Why Do I Get Tonsil Stones

Overview

Have you ever noticed some whitish or yellowish spots at the back of your throat when you open your mouth? You could be having tonsil stones. They are known medically as tonsilloliths. Tonsil stones are hard white to yellow formations in the tonsils (Immune structures in the throat that fight infections). Your tonsils contain some tunnels (tonsillar crypts) that are very suitable for the function of trapping bacteria, viruses, fungi, and even food substances. These can lead to build-up of calcium around them, forming tonsil stones. They vary in size; can be small and then become large over time.

Tonsil stones are very common (most people don't even realize they have tonsil stones) and do not pose any danger to health except for some symptoms like bad breath and sore throat which could be discomforting. They are not painful and also occur in all ages but are common between ages 10 and 77 with their peak at 50 years. Overall, they are more common in adults than in children.

Causes of tonsil stones

are just products of accumulated bacteria and debris in the tonsils. Tonsil stones are made up of minerals of which calcium is the commonest.

The following are risk factors for developing tonsilloliths:

• People with more crypts in their tonsils (the most important risk factor because these crypts/tunnels harbour food particles and debris and easily lead to tonsil stone formation)
• Poor oral hygiene
• Dental/oral infections
• Chronic sinus infection (infection of air spaces in the facial bones) 
• Smoking
• Recurrent tonsillitis (Enlarged and painful tonsils)
• Increased intake of sugary drinks or foods
• High alcohol/ caffeine intake
• Diet high in meat and dairy

Signs and symptoms of tonsil stones

can often go unnoticed as they are painless and can show no symptoms. The stones may be very small or even buried so deep that you can't see them. 

This is the reason many health practitioners believe that though tonsil stones are prevalent, the incidence is still under-reported. 

Common symptoms include:

• Halitosis /Bad breath
• Seeing white or yellow bumps on the tonsils
• Sore throat
• Ear ache
• Cough
• Bad taste
• Difficulty swallowing
• Feeling of something stuck in the throat
• Enlarged tonsils

Tonsil stones rarely cause complications but when they do, they can lead to tonsilitis (swollen, painful and infected tonsils). 

They could cause breathing or swallowing problems and also lead to tooth decay and halitosis (bad breath).

It's important you be on the lookout for signs of more serious illness like strep. throat, tonsillitis, or even cancer.

These signs include:

• Asymmetrical swelling of one tonsil (one tonsil is swollen and the other normal-sized)
• Sore throat lasting up to a month or more
• Severe earache 

Management and treatment for tonsil stones

Tonsils generally do not pose any harm to the individuals and are not a serious health issue. If they are not bothering you with any additional symptoms, your doctor may advise you to leave them alone. In many cases, they can actually be managed at home.

Home remedies

• Regular gargling with mouthwash or salt in warm water could minimize discomfort and dislodge some stones. It also reduces the odor associated with tonsil stones
• Coughing energetically could also dislodge some stones
• Manual removal of tonsil stones can be done with a cotton swab to push them out. Toothpicks, pins and toothbrushes should not be used as they can cause some injury to the tonsils and make an originally mild case worse
• Gentle irrigation with a water flosser is a better option especially if manual removal methods trigger gagging

If these home remedies do not work or if your tonsil stones are too big to be removed at home you could request to see your ENT (Ear, nose and throat) doctor. You should also see a doctor if additional symptoms are noticed or your experience a recurrence and would love to discuss other options with your doctor. 

Available options include:

• Medical options
• Surgical options

Medical options

Involve the use of certain medications to treat tonsil stones.

Antibiotics play a vital role in lowering bacterial counts which are responsible for tonsil stone formation.

Corticosteroids are sometimes prescribed for tonsil stone flare. However, these should not be taken for long periods due to their side effects. They should be limited to the episode of tonsil stone inflammation

Surgical options

Involves surgery in the removal of tonsil stones.

Coblation cryptolysis

This involves the use of a laser to smoothen the crevices (tunnels) in the tonsils hence reducing the trapping of debris in them. It is performed using local anesthesia to reduce the discomfort associated with it. This is a safer option. It is less painful and recovery is faster.

Tonsillectomy

Here, the tonsils are completely removed. It is not the first line of course unless a person's life is negatively impacted by tonsilloliths and such a person has frequent tonsillitis from it. Remember tonsil stones can increase the risk of tonsilitis. General anesthesia is required and the pain and recovery process is more demanding. However, this ensures the tonsils stone won't be able to form anymore.

Preventive measures include:

• Regular brushing and flossing. You should ensure this is done properly by brushing the front and back of your tongue too.
• Quit smoking
• Gargle with salted warm water or mouth wash especially after eating
• Stay hydrated by drinking enough water
• Quit alcohol and excess caffeine intake
• Reduce intake of sugary drinks or foods 

FAQs

How common are tonsil stones?

Tonsil stones are prevalent. Anyone with tonsils could have tonsil stones. Because tonsil stones could go unnoticed, there are no exact data showing how many people are actually affected by tonsilloliths. Some persons with tonsil stones may not even see medical care as they may be without symptoms.

Who’s at risk of tonsil stone?

Anyone with tonsils can have tonsil stones. The risk is increased in people with more crevices in their tonsils making them easily trap tons of food debris and bacteria which eventually calcify to form stones. Also, persons with poor oral hygiene are prone to tonsil stone formation as they harbor large amounts of bacteria, among other risk factors. 

How are tonsil stones diagnosed?

Tonsil stones are noticed when they are seen in the throat as white or yellow bumps or when they are symptomatic. At other times, people cough them out or notice them when they gargle. Your doctor could also see them during a physical examination of your mouth. No special investigation is needed to diagnose them. However, they could be found on X-rays or other specialized investigations as incident findings when investigating another illness. 

How can I prevent tonsil stones?

Tonsil stones can be prevented by ensuring good oral hygiene. This is done through regular brushing and flossing. Also, alcohol should be avoided. Excess caffeine and sugary drinks can also predispose to tonsillolith formation and should be avoided. Quit smoking. Practicing regular gargle warm water will also improve oral hygiene and in turn, reduce the incidence of tonsil stones. Drinking plenty of water and staying hydrated are also important in preventing tonsilloliths.

When should I see a doctor?

You should see an ENT doctor if you experience symptoms of tonsillar enlargement, earache bad breath or even breathing and swallowing difficulties. Also, see your doctor if it occurs frequently; with or without symptoms. Your doctor will discuss suitable treatment options with you so as to put your symptoms under control.

Summary

Tonsil stones are common but do not pose any danger to the health of the individual. They are usually asymptomatic but could become complicated. A throat specialist should be consulted for expert management.