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Tonsilloliths (Tonsil Stones): Risk Factors, Symptoms & Treatment

Tonsilloliths (Tonsil Stones): Risk Factors, Symptoms & Treatment

What are Tonsil Stones?

When someone mentions stones that form in the body, most of the time people will think about the kidneys. However, kidneys are not the only organs that can form stones. Sometimes patients develop hard, painful stones in the tonsils as well, a condition called tonsilloliths. There are three types of tonsils in the back of the throat and they serve as a part of the body’s immune and lymphatic systems (x). According to the American Academy of Otolaryngology, the tonsils are the body’s first line of defense (x).

Tonsilloliths occur when debris gets trapped in pockets in the tonsils (x). Mucus, food, bacteria, dead cells and other debris may collect in the crypts or grooves on the tonsils. The debris hardens over time to form tonsil stones. Some patients may develop only one tonsil stone, while others may have several smaller formations. Potential causes may include poor dental hygiene and chronic tonsillitis (inflamed tonsils) (x, x).

Sometimes a patient may have a tonsil stone without knowing it. They are typically harmless, but sometimes they may cause discomfort and other noticeable symptoms, even if they are small and hard to see. Patients may have a sore throat, bad breath, difficulties swallowing, swelling in the tonsils, ear pain and yellow or white debris on the tonsils. There are many ways to prevent tonsilloliths, including staying hydrated, practicing good oral hygiene, gargling with salt water and avoiding smoking (x).

Other Conditions that Affect the Throat

There are other health conditions that can cause similar symptoms as tonsilloliths, but do not necessarily involve tonsil stones. It’s important to visit a physician for an accurate diagnosis and to confirm the cause (x).

Tonsillitis

Tonsillitis is inflammation in the tonsils and sometimes the adenoids, usually as a result of a viral infection. The tonsils look red and swollen and the patient may have a fever and difficulty swallowing (x).

Strep Throat

Unlike tonsillitis, strep throat usually results from a bacteria group, specifically A Streptococcus. The bacteria lives in the nose and throat and spread through coughing or sneezing. It causes a very sore throat, fever, swollen tonsils and sometimes patients may also contract scarlet fever (x).

Tonsil Cancer

Most of the time, tonsil cancer affects the tonsils on the sides of the throat. Usually the tumor is made up of squamous cell, but some cases are lymphomas. The cancer causes a sore to develop in the back of the throat that does not heal. Other symptoms include blood in the mouth, bad breath, a persistent sore throat, one swollen tonsil and difficulty swallowing, chewing and talking (x).

Risk Factors for Tonsil Stones 

Anyone can develop tonsil stones. However, teenagers are more likely to develop the condition. It is also more common in individuals with chronic tonsil inflammation and repeated cases of tonsillitis, as well as people with large tonsils (x).

Chronic Sinusitis

Repeated cases of sinusitis may infect the tonsils. The tonsils contribute to the immune system, so when they do not function correctly, the body cannot trap bacteria and viruses. When a patient has sinus problems, it can cause post-nasal drip and bacteria can drip into the throat.

The bacteria then settles into tonsillar crypts, producing thick excess mucus. The crypts become the focus point for the infection because they trap more mucus and collect more bacteria (x, x).

Tonsillitis

Repeated bouts of tonsillitis can also cause tonsil stones. Inflammation in the tonsils makes them more vulnerable to bacterial infections because the body cannot rid itself from harmful debris that collect and harden on the swollen tonsils, creating stones (x).

Poor Dental Hygiene

Patients who fail to brush or floss their teeth properly or regularly are highly vulnerable to tonsil stones. When patients do not wash their mouths frequently or thoroughly, food particles and debris enter the throat, collect on the surface of the tonsils and cause tonsil stones (x).

Smoking 

A smoking habit causes damage in the mouth by reducing its ability to clean itself, which leaves the tonsils susceptible to bacterial infection and inflammation (x).

Symptoms of Tonsil Stones

Many people with tonsil stones do not experience any noticeable symptoms at all, especially if the stones are small (x). Even when tonsil stones are larger, sometimes patients only discover them by accident on CT scans or X-rays. However, some larger stones may cause multiple noticeable symptoms (x).

Sore Throat

Sometimes, tonsil stones cause pain and discomfort in the back of the throat where debris gets trapped. Patients report that tonsilloliths feel as if there is something stuck in the throat. However, sometimes the patient may have tonsilloliths in conjunction with tonsillitis. In these cases, it can be hard to determine if the pain is a result of the tonsil stones or tonsillitis (x).

Swelling

Once the debris collects in the throat, it hardens and tonsil stones are formed. The stones may cause irritation in the throat and cause them to swell (x).

Growths on the Throat

Although the symptoms of tonsilloliths are similar to tonsillitis, there is one major difference. Patients with tonsil stones develop white or yellow growths on the tonsils. Sometimes the growths are small enough where the patient cannot even see them or they don’t cause enough irritation to raise concern (x).

Bad Breath

This is one of the prime indicators that a patient has tonsil stones. They act as a home for bacteria, which release sulfides that give off an unpleasant smell. One study determined that 75 percent of its subjects with tonsilloliths had high levels of volatile sulfur compounds in their breath (x). These sulfur compounds are responsible for bad breath. According to other studies, tonsil stones may also be responsible for halitosis, which research links to around 3 percent of cases of bad breath (x).

Ear Pain

The ears and tonsils share the same nerve. So when tonsil stones develop, they put pressure on this nerve, which can cause pain and irritation in the ear. Research suggests that ear pain may have a connection to tonsilloliths (x).

Other Symptoms

In addition, patients may have difficulties or feel pain swallowing food or drinks, depending on the size of the stones. The patient may also choke as they try to swallow because the stones limit food passage. It may also affect the patient’s ability to taste. It may cause a metallic aftertaste in the mouth that results from the debris mixing and decomposing in the throat (x, x).

Symptoms of Tonsil Stones

Complications from Tonsil Stones

Tonsil stones do not cause any serious health complications, even though they can cause pain or discomfort. However, tonsilloliths may cause dental problems. According to studies, the stones are similar to dental plaque, which can cause cavities and gum disease (x).

When to See a Doctor

Even though they are harmless, sometimes a medical professional is the best option. It is best to visit a doctor if the patient cannot remove the stone at home themselves, if they have symptoms of tonsilloliths but cannot see any stones or if they manage to remove the stone but feel pain afterward. If the tonsils are red, swollen or painful, the condition may require medical treatment (x).

Treatment for Tonsil Stones 

Usually tonsil stones do not require any medical treatment and patients can treat the condition themselves at home (x).

Home Remedies

Gargling vigorously with salt water may help dislodge the stones and ease throat discomfort. It can also help them detach from the tonsils. Some individuals discover that they have tonsil stones once they expel one from coughing. Coughing intentionally may help loosen the stones.

Try loosening the stone with a cotton swab. Press down on the tissue around it and push forward toward the front of the mouth, but don’t push too hard. Tonsils have soft and gentle tissues, so don’t use anything pointed or sharp to avoid infections, bleeding or any other damage to the throat (x).

Medical Treatment

Patients with large, frequently recurring tonsil stones may require surgical removal if they cannot remove the growths themselves. If the stone or the symptoms do not go away after a few weeks, consult a doctor.

Tonsillectomy

A tonsillectomy is a surgical procedure that completely removes the tonsils. Doctors recommend it to patients with severe, chronic cases of tonsilloliths with significant pain, infection or bad breath. However, a tonsillectomy has some potential risks attached to it: bleeding, infection and even life-threatening reactions to anesthesia, in rare cases (x).

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Laser Tonsil Cryptolysis

Laser resurfacing is another conventional treatment. The surgeon reshapes the crypts that collect the tonsil stones, reducing them using laser cryptolysis (x).

Coblation Cryptolysis

Coblation cryptolysis is another treatment option. It uses radio waves and salt solution that remove the crypts. It reduces the crypts, but without the high temperature, so it is less risky than laser treatment (x).

Preventing Tonsil Stones

Practicing consistent, proactive oral hygiene is imperative when it comes to preventing tonsil stones. It keeps away undigested food particles and other debris that can get trapped in the throat (x). Staying hydrated also helps prevent and remove tonsil stones. Bacteria can easily grow in a dry mouth that produces little saliva (x).

Supplements for Tonsil Stones

Supplements are another method that may help eliminate tonsilloliths. Certain varieties can help boost the immune system so that the body can fight off bacteria and prevent it from collecting in the tonsils.

Grapefruit Seed

This tropical citrus fruit is known for its bitter and sweet taste. But grapefruit seeds are also rich in antioxidants and a natural antibacterial that can suppress bacteria growth. As a dietary supplement, take 500 to 1,000 mg of grapefruit seed extract powder up to three times a day, or following a doctor’s instructions.

Vitamin E

Popular in cosmetic products for its ability to improve skin health, Vitamin E is an effective antioxidant that can reduce free radical damage in the body. As a dietary supplement, the recommended dosage for Vitamin E powder is 350 mg with food and water. Consult with a doctor before adding Vitamin E to your supplement regimen. 

Vitamin C

This vitamin is a powerful antioxidant and immune booster. Vitamin C can help the body fight off damaging bacteria that may cause tonsil stones. For this supplement, take 1,000 mg (1/4 tsp) of Vitamin C powder daily. Consult with a doctor to confirm safety and dosage. 

Zinc

As the second most abundant mineral in the body, zinc has several benefits on the body, including boosting the immune system to fight off infections. The recommended serving for zinc gluconate powder is between 225 mg and 450 mg per day. Do not exceed 450 mg under any circumstances and seek medical advice before taking this supplement. 

Echinacea

This is a traditional herb with a long history of treating different medical conditions. Echinacea is effective to strengthen the immune system and fight off infections. The suggested serving for echinacea extract powder is 450 mg once or twice a day, or as directed by a physician.

Licorice Root

Licorice root is not only a sweetener for drinks and candies, it is also a powerful remedy for sore throat and cough. It helps kill bacteria in the mouth that cause tooth decay. As a dietary supplement, take 600 mg of licorice root extract daily, unless a physician recommends a different dosage.

Garlic

Chewing raw garlic can help kill the bacteria that cause infection in the tonsil stones. It may prevent the bacteria from increasing, as well as decrease unwanted symptoms. One of its active components, allicin, has beneficial and powerful antimicrobial abilities (x, x). As a dietary supplement, take 650 mg of garlic extract powder twice a day with meals, or following a physician’s instructions. 

The Bottom Line

Tonsil stones form when debris collects in the tonsils, such as food particles and bacteria. Over time, the debris hardens and forms into small bumps. They are generally harmless. Some patients have tonsil stones without even realizing it. But even though they are small, patients may experience some uncomfortable symptoms, including a sore throat, difficulty swallowing and bad breath. It may be difficult for patients to tell if they have tonsil stones or tonsillitis, since they have similar symptoms. However, the main difference is that the patient will have visible stones. 

Medical treatment for tonsil stones is usually not necessary. Patients can usually treat the condition themselves with home remedies, including gargling salt water or using a cotton swab to gently push the stone out of the mouth. If a patient cannot remove it themselves, they may need medical treatment. The only way to permanently get rid of tonsil stones is to completely remove the tonsils with a tonsillectomy. There are also a variety of supplements that can help eliminate tonsil stones and fight the bacteria that causes them. 

 
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