Tonsil Stones: the Good, the Bad and the Ugly

Last updated: November 1, 2019

Contributed by:
Richard Honaker M.D.
Primary Care Physician
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Tonsil stones: a tiny stone in your mouth that can lead to big problems

Do you often need to check your breath to make sure it’s fresh? If you often find your breath has an unpleasant odor you are certainly not alone. It is estimated that 50 million Americans suffer from bad breath each year and the causes aren’t always what you think.

While many smelly mouths may be caused by a lack of good oral hygiene, there can also be one small reason for this stinky problem: tonsil stones. You could easily have this smelly problem in your mouth and not even know it.


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What are Tonsil Stones?

a young boy opening his mouth to show his tonsils

Tonsil stones, also called tonsilloliths occur when debris gets caught in the crypts on your tonsils. Debris getting caught in your tonsils is actually a normal part of the function of your tonsils. This is because your tonsils are actually a part of your immune system. They act as a net to catch bacteria and other foreign objects before they enter the throat.

Your tonsils are made up of lymphoid tissue. Lymphoid tissue contains cells that fight off disease.

In order to perform their function well, your tonsils may change shape by swelling with blood to trap germs.

Your tonsils contain ‘crypts’ which are little caves in which debris may become trapped. Normally this debris will be dislodged and go down your throat unnoticed. While unpleasant to think about, it is the best case scenario. If the debris is not dislodged naturally it may stay and attract bacteria which can leave an unpleasant taste in your mouth and cause bad breath.

It can take on a ‘cheesy’ texture and may cause other symptoms. In some cases the stones may pick up mineral elements from your saliva and calcify. Then they take on a stone-like texture and can become problematic.


What do Tonsil Stones Look Like?

Close up picture of tonsil stone

Many tonsil stones are not easily detected. They are all the way at the back of the throat and are often too small to notice. If you do see a stone it will likely be white, yellow or grayish in color and about as big as the eraser at the end of your pencil. The stone may be round or take on a raisin like shape due to its formation in the crypt.

While often unnoticeable, some stones will show up on an x ray.



How Big can Tonsil Stones Get?


Most stones are about 1-2 mm in length but not all people are so lucky. Recently a stone removal was recorded in the Saudi Medical Journal because of its unusually large size.

The patient was a 45 year old man who had experienced recurrent tonsillitis and sore throat. The article noted that recurrent tonsillitis and the inflammation associated is often linked with the formation of tonsil stones.

The man decided to undergo an elective stone removal and tonsillectomy. During the procedure the medical team removed a stone that was 3.1 × 2.3 cm. You can check out just how big the stone was here.

While unusual stones like this one are rare, it is tiny compared to the biggest stone ever removed. The largest stone ever removed was more than 14 cm. It should be noted that this removed was in 1936, when oral hygiene was much more primary than it is today.


Signs and Symptoms of Tonsil Stones

woman clutching her throat

One of the most common symptoms of tonsil stones is the prevalence of bad breath. That is because the stones often grow bacteria that can literally leave a bad taste in your mouth.

Along with bad breath, some people experience a persistent sore throat or even difficulty swallowing. As the ear and throat have shared nerve pathways, some sufferers experience ear pain even though the stone in in the throat. Some stones may even cause the tonsil to swell or become larger.

Many of the symptoms of tonsil stones mimic other oral issues. A sore throat can also be linked to viral or bacterial throat infections, tonsillitis, or even tonsil cancer.


Causes of Tonsil Stones

mother looking at daughter's throat

While small occasional tonsil stones may be considered normal. Larger recurrent stones are often linked to repeated cases of tonsillitis or inflammation of the tonsil. There may also be a link between tonsil stones and, large tonsils, chronic sinus issues as well as poor dental hygiene. A study concluded that the bacteria that forms tonsil stones is the same bacteria which can lead to tooth decay, gum disease and oral infections. Tonsil stones are similar to the plaque that causes cavities and gum disease.


Removal of Tonsil Stones

man gargling at a sink

Many tonsil stones are removed naturally with the everyday tasks of eating and drinking. If you are noticing a frequent build-up of stones in your tonsils, your healthcare provider may recommend some basic ways you can remove tonsil stones at home such as:

  • Gargling with salt water or non-alcohol mouthwash to naturally dislodge the stones
  • Using a waterpik to clean out the area
  • Using a small instrument such as a cotton swab to dislodge the stones


In some cases, where the stones are large and causing many uncomfortable symptoms you may want to discuss removal options with your doctors. In some cases a numbing agent can be used and the procedure is generally low-risk.

While tonsillectomies (removal of the tonsils) used to be considered a routine procedure, they are now considered a last resort. One of the reasons for this is the risk of complications associated with the procedure, including bleeding.

While a tonsillectomy is a ‘cure’ for tonsil stones, it is usually only perform in extreme cases. While it is considered a generally safe procedure, it can produce risks.

  • Bleeding
  • Infection
  • Swelling-related breathing difficulties
  • Life-threatening reactions to anesthesia (this is rare)


Prevention of Tonsil Stones

child brushing her teeth

For some people the only possible true prevention of tonsil stones is to have a tonsillectomy. These are often cases where stones are associated with frequent tonsil inflammation and tonsillitis.

For others, prevention is possible with good oral hygiene. Regular flossing, brushing and gargling or using a waterpik is enough to keep the tonsils free of debris.

dentist treating a female patient

There is also a possibility to treat tonsil stones with laser resurfacing. The process is called coblation tonsil cryptolysis and reshapes the tonsils and reduces the number of crevices in which the stones can grow.

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

While it carries less risk than a tonsillectomy, it is not a guaranteed cure and tonsil stones may grow back again.


A new Approach to Healthcare

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Speaking to a doctor about pain in your throat doesn’t have to be a pain in the butt. Connect easily with one of our doctors 24 hours a day with the free Your Doctors Online app. One click of a button can connect you with a real doctor absolutely free.

Don’t waste time sitting around in a waiting room when you could be chatting with a doctor instantly from the comfort of your own home.


Disclaimer: This article provides general information and is not intended to diagnose, treat or cure any disease or medical condition. If you require specific advice, please consult one of our medical professionals through the app. However, in case of an emergency, please call 911.

About Richard Honaker M.D.

Dr. Richard Honaker has over 40 years of experience as a primary care physician specializing in several different areas of medicine. He is able to provide expert case review and analysis for insurance and workers compensation cases as well as providing online medical consultations as the Chief Medical Advisor for Your Doctors Online.

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