What Is the Main Cause of Tonsil Stones and Ways to Remove Them?

Tonsils play an important role in our body’s immune systems. They contain white blood cells, the first line of defence against viruses and bacteria that enter through the mouth and nose. We have 3 types of tonsils, namely palatine tonsils, lingual tonsils, and adenoids. The palatine tonsils are those we see at the back of our throats. Your tonsils can develop tonsil stones if you are not careful. So, what are tonsil stones, how do they manifest, why are they dangerous, and how can they be prevented and removed? Our dentist in Bolton answers all of these questions below.

What Are the Tonsil Stones?

Tonsils have tonsillar crypts which look like crevices, pits, or tunnels. Tonsil stones are small white or yellow lumps made up of live biofilm, dead cells, mucus, and bacteria that get trapped in these tonsillar crypts and harden or calcify.

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The body’s white blood cells attack the foreign objects, but when the white blood cells are finished, the hard particles remain on the tonsils. Most of us have been swallowing tonsil stones left behind without even knowing there was something there in the first place. However, if these particles are lodged into the crypts, they continue to grow with time. Tonsil stones, also called tonsilloliths, should be dealt with properly to prevent a myriad of problems, including:

• Tonsil stones give you bad breath. This makes conversing with your colleagues, friends, and relatives awkward and can even affect your self-esteem.
• Large tonsil stones can make the tonsils swell, giving you trouble swallowing.
• Large tonsil stones can disrupt or damage normal tonsil tissue, which can cause significant swelling, inflammation, and even infection. The most serious tonsil stones complication is a deep infection called an abscess.

What Causes Tonsil Stones

Tonsil stones are a fairly common problem, with up to 10% of the population experiencing the issue. The stones are not contagious, and biological sex does not influence the chances of having the stones. Common causes and risk factors of tonsil stones are:

• Tonsillitis: Tonsil stones are most prevalent in people who have repeated cases of tonsillitis or who have long-term inflammation in their tonsils.
• Poor dental hygiene: If you do not brush your teeth well, food, cellular debris like skin cells, and plaque can collect in the pits and crevices of your tonsils and cause tonsil stones.
• Are tonsil stones hereditary?Our tonsils are shaped differently and come in different sizes. The shape and size of your tonsils are a big factor since some have more crypts than others.
• Sinusitis and allergic reactions: Sinusitis (inflammation of the sinus gland) and some allergic reactions often result in mucus build-up. This mucus can drain into the nasopharynx area and end up in the tonsillar pockets.
• Dry mouth: Dry mouth is a condition caused by the absence of salivary secretions. This can be caused by some medications like antihypertensives. Saliva has antibacterial agents and enzymes, and so a dry mouth encourages bacterial growth, which can lead to tonsil stone formation.

Difference Between Tonsil Stones and Tonsillitis

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Both tonsil stones and tonsillitis, which affect the tonsils, cause bad breath and make it difficult to swallow. However, the discomfort and difficulty swallowing are more pronounced in tonsillitis. This is where the similarities end, so it is important that you understand the differences so that you can get the right treatment, including home remedies.

• Tonsil stones are more common in adults, while tonsillitis is more common in children.
• While tonsil stones are small hard lumps on the tonsils, tonsillitis is the inflammation of the tonsils that causes swelling. Tonsil stones are white, yellow, or grey “stones”, while tonsillitis manifests as white or yellow spots or coating on the tonsils.
• Tonsil stones are caused by the accumulation of bacteria and other debris, while tonsillitis is caused by viral and bacterial infection, the most common virus being the common cold virus.
• Tonsillitis can occur at any time, but tonsillitis is most prevalent during the cold season due to its association with the common cold.
• Tonsillitis causes fever, while tonsil stones do not.
• Tonsillitis causes enlarged and tender lymph nodes in the neck, while tonsil stones do not.
• Tonsillitis can affect your voice, giving you a scratchy, throaty, or muffled voice. Tonsil stones do not affect your voice.
• While tonsillitis alters your taste, tonsil stones do not, and you will not even realize you have them in most cases.
• Tonsillitis is often painful, while you only feel discomfort in most cases of tonsil stones.
• Tonsillitis will clear once the infection is over, but tonsil stones will be there to stay until they are dislodged.

Symptoms of Tonsil Stones

Tonsil stones can grow to between 1 and 2 millimetres across. Larger ones can be up to 1 centimetre across. To the naked eye, they look like white, yellow or grey nodes on the tonsils. A dentist can physically see the tonsil stones at the back of your throat but note that some stones are burrowed down inside the tonsils. Other tonsil stone symptoms are:

• Can tonsil stones cause bad breath?Severely bad breath, or halitosis, is the main sign of tonsil stones. People with long-term tonsillitis also have high amounts of volatile sulphur compounds and are more likely to have tonsil stones.
• Sore throat: When you get tonsillitis and tonsil stones together, it becomes hard to know what is causing pain in the throat.
• Discomfort: Tonsil stones are associated with discomfort in the throat. Although generally, they are not painful, you will get a foreign body sensation at the back of your throat:
• Cough: When tonsil stones irritate the throat, they can make you cough.
• White debris: The solid white lump on your tonsils may be visible when a doctor checks at the back of your throat.
• Trouble swallowing: Depending on the size and location of the tonsil stones, it may be hard to swallow foods and liquids.
• Ear pain: Tonsil stones can develop anywhere in your tonsils. Since the nervous system has some shared nerve pathways, you may experience pain in your ear, even when the stone is not touching the ear.
• Swollen tonsils: Tonsil stones cause inflammation of the tonsils and sometimes infection, making the tonsils swell.

Note some conditions mimic the symptoms of tonsil stones. These include tonsillitis, strep throat, untreated infections in the gums and teeth that spread throughout the mouth, and tonsil cancers like lymphoma and squamous cell carcinoma. It is, therefore, important that you consult a doctor to determine if what you have is tonsil stones or something else.

How to Diagnose Tonsil Stones

If you exhibit the symptoms of tonsil stones, the dental or medical practitioner can do a physical inspection inside your mouth and throat using a lighted instrument. However, the most effective way to diagnose the stones is a CT scan of tonsilloliths. However, even CT scans are rarely used for tonsil stone diagnosis – the stones are usually accidentally found in imaging studies of other conditions.

How to Get Rid of Tonsil Stones

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If the tonsil stones are not bothering you, then home remedies are enough. However, if the discomfort is too much or the stones are causing an infection, treatment at your dentist’s office is recommended. Tonsil stone treatment options include:

1. Curettage: Curettage/scooping may be required to remove larger tonsil stones. Irrigation will, however, still be required to wash out smaller pieces. Local excision is required for larger lesions. Note that curettage and excision may not completely help with the bad breath.
2. Laser: Laser resurfacing can be used to decrease the surface area of the crevices or crypts of the tonsils. Laser resurfacing of the crevices and crypts, also called laser cryptolysis, can be done under a local anesthetic. The procedure involves the use of a scanned carbon dioxide laser to selectively vaporize and smooth the surface of the tonsils.
3. Tonsillectomy: Tonsillectomy, or the removal of the tonsils, may be necessary if there is persistent bad breath resulting from tonsillar stones. This can be done with a scalpel, a coblation device, or a laser. Given the important role, tonsils have on our immune system, this should only be left for severe, chronic cases after other solutions have failed.
4. Coblation cryptolysis: With coblation cryptolysis, there is no use of heat. Instead, radio waves react with a salt solution, transforming it into charged ions that can cut through tissue. Coblation cryptolysis, just like laser cryptolysis, flattens the tonsil crypts without a burning sensation.
5. Antibiotics: Antibiotics can lower the count of bacteria that are responsible for the development and growth of tonsil stones. However, antibiotics are not the best tonsil stone removal method as they will not be treating the underlying cause, and the stones can come back when you stop using them.

Can You Remove Tonsil Stones Yourself?

Are you wondering what to do about tonsil stones? There are several home remedies that have been shown to be effective against tonsil stones. They include:

• Saline gargle: Gargling warm, salty water is the most commonly used tonsil stones home remedy. It elevates the associated discomfort. When done vigorously, gargling can keep the tonsil crypts clear of most stones. Gaggling also helps change the mouth chemistry and can help get rid of bad odour.
• Manual removal: Some people are able to dislodge and remove tonsil stones using their fingers or a cotton swab. Manual removal with rigid items like your toothbrush is not recommended since tonsils are delicate.
• Chlorhexidine or cetylpyridinium chloride: These solutions can be used in the place of gargling salt water.
• Oral irrigators: You can use an oral irrigator to dislodge the tonsil stone. However, note that most electric oral irrigators are too powerful and can cause discomfort or even rapture the tonsils. The best irrigators are those that connect directly to the sink tap through a threaded attachment since they can jet water at low pressure.
• Essential oils: Some essential oils have antibacterial and anti-inflammatory properties, good examples being thieves oil, myrrh, and lemongrass. You can dilute these essential oils in carrier oils and place 1 or 2 drops on your toothbrush before brushing the stones.
• Vinegar: Vinegar, including apple cider vinegar, is acidic and can help break down the tonsil stone. Dilute the vinegar with water and gargle.

Can tonsil stones dislodge themselves, and can I swallow tonsil stones? Yes, they can dislodge themselves, and there is no danger in swallowing the stones.

What Are the Ways to Prevent Tonsil Stones?

The only way to be 100% sure that you will never get tonsil stones is to do a Tonsillectomy, but this is not advisable. The next best thing is to reduce the risk of getting dry mouth and tonsil stones in the following ways:

• Practice good oral hygiene. Brush and floss after every meal. Do not forget to clean the back of your tongue when brushing your teeth to keep away the bacteria.
• Stop smoking. If you are a smoker, stop smoking as this messes up the mouth chemistry and increases the risk of getting tonsil stones.
• Use a mouthwash. Mouthwash can help flush bacteria and debris down the throat, making tonsil stones less likely to form. The best mouthwashes are non-alcoholic ones.
• Eat foods with strong antibacterial properties. Foods like onions and carrots have strong antibacterial properties, which can help fight bacteria that contribute to tonsil stones. Saliva helps push down debris and bacteria in the mouth, and you should, therefore, consider chewy foods that help increase saliva, like carrots and non-sugar chewing gums. You can also eat yogurt that has probiotics to help counteract the bacteria causing tonsil stones. Garlic has strong antibacterial, antiviral, and antifungal properties that help combat bacterial growth and cure infections.
• Drinking plenty of water is another way how to avoid tonsil stones – waterwashes down bacteria and debris in the mouth.

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