Did you know that tonsils, those small, glandular structures lying in the back of your throat were once primarily responsible for preventing harmful pathogens from entering our bodies via the nose and mouth? Today, however, tonsils have lost their evolutionary advantage to our matured immune systems and also to technological advances that have created a cleaner, more antiseptic society. Because the presence of our tonsils is now inconsequential to our ability to fight infections, they are frequently instigators of health problems rather than supporters of the immune system. One major inconvenience generated by our essentially useless tonsils is the development of tonsilloliths, or tiny, pebble-like particles commonly referred to as tonsil stones. This guide is aimed at helping you understand tonsil stones – their causes and symptoms – as well as how to prevent and treat them.

What Are Tonsil Stones?

Tonsil stones, also known scientifically as tonsilloliths, are irregularly shaped, whitish/yellow, foul-smelling globs of mucus and bacteria that get caught in the back of the throat. The tonsil stones form in the tonsil crypts, which are simply small pockets or divots that appear in everyone’s tonsils.

It is only recently that the oral care community has begun to understand what these white spots actually are. Many people have reported that their dentist told them that they were just extra food debris, which is not true! These tonsillar stones don’t do any physical harm and sporadically coughing them up doesn’t mean that there is anything wrong with you. However, they can be annoying (who wants to cough one up while they are kissing someone?), and usually they are an indication that you have bad breath.


A tonsil stone begins to take shape when tiny pieces of mouth debris that have collected in the mouth due to lack of saliva flow (dry mouth), chronic respiratory illnesses or poor oral hygiene become trapped in tonsil fissures. Calcification of these elements rapidly occurs, turning the chunk of mouth detritus into a small, whitish, hardened tonsil stone. If you have ever broken open a tonsil stone, then you know that they smell absolutely terrible! The smell is actually caused by a combination of volatile sulfur compounds, post nasal drip, and bacteria.


A Tonsil Stone

The smell produced by a tonsillolith is usually contained within the tonsil stones themselves. Unless it actually breaks open in the back of your throat, this odor is not usually released. However, if you are creating these tonsillar stones, then you most likely have the exact same oral environment that is conducive to a bad breath problem – either occasional or chronic. This is because the exact conditions that cause tonsil stones; post-nasal drip, dry mouth, white tongue, excess mucous, are also very likely to cause halitosis.

For more information on halitosis and all of its causes, we highly recommend taking a moment to download a free ebook called The Bad Breath Bible. This highly informative ebook, written by Dr. Harold Katz, tells you everything you need to know about breath issues, and how to stop them.

Causes of Tonsil Stones

Tonsil stones will only form in people who still have their tonsils. However, that does not mean you should run out and get your tonsils removed! There are various treatments to get rid of them, without having your tonsils removed – which can be dangerous as people get older.

Why do some people suffer from tonsil stones while others do not? When investigating possible causes of tonsil stones, it is important to understand that the tonsils are not the root cause of tonsil stones but only provide a medium in which tonsil stones develop. Our tonsils evolved to assist our immune system by trapping bacteria, viruses and other pathogens before they reach the bloodstream and organs. The crevices covering the surface of the tonsils are specially designed to filter the air we breathe and prevent harmful microorganisms from escaping into the interior of the body. Tonsil surfaces are comprised of crevices known as “tonsillar crypts” and accumulations of protein-rich mouth debris collect in these crevices. Coupled with excess mucus and anaerobic bacteria growth, this debris eventually calcifies into tonsil stones.

If tonsils did not possess such a moist, deeply wrinkled surface, tonsil stones would not be able to develop and lodge themselves into these tonsillar fissures.

10 Tonsil Stone Causes

  1. Food particles – poor oral hygiene is a known contributor to tonsil stones. When someone does not brush, floss and rinse regularly, food particles collect in between teeth and in the tiny pockets existing where the teeth meet the gums. Decaying food bits in the mouth attract harmful bacteria that feed on the proteins in the food. When food particles are not removed in a timely manner, they help bacteria reproduce by the billions, which encourages tonsil stone formation as well as gingivitis-causing plaque and tooth decay.
  2. Anaerobic bacteria – primarily responsible for tooth decay and gum disease, anaerobic bacteria is also the primary cause of halitosis also known as chronic bad breath. This type of oral bacteria excretes volatile sulfur compounds after consuming proteins found in mouth debris. Volatile sulfur compounds, or VSCs, are comprised of gases such as skatole and cadaverine, two malodorous fumes that smell like decaying flesh. These bacteria cluster around debris particles that find their way into tonsillar crypts where they swiftly reproduce and promote the creation of tonsil stones
  3. Mucus and phlegm – nasal passages that remain chronically irritated by allergies, sinusitis and other respiratory illnesses produce mass quantities of mucus that drip down the back of the throat. Unable to keep up with the excess mucus, the throat becomes a thriving breeding ground for anaerobic bacteria nourished by unrelieved accumulations of mucus and phlegm.
  4. Dry mouth/xerostomia – having a dry mouth not only prevents saliva from cleansing the mouth but also gives bacteria the perfect environment in which to proliferate. Anaerobic bacteria cannot live in oxygenated conditions so a mouth that is chronically dehydrated and stagnant encourages rapid production of bacteria that compose a large part of tonsil stones. Post nasal drip and dry mouth frequently accompany each other because illnesses that cause post nasal drip often create swelled nasal passages that make it hard to breathe normally through the nose.
  5. Dead white cells – because tonsils are associated with the immune system, any time the system detects a potential pathogen embedded in tonsillar crypts, it immediately floods that area with white blood cells, or macrophages. White cells are considered the natural “antibiotic” produced by the human body in response to viral and bacterial infections. Once these disease-attacking cells surround particles inside tonsil fissures and expend themselves, they simply die and add to the particle’s mass, whether it is a bit of food or tiny blobs of mucus.
  6. Abnormal oral pH levels – a fluid’s pH level determines whether it is acidic or alkaline. When the pH level of the mouth is too low–below 5.5–an acidic condition exists that encourages bacterial growth. In addition, an acidic environment will rapidly demineralize tooth enamel that leads to cavities, tooth decay and gum disease. Dry mouth is a major cause of low oral pH levels, along with poor oral hygiene and bad dietary choices. Normalizing oral acidic levels involves avoiding foods high in sugar, flossing and brushing twice a day and using oral hygiene products containing xylitol and sodium bicarbonate
  7. Excess blood cells and dead tissue – people who suffer from frequent mouth lesions such as canker sores or gum disease like gingivitis provides an extra food source for anaerobic bacteria. Blood cells and pieces of dead skin are rich in the proteins that bacteria love to consume.
  8. Oral fungal infections – oral thrush, medically referred to as Candida, is a fungal infection that arises in response to a compromised immune system. Reasons for developing thrush include being elderly; taking some kind of steroid medication or antibiotics; receiving radiation or chemotherapy; experiencing various health problems and being diabetic. Bacterial growth within a mouth that is suffering from a fungal infection is explosive, resulting in the rapid creation of tonsil stones.
  9. High dietary intake of dairy products – consuming large amounts of cheese and milk, which are full of proteins, often cause dry mouth, elevates oral acidic levels and assists in the calcification process that hardens tonsil stones. In addition, milk exacerbates mucus density lying in the back of the throat due to post nasal drip, adding to the difficulty of eliminating phlegm and harmful bacteria within the mouth.
  10. Recurring tonsillitis – frequently inflamed tonsils promote tonsil stone development because of the excess bacteria infecting the tonsils. Since tonsilloliths are primarily comprised of oral bacteria, repeating bouts with tonsillitis will only accelerate tonsil stone development

Inspecting Tonsils for Tonsil Stones


Tonsil Stone stuck in the Tonsil Crypt

If you suspect that you may have tonsil stones, take a cotton swab or toothbrush and look into a mirror as you gently prod the tonsils. Spreading crevices apart may help reveal tonsil stones that were previously concealed by these small fissures. When tonsils stones are large enough, you will be able to see them without using objects or other aides because they will protrude from the fissures and appear like tiny, yellowish white specks.

Tonsil Stones Symptoms

If someone has never experienced tonsil stones, he or she may remain unaware of the existence of tonsil stones and think that symptoms such as bad breath, sore throat, swallowing difficulties (lump in the throat feeling), an unpleasantly metallic taste in the mouth, and ear pain are an indication of some other medical condition. While tonsil stones can usually be seen by examining the tonsils close-up with a mirror or having another person check for tonsil stones, they can also be too small or too deeply embedded in a tonsil’s fissures to be viewed without magnification or even an x-ray. In this case, it is the family physician that usually discovers tonsil stones the affected individual visits their doctor for treatment. Tonsil stones rarely cause medical problems that require a visit to the doctor but the symptoms they do provoke, especially severe halitosis, can disrupt daily life and be embarrassing as well.

Here are some common symptoms of tonsil stones:

Bad Breath – The most common complaint given by people suffering from recurrent tonsil stones is the horrible bad breath they cause. Because tonsilloliths are comprised mainly of putrefying mouth debris and anaerobic bacteria, the odor emanating from a tonsil stone is worse than bad breath unaccompanied by tonsil stones. People with tonsil stones say that no matter how many times they brush their teeth or gargle during the day, halitosis still lingers simply because the tonsil stones remain embedded in tonsillar crypts until they are removed.

Worsening bad breath from tonsil stones are other conditions often accompanying development of tonsilloliths, such as post nasal drip. Allergies and chronic sinusitis infections constantly irritate nasal passages and forces excess drainage and mucus to flow into the throat. As this phlegm thickens and becomes difficult to swallow, anaerobic bacteria swarm into this stagnant, airless environment and start to consume the mucus. Consumption of this protein-rich oral debris promotes bacterial excretion of highly odorous, sulfuric gases called volatile sulfur compounds (VSCs) that are entirely responsible for severe bad breath.

In addition, these bacteria help create tonsil stones as mucus, food particles and dead tissue cells bind together in tonsil fissures, attracting vast amounts of anaerobes as the calcification process begins to form a tonsillolith. While tonsil stones smell on their own, a stone that is bitten or broken will release concentrated quantities of bacteria and mouth debris that smell ten times worse than the stone by itself.

Sore Throat – Larger than normal tonsil stones may cause sore throats or the feeling of having a “lump” in the throat that cannot be swallowed away. Usually, tonsil stones are very tiny and are detected only after chronic bad breath does not go away and the person sees one or more stones when inspecting the mouth. Stones are generally globular in shape but some could develop sharper edges that dig into sensitive tonsil tissue and produce pain that spread into the throat.

Bitter and/or Metallic Taste – When an odd taste remains in the mouth even after brushing, flossing and gargling every day, the culprit may be tonsil stones that are secreting heavy amounts of bacterial gases and a sticky discharge comprised of decayed material.

Coughing and Gagging – Tonsils stones that are embedded in tonsil areas closest to the middle of the throat may produce coughing spells that last until the stone is dislodged. For people who have sensitive gag reflexes, stones that are large enough to protrude from a tonsil and touch the back of the throat may initiate a gagging fit as well.

Chronic Tonsillitis – Recurring tonsil stones may irritate tonsils enough to trigger a response from the immune system which generates inflammation of the tonsils, or tonsillitis. People who suffer from chronic tonsillitis may want to inspect tonsils to determine whether tonsilloliths are aggravating tissues comprising the tonsillar crypts

Ear Pain – Secondary otalgia (ear pain) is pain occurring within the ear. When ear pain is caused by tonsil stones, this usually indicates the stones are in some way irritating the glossopharyngeal nerve, also called cranial nerve number nine, that connects the throat, tonsils and base of the tongue to the inner ear. Functions of this nerve include reception of taste fibers from the front of the tongue as well as sensory fibers emanating from the carotid sinus region. Some tonsil stone sufferers have also reported hearing ringing in the ears when tonsil stones are present, a condition called tinnitus that results from allergies or chronic sinusitis creating fluid build-up behind the ear drum.

White Tongue – Many people who have tonsilloliths also complain about having a white tongue, or more specifically a thick white coating on the tongue that won’t come off.

It is very possible to have tonsil stones without having this white coating, yet in many people they seem to go hand-in-hand. The reason for this is simply because what causes this problem is essentially the same thing that aids in the production of tonsil stones.

A white coated tongue is caused by an accumulation of volatile sulfur compounds that collect on the back of your tongue and throat. These volatile sulfur compounds are created by the anaerobic bacteria that live under the surface of your tongue and they are the same sulfur compounds that cause the foul smell experienced when you break open a tonsil stone.

Just because you have a white coated tongue though, doesn’t mean you will get tonsilloliths. What it does mean though is that you already have an accumulation of volatile sulfur compounds in the back of your throat and tongue and that you do have one of the components that are found in people with tonsil stones.

Many people have found that applying an oxygenating toothpaste to the back of the tongue and daily tongue scraping can help to eliminate their white tongue and return it to a nice, normal pink color.

Tonsil Stones Treatments

Tonsillectomies – Clearly, surgical removal of the tonsils is one way to eliminate tonsil stones. However, doctors usually only recommend a tonsillectomy for children who suffer frequent bouts of tonsillitis and/or strep throat. It is somewhat uncommon for physicians to suggest that adults undergo a tonsillectomy unless the tonsils are diseased or causing serious health problems. The rate of heavy, post-operative bleeding increases in older individuals who have their tonsils and adenoids excised due to surgical site scabs falling off prematurely and exposing raw tissue. In addition, adults experiencing a tonsillectomy often endure longer recovery times as well as worse pain than children experience.

Using Antibiotics to Treat Tonsil Stones – Antibiotics are prescription medications that target bacterial infections in the body. Because tonsil stones are composed primarily of anaerobic bacteria, many doctors will prescribe antibiotics for people suffering from tonsil stones. Unfortunately, the simplicity of a bacterium allows it to evolve rapidly in developing resistance against antibiotics, which renders that specific antibiotic useless as a defensive measure against a specific type of bacteria.

Another reason why antibiotics may not work as a reliable tonsil stone treatment method is due to additional underlying causes of tonsil stone formation. Because oral anaerobic bacteria thrive in a dry, airless environment rich with food particles, mucus and dead cells, antibiotics cannot fully work as well as they should until these root causes of tonsils stones are removed. In essence, taking antibiotics for tonsil stones is impractical and only contributes to the potential for someone to develop antibiotic resistance, which may prove detrimental when fighting future bacterial infections.

Laser Resurfacing of Tonsils – Using a carbon dioxide laser beam, doctors can literally reshape or smooth out tonsil fissures so that tonsil stones have no place to form and harden. Because a laser simply destroys rather than cuts away tonsillar crypts, pain and scar tissue is minimal during and after the procedure. However, more than one treatment is often required before tonsil stones and halitosis caused by these stones are eliminated. In addition, people undergoing this laser cryptolysis do not always experience permanent success with this type of tonsil stone treatment due to the tendency for tonsils to shrink as they age. Crevices can reappear as tonsil tissues lose moisture, allowing for the re-development of tonsils stones and bad breath.

Curettage – When tonsils stones are larger than normal and cannot be removed by traditional methods, doctors may need to make tiny incisions in the area surrounding the stone in order to scoop out the tonsillolith. This procedure is called “curettage” and further involves irrigating the incision to eliminate any fragments that may have remained following the curettage. People who do not want to undergo a tonsillectomy and experience abnormally large tonsil stones often opt for curettage but this procedure does nothing to prevent future stones from calcifying within tonsillar crypts.

Tonsil Stone Home Remedies – Searching for tonsil stone home remedies on the internet finds a wide range of folk remedies that have no basis in medical facts concerning the prevention of tonsil stones. Chinese herbal teas, gargling with salt water and homeopathic solutions are not recommended by physicians as a viable tonsil stone treatment. In fact, some of these untested “cures” may exacerbate oral conditions responsible for tonsil stones, bad breath and post nasal drip.

Tonsil Stone Treatment Products – Eliminating tonsil stones without resorting to expensive, painful surgery means using powerfully effective oral hygiene products that contain ingredients formulated to kill anaerobic bacteria, hydrate the mouth and create an oxygen-rich oral environment in which anaerobic bacteria cannot live. Dr. Harold Katz, the developer of TheraBreath products offers very effective tonsil stones treatment kits.

Results of Dr. Katz’s clinical investigations into tonsillolith treatment showed that treatments creating an oral environment which was free from oral debris, had a high oxygen content, was non-acidic and had adequate salivation, were very effective at dissolving existing tonsil stones and preventing new ones from forming. In fact, TheraBreath’s effective tonsil stones treatment kits promote all aspects of oral health and can also significantly reduce the risk of tooth decay and gum disease.

You can learn more about TheraBreath Tonsil Stone Treatment Kits by clicking here.

It should be noted that in rare cases surgery may, in fact, be needed to treat tonsil stones, so be sure to consult your doctor if the problem is persistent.

Preventing Tonsil Stones

The best way to relieve tonsil stone symptoms is to prevent them altogether by eliminating oral conditions conducive to tonsil stone formation. This means getting rid of excessive anaerobic bacterial activity and mouth debris that is rich with bacteria’s primary food source–proteins. Practice good oral hygiene by using oral care products containing oxygenating ingredients that kill anaerobic bacteria along with a diet that emphasizes fresh vegetables and fruits. Correcting the harmful oral conditions caused by dry mouth syndrome, poor brushing and flossing habits and post nasal drip can substantially reduce formation of tonsil stones.

Brush and Floss – Because tonsils stones are the calcified remains of mouth debris such as food particles, dead cells, and mucus collecting and solidifying in tonsillar crypts, decreasing the amount of oral detritus by brushing and flossing at least twice a day can reduce tonsil stone formation. Although proper brushing removes food residue and the damaging plaque biofilm that causes cavities and tooth decay, a toothbrush cannot fully reach in between teeth to dislodge debris and scrape away plaque.

Flossing in between teeth before brushing cleans these hard to reach areas of food particles and helps with preventing tonsil stones by reducing anaerobic bacterial activity. Tonsil stones also contain huge amounts of anaerobes that assist in the calcification process. Since anaerobic bacteria is one of the primary culprits behind chronically severe bad breath, eliminating protein-rich food sources for bad oral bacteria can potentially be a powerful tonsil stones prevention tool.

Minimize Post Nasal Drip – Drink plenty of water each day and use nasal/sinus drops containing ingredients that kill anaerobic bacteria, freshen breath and relieve phlegm in the throat. Unfortunately, most brand name sinus drops, mouthwashes or gargles that say they eliminate halitosis do just the opposite by introducing ingredients into the mouth and throat that actually promote dry mouth and proliferation of bad oral bacteria. Ingredients like sodium laurel sulfate, alcohol and saccharine are all desiccants, substances that remove moisture from oral tissues and worsen dry mouth rather than
improve it. Manufacturers only include these ingredients in their toothpastes and mouthwashes to make them taste better and to add a “foaming” action in order to make consumers think the product is “effective”.

Tongue Scraping – Scraping the tongue is another tonsil stones prevention practice that gets rid of excess anaerobic bacteria. That white, fuzzy coating seen on the tongue in the morning and when the mouth is dry indicates out of control bacterial growth. Just like the tonsils, the tongue’s surface ripples with tiny crevices called papillae in which anaerobes nestle, consume proteins and reproduce. Unless you scrape or brush this coating off the tongue, bacteria will continue breeding and emitting foul smelling volatile sulfur compounds.

Avoid Dairy Products – Dairy products like cheese and milk contain tremendous amounts of protein that is the preferred food source of anaerobic bacteria. When bits of cheese and milk residue are allowed to remain in the mouth, bacterial growth accelerates and tonsil stone formation drastically increases. In addition, the high level of calcium in milk promotes mucus build-up and should be expressly avoided by people who suffer from post nasal drip.

Stop Smoking and Drinking – Smoking cigarettes and drinking alcohol also contribute to tonsil stones because of the dehydrating affect they have on oral tissues.

For people suffering from tonsil stones, there is indeed hope. By practicing good oral hygiene, making small lifestyle changes and addressing underlying causes of tonsil stones, there is a very good chance that they can be neutralized and prevented without resorting to more drastic treatments such as antibiotics or even surgery.


What Client’s Say

I suffered from tonsiloliths until I tried TheraBreath nasal drops. I have not had one tonsilolith since I started using the product, only 3 months ago. You have no idea how much I appreciate the research!
Dan Y., Fort Worth, TX