Chronic Tonsillitis and Tonsil Stones

Tonsilloliths, commonly known as tonsil stones are a calcified mixture of food particles, bacteria, white blood cells and old mucus which can get trapped in the folds of the tonsils. Although tonsils sample food, bacteria, viruses from the world to develop your immune system early in life as you mature they are not needed. Deep folds, known as crypts, in the tonsils can allow debris to become trapped and cause chronic low-grade infection. The growth of bacteria which feed on trapped old food particles and sugars can cause many of the symptoms associated with tonsilloliths including chronic sore throats, chronic cough, and bad breath. Certain bacteria in particular can produce sulfur-containing gases which are similar to those in rotten eggs and additives to natural gas. These can be a source of persistent bad breath for some people.

What can I do to prevent tonsil stones from forming?

  • Eat at least 1 hour prior to going to bed so saliva washes food particles out while you are awake.
  • Practice good oral/dental hygiene gently brushing and flossing at least twice a day. This reduces bacterial counts in the mouth.
  • Clean the back part of your tongue gently with a wet gauze or very gentle brushing. The back of the tongue is one of the largest sources of bacteria in the mouth.
  • Gargle with saline (salt water) or half water, half hydrogen peroxide after every meal. Spit out peroxide and do not swallow.
  • Dietary modifications:
    1. Reduced processed and added sugars in your diet – In addition to the extensive general health benefits of reducing/eliminating sugars in your diet, reduced sugar intake can limit the bacteria growth in the crypts of the tonsils.
    2. Eliminate dairy – Dairy contains lactose which bacteria can grow on. It also thickens the mucous and contains calcium which allows stones form. This is particularly helpful if you are lactose intolerant. Prior to considering tonsillectomy it is reasonable to try eliminating all dairy for a couple months to see if this is helpful.

How do I remove tonsil stones once they have formed?

There are several methods to remove tonsil stones. The key is finding ways to remove them without causing trauma. This means you need to visualize the stone well and not blindly poke. Looking in the mirror with the aid of a flashlight is helpful. With any method it is recommended to gargle with saline or peroxide after they are loosened to try and remove any remaining debris.

1. Cotton swabs – Make sure to wet the tip first. Gently push around the stone until it can be swept out.
2. Water pik – A manual syringe is used allowing controlled pressure to flush out the stone. Use lukewarm salt water with moderate pressure applied to the crypts of the tonsil.

Water Pik

3. Oral irrigator – These are commonly used as an adjunct for dental flossing. Start with a low pressure setting to avoid unnecessary trauma and bleeding of the tonsil. Use similarly to a water pik.

Oral Irrigator