What is it?
The surface of the tonsils carries pits called crypts. Food debris, shed cells, saliva and bacteria collect in these pits; over time they harden into white or yellowish lumps that can reach the size of a lentil. These are called tonsil stones, or tonsilloliths. In themselves they are not an infection.
Many people who have these stones have no symptoms at all, and the stones are noticed by chance. When symptoms do appear, the ones most often described are a bad smell on the breath, the feeling of something caught in the throat, and foul-smelling lumps that now and then drop into the mouth. A high temperature and severe throat pain are not the expected findings here; those point more towards tonsillitis.
The reason this subject concerns a dental clinic is bad breath. In some of the people who come in about a smell, the symptom carries on after an examination of the mouth, having the tartar removed and cleaning the tongue. In that situation the source may lie outside the mouth, in the tonsils. Dentistry does not treat this picture; it assesses and rules out the causes inside the mouth, and refers you on.
Signs
You will not necessarily have all of these at once.
Why does it happen?
- 01
The structure of the tonsil crypts
Where the crypts are deep and many in number, debris collects more easily. This structural feature varies from person to person and helps explain why the stones keep coming back in some people.
- 02
Repeated bouts of tonsillitis
After previous bouts of inflammation the crypts can widen and the surface can become irregular. That change creates ground more open to build-up and adds to the symptoms carrying on.
- 03
Post-nasal drip
Discharge coming from the nose and sinuses and passing over the tonsil area can add to the build-up. That same discharge is also, in itself, one of the common causes of bad breath.
- 04
A dry mouth and too little saliva
When the washing effect of saliva drops, debris stays in the crypts for longer. Breathing through the mouth, some medicines and salivary gland problems can all deepen that dryness.
How does it progress?
- Silent
A stone that produces no symptoms
It is seen by chance during an examination. There is no smell, no sharp sensation and no feeling of something caught; in this situation no procedure aimed at the stone may be needed.
- Smelly
A stone that shows up as bad breath
The only symptom is a bad smell on the breath and in the mouth. Lumps come up with a cough or drop into the mouth on their own, the smell eases for a while and then comes back.
- Caught
A stone that feels like a foreign body
A stone that has grown can give a sharp sensation on swallowing and a feeling of something caught in the throat. In some people the discomfort is felt towards the ear.
- Recurring
A stone that keeps forming again
It forms again soon after being cleared, and bouts of inflammation are sometimes added. In this group, longer lasting options are talked through with an ear, nose and throat specialist.
How is it treated?
The doctor to see about this picture is an ear, nose and throat specialist. A tonsil stone does not clear with a dental treatment; having the tartar removed, fillings, root canal treatment or mouthwashes will not change the outcome if the source of the smell is in the tonsils. The dental clinic's role here is to assess and rule out the causes inside the mouth, namely gum inflammation, decay, build-up on the back of the tongue and denture hygiene, and then to refer you on.
At the ear, nose and throat examination the tonsils are looked at directly and assessed; if it is thought necessary, an endoscopic examination is carried out. Where the stones produce no symptoms, keeping an eye on them is most often found to be enough. Stones that can be seen may be cleared there and then. Where they come back often and affect daily life, procedures aimed at the crypts or removal of the tonsils may come onto the agenda; that decision and its timing rest with the doctor involved.
It is worth being careful about dealing with these yourself. Poking at a tonsil with hard or sharp objects can lead to bleeding and damage the tissue, and a damaged surface can become more suitable ground for fresh build-up. Even before trying gentler methods such as a mouthwash, it is sensible to ask your dentist or doctor.
- If one of your tonsils stays constantly larger than the other
- If there is bleeding coming from your throat
- If one-sided throat pain or difficulty swallowing carries on for weeks
- If a hard, painless swelling in the neck that will not go away has been added
How is it prevented?
- Do not let your fluid intake drop during the day; a mouth left dry makes build-up easier.
- Clean the back of your tongue regularly with a soft scraper; that is how you can tell how much of the smell is coming from inside your mouth.
- If you have post-nasal drip or a blocked nose that carries on, have that assessed separately.
- Do not poke at your tonsils with hard objects.
Frequently asked questions
- Are tonsil stones the cause of my bad breath?
- No definite answer can be given without an examination. Most bad breath comes from causes inside the mouth, such as build-up on the back of the tongue and gum inflammation. If the smell carries on once those have been assessed and dealt with, sources outside the mouth such as the tonsils, post-nasal drip and the digestive system come into the picture.
- Can I remove the stones myself?
- Small lumps that you can see most often come up with a cough or drop out on their own. Poking at them with hard objects carries a risk of bleeding, pain and tissue damage, and it does not stop the stones forming again either. If the symptoms carry on, it is safer to leave the assessment to an ear, nose and throat specialist.
- Do the tonsils need to be taken out?
- That decision rests with the ear, nose and throat specialist, and it is not made for everyone. Where the stones produce no symptoms, no procedure is most often needed. Where there are frequent bouts of inflammation, or a constant smell that affects daily life, the options are weighed up together with the doctor.
This content is for general information and does not replace an in-person examination. Symptoms overlap between conditions, and a diagnosis can only be made clinically.