What are tonsil stones?

Tonsil stones, also called tonsilloliths, are small, hard lumps that can form in the tiny pockets on your tonsils.

Your tonsils are small, soft tissues at the back of your throat. They are part of your immune system and help protect your body against infection.

Tonsil stones are made of calcium, bits of food, bacteria and dead cells. Small tonsil stones are common and usually don't lead to problems. Larger stones may lead to bad breath, a sore throat or the feeling of something stuck in your throat.

Tonsilloliths are not the same as tonsillitis. Tonsillitis is when your tonsils become swollen and sore. Tonsil stones are solid lumps that form in the pockets of your tonsils.

What are the symptoms of tonsil stones?

Many people have small tonsil stones and don't have any symptoms. Larger tonsil stones may lead to symptoms, such as:

• bad breath
• difficulty swallowing
• earache
• sore throat and hoarseness
• a feeling of something stuck in the throat
• visible white or yellow stones in the tonsils

What causes tonsil stones?

Tonsil stones happen when bits of food, dead cells and bacteria get stuck in the small pockets of your tonsils. Over time, this material can harden into small lumps.

You may be more likely to develop tonsil stones if you have:

• poor oral hygiene
• frequent tonsil infections
• deep pockets in your tonsils

When should I see my doctor?

See your doctor if you have symptoms of tonsil stones that are leading to discomfort. Also see your doctor if your tonsil stones are not improving with self-care. Signs may include:

• persistent bad breath that doesn't improve with good oral hygiene
• a sore throat or the feeling of something stuck in your throat
• difficulty swallowing or ear pain that doesn't improve
• large or visible tonsil stones
• pain or irritation in your throat

If you notice any of these symptoms, or if your tonsil stones keep coming back, see your doctor.

How are tonsil stones diagnosed?

Tonsil stones are usually diagnosed during a physical examination by your doctor. Your doctor may look at your throat to check for stones in your tonsils.

They may also ask about your symptoms, such as bad breath or throat irritation. Most of the time, tonsil stones can be found during a simple check-up.

Sometimes, imaging tests may be used to find stones that are not visible but are causing discomfort. Imaging tests may include:

• ultrasounds
• x-rays
• CT scans — usually only needed if your doctor is worried about something other than tonsil stones causing your symptoms

How are tonsil stones treated?

Tonsil stones often go away on their own without the need for treatment. Good oral hygiene is important, such as brushing your teeth and gargling with saltwater. You can also take steps to help lessen bad breath:

• Clean your tongue — use a soft toothbrush to clean the back of your tongue, where bacteria can build up.
• Rinse with mouthwash — use an antimicrobial mouthwash with ingredients such as zinc or chlorhexidine.
• Stay hydrated — drink plenty of water to prevent dry mouth, which may lead to bad breath.

In rare situations, your doctor may recommend surgery to remove your tonsils (tonsillectomy). Your doctor may recommend surgery if the tonsil stones grow too large and cannot come out on their own, or if your symptoms continue despite self-care.

What are the complications of tonsil stones?

Complications from tonsil stones are rare. Large tonsil stones may press against nearby areas, leading to damage or tissue death in the affected areas.

Can tonsil stones be prevented?

You can help prevent tonsil stones by keeping your mouth clean. This may lessen your chance of bacteria and debris building up in the tiny pockets of your tonsils.

Resources and support

• Sydney Children's Hospitals Network provides a tonsillectomy fact sheet.
• Queensland Government offers information about bad breath.
• Queensland Government also offers information about toothbrushing and flossing.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available 24 hours a day, 7 days a week.

Looking for information for Aboriginal and/or Torres Strait Islander people?

View the Aboriginal Health Council of South Australia's oral health poster.