What’s the Deal With Tonsil Stones?

Practically everyone’s heard of bad breath (or experienced it themselves), but not nearly as many people have ever heard of tonsil stones. If you’ve ever dealt with tonsil stones, you know why nobody’s eager to talk about them. They’re a perplexing but harmless phenomenon, occasionally going completely unnoticed but often resulting in swollen tonsils and a distinctly unpleasant smell. But what exactly are tonsil stones, and what’s the best way to get rid of tonsil stones?

What Are Tonsil Stones?

Scientifically speaking, tonsil stones, or tonsilloliths, are hard formations that develop on or inside the tonsils. They’re typically white or yellow, and they can range anywhere from the size of a grain of rice all the way up to the size of a large grape. They also come with a specific tonsil stone smell, which anyone who has suffered from tonsil stones before will tell you is far from pleasant. They form when various forms of debris — such as dead skin cells, food, and saliva — get trapped inside the crevices of the tonsils (also known as tonsil crypts). Over time, bacteria and fungi harden, thus creating tonsil stones in the tonsil crypts. Typically, they come from improper dental hygiene, abnormally large tonsils, sinus issues, or inflammation of the tonsils (also known as chronic tonsillitis).

What Are the Symptoms of Tonsil Stones?

While the most obvious symptom of tonsil stones is the appearance of the stones in the tonsils in the back of the throat, there are a handful of symptoms that can help you identify tonsil stones if they haven’t grown to visible size yet. These symptoms include (but are not limited to):

sore throat
bad breath
difficulty swallowing
pain in the ear
a persistent cough
swelling of the tonsils
visible white or yellow debris on or around the tonsils

Of course, for smaller tonsil stones that are just beginning to develop, it’s possible that none of these symptoms may be present. These tiny ones are much more common than the larger, more obvious stones.

How to Avoid Tonsil Stones

If tonsil stones are a regular problem for you, then it might be time to consider the ways you can prevent them from even forming in the first place. For starters, you’ll want to prioritize proper oral hygiene (if you don’t already). This includes cleaning the tongue, which is a step that many skip (or possibly might not even know is necessary), but it’s also critical to use a toothpaste and mouth rinse that do a proper job of killing harmful bacteria in your mouth. Beyond this, you’ll want to quit smoking or avoid taking it up. Not only is this good for your general health and wellbeing, it can do wonders in preventing tonsil stones from forming. If these steps don’t help, you can also try gargling salt water regularly and making sure you drink enough water to stay hydrated. If you’re still regularly experiencing the development of tonsil stones, you might want to talk to your dentist about specific tonsil stone management and treatment.

How Are Tonsil Stones Managed and Treated?

It’s important to remember that tonsil stones are completely harmless from a medical standpoint. However, that isn’t to say that they don’t bring discomfort and foul odors when left unmanaged or untreated. Thankfully, there are several medical procedures that can be done to help remove your tonsil stones. One of the most common treatment methods is called laser tonsil cryptolysis, which sounds a lot more serious than it actually is. All that needs to be done here is to administer local anesthesia, then use a medical-grade laser to eliminate the tonsil crypts that the stones are lodged inside. There’s very minimal recovery time or discomfort with this procedure, and it’s quite effective for those who regularly deal with large tonsil stones. Alternatively, medical professionals may try a coblation cryptolysis — this involves administering a salt solution to the tonsils, then transmitting radio waves that transform the ions in the solution into charges. The charged ions then cut through the tissue and relieve the tonsils from the stones. If the stones are large enough or regular enough, a dental surgeon might opt for a tonsillectomy — also known as the removal of the tonsils — to prevent them from ever occurring again. This is only in the most severe instances, though.

How to Remove Tonsil Stones

If your tonsil stones aren’t serious enough to warrant one of these medical procedures, there are all sorts of at-home remedies you can try out yourself. For starters, try gargling vigorously, ideally with a saltwater solution. This can help to dislodge the stones, remove the odor of the stones, and change the chemistry of your mouth to prevent them from forming again. Many tonsil stone sufferers have also had success with simply coughing hard, loosening the stones in the tonsils with the force of their coughing. Manual removal is also an option, but not one that many oral health experts would recommend: The tonsils are extremely delicate, and anything from the bristles of a toothbrush to the fingers themselves could lead to bleeding, infection, or tearing of the tissue. If you insist on trying manual removal, you’ll be better off using a cotton swab or Waterpik.

Mouthwash for Tonsil Stones

At the end of the day, one of the best ways to prevent tonsil stones is to start with proper oral hygiene. This begins with brushing your teeth, flossing, and, just as importantly, using mouthwash. Elementa Silver mouthwash is one such solution. Combining the power of Nano Silver with calcium, xylitol, water, and natural flavors, Elementa Silver mouthwash helps promote the kind of proper oral hygiene that can help stop bad breath caused by tonsil stones and prevent tonsil stones from ever forming. Learn more about Elementa’s revolutionary Nano Silver technology and view their different toothpaste and mouth rinse products today, along with Elementa’s complete shop.

One of the things in hygiene that we don’t frequently bring up is sorbitol. On first glance, you may think this sugar free polyol effectively targets cariogenic oral bacteria. However, although it is the most commonly used sweetener in dental products, it has some dark sides many don’t discuss.

I started my new years goal just like most of you. I’d like to lose weight and focus on eating healthier. So I started buying foods labeled “sugar free,” “diet,” and so on. This is when I realized that most of these products contain sorbitol. As I looked deeper I realized that sorbitol was in so many of my own personal foods, supplements, and dental products.

So here’s my question: Why pick a sweetener that has half the benefits, when we could use xylitol and get them all? Before you strike me down, hear me out.

Sorbitol isn’t by any means inherently “harmful”, but it just doesn’t pack nearly the same punch as its sibling xylitol. Let me explain.

Cariogenic bacteria can easily ferment sorbitol into lactic acid. S.Mutans even has the ability to use and recycle this lactic acid repeatedly with minimal energy. This ultimately gives it a huge competitive advantage for growth. Why would we ever want that!?

Yes, I do believe this is a slower process than with a standard sugar. However, for those who may already be compromised by xerostomia, this can really throw a wrench into the equation. Why?- because low salivary flow means high clearance times for oral acids and bacteria. This can create a bad situation quickly, especially for compromised patients. Xylitol, however, can NOT be broken down to lactic acid EVER due to its 5 carbon chemical structure.

Simply put, cariogenic bacteria cannot use xylitol for energy. The key difference is that when you look at the structure of xylitol and sorbitol, one looks like glucose, and the other doesn’t. This is why S.mutans easily recognizes the structure of sorbitol, but not xylitol.

Since cariogenic bacteria can’t metabolize xylitol, it builds up and over time and it becomes toxic to them. In short of so many words, they starve to death. On top of this, xylitol will also interfere with bacterial acid production, increasing the pH of plaque and preventing damage to teeth.

When the plaque pH remains low, enamel is weakened and demineralizes forming an oh so familiar white spot that we all hate to see. Over time this lesion can turn into decay. Not so wonderful.

So what’s the take home? Sorbitol is a better substitute for sucrose, but xylitol is the far better choice overall by a longshot. Many of our patients can benefit from the use of daily xylitol supplements- especially those who have xerostomia, less salivary flow and even diabetics.

Everything that I have seen and read about why sorbitol is still the standard sweetener is because it is less expensive than xylitol. If you ask me, I’d rather pay a little more to have all the health benefits.

I challenge you to do your own research, even if you are not a dental or health professional. Really take a good hard look at your food labels- especially your “sugar free” ones. If you are as frustrated as me, don’t settle. It’s about time hygienists started pushing for what we really want to see in dental products: xylitol.

-Kellie Hamilton, RDH

Kellie’s BIO:

Kellie is a practicing hygienist in Payson, Utah with 12 years of clinical practice. She frequently reads the literature, and is highly active in the Dental community. Kelly can be reached at khamilton915@hotmail.com.