What are tonsil stones?

Tonsil stones, or 'tonsilloliths', are small lumps of hardened material that can form in your tonsils. They can cause bad breath and most commonly occur in teenagers. The stones are usually small — it is rare to have a large tonsil stone.

Tonsil stones are not harmful and may not need to be treated, but surgical options are available if they become a problem.

What are the symptoms of tonsil stones?

Many people with tonsil stones don't experience any symptoms.

In people who have symptoms, they can cause:

• bad breath
• cough
• earache
• sore throat
• a bad taste in your mouth

If you have tonsil stones, you might find it hard to swallow. It might feel like there's something stuck at the back of your throat. You might be able to see small patches of white on your tonsils.

Tonsil stones can also trigger infections that can be difficult to treat with antibiotics.

Sometimes they are found incidentally on a scan or x-ray or during a dental examination.

CHECK YOUR SYMPTOMS — Use the Symptom Checker and find out if you need to seek medical help.

What causes tonsil stones?

Your tonsils are glands found at the back of your throat that help protect you against infection. Tonsil stones are formed by debris that can build up in your tonsils. Most tonsil stones are small, usually under 5mm across.

The glands contain folds known as tonsillar crypts (folds). If your tonsillar crypts are enlarged, minerals such as calcium can become trapped, and calcify (harden) into stones. Bacteria or fungi that cause tonsillitis can also cause tonsil stones to form.

How are tonsil stones diagnosed?

If you think you might have tonsil stones, your doctor will ask about your symptoms and examine you. The stones might or might not be visible. An imaging scan might help to find them if they are not obvious.

How are tonsil stones treated?

Tonsil stones are not a health risk, and often go away on their own.

There is no specific treatment for tonsil stones, but you can manage any symptoms they cause, such as bad breath.

Good oral hygiene is important. This includes:

• gargling with warm salt water
• brushing your teeth regularly
• managing any allergies that cause increased nasal mucus
• coughing to loosen the stones

During vigorous gargling, the tonsil stones may become detached.

Do NOT try to dislodge stones with a water jet or manually with a finger or dental swab. You can risk damage to your tonsils and complications such as infection, bleeding or choking.

When should I see my doctor?

Tonsil stones are usually harmless. Unless there are symptoms of infection, they do not usually require any medical treatment.

However, you should consult your doctor if you are experiencing any of the following:

• chronic sore throat that lasts more than a month
• reoccurring bouts of tonsillitis that are interfering with school or work
• breathing problems
• trouble swallowing
• severe pain, especially on one side, which can be a sign of an infection

Can I have my tonsil stones removed by surgery?

In rare cases,an ear,nose and throat (ENT) specialist might need to surgically remove your tonsil stones if they become too large to pass on their own.

How can I prevent tonsil stones?

You can help reduce your chance of tonsil stones forming by maintaining good oral hygiene:

• Brush your teeth twice a day, or after meals.
• Floss once a day to stop food getting trapped between teeth and in hard-to-reach areas.
• Clean your tongue to prevent plaque bacteria build-up on the surface of your tongue.
• Gargle with saltwater or an alcohol-free mouthwash to neutralise bad breath.
• See your dentist for regular check-ups and cleaning.

Drinking plenty of water can also help prevent tonsil stones. Hydration helps limit build-up of debris and keep saliva production up for a healthy mouth.