What Are Tonsil Stones? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Here’s what you need to know about why tonsil stones form, symptoms they cause, and how to get rid of them.

These spots usually pose no serious risks to your health, and you can often easily remove them at home. They are not a sign of illness or disease, and they generally do not cause other negative effects on your health.

Signs and Symptoms of Tonsil Stones

Some typical symptoms of tonsil stones include:

• Persistent bad breath
• Pale yellow or white gravel-sized bumps on your tonsils
• Sore throat
• Discomfort and a sensation of something being stuck in the back of your throat
• Problems swallowing

It’s also possible that you won’t experience any symptoms at all. “Tonsil stones may be very common,” says Aaron Thatcher, MD, a clinical assistant professor of otolaryngology at the University of Michigan in Ann Arbor. “But in some people, they may be small and buried so deep that they might not see them.” This is one reason why doctors think the condition is underestimated, Dr. Thatcher notes.

Be sure to see your doctor if you see or feel the following:

• Swelling
• Inflammation
• Bleeding in your tonsils
• Any asymmetry (if one side is bigger, looks different from the other, or is more painful),
• Ear pain
• Trouble swallowing
• A sore throat that lasts for more than a month

These symptoms may be signs of a more serious illness, such as strep throat, tonsillitis, or even cancer.

Learn More About the Signs and Symptoms of Tonsil Stones

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

It’s usually not the case that tonsil stones result from poor oral hygiene, despite the common misconception. The shape of your tonsils is a bigger factor. People with more crypts are usually more likely to develop growths because those crevices allow food and debris to build up. “It has to do with the structure of tonsils,” says Thatcher.

Learn More About Causes of Tonsil Stones

Your primary care provider may refer you to an otolaryngologist (sometimes referred to as an ear, nose, and throat doctor, or ENT) for diagnosis and treatment, notes Helena Yip, MD, assistant professor of otolaryngology at Banner University Medical Center in Tucson, Arizona. A specialist likely wouldn’t need to conduct any additional tests if they see the white, pearl-like growths in the back of the throat, Dr. Yip says. “They wouldn’t be mistaken for anything else.”

Since tonsil stones are not a serious health problem and are generally not harmful, your doctor will probably recommend preventive measures to clear them out periodically and reduce your symptoms. If they’re not bothering you, and you’re not noticing unpleasant symptoms, your doctor may advise you to leave them alone, Yip says.

Most people can manage tonsil stones at home. Some people prefer to push these objects out themselves using a cotton swab or their finger. If that poses a problem because it triggers your gag reflex, using a water flosser usually allows you to flush out the stones may be a better option.

Both Thatcher and Dr. Setlur recommend using a water flosser for tonsil stone removal because it’s effective and safe and doesn’t cause gagging. If you decide to use something else to dislodge the stones, do not use anything sharp (such as toothpicks or pins) to do so, Setlur says. Using these types of tools can cause injury to the tonsils or bleeding.

Medication Options

Your doctor may prescribe antibiotics or an anti-inflammatory medication such as a corticosteroid for tonsil stone flares, only to help clear up an episode of stones. They are not suitable for long-term use, Dr. Kezirian says. “These medications can help decrease swelling and make the crypts less shallow.”

Surgery Options

Such surgical options to treat tonsil stones include:

• Tonsillectomy This surgery completely removes the tonsils, which means that the stones cannot grow back. While a tonsillectomy is the most effective way to prevent tonsil stones from forming, there are potentially serious risks to be aware of when considering this option. For one thing, a tonsillectomy requires general anesthesia, and it can involve pain that may last for weeks, says Thatcher. And, as with any surgery, there is a risk of bleeding and infection.

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• Laser Tonsil Cryptolysis In this procedure, surgeons use a laser to get rid of tonsil crypts to prevent tonsil stones from forming. However, the procedure only helps temporarily. According to a study published in 2022, the procedure improved tonsil stones at three months, but they returned within a year.

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  More evidence is necessary to support laser tonsil cryptolysis as a long-term remedy.
• Coblation Cryptolysis In this procedure, surgeons use radiofrequency energy and saline to remove tonsil crypts and crevices. Because surgeons are able to do this procedure at a lower temperature than with laser tonsil cryptolysis, there is lower risk of certain complications.

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Learn More About Treatment for Tonsil Stones: Medication, Surgery Options, and More

Poor oral hygiene is not the only reason tonsil stones develop, but keeping your mouth clean and free of any food particles or bacteria can play an important role in preventing tonsil stones from showing up. Take the following measures to prevent tonsil stones:

• Brush your teeth and floss regularly. Keeping your mouth clean and removing food particles can play an important role in preventing tonsil stones from flourishing by reducing the amount of materials and bacteria in your mouth that may contribute to tonsil stone growth. Brush your teeth after meals, as well as in the morning after you wake up and before bed. Floss daily.
• Gargle water. In addition to brushing your teeth and flossing regularly, gargling water in the back of your throat after eating (as well as after brushing your teeth and flossing) can also help clear away debris and food particles to prevent the buildup of material that leads to tonsil stones, Setlur says. Avoid gargling with mouthwashes that contain alcohol, which may cause irritation and lead to swelling in the area in which the tonsil stones occur. Kezirian recommends gargling with salt water, as this may provide additional benefits by helping to reduce any swelling in the area and preventing the buildup of food or other materials, Kezirian says.

Lifestyle choices can affect tonsil stone formation, too. To help prevent stones, you can also:

• Stop smoking. Anything that causes inflammation in the mouth or throat, such as smoking, can irritate the tonsils, which can set the stage for worsening of crypts and increased risk of tonsil stones.
• Avoid sugary drinks. Steer clear of beverages that are high in sugar, such as juice and sodas, as they may act as a nutrient source for bacteria, helping it accumulate in the tonsils, Kezirian says.

But otherwise, tonsil stones rarely cause complications.

Several conditions may have links to tonsil stones:

• Gingivitis: Gum disease can be another cause of foul-smelling breath.
• Sore throat: Tonsil stones may contribute to discomfort at the back of the throat.
• Tonsillitis: Tonsillitis is another common condition affecting the tonsils.

The Takeaway

Tonsil stones are small, often yellowish-white deposits that form on your tonsils from trapped debris like food particles or bacteria. They can sometimes cause bad breath or throat discomfort but are typically harmless and can be managed at home with simple hygiene practices. Regularly gargling water and having excellent oral hygiene are the best prevention tactics.