Treating Tonsil Stones

Treating tonsil stones almost never requires surgery, but when needed, treatment consists of either removing the tonsils or removing the calculi.

Question

My daughter has very large tonsils with deep crevices. She has large numbers of small, hard lumps that she scrapes out. Her doctor said they were food particles that had gotten stuck. I find this hard to believe. Could there be other reasons for the lumps?
Alice Bradford - Carrollton, Texas

Dr. Greene’s Answer:

The tonsils are sentinels, standing guard at the back of the throat to protect the delicate tissues of our lungs and intestines from foreign invaders. They are part of a ring of defenders, Waldeyer’s Ring (which includes the tonsils, adenoids, and other lymphoid tissue), encircling the back of the throat as an important line of defense. The tonsils and adenoids are largest during childhood; they are front-line guardians while the body’s more sophisticated internal immune system learns and develops.

The situation you describe, Alice, is a very common one. The tonsils usually appear like small, dimpled golf balls set on either side of the back of the throat. Children with large tonsils and deep crypts often do get food particles trapped in there. Because saliva contains digestive enzymes, trapped food begins to break down. Particularly, the starch or carbohydrate part of the food melts away, leaving firmer, harder remains of food in the tonsils. This does not look like the food that went into the mouth.

As you suspect, however, there is more to these hard lumps than just food. The tonsils also trap other mouth debris such as bacteria and old cells from the surface of the mouth’s lining. Some of these cells contain small amounts of keratin, the same substance found in fingernails and rhinoceros horns. Whatever the nature of the debris, it is then attacked by white blood cells. The aftermath of this battle leaves the crevices of the tonsil strewn with hardened remains.

Most people swallow this material without ever noticing it, while it is still tiny. In those whose tonsils are large, however, the particles can lodge in the deep crypts, where they continue to grow. The enlarging lumps are called calculi of the tonsil, or tonsilloliths (tonsil stones). These stones are most common during adolescence.

Microscopic studies of these tonsilloliths have shown them to contain a combination of food particles, bacteria, oral debris, and white blood cells in a concentrically laminated pattern — rather like a pearl. Usually they are small gritty particles found in the center of soft, cheesy flecks. Sometimes, however, they become quite large, appearing as rough, yellow or gray, round stones. At times they reach an extraordinary size. Affected people usually have a history of repeated attacks of tonsillitis in earlier years.

Most people with calculi of the tonsils have no associated symptoms. In that case nothing need be done, except perhaps for brushing or scraping them out, as your daughter does. Gargling, refraining from eating during the 30 minutes before falling asleep, and careful oral hygiene may help minimize their formation.

For some people, however, the calculi can be quite bothersome, causing a constant foreign-body sensation, a chronic low-grade sore throat, recurrent episodes of tonsillitis persisting beyond childhood, or chronic bad breath.

Treating tonsil stones almost never requires surgery, but when needed, treatment consists of either removing the tonsils or removing the calculi. Troublesome large calculi that are not easily dislodged may need an ear, nose, and throat doctor to remove them.

Not too long ago, tonsils were routinely removed for the sole crime of being swollen and inflamed. We didn’t understand, then, that the tonsils purposely accept the infections to prevent the organisms from traveling deeper, and to show the invaders to the developing immune system to train it for the future. The tonsils are selfless protectors. As a child becomes an adult, the tonsils usually begin to shrink; the watchful guardians of childhood are no longer much-needed.

Tonsils are a bit like parents: looming large early in life, diminishing over time, ever-protecting, ever-teaching, but sometimes with rough or hard spots when we let things build up ;^)

Did you find this article helpful? Do you still need more information? Let us know below.

Last medical review on: October 31, 2014
About the Author
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Dr. Greene is a practicing physician, author, national and international TEDx speaker, and global health advocate. He is a graduate of Princeton University and University of California San Francisco.
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Recent Comments

hi,
I took a large tonsil stone out with my finger a week ago, and part of it was white and soft, and part of it was hard and black like a piece of charcoal. there was some bleeding when the stone came out. Also, since the stone came out, I have been feeling like there is something stuck or swollen in my throat on that same side. thoughts? I am worried that somethung is wrong

Hi Yana,

Yuck. That sounds miserable. Other folks with tonsil stones may weigh-in with more insight, but here are my thoughts:

  • Stones form over time so it’s likely the rock-like portion is just older than the newer portion.
    1. Swelling is likely from the irritation of the removal. Sound like you did some damage getting it out.
  • Bleeding means you opened up a wound when digging it out. The mouth heals very quickly, but an open wound can lead to an infection. So you may want to get that checked out by a doctor or your dentist.

I hope that helps.
Best, @MsGreene
Note: I am the co-founder of DrGreene.com, but I am not Dr. Greene and I am not a doctor. Please keep that in mind when reading my comments and replies.

Hi Yana,

Yuck. That sounds miserable. Other folks with tonsil stones may weigh-in with more insight, but here are my thoughts:

  • Stones form over time so it’s likely the rock-like portion is just older than the newer portion.
    1. Swelling is likely from the irritation of the removal. Sound like you did some damage getting it out.
  • Bleeding means you opened up a wound when digging it out. The mouth heals very quickly, but an open wound can lead to an infection. So you may want to get that checked out by a doctor or your dentist.

I hope that helps.
Best, @MsGreene
Note: I am the co-founder of DrGreene.com, but I am not Dr. Greene and I am not a doctor. Please keep that in mind when reading my comments and replies.

Thanks for the great comment. Please let us know how it’s going.

Best, @MsGreene
Note: I am the co-founder of DrGreene.com, but I am not Dr. Greene and I am not a doctor. Please keep that in mind when reading my comments and replies.

Try taking Braggs Apple cider vinegar (with Mother) every night before bed 1 tabelspoon, mix with water. It might help. I haven’t got this problem ever since taking this Braggs ACV.

Thanks for the great comment. Please let us know how it’s going.

Best, @MsGreene
Note: I am the co-founder of DrGreene.com, but I am not Dr. Greene and I am not a doctor. Please keep that in mind when reading my comments and replies.

Hi Aaron,

Bleeding is not good. If it continues, it would be wise to call your doctor and see what they think. In the meantime, it can be comforting, and help the healing process, to gargle with warm salt water.

I hope that helps.
Best, @MsGreene
Note: I am the co-founder of DrGreene.com, but I am not Dr. Greene and I am not a doctor. Please keep that in mind when reading my comments and replies.

i’m not sure what to do. i started poking my tonsils with a swab because i can tell the stones are there even if i can’t see them because of terrible bad breath and taste and my throat hurts a little, and a bunch of a little stones came out but it also spurted blood. now my tonsil is bleeding quite a lot and hurts and there’s a red thing poking out

Hi Aaron,

Bleeding is not good. If it continues, it would be wise to call your doctor and see what they think. In the meantime, it can be comforting, and help the healing process, to gargle with warm salt water.

I hope that helps.
Best, @MsGreene
Note: I am the co-founder of DrGreene.com, but I am not Dr. Greene and I am not a doctor. Please keep that in mind when reading my comments and replies.

Hi Matson,

This sounds like a terrible situation. I’m so sorry.

Typically tonsil stones aren’t a good reason to remove tonsils. But in your case, I think it would be smart to talk with your doctor about your overall anxiety around choking and decide together if this might tip the scales in the direction of removal.

In the meantime, try swishing coconut oil in your mouth (and as far back in your throat as you can) to help relieve the pain and loosen up the tonsil stones.

I hope that helps.
Best, @MsGreene
Note: I am the co-founder of DrGreene.com, but I am not Dr. Greene and I am not a doctor. Please keep that in mind when reading my comments and replies.

Hi, I’m an 18 year old girl who has been dealing with this things for years and could really use some advice right now. I happen to have major anxiety and a literal fear of choking/having something stuck in my throat. So all day I’ve had this massive stone that fell out and got caught in the back of my throat and now it’s stuck and won’t come out. I don’t think it helps with the fact that my tonsils are irritated anyway, but the more I focused on it, the more I started and am panicking about the feeling. I’m trying to calm down, but I’m so tired of dealing with these. Should I get my tonsils out??? I just feel stuck.

Hi Matson,

This sounds like a terrible situation. I’m so sorry.

Typically tonsil stones aren’t a good reason to remove tonsils. But in your case, I think it would be smart to talk with your doctor about your overall anxiety around choking and decide together if this might tip the scales in the direction of removal.

In the meantime, try swishing coconut oil in your mouth (and as far back in your throat as you can) to help relieve the pain and loosen up the tonsil stones.

I hope that helps.
Best, @MsGreene
Note: I am the co-founder of DrGreene.com, but I am not Dr. Greene and I am not a doctor. Please keep that in mind when reading my comments and replies.

Hi Raini,

That sounds a lot like tonsil stones. I hope you can follow the tips in this post to get rid of them.

BTW — some of our readers also recommend “oil pulling” which is pretty simple. Just put a spoon of coconut oil in your mouth and swish for as long as you can. It may coat the throat and help the stone slip out.

I hope that helps.
Best, @MsGreene
Note: I am the co-founder of DrGreene.com, but I am not Dr. Greene and I am not a doctor. Please keep that in mind when reading my comments and replies.

Hello. I’ve been feeling like something is in my throat for months now. I feel like I have phlegm in my throat. I’ve also been coughing up white smelly balls. They give me bad breath. I’ve tried to gargle salt water but it hasn’t been working.

Hi Raini,

That sounds a lot like tonsil stones. I hope you can follow the tips in this post to get rid of them.

BTW — some of our readers also recommend “oil pulling” which is pretty simple. Just put a spoon of coconut oil in your mouth and swish for as long as you can. It may coat the throat and help the stone slip out.

I hope that helps.
Best, @MsGreene
Note: I am the co-founder of DrGreene.com, but I am not Dr. Greene and I am not a doctor. Please keep that in mind when reading my comments and replies.