections.

Causes and Risk Factors

You may have tonsil stones because of your previous cases of tonsillitis, poor dental hygiene, too much calcium, or significant hormonal changes. Dehydration and a lack of lymphatic drainage can also be root issues, and tonsilloliths are signs of stagnancy from the lymph nodes.

The potential causes of tonsil stones include:

• Chronic tonsillitis (inflammation of the tonsils)
• Poor oral hygiene
• Chronic mouth breathing (waking or sleeping)
• Food particles lodged in your tonsillar crypts
• Hormonal changes (such as during pregnancy or menopause)
• Too much calcium intake without enough vitamins K2 and D3 to transport calcium through your bloodstream to its proper location in your teeth and bones
• Imbalanced oral microbiome

Enlarged tonsils are an additional risk factor for tonsil stones, which are most common in:

• The male gender
• Anyone under the age of 40
• Those of Hispanic or Caucasian ethnicity
• Anyone who has a history of frequent tonsil infections or sinus infections

Diagnoses 

To diagnose tonsil stones, your dentist or doctor may do the following:

• Look inside your mouth and at the back of your throat to identify the stones.
• Do a CT scan, X-ray, or MRI if they can’t easily identify the stones with just their eyesight.

Your provider may refer you to a doctor of otolaryngology (ear, nose, and throat doctor) for treatment or to confirm the diagnosis.

Your dentist may notice the stones during your twice-yearly checkup. This is just one of many reasons to see your dentist at least once, preferably twice, a year.

At-Home Remedies 

Promoting a healthier oral environment and balancing the microbiome is also important. Proper hydration, partnered with good oral hygiene, is a key way to achieve this homeostasis.

Treatments for tonsil stones include saltwater gargles and antibiotics. In severe cases, where at-home remedies are not working, it is suggested that you see your oral health specialist and see if they suggest a tonsil stone removal surgery.

To safely get rid of tonsil stones at home, try these home remedies:

• Gargle warm saltwater; saltwater is the most reliable home remedy.
• Gargle diluted apple cider vinegar; the acidic vinegar should break down the tonsil stones.
• Use a water flosser to dislodge the calcified stone. Spray water carefully at your tonsils for tonsil stone removal. Without proper caution, you may risk damaging your tonsils or causing an infection.
• Gently dislodge tonsil stones with a cotton swab. You have to be very careful that you don’t gag yourself or scratch your delicate tonsils. However, this can also run the risk of causing damage to your tonsils.
• Making yourself cough can dislodge tonsil stones. You may have to cough hard, so have some warm tea on standby to loosen up.

When to See a Healthcare Professional 

You should see a healthcare provider to diagnose persistent tonsil stones or in case of an emergency.

Seek medical advice immediately if you experience any of the following emergency symptoms:

• Blood in your saliva
• Serious problems swallowing, speaking, or breathing
• Pain, swelling, or lumps in your mouth or neck, especially if it’s persistent
• Pus discharge or bleeding from your tonsils
• Inability to tolerate eating or drinking foods that contain citric acid (lemons, oranges, grapefruit, etc.)

In non-emergencies, your healthcare provider can diagnose tonsil stones, too. While many cases of tonsil stones will clear up on their own, seek medical care if your symptoms persist for longer than 3 weeks.

Medical and Dental Treatments 

If your tonsil stones don’t resolve within 1-3 weeks, it’s time to seek treatment from your ENT, dentist, or healthcare provider. Here are the most common treatments of tonsil stones after home remedies don’t work:

• Antibiotic drugs: Antibiotics can reduce the symptoms of tonsil stones caused by bacterial buildup. However, they should not be overused to avoid antibiotic resistance or disrupting your oral and gut microbiomes.
• Anti-inflammatory drugs: Over-the-counter and prescription anti-inflammatories (ibuprofen) may reduce swelling of the tonsils. This treatment reduces discomfort and makes tonsil stones easier to dislodge.
• Laser tonsil cryptolysis: This outpatient procedure uses a laser to eliminate deep tonsil crypts that contribute to tonsil stone formation. Expect to miss 1-2 days of work during recovery from laser tonsil cryptolysis.
• Coblation cryptolysis: Coblation uses radio waves to destroy tonsil crevices without heat. Only introduced in 2012, coblation cryptolysis’s main benefit is the lack of a “burning sensation” on the mouth, face, or eyes.
• Tonsillotomy: This tonsil surgery removes the palatine tonsils, where tonsil stones occur. Also known as a partial tonsillectomy, this surgery requires general anesthesia. However, a tonsillotomy is less invasive and easier to recover from than a complete tonsillectomy.
• Tonsillectomy: A full tonsillectomy is the most drastic surgical option for tonsil stones. This tonsil surgery removes all three types of tonsils (palatine, pharyngeal, and lingual). Recovery time may be 10-14 days.

Surgery for tonsil stones should be performed only as a last resort after other options have been exhausted. Surgery is invasive and comes with unavoidable risks and side effects.

Tips to Prevent Tonsil Stones

Several strategies can contribute to the prevention of tonsil stones and promote better oral microbiome health. To prevent tonsil stones, you should: 

• Brush your teeth twice a day with a soft-bristled toothbrush to eliminate bacteria that may contribute to tonsil stones. You should also make sure to floss in between your teeth every day.
• Rinse your mouth after eating sugary, acidic, or processed food and drink. Food particles can get lodged in your tonsil crevices, but food particles stuck in your teeth can also promote bacterial proliferation.
• Avoid alcohol-based or antibacterial mouthwash, which disrupts the oral microbiome and dries out your mouth. Paradoxically, alcohol-based mouthwashes can lead to more bacterial growth in your oral cavity and tonsils.
• Use natural toothpaste that supports the microbiome, like Revitin.

• Use dental probiotics. These probiotics consist of beneficial bacteria that balance your oral microbiome and contribute to good oral hygiene.
• Scrape your tongue every day to remove excess bacteria. Just be sure not to harm your tongue by scraping too hard.
• Eat a healthy diet rich in nutrient-dense foods and low in processed foods. Sugary foods contribute to bacterial proliferation in your oral microbiome. Make sure you’re drinking plenty of water throughout the day, too.
• Use mouth tape when you go to bed, especially if you’re experiencing sleep apnea, chronic snoring, or even teeth grinding, which may be associated with mouth breathing at night. Mouth tape promotes nasal breathing, which is good for both your cardiovascular and tonsil health.
• Talk to your dentist about the DNA appliance, particularly if you have sleep apnea.
• Don’t overuse alcohol; it can dry out your mouth and mess with your oral microbiome, promoting the growth of harmful bacteria.
• Visit your dentist twice a year. Your dentist can identify early signs of tonsil stones and other oral conditions.

FAQs

Getting to the Root of Your Dental Health Issues

If you’re experiencing recurrent oral wellness issues like tonsil stones, chronic halitosis, and bacterial mouth or throat infections, you need to get to the root cause. Rejuvenation Dentistry is a biological dentistry clinic that identifies the underlying causes of oral health problems. That way, we can treat the root cause of your condition, not just the symptoms. Schedule an appointment with us today! Virtual consultations are also available for expert advice around personalized, wellness-focused treatments.