"Oh man, Bri," my wife says as I kiss her on my way out the door.  "You need some mouthwash.” 

I sigh in frustration at the situation.  It's another day that skipping breakfast and recently brushing my teeth aren't adequate enough to spare the masses with my bad breath.

My wife helped me discover that the reason for my occasional halitosis (the clinical term for bad breath) was due to holes in my tonsils.  Years ago I had a sore throat so I was gargling with warm salt water when she noticed these tiny crystals lining the sink after I spit.  My initial thrill of discovering a potential superhero power was quickly eclipsed by confusion when she told me that I had holes in my tonsils.  She confirmed this moments later when she held her breath and looked in my mouth with a flashlight to discover many more of these tiny white stones in my mouth.

This began a journey to discover that these little white stones, or tonsil stones, are not only common but they're preventable. 

What Are Tonsil Stones?

Tonsil stones, also known as tonsiliths, tonsilloliths, tonsil calculi, and tonsillar concretions, are little white stones or calcified deposits that form in the crevices of the tonsils. Tonsils are small mounds of tissue located at the back of the throat that help fight off infections entering through the mouth.  Since tonsils are lymphoid tissue, they have "crypts" or holes where debris can get trapped.  This debris, typically dead cells and bacteria, can harden over time and turn into tonsil stones.  While they're not usually a serious medical condition, they can be uncomfortable and may require treatment in some cases (more on that below).

Tonsil stones are a relatively common condition, affecting an estimated 10% of the population. They're more common in people who have frequent episodes of tonsillitis or inflammation of the tonsils, as well as those who have naturally larger tonsil crypts. While tonsil stones can occur at any age, they're more common in adults than children.  Fortunately, research has found that having tonsils stones does not increase the odds of calcification in other parts of the body (e.g. body tissues, organs, ducts).

Signs and Symptoms of Tonsil Stones

Tonsil stones may not always cause symptoms, but when they do, the most common signs and symptoms include:

1. White or yellow debris at the back of your throat.  Seeing little white or yellow stone-like particles is a good indicator that you have tonsil stones, however, often times these stones can hide out of view.

2. Bad breath: One of the most common symptoms of tonsil stones is bad breath or halitosis, which is caused by the sulfur compounds produced by bacteria that accumulate in the tonsil crypts.  One study found that of those who had chronic halitosis, 75% had tonsil stones.

3. Sore throat: Tonsil stones can cause irritation and inflammation in the throat, leading to a sore throat.

4. Difficulty swallowing: Due to a feeling of discomfort or blockage in the throat, swallowing may be difficult.

5. Ear pain: Ear pain can occur with tonsil stones because the tonsils and the ears share nerve pathways, specifically the glossopharyngeal nerve (CN IX) and the vagus nerve (CN X). When the stones become lodged or cause inflammation, it can lead to referred pain along these nerve pathways, causing discomfort in the ears.

6. Coughing: Persistent coughing can be triggered by the irritation and inflammation caused by tonsil stones in the throat.

7. Swollen tonsils: Tonsil stones can also cause the tonsils to become swollen or inflamed.

It's worth noting that these symptoms can also be caused by other conditions, such as tonsillitis, strep throat, and even cancer. If a person experiences persistent symptoms, they should consult a healthcare professional for an accurate diagnosis and appropriate treatment.

How To Prevent Tonsil Stones

There are several treatments available for tonsil stones, ranging from home remedies to medical intervention and surgery.  

Natural Home Remedies

In mild cases, small tonsil stones may be removed using simple home remedies, including:

• Oil pulling.  Oil pulling is an ancient Ayurvedic practice that involves swishing a tablespoon of oil (such as coconut or sesame oil) in your mouth for 15-20 minutes, pulling it through your teeth and around your gums. This process helps to remove bacteria, plaque, and debris from the mouth, potentially reducing the risk of tonsil stones.  See how I use it here.

• Chew on garlic.  Chewing on garlic releases allicin, a compound known for its antimicrobial properties, which can help combat the bacteria responsible for tonsil stone formation. Regularly incorporating garlic into your diet or chewing on raw garlic cloves may contribute to preventing tonsil stones by reducing bacterial growth in the throat and tonsil areas.  Maybe save this one for the end of the day.   

• Drink enough water. A dry mouth can be a breeding ground for bacteria which can form and live in the tonsil crypts. Make sure the water is truly clean.

• Tape your mouth at night.  About 71% of people report that they are nightly mouth breathers.  This dries out your mouth and increases the number of harmful bacteria that can live in your mouth.  Mouth breathing is not good for many reasons so to counter this, consider mouth taping. 

• Limit or avoid dairy and sugary foods: Dairy and sugary foods can contribute to the buildup of bacteria and mucus in the mouth, providing a food source for bacteria.

• Consider tonsil-plumbing. A New York Times article referenced one individual with tonsil stones who waits until they get large enough and then does "tonsil-plumbing" where she pushes on her tonsils until the stones pop out.

• Using a water pick or oral irrigator: You can use these tools to remove bacteria as well as to blast the tonsils and dislodge the stones.

• Practice good oral hygiene: If a person does not brush and floss regularly, food particles and bacteria can accumulate in the mouth and throat, providing a breeding ground for bacteria and contributing to the formation of tonsil stones.

• Gargle with mouthwash.  Take a swig, tilt your head back, and gargle.  Be sure to choose a mouthwash that is alcohol-free and doesn't contain artificial dyes.  More on that here.

• Schedule regular visits to a dentist: Regular checkups and cleanings can help identify and treat any underlying dental or medical conditions that may contribute to tonsil stone formation.

• Quit smoking: Smoking can contribute to dry mouth and the buildup of bacteria in the mouth, increasing the risk of tonsil stone formation.

Medical Intervention

In more severe cases, medical intervention may be necessary. A healthcare professional may use a special tool to remove the tonsil stones, or may prescribe antibiotics to treat any infection that may be present. In some cases, laser treatment or coblation may be used to remove tonsil stones and reduce the size of the tonsils.

Surgery

If tonsil stones are large or causing significant symptoms, surgery may be recommended. A tonsillectomy, which involves the removal of the tonsils, is a common surgical procedure used to treat tonsil stones. This is typically reserved for cases where other treatments have failed or when tonsillitis or other complications are present.

The choice of treatment will depend on the size and location of the tonsil stones, as well as the severity of symptoms.  It is important to note that while home remedies and medical intervention can be effective in treating tonsil stones, surgery is usually considered a last resort.

Ultimately, the best approach to treating tonsil stones will depend on the individual case. Consulting a healthcare professional is the best way to determine the most appropriate course of treatment.

What I Do

I tend to use a multipronged approach to combat tonsil stones.  Aside from daily brushing and flossing, I do weekly oil pulling (usually in the car on my way to work), and I gargle with this mouthwash a couple of times a week.

For reasons other than just preventing tonsil stones I also tape my mouth at night and I've been trying to drink more RO water with my coffee before heading out the door in the morning.  While I love garlic (much to my wife's dismay when I overuse it with some dishes), I have yet to chew on any cloves to see if that helps but it's something I'm planning on doing. 

Since learning that I have tonsil stones I've been more consistent with doing the above and I've definitely noticed a decrease in their presence and my halitosis.  That being said, this is likely a lifelong issue so I plan to be more diligent on creating these good habits to get ahead of it and prevent my friends, family, and patients from cowering when I talk to them. 

Conclusion

Those little white stones in your mouth, also known as tonsil stones, are a relatively common condition that can cause discomfort, bad breath, and other symptoms. While they may not always require medical treatment, it is important to be aware of the signs and symptoms of tonsil stones, as well as the available treatments. Home remedies such as gargling with salt water or using a water pick can be effective in mild cases, while medical intervention may be necessary for more severe cases. In some cases, surgery may be recommended to remove large or problematic tonsil stones.

Preventive measures such as good oral hygiene, staying hydrated, and avoiding certain foods can help reduce the risk of tonsil stone formation. By taking steps to maintain good oral and overall health, a person can reduce their risk of developing tonsil stones and minimize their impact on their daily life. Ultimately, consulting a healthcare professional is the best way to determine the most appropriate course of treatment and preventive measures for each individual case.

Have you had tonsil stones? What do you do to take care of them?

Related:

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