Tonsilloliths or tonsil stones form in the crevices of the tonsils, the small, soft tissue glands on both sides of the back of the throat. While the growths do not pose an immediate health risk, symptoms of tonsil stones can be unpleasant and uncomfortable, causing bad breath and throat pain. Stones that grow abnormally large may require minor surgery.
Tonsil stones are tiny, pebble-like pieces of bacteria, dead cells, food particles, and mucus that collect in tiny crevices dotting the surface of the tonsils (tonsil crypts). They are composed of magnesium and calcium salts such as oxalates, ammonium radicals, and hydroxyapatites. The white or gray stones often remain undetected until a dentist discovers them during an examination.
Oral anaerobic bacteria flourish in low-oxygen conditions, such as the environment in and around tonsil crypts. When combined with a chronically dry mouth or poor oral hygiene, anaerobic bacteria reproduce rapidly because the antibacterial properties of saliva do not prevent it. Food debris, dead skin cells, and oral mucous not removed through regularly brushing or flossing can further exacerbate the issue.
Some people frequently experience tonsillitis and other tonsil-related illnesses that can also cause tonsil stones. Tonsillitis is an infection that develops when the glands cannot fight off the viruses and bacteria attacking them. Tonsillitis causes increased bacterial growth, oral mucous, and dry mouth. The recurrent inflammation that people with tonsillitis experience creates an environment that makes it easy for tonsil stones to form.
People suffering post-nasal drip due to chronic allergies, sinusitis, or other respiratory conditions that irritate nasal passages often develop tonsil stones. Excess sinus drainage flowing into the back of the throat, combined with a lack of saliva, creates the perfect environment for bacteria to multiply, accumulate, and eventually calcify into tonsil stones.
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One of the first symptoms of tonsil stones is chronic halitosis or bad breath. In many cases, the stones dislodge from tonsil crevices, and the person accidentally bites down on them, releasing the volatile sulfur compounds and other foul-smelling gases created by bacteria. Other signs include
As the stones grow larger, the tonsils become irritated and swollen because they are trying to protect themselves from a perceived infection and force the objects out of the crevices.
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Often, people can safely remove their tonsil stones using cotton swabs or a toothbrush. Never use tweezers or other sharp objects, as they could pierce the tonsil tissue and cause a serious infection. On rare occasions, the stones grow larger than normal and cause painful symptoms. When they are too difficult to remove at home, a dentist can remove them with a local anesthetic.
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Antibiotics fight bacterial infections. However, anaerobic bacteria (the kind found in the mouth) produce an enzyme called beta-lactamase, which is resistant to many antibiotics, and this type of treatment is often ineffective in fighting tonsil stones. Antibiotics also do not treat the underlying cause of the tonsil stones, but some physicians prescribe them because they reduce the bacterial count in the throat.
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Various oral hygiene practices can help prevent tonsil stones. Brushing your teeth and tongue twice a day, rinsing your mouth with an oxygenating mouthwash, and drinking water after meals to wash down food particles remaining in the throat can all lower the risk of unwanted bacterial growth. Additionally, irrigating the tonsils with an oral irrigator can stop debris and bacteria from accumulating in the crevices. Avoiding alcoholic drinks can also help, as alcohol is a diuretic and contributes to a dry mouth. Some sources recommend that people with recurring tonsilloliths eliminate dairy. There is no evidence that dairy causes tonsil stones, but people who are allergic can develop throat symptoms.
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Flossing between teeth before brushing removes food particles and helps reduce anaerobic bacteria growth. Flossing also removes plaque, which is composed of bacteria and causes tooth decay, gum disease, and periodontitis. Always floss with clean material and dispose of the used floss immediately. Though gingivitis, unfilled cavities, and poor oral health significantly increase the risk of tonsil stones, even people who take good care of their teeth and gums can develop them.
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People experiencing repeated bouts of tonsillitis are more prone to tonsil stones simply because the tonsillitis infection is a breeding ground for bacteria. The only way to guarantee an end to the infections is to have the tonsils surgically removed. A tonsillectomy is minimally invasive, and the surgeon performs the surgery using general anesthesia. Recovery time following a tonsillectomy is typically two or three days.
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