Tonsil Stones: Symptoms, Causes, Prevention & Removal

Tonsil stones: Causes, symptoms, and treatment

Tonsil Stones: Symptoms, Causes, Prevention & Removal
Written by Zawn Villines on July 17, 2018

  • Causes
  • Symptoms
  • Complications
  • Treatment
  • Removal
  • Prevention

If you buy something through a link on this page, we may earn a small commission. How this works.

Tonsil stones are formed when debris, such as food, dead cells, and other substances, become trapped on the tonsils.

The debris turns hard, forming tonsil stones. Sometimes called tonsil calculi or tonsilloliths, tonsil stones can sometimes irritate the tonsils and the throat.

They appear as a white or yellowish hard mass, ranging in size from very small to very large. The largest recorded tonsillolith, at 14.5 centimeters (cm) was recorded in 1936.

People with tonsil stones may not know what they are. Tonsil stones can become a home for bacteria and may have an unpleasant smell.

The tonsils are two small mounds of tissue that lie at the back of the throat, one on either side.

They help fight infections that enter through the mouth. They trap bacteria, viruses, and other foreign invaders and then “teach” the immune system how to fight these germs.

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

Because tonsillectomies are less common now than they once were, more people have tonsils and therefore more people are vulnerable to tonsil stones.

Removing tonsils to prevent tonsillitis used to be a very common procedure.

Now tonsillectomies are considered a treatment of last resort.

Many people with tonsil stones have no symptoms.

If symptoms occur, they include:

  • a very bad smell when the stones appear, because tonsil stones provide a home for anaerobic bacteria, which produce foul-smelling sulfides
  • a sense that something is stuck in your mouth or in the back of your throat
  • pressure or pain in your ears

Tonsil stones can look small white or yellow flecks at the back of the throat. A large stone may be visible. Some are large enough that they jut the tonsils, resembling tiny rocks trapped in the mouth.

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

They may, however, signal problems with oral hygiene. People who do not brush their teeth or floss regularly are more vulnerable to tonsil stones. The bacteria that cause tonsil stones can also cause tooth decay, gum disease, and oral infections.

Occasionally, tonsil stones can become a breeding ground for bacteria. One study has found that tonsil stones are similar to the dental plaque that causes cavities and gum disease.

Tonsil stones can usually be treated at home. They often detach during vigorous gargling.

However, if you see tonsil stones in the back of your throat but do not have any symptoms, you do not have to try to remove them.

People can use a cotton swab to loosen the stone and gently press on the tissue immediately surrounding it. They should position the swab behind the stone and push forward, pushing the tonsil stone toward the front of the mouth instead of into the throat.

Be careful not to push too hard, as you risk injuring the back of your throat. Do not use your finger or anything pointed or sharp to try to remove a tonsil stone.

A range of cotton swabs are available for purchase online.

If tonsil stones hurt or make it difficult to swallow, people can try gargling with warm salt water.

Share on PinterestA doctor may recommend treatment to remove tonsil stones.

A doctor should be consulted if:

  • a person has symptoms of tonsil stones, but no stones are visible
  • removing the tonsil stones at home is not possible, or only a portion of the stone can be removed
  • the tonsils are red, swollen, or painful
  • pain is felt after removing a tonsil stone at home

The doctor may treat tonsil stones with laser resurfacing.

A process called coblation tonsil cryptolysis involves reshaping the tonsils and reducing the number of crevices in which tonsil stones can grow.

The procedure can be completed using a local anesthetic, and patients can resume a normal diet and activity after one week.

However, tonsil stones may grow back again.

The only way to permanently prevent tonsil stones is to have the tonsils removed via tonsillectomy. It is possible, although very rare, that the tonsils will grow back.

A tonsillectomy is safe, but it can cause throat pain for several days after surgery. 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 and stress of surgery might outweigh the benefits.

Share on PinterestGood oral hygiene may help to prevent tonsil stones.

Preventing the growth of tonsil stones completely is almost impossible. For people who have chronic tonsillitis, a tonsillectomy may be the only way to prevent tonsil stones.

However, good oral hygiene, including frequent brushing and flossing, can help. Irrigating the tonsils and mouth with a water sprayer can remove debris and bacteria, reducing the risk of tonsil stones.

Other conditions affecting the tonsils

A number of other conditions can cause pain in or near the tonsils. A doctor can help determine what causes tonsil stones.

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 in the tonsils. Tonsillitis is often accompanied by a fever.
  • Strep throat: This is one type of tonsillitis that can cause intense pain in the throat or at the back of the mouth. 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 even the throat. Untreated infections in the teeth and gums can spread throughout the mouth, and even to other areas of the body.
  • Tonsil cancer: Tonsil cancer, also known as tonsil lymphoma, can 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.

An otolaryngologist, commonly known as an ear, nose, and throat doctor, can treat most tonsil and throat conditions.


Tonsil Stones (Tonsilloliths)

Tonsil Stones: Symptoms, Causes, Prevention & Removal

Tonsil stones, or tonsilloliths, are hard, sometimes painful bits of bacteria and debris that get stuck in nooks on your tonsils.

Your tonsils are gland- structures in the back of your throat. You have one on each side. Tonsils are made of tissue with lymphocytes, cells that prevent and fight infections. Many experts think your tonsils play a role in your immune system and are meant to work nets, trapping bacteria and viruses that come in through your throat.

But your tonsils don’t always do their job well. For some people, they’re more trouble than help. Research suggests that people who have their tonsils removed are no more ly to get bacterial or viral infections than people with who keep their tonsils.

Your tonsils are filled with nooks and crannies where bacteria and other things, including dead cells and mucus, can get trapped. When this happens, the debris can bond together.

Tonsil stones form when this debris hardens, or calcifies. This tends to happen most often in people who have long-term inflammation in their tonsils or repeated cases of tonsillitis.

Many people have small tonsilloliths, but it’s rare to have a large tonsil stone.

Small tonsil stones may not cause any symptoms that you’d notice. Even when they’re large, some tonsil stones are found only after X-rays or CT scans. Symptoms include:

  • Bad breath . A main sign of a tonsil stone is severely bad breath, or halitosis, that comes along with a tonsil infection. One study of patients with a form of long-term tonsillitis checked their breath for things called volatile sulfur compounds, which can mean bad breath. The researchers found that 75% of the people who had unusually high amounts of these compounds also had tonsil stones.
  • Sore throat. When you get a tonsil stone and tonsillitis together, it can be hard to figure out which is causing pain in your throat. The tonsil stone itself might give you pain or discomfort.
  • Cough. A stone might irritate your throat and make you cough.
  • White debris. You might be able to see a tonsil stone in the back of your throat as a lump of solid white material.
  • Trouble swallowing. Depending on the location or size of the tonsil stone, it may be hard or painful to swallow food or liquids.
  • Ear painTonsil stones can develop anywhere in your tonsil. Because of shared nerve pathways, you might feel pain in your ear, even though the stone itself isn’t touching your ear.
  • Tonsil swelling. When debris hardens and a tonsil stone forms, inflammation, infection, and the tonsil stone itself may make your tonsil swell.

Your doctor can usually diagnose tonsil stones with a physical exam. If they’re hidden in the folds of your tonsils, you might need imaging tests, such as CT or MRI scans, to spot them.

Many tonsil stones, especially those that don’t have symptoms, don’t need special treatment. It depends on their size and whether they might cause you trouble.

Treatments include:

  • AntibioticsMedications may help, but they have side effects and can’t fix what’s causing your tonsil stones.
  • Surgical removal. If your tonsil stones are unusually large or causing problems, your doctor might remove them.
  • Tonsillectomy. If tonsil stones are a long-term problem, you might need to have your tonsils taken out.
  • Cryptolysis. This uses a laser or a radiofrequency wand to scar your tonsils, making tonsil stones less ly.

For smaller stones, you can try:

  • At-home removal. You might be able to remove tonsil stones by scraping gently with water picks or swabs.
  • Saltwater gargles. Gargling with warm, salty water may help ease the pain of tonsillitis and help remove stones.

Large tonsil stones can cause swollen tonsils and give you trouble swallowing. Tonsil stones can also sometimes trigger infections.

People who have long-term tonsillitis are more ly to get tonsil stones. The only way to prevent them is to remove your tonsils.

Good dental habits can help prevent tonsil stones. Brush and floss your teeth regularly to remove bacteria and keep things from getting stuck in your tonsils. Gargling after eating can also prevent food buildup.


American Academy of Otolaryngology: “Tonsils and Adenoids.”

Ansai, T and Takehara, T. British Dental Journal, Mar 2005; vol 198: pp 263-264.

Australian Department of Health: “Tonsil stones.”

UPMC: “What Are Tonsil Stones (Tonsilloliths)? Tonsil Stone Symptoms and Treatment.”

Ear, Nose and Throat Journal: “Coblation Cryptolysis to Treat Tonsil Stones: A Retrospective Case Series.”

Journal of Surgical Case Reports: “Giant tonsillolith – a rare cause of dysphagia.”

Cleveland Clinic: “Are Troublesome Tonsil Stones Causing Your Bad Breath?”

Texas Pediatric Surgical Associates: “Tonsils and Tonsillectomy.”

© 2019 WebMD, LLC. All rights reserved. Tonsillitis: Symptoms, Causes, and Treatments


Tonsil stones: causes, signs, removal – iMS

Tonsil Stones: Symptoms, Causes, Prevention & Removal

Tonsil stones are called this way because they are formed in the furrows of the palatine tonsils and look small white-yellow stones. They can vary in size, but their diameter is usually no more than five to six millimetres. Their consistency varies from rather soft and crumbly to hard as stone.

How are tonsil stones made?

This refers to the palatine tonsils (Tonsilla palatina). These are located on both sides of the posterior (soft) palate behind the palatal arch. They belong to the immune system and have the task of adapting the body’s defences to pathogens that enter the body with food.

The surface of the palatine tonsils has innumerable small depressions (crypts) that extend deep into the interior of the tonsil. In these crypts a mixture of food pulp, mucous membrane cells, white blood cells and bacteria collects, which is completely normal. When chewing, the palate muscles tense up, causing the crypts to regularly empty and refill.

However, certain lime salts are also found in food and saliva, which can be deposited in the pulp mixture of the crypts. When this happens, it hardens and the consistency appears stone-. The tonsil stones are often located deep in the crypts, but can also reach the surface.

In most cases, tonsil stones do not cause any complaints. They are often only very small and – if they reach the surface of the almonds – are swallowed, coughed up or sneezed out unnoticed.

However, the components of a tonsil stone have an unpleasant smell that reminds one of rotten eggs. Therefore, especially larger tonsil stones can cause bad breath.

In rare cases, large tonsil stone can also cause a foreign body sensation on the posterior palate, which is particularly noticeable when swallowed. Swelling and pain in the affected tonsils are also possible.

Tonsil stones are found in all people, but they are usually so small that they are not noticeable. Why they occur more frequently or even become larger is not known exactly.

However, doctors suspect that the size of the tonsils themselves plays a role. In people who basically have large tonsils, the crypts are also deeper. This makes tonsil stones lighter. The cause can also be a disturbed emptying of the crypts.

They are often observed as a result of recurrent inflammation with scarring of the tonsils. This is why tonsil stones are particularly common in young adults who suffer from tonsillitis several times a year.

However, this does not mean that people with tonsil stones automatically have more frequent tonsillitis.

An tonsil stone is often a coincidental finding during a visit to the dentist or ENT doctor. Sometimes, however, a doctor will explicitly look for it, for example in the case of unexplained bad breath.

Depending on its size and distance from the surface, an tonsil stone may shimmer whitish through the mucous membrane or appear as a white deposit on the tonsils.

If it is deeper, it is normally not visible to the naked eye.

Ultimately, tonsil stones can be detected on X-rays and even better with computer tomography. Due to the costs and radiation exposure of these examinations, however, they are generally not used to detect tonsil stones. Only larger stones on the surface usually cause complaints.

Sometimes tonsil stones are confused with pus, which occurs with tonsillitis. In the case of an inflammation, however, the tonsils would also be severely reddened and swollen and the infection would usually be accompanied by fever.

If you want to remove tonsil stones, there are several possibilities. Often no doctor is needed for this. Helpful methods to remove tonsil stones yourself are:

  • With the head stretched backwards, open the mouth wide several times and close it again. This creates a tension in the palate muscles, which may massage out the tonsil stone.
  • Press upwards against the underside of the tonsil, for example with a cotton swab or the back of the toothbrush. Some patients can also press tonsil stones with their tongue, which causes less gagging.
  • Clean the tonsil with a mouth shower under low pressure. This often solves the tonsil stones.
  • Household remedies such as mouthwashes sage or chamomile can also be helpful.

Anyone who wants to remove tonsil stones from themselves should never use pointed or sharp-edged objects for this purpose, as this could cause injuries.

If the attempt to remove the tonsil stones by yourself is unsuccessful, the ENT physician can usually help. He has special tools such as cuvettes or pipettes with which he can squeeze or aspirate the tonsil stones. The so-called roeder treatment is also a helpful method. The doctor places cupping glasses on the tonsils and sucks the stones out with the help of the vacuum.

Tonsil stones: Preventing

To prevent almond stones from forming in the first place, it can help to clean the tonsil regularly with a mouth shower. Even if you brush them gently when brushing your teeth, this cleans the crypts and thus makes the formation of tonsil stones more difficult.

Tonsil stones are usually harmless and are not even noticed by those affected. Larger stones can cause discomfort, but are usually easy to remove. However, tonsil stones often reappear after they have been removed


Tonsil Stones: Symptoms, Causes, Prevention & Removal

Tonsil Stones: Symptoms, Causes, Prevention & Removal

Say ahhh for the doctor! They are checking out your tonsils, an organ that is vital for your systemic immunity. Chronic inflammation of the tonsils can cause the development of tonsil stones, and large tonsil stones can lead to a variety of troublesome symptoms. People with particularly severe symptoms may even have to have their tonsils surgically removed.

Read on to learn more about what the tonsils do, why tonsil stones develop, and how you can prevent and treat them.

What are Tonsils?

The tonsils are an important organ in the immune system.

They are located towards the back of the throat and are made up of connective tissue, lymphoid tissues, and blood vessels covered by epithelial cells.

Running throughout the tonsils are deep, branched pockets and folds called “crypts.” If inhaled or ingested foreign substances become trapped in these pockets, they can cause an immune response [1].

Because of its role in the immune system, the tonsils tend to become inflamed when the immune system is activated by an infection. For this reason, the level of inflammation in the tonsils can be used as an indicator of the status of the immune system.

The tonsils can also become inflamed due to the activity of foreign bacteria.

This becomes especially ly when the folds and pockets of the tonsils get filled up by bits of cellular “junk” from dead or dying cells.

These dead remains of cells create an ideal environment for the growth of various bacteria (especially anaerobic bacteria), which can lead to further inflammation or even full-blown infection [2].

What are Tonsil Stones?

Tonsil stones (also called tonsilloliths) are calcified structures that form on the cellular debris and bacteria present in enlarged tubular glands of the tonsils. The bacteria on the surface of the tonsils can start to form biofilm. Tonsil stones progress from a gel- structure to a hard mineral structure made up of calcium [3, 4, 5].

Small tonsil stones are common in adults, while it is rare for adults to develop large tonsil stones. People with small tonsil stones don’t usually experience symptoms. However, people with large tonsil stones often experience painful symptoms [6].


Tonsil stones can cause a variety of symptoms, ranging in severity from bad breath to chronic pain, and can even result in severe infections.

While the symptoms discussed here are associated with tonsil stones, they may also indicate another underlying cause. Do not attempt to self-diagnose; your doctor is best equipped to evaluate your symptoms and make an accurate diagnosis.

Some species of bacteria that can collect in and around the folds and pockets of the tonsils produce large amounts of compounds such as volatile sulfur, which can cause chronic bad breath (halitosis) [5, 7].

The build-up of bacteria that causes bad breath can sometimes also result in a lingering sensation of foul taste. This affects about 3% of tonsil stone sufferers and usually occurs alongside bad breath [3, 8].

As they grow in size, tonsil stones can also begin to cause pain throughout the mouth, jaw, and face. This can result in attacks of pain that last anywhere from a few seconds to several minutes, and which can be triggered by specific activities such as talking, coughing, or swallowing [9].

Pain can be triggered by many activities including talking, coughing and swallowing [9].

If they’re large enough, tonsil stones can also block up the throat, causing difficulties with swallowing [10, 11].

The painful symptoms of tonsil stones can also spread beyond the throat and mouth. The tonsils are connected to the ears by the glossopharyngeal nerve (also known as Jacobsen’s nerve). This connection may cause the pain from tonsil stones to spread to the ear, resulting in a chronic earache [6, 12].

Sleep-disordered breathing (dyspnea) is a very rare symptom associated with large tonsil stones and infection [13, 10].

Tonsil stone symptoms may also include:

  • Sore throat [3]
  • Cough [3]
  • Abscesses [14]

Chronic Tonsillitis

Chronic inflammation of the tonsils can lead to the thickening and scarring of the connective tissue within the tonsils.

This scarring leads to stiff tissues where cellular debris and bacteria become trapped in the folds and pockets of the tonsils. Calcification of the trapped material forms tonsil stones.

Chronic inflammation is enough to promote the formation of tonsil stones [9, 15].

Chronic inflammation of the tonsils results in rare calcium salt deposits in the soft tissue of the tonsil. This deposition occurs despite normal blood levels of calcium and phosphatase and results in the development of tonsil stones [16].

Chronic Saliva Stasis

The “chronic saliva stasis hypothesis” was first presented in 1965 when analysis of the tissue next to a tonsil stone revealed a small salivary gland surrounded by lymphoid tissue.

From this observation, they concluded that scarring of the tonsils could block the salivary gland flow resulting in a build-up of saliva.

Saliva stasis can give rise to the formation of tonsil stones [15].

In support of this, a recent case report of a 32 year-old-man with a large tonsil stone reported finding blocked saliva and a local accessory salivary duct during the tonsillectomy surgery.

Despite the lack of tonsil inflammation, these doctors attributed the formation of the tonsil stone to saliva build-up.

This accumulation of deposits from the saliva resulted in tonsil stones [15].

Other Risk Factors

Risk factors for chronic tonsillitis include:

  • Bacterial infections [17]
  • Smoke exposure (cigarettes) [18, 19]


Good oral hygiene habits ( gargling with salt water) are important to wash out the tonsil folds and pockets [20].

Removal of the tonsils is the only known complete cure for tonsil stones [21].


The majority of people with tonsil stones don’t have symptoms and may not know they have tonsil stones [22].

Doctors typically monitor patients with asymptomatic tonsil stones. If you are one such patient, stay in contact with your doctor and make sure to let them know about any new symptoms or developments [23].

Natural Prevention & Removal

Saltwater gargling may flush out the tonsil folds and pockets [20, 3].

In some cases, applying pressure to tonsils using a sterilized swab can release a tonsil stone. [20, 24].

Talk to your doctor about these and other options for preventing and removing tonsil stones.

Invasive Treatment

Tonsillectomy, or removal of the tonsils, is only recommended for patients who have recurrent tonsil stones. It is associated with a significant risk of illness that can last for weeks after the procedure, but it also may provide immediate relief from the pain associated with tonsil stones [21, 10, 24].

In some cases, a tonsil incision can enable the release of the tonsil stone [23].

There are some types of laser surgery for tonsil stones. It requires that the patient has small tonsils and a controllable gag reflex. Some disadvantages of this procedure include high costs, the potential of burns, and the possibility of retinal damage [25, 21].

Radio frequencies (coblation cryptolysis) may also be used to remove the tonsil stones. Pain lasts for only a few days following the procedure, and patients can return to their normal routine in one week. A single coblation cryptolysis procedure can entirely remove tonsil stones in some cases [21, 26].

As always, your doctor is best equipped to determine the best course of action in your case.


Tonsil Stones: Causes, Removal & Prevention

Tonsil Stones: Symptoms, Causes, Prevention & Removal

While tonsil stones may seem a bad medical hoax, they can be a real problem. Tonsil stones, also known as tonsilloliths or tonsilliths, are benign accumulations of bacteria and debris in the crypts of some people's tonsils. Though this problem may cause discomfort, it is not dangerous and is usually easily treatable. 


The tonsils are part of a protection system that keeps foreign objects from slipping into the lungs.

They are also lymph nodes that filter for bacteria and viruses while producing white blood cells and antibodies, according to the Mayo Clinic.

Objects such as food, dirt and other particles can get stuck in the groves on the surface of the tonsils. The grooves, called crypts, also collect old cells and bacteria. 

The body's white blood cells proceed to attack the foreign objects stuck in the tonsils. When the white blood cells are finished, hard particles remain on the tonsils.

Most people simply swallow what is left behind and never know that it was there in the first place. If the particles are lodged into the crypts, though, the particles will continue to grow.

These growing objects are tonsil stones, which are also called tonsil calculi.

According to a study in 2009 by the Center for Genomic Science at the Allegheny-Singer Research Institute in the Otolaryngology journal, tonsil stones are more alive than actual stones. They are actually a living biofilm that breathes oxygen. 

According to Dr. Alan Greene, a pediatrician and author, tonsil stones are most common in teens and those with large tonsils. Those with poor dental hygiene may also experience tonsil stones.


Some people have no symptoms when afflicted with tonsil stones. Those who do have symptoms often report redness or irritation of the tonsils. There are several other symptoms that can be related to tonsil stones, with bad breath being one of the most obvious. According to the Mayo Clinic, bacteria grow on the stones, which produces a foul odor. 

People with throat stones can also feel they have something stuck in their throats, according to Dr. Erich P. Voigt, an associate professor of otolaryngology at NYU-Langone Medical Center. Other symptoms can include chronic, mild sore throat and reoccurring tonsillitis.

Tonsil stones can often be seen in the mirror. The tonsils won't seem smooth. “Instead, they look prunes, with crevices where bacteria can accumulate,” said Chetan Kaher, a dentist in London.

Typically, tonsil stones can be seen as white, yellow or grey nodes on the tonsils. This isn't always the case, though. Many tonsil stones aren't visible because they are burrowed down inside of the tonsil, said Dr. Ileana Showalter, an otolaryngologist at Mercy Medical Center in Baltimore, Maryland. 

Tonsil stones can grow to 1 to 2 millimeters across. But they can be up to 1 centimeters across, according to the Australian Government Department of Health.


One of most common treatments to cure tonsil stones is simply scraping them off with a toothbrush. If that doesn't work, there are several other at-home options. “Gargling with salt water can help dislodge them.

Using a cotton swab to express them from the little small cavities that are visible is another option,” said Showalter. A water flossing device such as a Waterpik can also be used to power wash the debris the tonsils.


Sometimes the tonsil stones are so deeply embedded that they cannot be removed at home. In this case, an ear, nose and throat specialist can often remove the stones. If a person gets tonsil stones often, then the patient and doctor may discuss removing the tonsils.

“A last resort cure of this problem is tonsillectomy. However, this surgery carries risks of anesthesia, pain and bleeding, as well as other risks, thus a decision of this type must be balanced by a risk/benefit discussion,” said Voigt. 


Preventing the formation of tonsil stones is as simple as good dental hygiene. The Mayo Clinic suggests brushing teeth and tongue after meals, at bedtime and first thing in the morning.

Flossing teeth daily can also help by cleaning out bacteria. Voigt also suggested gargling daily suing commercial gargles, or a homemade solution of hydrogen peroxide and water.

The Mayo Clinic advises against using a mouthwash that contains alcohol.

Additional resources


Tonsil stones: Symptoms, prevention, and treatment in the dental setting

Tonsil Stones: Symptoms, Causes, Prevention & Removal

The tonsils offer many nooks and crannies that bacteria can use to thrive. The multiplying bacteria can become trapped, allowing mucous and dead cells to linger and form tonsil stones in the pockets of the tonsils. (1) Tonsil stones, also known as tonsilloliths, are formed when the trapped debris calcifies. The stones can lead to chronic inflammation and discomfort.

The most common symptom (and often the only symptom patients experience) is halitosis. If the tonsil stones are left untreated, bacteria continue to multiply and increase the inflammation of the tonsillar tissue.

Symptoms of a severe throat and discomfort when swallowing are frequently experienced with tonsil stones that have gone undiagnosed and untreated.

Additionally, patients can experience ear pain due to the swelling of the tonsils. (1)

When studying the bacteria causing inflammation of the tonsils, researchers have found both aerobic and anaerobic bacteria.

One study reported that “[s]ome of the anaerobic bacteria produce volatile sulfur compounds such as hydrogen sulfide and methyl mercaptan. The volatile sulfur has been implicated in halitosis.

” (2)Therefore, patients who are prone to tonsil stones should avoid pastes, rinses, and drinks, such as wines, that contain sulfur.

Patients that have postnasal drip, allergies, or colds are more prone to the formation of tonsil stones due to the mucus in the back of the throat. Implementing a natural xylitol-containing nasal spray, such as Xlear, two to three times daily can help eliminate the mucus and prevent the progression and formation of tonsil stones.

The active ingredient of xylitol works to reduce the amount of bacteria by increasing the salivary flow to create a moist environment that is oxygen-rich. (3) The oxygen-rich environment inhibits the bacteria. This can lead to prevention and eliminate the progression of tonsil stones. (3)

Reducing the amount of bacteria in the oral cavity will help prevent tonsil stones. Dental hygienists can advise patients to have meticulous home care with electric toothbrushes, flossing, and rinsing with sulfate-free products. Avoiding consuming beverages with carbonatation, sulfur, or dairy products will reduce the risk and growth of tonsil stones. (4)

Removing tonsil stones chairside can be completed with an air/water syringe or a tongue depressor. Gently use the air/water syringe to spray the stones the tonsillar folds while using the suction to remove debris. The back of a tongue depressor can also be used to gently push the tissue down around the stone to then elevate the stone up and out.

Properly screening the patient for abnormalities through a head and neck exam will allow the clinician to identify the presence of tonsillar inflammation and stones. If left untreated, tonsil stones can lead to severe throat and ear pain. Chronic tonsil stones can lead to the removal of the tonsils, which are a vital part of the immune system.

Editor's note: Article originally published April 17, 2017; updated February 19, 2019.


1. WebMD. Tonsil Stones. Available at: Accessed March 2, 2017.

2. Ansai T, Takehara T. “Tonsillolith as a halitosis-inducing factor,” British Dental Journal, vol. 198, no. 5, pp. 263–264, 2005. Accessed March 2, 2017.

3. Xlear. Xlear Sinus Care. Available at: Accessed March 2, 2017.

4. Kim C. How to Prevent Tonsil Stones.Tonsil Stone Advisor. Available at: Accessed March 2, 2017.

Amber Auger, MPH, RDH, is a hygienist with experience in multiple clinical settings, including facilities abroad.

Amber obtained a master's degree in public health from the University of New England and a bachelor's in dental hygiene from the University of New Haven.

Auger is a key opinion leader for several dental companies, speaker and published author, and can be contacted through her website at

For the most current dental headlines, click visit the DentistryIQ homepage.


Tonsil Stones: Causes, Symptoms, Treatments, and How to Prevent Them

Tonsil Stones: Symptoms, Causes, Prevention & Removal

Tonsil stones are growths that can form, harden, and grow on and inside the tonsils, which are the oval-shaped pads of tissue that sit on either side of the back of the mouth. These stones are not a sign of illness or disease and they do not cause other negative outcomes for your health.

But they can cause symptoms such as bad breath and discomfort in the back of the throat. They can also be a nuisance, because they may repeatedly grow back after they’re removed. (1,2)

How and Why Tonsil Stones Form

In some people, the surface of the tonsils is more irregular than smooth, with crevices and pockets that are deep enough to trap food particles, bacteria, saliva, and other debris.

“Food, plaque, cellular debris such as skin cells and the lining of the mouth all collect in the pits and crevices,” says Jennifer Setlur, MD, an otolaryngologist at Massachusetts Eye and Ear, in Boston.

Over time, these materials become impacted, and eventually they develop into stones. (1,2)

Tonsil stones are usually about gravel-size, but they can also be quite small — sometimes even too tiny to be seen with the naked eye. They can also potentially grow to be even as large as a golf ball or bigger, especially if they go unchecked.

They’re usually soft but they can harden, and they are light yellowish or white in color. Unfortunately, they often smell extremely unpleasant because of the bacteria that is a component of tonsil stones.

(One of the most commonly noticed symptoms of tonsil stones is bad breath.) (1,2)

RELATED: Drinking Alcohol Increases Mouth Bacteria

Your Tonsils’ Structure Determines Your Risk of Developing Tonsil Stones

There’s a common misconception that having tonsil stones means you have poor oral hygiene. But the fact is that people who brush and are vigilant about oral hygiene can also be prone to developing tonsil stones.

What does determine who is and is not prone to developing these growths is usually the presence of crypts on the surface of the tonsils. “It has to do with the structure of tonsils,” says Aaron Thatcher, MD, an assistant professor with the University of Michigan's Department of Otolaryngology–Head and Neck Surgery in Ann Arbor.

The crypts in the tonsils allow material food and debris to build up and eventually turn into tonsil stones. (1,2)

It should be noted, though, that poor oral hygiene can indeed contribute to the development of tonsil stones, and brushing, flossing, and gargling water in the back of your throat regularly are important ways to help prevent the problem. (1)

An individual’s propensity to develop tonsil stones may change over time, meaning that someone who once regularly got tonsilliths may get them less frequently, or vice versa. That’s because tonsils can develop more crypts as we reach adolescence and into young adulthood, and then become smaller and less prone to tonsil stones as we age, Dr. Setlur explains. (1,2)

Learn More About What Tonsil Stones Are and What Causes Them


How to Get Rid of Tonsil Stones: Removal, Causes, Symptoms, How to Prevent

Tonsil Stones: Symptoms, Causes, Prevention & Removal

Tonsil stones can form when food, mucus, and bacteria get stuck in craters of the tonsils.

The tonsils are lymph nodes located at the back of the throat. Tonsil stones (also called tonsilloliths or tonsil calculi) are small clusters of calcifications or stones that form in the craters (crypts) of the tonsils. Tonsil stones are hard, and appear as white or yellowish formations on the tonsils. They usually smell bad (and make your breath smell bad) due to bacteria.

What causes tonsil stones?

Several factors can cause or contribute to the formation of tonsil stones.

  • Substances such as food, dead cells, mucus, and bacteria may get stuck in the nooks and crannies of the tonsils.
  • The body’s immune system, which sees these as foreign invaders, sends white blood cells to the area to fight infection. When the white blood cells are done, they leave small calcifications behind.
  • Usually, these small stones are swallowed but sometimes they get stuck in the tonsillar crypts and continue to grow into tonsil stones. Small stones are common; large stones are rare.

Risk factors for developing tonsil stones include people with:

  • Chronic or recurring tonsillitis (inflammation of the tonsils)
  • Large tonsils
  • Chronic sinus problems
  • Poor dental hygiene
  • Certain medications that make your mouth dry

Tonsillitis, or inflammation of the tonsils, typically occurs due to infection caused by viruses or bacteria. Tonsillitis is often accompanied by these symptoms:

  • Sore throat
  • Cough
  • Sneezing
  • Enlarged lymph nodes
  • Fever
  • Chills
  • Hoarseness
  • Headache
  • Muscle aches
  • Fatigue

Learn more about the symptoms of tonsillitis »

What specialists treat tonsil stones?

If symptoms of tonsil stones are severe, you may see an ear, nose, and throat (ENT) specialist, also called an otolaryngologist.

How are tonsil stones diagnosed?

Tonsil stones can frequently be seen in the back of the throat. They typically appear as white or yellowish spots on or around the tonsils that may range in size from a grain of rice to a pea.

For stones that cannot be visualized, an MRI or CT scan can help make a definitive diagnosis.

What are the treatments for tonsil stones?

Tonsil stones treatment is not always needed. Stones frequently either dissolve on their own or are coughed up.

For stones that do not go away on their own, there are several types of treatments:

  • Medications:
  • Laser treatment (laser tonsil cryptolysis): a noninvasive treatment that helps minimize or remove the tonsil pockets (crypts) where the tonsil stones are lodged
  • Coblation cryptolysis: radio waves used to change a salt solution into charged ions that can cut through tissue to reduce crypts on the tonsils and eliminate tonsil stones
  • Tonsillectomy: removal of the tonsils, usually a last resort but the only way to completely eliminate tonsil stones and prevent new ones from forming

How to get rid of tonsil stones at home

Manual tonsil stone removal at home is generally not recommended. Tonsils are delicate tissues, and removing them on your own may cause bleeding and infection.

Home remedies to get rid of tonsil stones include:

  • Salt-water gargle: This may help dislodge tonsil stones and get rid of the odor and bad breath they cause.
  • Coughing: Tonsil stones are often coughed up inadvertently. In some cases, a hard cough may help dislodge them.
  • Oral irrigation: Oral irrigators can sometimes be used to gently shoot water into the back of the mouth in an attempt to dislodge the tonsil stones. Follow instructions and use caution because it is possible to injure the tonsils if it is not done gently.

How to prevent tonsil stones

There are several ways to prevent tonsil stones:

  • Maintain good oral hygiene: Brush and floss regularly; consider using a tongue scraper to remove bacteria.
  • Gargle regularly with mouthwash or salt water solution.
  • Drink plenty of water.
  • Quit smoking.
  • Avoid excess alcohol.
  • Reduce consumption of carbonated beverages such as sodas.
  • Treat sinus infections or allergy symptoms promptly.
  • Limit dairy products.

How long do tonsil stones last?

The length of time tonsil stones last varies and depends on a number of factors.

Tonsil stones may dislodge or dissolve on their own in a short time.

Tonsil stones may last for weeks if bacteria continue to grow on the tonsils due to tonsil stones deep in the throat.

If tonsil stones are ignored and left in place without lifestyle changes, they may last for years.

The only surefire way to cure tonsil stones and prevent any recurrence is to have the tonsils removed (tonsillectomy).

Medically Reviewed on 10/14/2019


American Academy of Otolaryngology. Tonsils and Adenoids. 2019. October 2019. Bickle, Ian and Maxime St-Amant. Tonsillolith. 2019. October 2019. Busaba, Nicholas and Shira Doron. Tonsillectomy in adults: Indications. Sept. 24, 2019. October 2019. Tonsil Stones Guide. 2019. October 2019.