White Stuff on Tonsils

Overview

Seeing white spots on your tonsils may initially be a little worrying, especially if you do not know what it is or what caused it, however in most cases, it is usually not serious and can be treated. 

There are a few different reasons why white spots may appear on the tonsils. They may clear up on their own, or their removal may require intervention with medication.

We have two tonsils, one on either side, in the back of the throat. They are oval-shaped tissues that make up part of the body’s immune system as they help prevent germs from entering the body via the nose and mouth.1 This is actually the reason why they can often get infected; they have a lot of exposure to viruses and bacteria. As we age, it is thought that the tonsils play a less active role in the immune system response, which may also be why tonsilitis occurs less frequently in adults.2 

Causes of white stuff on tonsils

Viral infections

A virus that comes from the Herpes family called the Epstein-Barr Virus (EBV) is usually the cause of a condition called infectious mononucleosis (IM). It is a very commonly occurring infection and is more commonly known as glandular fever. Once a person is infected with the virus, it often takes around four to seven weeks for symptoms to manifest. The white pus-filled patches are seen on the tonsils but can also be seen around the tongue; this spreading of white patches may help differentiate between bacterial infections.3 

Tonsillitis is another condition that causes white spots on the tonsils and its cause can either be from a bacteria or a virus, however it is more likely that the cause is viral.4 It most commonly occurs in children, however, teenagers and adults can still suffer from tonsillitis. 

Bacterial infections

A common bacteria that causes white spots on the tonsils is Streptococcus pyogenes. The resulting infection is often referred to as ‘Strep throat’. This infection occurs most commonly in children aged three to fifteen years of age and during the colder seasons of the year.5 Strep throat is highly contagious and can be spread to others through droplets when sneezing or coughing for example. 

Fungal infections

Oral fungal infections are considered to be fairly common, often caused by the overgrowth of a fungus called Candida albicans. This condition is commonly referred to as ‘oral thrush’. There are several reasons why someone would get oral thrush. Examples include the use of certain medications such as antibiotics or inhaled corticosteroids and diabetes. The white spots on the tonsils may also be present on the roof of the mouth, the cheeks, and the tongue.6 

Tonsil stones

Tonsil stones are actually termed tonsilloliths and are hard, white calcium deposits that take on a stone-like appearance on the tonsils. They may not always be noticeable, especially if they are small, however, if they are large they may be unsightly and worrying to the sufferer. Tonsil stones can occur due to a build-up of food particles in the mouth, mucus, or bacteria.6 Usually, tonsil stones dislodge on their own or can be prompted out carefully with the use of a cotton swab. Good oral hygiene such as regular tooth brushing and flossing after meals is also recommended. Salt gargling may provide symptomatic relief and can also have an anti-bacterial effect on the mouth. Sometimes, the stones can be particularly large and troublesome, in which case, consult with your doctor to discuss ways to get them removed. 

Enlarged tonsils

Leukoplakia

Leukoplakia presents as white or grey, thick patches in the mouth or throat that are unable to be removed when scraping. Its presence has been linked with either chewing or smoking tobacco or injury to the mouth. A biopsy may sometimes be offered to patients with leukoplakia as rarely, it can be an early sign of cancer.6 

Lichen Planus

An inflammatory condition affecting mostly adults and more commonly occurring in people assigned female at birth. Symptoms can include white patches in the mouth, open sores, inflammation of the gums, and sensitivity to certain foods such as spicy or acidic foods. As this is a chronic condition, there is no cure for Lichen planus, however, the symptoms can be managed with numbing agents or other forms of pain relief. Sometimes there will be no pain associated with the condition and therefore no treatment is required.7

Other symptoms associated with white spots on the tonsils

Strep Throat

Like other bacterial infections of the body, it is also common to experience a fever, weakness, fatigue, and a headache. Other symptoms are usually localised to the throat area such as a sore throat, swollen lymph nodes, and red swollen tonsils. 

If the infection is associated with a cough, runny nose, and sore eyes, it is less likely to be a Strep infection as these symptoms are more commonly associated with a viral infection.4 

Tonsillitis

As well as white patches on the tonsils, other symptoms of tonsillitis include difficult and painful swallowing, fever, enlarged lymph nodes on the neck, bad breath, neck pain, headache, and swollen tonsils.8

Oral thrush

Symptoms other than white patches in the mouth include pain and difficulty when swallowing, feeling like there is cotton in the mouth, a loss of taste, and redness and soreness. The redness and soreness may be particularly noticeable if the sufferer tries to physically remove the white patches.6 

Mononucleosis

Symptoms of mononucleosis include:

  • Headache
  • Flu-like symptoms
  • Fever
  • Rashes
  • Swollen lymph nodes
  • Weakness and fatigue

Tonsil Stones

Along with the calcium deposits on the tonsils, a person with tonsil stones may also suffer from bad breath, painful swallowing, a feeling of having something stuck in the throat, and ear pain.

Diagnosis

The doctor will need to know about your symptoms to help differentiate between other infections and then offer the most appropriate advice and treatment. The doctor may also want to take a look at the back of your mouth to identify the white spots and any other symptoms. The neck area may also need to be felt to check if there are any swollen lymph glands. In some cases, the doctor may also deem it necessary to take a throat swab to identify the pathogen causing the infection. If the pathogen is bacterial in nature, then antibiotics can be prescribed.4

Treatment

Medications

Strep Throat

It is possible for Strep throat to clear up by itself with no intervention, and usually, this takes between three and five days.4 However if the symptoms of the infection are particularly troublesome, or there is a worry the infection could spread to vulnerable children or adults around them, antibiotics may be considered. Generally, the use of antibiotics speeds up recovery by around a day earlier than with no intervention. 

Viral Infections

In conditions such as glandular fever and tonsillitis, the cause is most often viral in nature and therefore antibiotics will not be able to treat the infection. 

Oral Thrush 

Antifungal medications can be prescribed although, usually, most antifungal medications used for oral thrush are available to buy over the counter. If you think you are suffering from oral thrush, it may be worthwhile to visit a pharmacist. If the oral thrush is caused as a result of other medications, the pharmacist may be able to advise you further, including tips on how to prevent oral thrush in the future. 

Pain and fever associated with infection

If an infection is associated with pain, an anti-inflammatory pain killer can be taken, such as Ibuprofen. Paracetamol can be considered when there is a fever. Both of these medications can be bought over the counter, without the need for a prescription. You can also buy lozenges or sprays that contain various ingredients to help with the symptoms associated with a sore throat. Sometimes, they can contain an anaesthetic to help numb the area. Some lozenges can provide relief by providing a cooling sensation with the ingredient Menthol. 

Home remedies

  • Salt gargling for around 15 seconds can provide symptomatic relief and natural salts such as Himalayan salt are anti-bacterial. Gargling can be achieved by mixing around half a teaspoon of salt into a glass of warm water. Stir the solution to help all of the salt dissolve, and then gargle towards the back of the throat for around 15 seconds or as long as is comfortable. You can then spit the solution out. It is generally not considered problematic if you end up swallowing the solution, however too much salt can cause health problems. You can gargle as many times as you want throughout the day, but  morning and evening prove to be quite beneficial. 
  • Warm, soothing drinks are also recommended to help soothe the throat, such as herbal teas or honey with lemon water. Honey is also anti-bacterial which may provide additional benefits. 
  • Avoid environments that may cause you irritation, such as polluted areas and cigarette smoke.
  • A humidifier can help add moisture to the environment which can be soothing especially if suffering from a dry throat. 
  • Get plenty of rest so your body can use most of its energy to fight the infection.

Prevention

Generally, conditions that cause white spots on the tonsils are either viral or bacterial in nature. These germs are contagious, which means that things can be done to prevent catching an infection. Practicing good hygiene is probably the most important aspect of preventing an infection, and includes:

  • Washing hands thoroughly with soap, paying particular attention to washing hands after using the toilet and before eating. 
  • Avoid sharing food, drinks, and utensils
  • Avoid sharing toiletries and towels

It is also important to take measures if you have contracted an infection as this can help minimise the risk of spreading to others. Examples include:

  • Staying at home and away from others (including family members) when ill 
  • Sneeze or cough into a tissue and discard the tissue when finished.

When to see a doctor

Generally, any aforementioned symptoms that are accompanied by a fever should be discussed with a medical professional. This is particularly important when considering vulnerable people such as young children and the elderly. 

If treatment is being given and there are side effects experienced it is best to inform a medical professional such as your doctor or pharmacist. In some cases, symptoms such as a rash, may indicate an allergic reaction and the medication will need to be immediately stopped and an alternative needs to be sought. 

Summary

There are several different reasons why someone may suffer from white spots on the tonsils. It is important to make a note of the symptoms and when to speak to a doctor. It is important for the doctor to be aware of all of your symptoms in order to identify the cause and advise on the best action to take. 

If the symptoms are severe, for example, difficulty breathing, emergency medical attention should be sought. 

In general, by taking necessary appropriate measures, such as rest and medication, the symptoms should improve and the infection will clear up. 

References

  1. How do the tonsils work? [Internet]. Institute for Quality and Efficiency in Health Care (IQWiG); 2019 [cited 2022 Jun 30]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279406/
  2. Tonsillitis - Symptoms and causes [Internet]. Mayo Clinic. [cited 2022 Jun 30]. Available from: https://www.mayoclinic.org/diseases-conditions/tonsillitis/symptoms-causes/syc-20378479
  3. Fugl A, Andersen CL. Epstein-Barr virus and its association with disease - a review of relevance to general practice. BMC Fam Pract [Internet]. 2019 May 14 [cited 2022 Jun 30];20:62. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6518816/
  4. Gardner A. What causes white spots in your throat? [Internet]. WebMD. [cited 2022 Jul 1]. Available from: https://www.webmd.com/cold-and-flu/white-spots-throat-causes
  5. Strep throat. afp [Internet]. 2016 Jul 1 [cited 2022 Jul 1];94(1):online-online. Available from: https://www.aafp.org/pubs/afp/issues/2016/0701/p24-s1.html
  6. What causes white spots on the tonsils? [Internet]. 2022 [cited 2022 Jul 1]. Available from: https://www.medicalnewstoday.com/articles/317891
  7. Hamour AF, Klieb H, Eskander A. Oral lichen planus. CMAJ [Internet]. 2020 Aug 4 [cited 2022 Jul 1];192(31):E892. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7828879/
  8. White spots on tonsils: Causes and treatments [Internet]. Healthily. [cited 2022 Jul 1]. Available from: https://www.livehealthily.com/sore-throat/white-spots-on-tonsils-causes-and-treatments

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