What Causes Tonsil Stones: Symptoms & Removal

What Causes Tonsil Stones: Symptoms & Removal

 Whitney DiFoggio MA, RDH
Written by Whitney DiFoggio MA, RDH
Medical Reviewed on Dec 1, 2022
byDr. Matthew Hannan DDS
🔬 Evidence Based
What Causes Tonsil Stones: Symptoms & Removal

If you’re one of the small percentages of people to get tonsil stones (“tonsilloliths”) you know what a bother they can be. Usually, tonsil stones cause serious bad breath, or halitosis. Understanding what causes tonsil stones can help you find ways to reduce their severity, cut back on how many you get, or prevent them altogether.

What Are Tonsil Stones?

A tonsil stone is a calcified buildup of debris that collects on the surface of and around your tonsils. They’re made up of things like calcium hydroxyapatite crystals, calcium carbonate, plus a mixture of other minerals, food debris, and oral bacteria.

Photos Of Tonsil Stones:

Source: https://commons.wikimedia.org/wiki/File%3ATonsilloliths_20091119_prior_to_tonsillectomy.JPG

What Causes Tonsil Stones

People who have recurring tonsillitis tend to develop what we call “tonsillar crypts” across their surface. These crypts look like crevices or craters in your tonsils, creating a range of openings or sunken-in areas that can collect bacteria and food debris. They’re caused by gradual accumulation of bacterial byproducts, food, and the natural microorganisms that are found inside of your mouth.

When a tonsil stone forms inside one of your tonsillar crypts, it gradually increases the size of that opening, enlarging the area and making you more likely to have recurring tonsil stones. Fortunately, these calcium deposits are usually temporary. Some people are able to remove them on their own, or they just work their way out over time.

Tonsil stones are more common in people who have several crevices or crypts across their tonsil surfaces typically due to a history of infections and illness. They tend to occur more frequently in teenagers. But if you’re a person who has had tonsilloliths in the past, you’ll be at a greater risk of getting them in the future.

Since your tonsils aren’t exactly a part of your mouth that you clean with a toothbrush, it’s important to reduce the number of oral bacteria inside of your mouth with rigorous brushing, flossing, and – my favorite – using a tongue scraper every day!

Potential Causes 

1) Poor Dental Hygiene

If you’re not great about brushing and flossing every day, you’re going to naturally have a higher number of bacteria inside of your mouth. Left alone, those bacteria then produce additional byproducts (aka cellular waste) that accumulate. The excess can spread to other parts of your mouth, throat, airway, and circulatory system. Naturally, your tonsils are one of the first places for that residue to accumulate. The less frequently (and thoroughly) you’re cleaning your teeth, gums, and tongue, the higher the risk you have of getting tonsil stones.

2) Large Tonsils

Tonsil stones are more common in people who have large tonsils. Enlarged tonsils are frequently associated with ongoing issues like allergies, strep throat, sinus infections, and mucous drainage. And when your tonsils are larger, they’re more prone to creating scar tissue or crypts on the surface. In time, those openings and crevices will be more likely to harbor bacteria that accumulates then calcified.

3) Chronic Sinus Issues

Mucous drainage down the back of your throat can irritate your tonsils and lead to bacterial accumulation around the tissues in the back of your mouth. If you’re someone who constantly battles bad breath because of seasonal allergies or chronic sinus infections, you might want to have your throat checked for tonsil stones! Although tonsils aren’t inherently part of your nasal sinuses, they can become irritated and develop tonsil stones if you have a constant “post-nasal drip” (drainage down the back of your throat.)

4) Chronic Tonsillitis 

Having constantly inflamed tonsils or recurring tonsillitis causes your tonsils (which are lymph nodes) to become swollen, stretching its surface and providing a larger area for bacteria to hide. On top of that, there’s an increased number of germs from the infection at hand. The more infections you experience, the greater the risk of scarring there is, which by nature raises your chances of getting tonsil stones wedged down around all of that scar tissue.

Tonsil Stone Symptoms

Bad Breath

Tonsil stones produce a particularly foul odor. So, if you have chronic bad breath or halitosis, but brushing and flossing doesn’t help, get your dentist to rule out tonsil stones in addition to periodontal infections. Since you can’t really clean that area, the smell may get progressively worse.

Sore Throat

Chronic discomfort is a normal symptom in people who have tonsil stones. It might feel like an itchy sensation in the back of your throat or as if tonsillitis is starting to set in. Sore throat symptoms could possibly be confused with strep throat, allergies, or a sinus infection.

Trouble Swallowing

Depending on how large the tonsil stone is, it could interfere with swallowing. You might find that it either hurts to swallow or it’s more difficult to swallow than it used to be. Of course, difficulty swallowing could be a risk factor for numerous different health problems, so it’s a symptom you really can’t afford to ignore.

Ear, Nose, and Throat Pain

Surprise: your tonsils are close to your ears! So if they’re swollen or have hard calcified growths in them, the pressure can push against the shared nerve pathways, creating what’s called “referred pain”, or where it makes your ear hurt even though there’s nothing in your ear.  

Ongoing Cough

Coughing is a natural reaction to having a foreign body in your mouth, throat, or respiratory system. If you have tonsil stones that are sort of “tickling” the back of your throat or roof of your mouth, it’s a normal response to feel the need to cough it out.

Swollen Tonsils 

When there are tonsil stones in your tonsillar crypts, the bacteria basically trigger a constant cycle of irritation and inflammation. As a result, your tonsils swell or stay swollen, even if you’re treating other possible risk factors. Remember, your tonsils are lymph nodes, so it’s common for them to swell or make it difficult to swallow if your immune system is fighting off an infection.

White Or Yellow Debris On The Tonsil

Not all tonsil stones are visible. But when they are, you’ll usually notice a clump of white or yellow on your tonsil. Sometimes they take on a more greyish color. It will generally look like a circular area or spot on your tonsil, but like an iceberg, the biggest part is typically hidden from plain view.

At-Home Treatment

Most people who have tonsil stones will at least some point try to remove them on their own. I just want to insert a HUGE disclaimer right here that if you choose to do so, you have the possibility of seriously injuring yourself or even setting yourself up for an infection afterward. For example – some people use cotton swabs to push on their tonsils and force them out – which can potentially be a recipe for disaster. That being said…here are some of the most common DIY ways to remove tonsil stones at home.

1) Low-Pressure Irrigator

If your dentist has them on hand, ask for a low-pressure irrigator. Basically, it’s like a huge plastic syringe with a curved, tapered tip (there isn’t a needle) that people can put mouthwash or water in to flush out infected areas in their mouth. In this case, you can aim the tip so that it sprays a steady stream of water around the sides of your tonsil stones to potentially loosen and flush them out.

Although a water flosser is a bit too heavy-duty to use, the ones with adjustable water pressure settings could also come in handy. Just start with the pressure on low and work your way up from there.

This method is a pretty messy way to treat tonsil stones, so you’ll need to make sure you have a handheld mirror while you’re leaning over the sink.  

2) Gargling Non-Alcoholic Mouth Rinses

Vigorous rinsing with a mouthwash can lower bacteria levels and potentially loosen your tonsil stone. Plus, the antimicrobial action could help prevent new stone growth.  

3) Gargling Warm Salt Water

Saltwater rinses help soothe sore throats and reduce inflammation. If your tonsil stones are causing irritation, the saltwater may provide some sense of relief. For best results, dissolve one teaspoon of salt into an 8 oz. glass of water.

4) Apple Cider Vinegar Gargle

Some people claim that apple cider vinegar is good for helping to break down the particles that cause tonsil stones. But don’t rinse with it straight from the bottle. Instead, dilute one tablespoon into a cup of warm water. Use it once or twice a day as needed. Apple cider vinegar rinse may make a better preventative than it does an actual treatment (the same goes for adding onion and/or garlic to your diet.)

5) Cough

Coughing is a natural way to get rid of foreign debris like tonsil stones. So, if you feel like you can cough the stone loose, then have at it! Just be warned, coughing too hard could make you vomit or even burst blood vessels. But gentle coughing is still forceful enough to knock out tonsil stones that are already starting to work their way out. The same goes for swallowing firmer, crunchy foods that rub up against your tonsils when you’re swallowing them (like carrots or apples.)

6) Antibiotics

An antibiotic won’t physically remove your tonsil stone, but it can treat the source of where that bacteria is coming from. If you recently had your tonsil stones removed but have some type of recurring infection, your doctor might want to write you a prescription to treat tonsil stones.

Tonsil Stones Treated Medically 

It’s possible to have your tonsil stones professionally removed. But whether it’s done in-office or by surgery, you run the risk of possible re-infection as you heal or new scar tissue is created.

Laser Tonsil Cryptolysis 

One of the most least invasive medical treatments for tonsil stone removal is laser cryptolysis. Depending on the case, recovery is just a few days. This treatment option is best for people who have smaller sized tonsils. Just know that people who opt for laser tonsil stone treatment may sometimes need a second follow-up treatment. Since the procedure is performed with a laser, it helps the surgical site to heal more quickly and with less inflammation and discomfort.

Minor Surgical Procedures

If you don’t quite want to have your tonsils removed, but you know you need to have your tonsil stones cleaned out, your doctor or ENT can arrange to physically remove them during a minor surgical appointment. In most cases, a special tool is used to clean or suction the stone out of your tonsil crypts. You’re typically awake for this type of procedure, but it can be performed under general anesthesia if your tonsil stone is severe.

Coblation Cryptolysis 

Less painful than a tonsillectomy, coblation cryptolysis is a procedure that your ENT or surgeon can complete with just local anesthetic (numbing medication) instead of “putting you to sleep.” It’s best for people who have less sensitive gag reflexes since you’re awake throughout the duration of the treatment. No laser is necessary.


For large tonsil stones, the recommended treatment is usually a tonsillectomy. Of course, this is the most aggressive approach and requires outpatient surgery (usually under general anesthesia.) Healing times can take around a week or two. With a tonsillectomy, you completely eliminate the habitat where tonsil stones form, because your tonsils are taken out altogether. There is little to no chance of your tonsilloliths coming back.

How To Prevent Tonsil Stones

1) Practicing Good Oral Hygiene

The best way to prevent tonsil stones is to practice good oral hygiene. The less bacteria you have inside of your mouth, the lower the chances are that it’s going to get lodged in and around your tonsils. Although tonsil stones can’t be completely blamed on poor oral hygiene, having a good brushing and flossing routine could significantly lower your chances of getting tonsilloliths. 

2) Use Tongue Scraper

It’s said that our tongues house about 90% of the bacteria responsible for causing bad breath because of how well those germs can hide on the bumpy surface. Using a tongue scraper is one of the best ways to remove the most bacterial residue (compared to using a toothbrush on your tongue.) Tongue scrapers are a great tool to help prevent tonsil stones. 

3) Stopping Smoking

Quitting smoking will help prevent tonsil stones. Tobacco use – be it cigarettes, smokeless tobacco, or cigar smoking – can alter the tissues inside of your mouth and raise your risk of both stain and tartar buildup. So, it’s no surprise that it’s a risk factor for tonsil stones too! 

4) Gargling With Nonalcoholic Mouthwash

Alcohol-free mouthwash is gentler on your tissues and better for treating (and preventing) bad breath. The antimicrobial ingredients can help you prevent new tonsil stone growth.

5) Gargling With Saltwater

Saltwater is a natural anti-inflammatory that helps prevent tonsil stones. It’s safe to rinse with it a few times a day when you have a scratchy or irritated throat or need to lift away food residue after meals.

Risks To Consider If Left Untreated

Most people don’t worry about treating their tonsil stones until they become problematic. As such, you can always go without treating them if they’re not really bothering you. But chances are, even if you don’t notice the odor, other people will. Bad breath isn’t something you can just rinse away or cover up with a mint.

Plus, with tonsil stones constantly irritating your throat, it will make it difficult to swallow or increasing your risk of recurring tonsillitis. You run the risk of other symptoms being masked by the tonsil stones, possibly setting you up for a concurrent infection that you don’t even know about.

How Long Do They Last

Just like tartar on your teeth, tonsil stones are hard, calcified bacteria. They tend to stay where they are until they’re physically cleaned out or removed by a professional. Sometimes they’ll come loose on their own, but most of the time they have to be forced out. You very well could have a tonsil stone that’s there for years.

Are Tonsil Stones Contagious

No. The bacteria inside of tonsil stones are the same type of germs and particles that are floating around inside of our mouths at other times. The only difference is that they’re calcified in one specific area. You can’t get them by drinking after, sharing food with, or kissing someone that has tonsil stones. But keep in mind, you might see tonsil stones run in families, since parents pass their genetic traits on to their children.

When To See A Doctor 

If you have noticeable tonsil stones that are causing a chronic sore throat, difficulty swallowing, or bad breath, then it’s time to see a doctor. Even if you’re not worried about the tonsil stone, you need to rule out other potential infections since your lymph nodes are involved. Chronic swollen tonsils could be linked with other types of infections as well.

By the time a tonsil stone is visible, it’s best to have it evaluated. Although tonsilloliths are typically bothersome anomalies, you still need to make sure that’s what is actually on your tonsils.

Problems like chronic halitosis are a serious concern when tonsil stones are present. No matter how well you’re brushing, flossing, rinsing, or cleaning your tongue, there may still be some odor behind. And since the smell can affect everything from your professional to your private life, a doctor is the only person who can help.

Tonsil Stones Recap

Tonsil stones are hard, mineralized deposits that form in the pits and craters (crypts) on the surface of your tonsils. They’re also called tonsilloliths. They can cause symptoms like bad breath and a sore throat. Some people are able to remove them on their own or with DIY home remedies, while others rely on the professional recommendations or surgery from their doctor. Bottom line don’t ignore them. You don’t want the symptoms to mask a more serious infection and run the risk of an undiagnosed health problems. 

 Whitney DiFoggio MA, RDH
Written by Whitney DiFoggio MA, RDH"Teeth Talk Girl," is a registered dental hygienist. She started her dental health journey on YouTube, educating the public through videos.
Dr. Matthew  Hannan DDS
Medical Reviewed byDr. Matthew Hannan DDSDr. Matthew Hannan is a board-certified dentist and graduate of UT Health San Antonio School of Dentistry.
Last updated onNovember 16, 2023Here is our process

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