What does this mean?
The surface of the tonsils is not smooth; it is covered with narrow pockets called crypts. Dead cells, food debris and bacteria collect in these pockets. Over time the packed mixture takes up calcium and turns into white or yellowish, fairly soft lumps about the size of a grain of rice. They can drop into your mouth on their own while you cough, swallow or brush your teeth.
The point that tells them apart is the smell and where the smell comes from. When these lumps are crushed they give off a strong, sulphurous odour, and for many people bad breath begins exactly here. What sets it apart from a smell coming from the teeth is that it carries on even when oral care is faultless. A scale and polish, tongue brushing and mouthwash do not reach inside a tonsil crypt; so a smell that does not respond to oral care is worth assessing from the tonsil side.
These lumps are harmless most of the time and do not in themselves mean a disease. Even so, they need to be told apart from the widespread white coating seen in tonsillitis: a stone is small, comes away one at a time, is usually painless and does not cause a fever. A widespread white membrane that goes with fever and severe, one-sided throat pain is a different picture and is assessed separately.
The source of the white lumps that come into your mouth is most often the structure of the tonsils themselves; conditions that make the build-up easier, such as a dry mouth and postnasal drip, may go along with the picture as well. The headings below gather these possibilities.
Likely causes
What helps at home?
- Do not use a toothpick, needle, fingernail or any hard object to get the lumps out; tonsil tissue bleeds easily, and a pocket that has been damaged may lead to even more build-up.
- Gargling with warm salt water after meals and before bed, together with regular oral care that also covers the back of the tongue, may reduce the build-up.
- Keep your mouth from staying dry; drinking water through the day and breathing through your nose as much as you can help your saliva to clear the pockets on its own.
- Trying to cover the smell with alcohol-based mouthwashes may dry the mouth even further. Note down instead how often the lumps appear; that information helps in working out whether the source is inside the mouth or in the tonsils.
- If the throat pain has settled on one side and has not gone away for days
- If you have trouble swallowing or find it hard to open your mouth
- If fever, tiredness and enlarged glands in the neck have been added to the picture
- If you have noticed a one-sided hard area or growth on a tonsil that does not go away
- If you see blood in your saliva, or your voice has been hoarse for weeks
Frequently asked questions
- Can tonsil stones be the only cause of bad breath?
- In some people they are the only cause. The most common sources of bad breath are the coating on the back of the tongue and gum disease; if the smell carries on even after these have been treated, tonsil crypts, postnasal drip and reflux are considered in turn. For that reason the inside of the mouth is assessed first, and if the smell cannot be explained from there, an ear, nose and throat assessment is added.
- Will it go away if I have a scale and polish?
- A scale and polish reduces the smell coming from the gums, but it does not reach the build-up inside a tonsil crypt. If the source is the tonsils, the smell is expected to carry on after the cleaning. That is why, in someone who comes in about bad breath, the findings inside the mouth and the findings on the tonsils are assessed together, and a referral is made where needed.
- Do tonsil stones come back?
- As long as the crypts stay where they are, the build-up may happen again. Regular oral care and gargling may make it less frequent, but they do not change the structure of the crypts. Where it recurs very often and affects daily life, an ear, nose and throat specialist weighs up the other options; that decision is made according to the state of the tonsils and how often the problem occurs.
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.