Why You Keep Getting Tonsil Stones and How to Prevent Them

For people who are prone to tonsil stones, the most effective and permanent way to remove existing ones and prevent future stones from developing is to have your tonsils removed surgically (the procedure is called a tonsillectomy). But if you prefer not to go that route (after all, tonsils are an important part of the immune system, and they protect us by helping prevent harmful bacteria and viruses from entering the body through the mouth), or if your doctor doesn’t recommend surgery as an option for you, then other preventive strategies are key to keeping tonsil stones at bay. (1,2,3)

The good news is that there are measures you can take to reduce the chances that these growths will form, or at least minimize their occurrence. And if tonsil stones do start to crop up, these steps can help keep their size and number in check.

In some people, the surface of the tonsils can be very irregular and marked by pits and craters. Tonsil stones, also known as tonsilloliths or tonsilliths, form when food particles, bacteria, mucus, and saliva become trapped in these crevices, or crypts. (2,3)

One of the best ways to prevent tonsil stones from forming is to practice good oral hygiene. That means you should brush your teeth regularly, as well as rinse well, especially after a meal. You should also be vigilant about flossing and brushing your tongue — all these steps help reduce the amount of bacteria in your mouth, which is a factor that can lead to tonsil stones. (1,2)

But while doctors recommend good oral care to prevent tonsil stones from forming, that doesn’t mean oral hygiene is necessarily to blame for tonsil stones showing up in the first place. The distinction is important.

Poor oral hygiene, as well as tobacco use, can increase the likelihood of tonsil stones. But in other individuals, it’s the structure of the tonsils themselves that makes them more prone to developing tonsil stones. Even if some people do take diligent care of their teeth and mouth, they will get stones because of the anatomy (the specific size and shape) of their tonsils. If the tonsils have a lot of crypts and crevices, they’re more likely to have debris trapped in them and form tonsil stones than tonsils that are smooth.

“We think they form because material enters the crypts,” says Aaron Thatcher, MD, a clinical assistant professor with the department of otolaryngology at the University of Michigan Medicine in Ann Arbor. “We don’t think it’s hygiene” he adds — because some people with meticulous oral hygiene still develop tonsil stones.

Aside from practicing good oral care to reduce bacteria in your mouth, you can also try doing the following to help prevent tonsil stones from forming.

Gargling “Gargling can help clean out debris and prevent buildup before stones form,” says Dr. Thatcher. Whether you use mouthwash or water doesn’t matter as much as the act of gargling to flush out germs and dislodge any small particles that may be gathering on the tonsils. Though some people say gargling with salt water or baking soda may help prevent or remove tonsil stones, Thatcher and Jennifer Setlur, MD, an otolaryngologist at Massachusetts Eye and Ear in Boston, note that there’s probably not a lot of difference between using some type of solution and just plain water. (1,2)
Using a water flosser to clean your mouth regularly Dislodging tonsil stones with a stream of water from a power flosser is a great way to remove tonsil stones, and it’s also an effective way to prevent them from forming in the first place, says Dr. Setlur. “You can aim the water more directly at the stones and safely rinse them out,” she says. (1,2,3)

The most effective way to permanently prevent tonsil stones from forming is to get a tonsillectomy, or surgical removal of the tonsils. “Tonsillectomy is a very painful procedure, and it can involve at least two weeks of moderate or severe pain,” says Thatcher. “There is also a risk of bleeding.” (1,2)

Another procedure is laser tonsil cryptolysis, in which a laser is used to remove the tonsil crypts and resurface the troublesome areas. (4) A newer surgical option is coblation cryptolysis, a procedure that uses lower temperatures and utilizes radio frequency and saline to smooth out crevices in the tonsils, Thatcher says. (5)

As with any surgery, these procedures are not without risks. That’s why many people opt to take measures to prevent tonsil stones from forming and deal with tonsil stones when they crop up rather than go under the knife (or laser or radio waves).

But some people may be so bothered by tonsil stones symptoms, like bad breath or persistent and frequent stones, that they may opt for surgery, Thatcher says. Some people may cough up irksome stones every couple of days. (1,2) For others, it’s how the stones and symptoms affect their career or social life. If your job requires you to interact with people frequently, for example, or if you’re a dentist who needs to be in close proximity to patients, chronic bad breath can be problematic, says Thatcher.

In some cases, frequent tonsil stones may increase your risk of tonsillitis, or infection of the tonsils, says Setlur. (1)

The key to deciding whether or not to choose tonsillectomy to prevent tonsil stones, says Thatcher, is to understand the risks and go over your options with your doctor. “Discuss the benefits and complications,” says Thatcher. “It’s very personal. Weigh and balance how deeply it affects your life.”

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