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Tonsil Stones or Tonsilloliths

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Tonsil stones or tonsilloliths are calcifications of the palatal tonsils that cause oral discomfort and malodor. Read the article to know about tonsil stones in detail.

Medically reviewed by

Dr. Infanteena Marily F.

Published At February 10, 2022
Reviewed AtOctober 26, 2022

What Are Tonsils?

Tonsils are fleshy tissue lumps at the back of our throat that act as an immune defense in the oral cavity.

What Are Tonsilloliths?

Tonsilloliths or tonsil stones are calcifications that usually form around or within the crypts of the palatal tonsils. Of the three sets of tonsils, one is the palatal tonsil, and the other two are pharyngeal tonsils or adenoids and the lingual tonsils. These stones can also be found in the throat or roof of the mouth, common occurrence locations.

Tonsils are easily prone to their crevices being filled by bacterial contamination of other foreign bodies, dead cells, mucus, etc., that can become trapped within them. When this entrapment occurs, the debris becomes concentrated as white formations in these pockets. Tonsilloliths are formed due to debris accumulation. They are generally soft and maybe sometimes rubbery. This often occurs in people who suffer from chronic inflammation in their tonsils or repeated bouts of tonsillitis.

How Are Tonsilloliths Manifested?

They are often associated with post-nasal drip. In the cases of tonsilloliths, patients express irritation, discomfort, and halitosis caused commonly due to the presence of tonsillolith (at the region of the right pharynx at the tonsillar crypt), with halitosis or bad breath being the most common symptom due to the release of volatile sulfur compounds produced by bacterial accumulation.

What Is the Etiology and Pathogenesis of Tonsilloliths?

Tonsilloliths usually occur rarely in children as compared to adults. The size of tonsilloliths ranges from visible size to pea-size. Patients with tonsillolith have increased halitosis, bad breath, or oral malodor and also feel the foreign body sensation causing oral discomfort. Tonsilloliths are not described by traditional research as just calcification but rather as an aggregated bacterial biofilm.

The mechanism of tonsillolith formation is due to the three-dimensional structure of the pathogenic bacterium, with the most dormant bacteria being in the center to serve as a constant nidus or reservoir for the biofilm. However, the exact cause and the pathogenesis of tonsillolith remains elusive.

Biofilm forms when bacteria adhere to the surface in a moist environment by secreting a slimy, glue-like substance. Biofilm is held together by molecules known as extracellular polymeric substances. The establishment of biofilm is an important event in the formation of tonsilloliths in the tonsillar crypt. The intracellular adhesion protects these pathogenic bacteria against significant components of the human innate immune system. Cell to cell signaling and communication remains enabled and enhances the biofilm composed of calcium salts either alone or in combination with other mineral salts.

Chemical analysis of tonsilloliths suggests that it is majorly composed of calcification of calcium salts such as calcium carbonate (CaCO3) and other chemical components like magnesium, chloride, sodium, potassium, sulfates, nitrates, silica, iron, fluoride, etc. Also, one more possible type other than the typical tonsil stones is giant tonsilloliths. Giant tonsilloliths can often be mistaken for other oral disease manifestations like peritonsillar abscesses or tonsillar tumors that must be diagnosed differently by the dentist or physician.

What Is the Differential Diagnosis of Tonsillolith?

The differential diagnosis must, however, be established through scanning and radiography. The following are the conditions to be ruled out while confirming the presence of tonsilloliths:

  • Acute and chronic tonsillitis.

  • Tonsillar hypertrophy.

  • Phleboliths.

  • Granulomatous lesions.

  • Eagle syndrome.

  • Calcification granuloma or calcified granulomatous lesions.

  • Certain Malignancies.

  • Enlargement of the styloid process.

What Is the Radiographic Presentation of Tonsillolith?

CT scan is a valuable modality that may reveal the tonsillar zone, outlining these non-specific areas of calcifications in detail. Tonsillitis usually appears in the midline of the mandibular ramus on the dental panoramic radiographs, where the posterior surface of the tongue crosses the mandibular ramus in the palatoglossus or the palatopharyngeal spaces.

The appearance resembles a cluster of multiple, small radiopacities with ill-defined margins. Tonsillitis should be the first differential diagnosis, especially when numerous opaque lesions with ill-defined borders are superimposed on the palatal uvula or the mandibular ramus.

These are most commonly detected on an OPG or panoramic radiography in routine dental checkups or by your dental surgeon. A correct diagnosis by the dentist will eliminate the need for further evaluations, including radiography and clinical examination.

Halitosis - A Major Effect of Tonsilloliths:

Tonsilloliths have the potential to cause oral halitosis. Foul-smelling compounds such as volatile sulfur compounds and sulfur-derived gases were produced during bacterial metabolism. A characteristic sulfur smell is present when the produced gases reach a particular concentration.

In the cases of tonsilloliths, patients express irritation, discomfort, and halitosis. Irritation and discomfort can be commonly caused in these patients due to the presence of tonsillolith (at the region of the right pharynx at the tonsillar crypt), with halitosis or bad breath being the most common symptom due to the release of volatile sulfur compounds produced by bacterial accumulation.

How Is a Tonsillolith Manage

  1. Surgical resection of tonsils is not recommended by the dental surgeon or the physician until indicated due to persistent discomfiture.

  2. Affected people can remove tonsils stones using a cotton swab or finger.

  3. The dentist may recommend chlorhexidine mouthwash rinse for the same.

  4. Oral irrigators are also effective. Dental surgeons do not recommend most electric oral irrigators for tonsillitis removal because they are too forceful in action and are more likely to cause trauma, discomfort, and rupture to the tonsils, resulting in further complications of swelling, infection, and malodor. Irrigators and manually pressurized tonsil stones removers available commercially may help these patients better pick out the masses.

  5. The manual pump-type tonsil stone remover remains influential and can adjust the water pressure depending on the number of pumps.

  6. Lukewarm or mildly hot salty water rinsing remains the most simple yet effective method that can be done multiple times a day. This may help alleviate the discomfort of tonsillitis, which often accompanies tonsils stones. Vigorous gargling each morning can also keep the tonsils crypt clear of all but the most persistent or very large tonsilloliths.

Conclusion:

Tonsilloliths or tonsil stones are thus a usually self-limiting condition, though a very orally disturbing and potentially long-term condition if left untreated and hence needs proper oral hygiene, irrigation, and mouth rinsing along with oral management of malodor and discomfort by the dental surgeon.

Frequently Asked Questions

1.

How Can You Tell the Difference Between Tonsillitis and Tonsil Stones?

Buildups of germs and debris in the crevices of the tonsils are known as tonsil stones or tonsilloliths. It becomes a tiny, stone-like growth as the waste solidifies. Tonsillitis happens when the tonsils get infected.

2.

What Is the Treatment of Tonsilloliths?

Gargling with warm water reduces swelling and discomfort. Try gargling with eight ounces of water and one teaspoon of salt. To get rid of a bothersome tonsil stone, use a cotton swab

3.

How to Self-Diagnose Tonsil Stones?

The following symptoms are helpful in the diagnosis of tonsil stones -
 
Bad breath (halitosis).
Cough.
Earache.
Sore throat.
Bad taste in your mouth.
Small white or yellow stones that you may spit up.

4.

Which STD Causes White Spots on the Tonsils?

White spots on the tonsils are most probably caused due to Neisseria gonorrhoeae or Chlamydia trachomatis. Sore throat, tonsillitis, and pharyngitis are common symptoms, but in many cases, no symptoms are present.

5.

Can Dentists Remove Tonsil Stones?

If it is impossible to remove the tonsil stone manually, a dentist can remove it with the help of a tongue depressor or air or water syringe

6.

How Long Do Tonsil Stones Take To Go Away?

Tonsil stones dissolved at some time on their own. In case of bacterial infection, it may last longer than a few weeks. If the tonsil stones are left untreated, they can stay for years

7.

Will Antibiotics Get Rid of Tonsil Stones?

In most cases, tonsil stones do not require any kind of antibiotics. It is possible to remove tonsil stones manually. In case of bacterial infection, antibiotic coverage is required to treat the tonsil stones.

8.

Are Tonsil Stones Soft and Smelly?

Tonsil stones, which develop in the crypts of the tonsils, are soft, foul-smelling, white or yellow balls of solid pus. Exudate is the correct term in medicine. They are made up of protein, white blood cells, and bacteria.

9.

Does Everyone Get Tonsil Stones?

Tonsil Stones are a very common occurrence. In most cases, tonsil stones are asymptomatic and do not show any signs or symptoms, which is why most people are unaware of the fact that they have tonsil stones

10.

Do Tonsil Stones Come Out on Their Own?

Tonsil stones typically disappear over time. Before swallowing a stone, one night cough it out or feel it move. However, a person should consult a doctor if they have a recurrent stone that appears to be growing larger.

11.

What Is Considered a Large Tonsil Stone?

Tonsil stones can range from very small to extremely large and typically take some time to produce. In reality, the largest tonsil stone ever measured was 14.5 cm or just under six inches. However, because tonsil stones tend to be small, some patients may not even know they have them at first.

12.

Can Sinus Drainage Cause Tonsil Stones?

Additionally, the tonsils' fissures may harbor bacteria. Tonsil stones, which are clumps of mucus that have become cemented, are produced when post-nasal drip and germs from the tonsils combine. These stones give off the odor of foul breath

13.

Does Apple Cider Vinegar Help With Tonsil Stones?

Gargling with diluted apple cider vinegar (ACV) can aid in removing and digesting the substances contained in tonsil stones. One can combine one tablespoon of apple cider vinegar with one cup of warm water to make this concoction. Stones can be loosened by gargling with this up to three times each day

14.

Does Peroxide Help With Tonsil Stones?

Gargling with 50 % salt water solution and 50 % hydrogen peroxide has also been found to relieve throat discomfort and keep tonsillar crypts clean. Ensure not to ingest hydrogen peroxide if you gargle a 50/50 solution of hydrogen peroxide and water

15.

Is It Possible That People Remove Tonsil Stones on Their Own?

A tonsil stone may typically be removed at home. To remove the stone, gently press on the tonsil behind it using a cotton swab. Additionally, vigorous coughing and gargling help remove stones. Gargle with salt water to remove any leftover bacteria once the stone has been removed
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Dr. Achanta Krishna Swaroop
Dr. Achanta Krishna Swaroop

Dentistry

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