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The tonsils are glands in the back of the throat, lying between the palate and the posterior pharynx. They are oval masses of lymph tissue that serve to fight off infection as part of our immune system.

Tonsils fight infection, but they also can become infected. Inflamed tonsils are called “tonsillitis.” Tonsils can become quite large and develop abscesses. Most tonsillar infections occur during childhood and resolve spontaneously or with antibiotic and anti-inflammatory medications. Occasionally, surgical removal, or tonsillectomy is required.

Approximately 10% of the populations suffer from the formation of tonsil stones, or tonsilloliths. Tonsil stones are hardened, calcified matter that form in or on the tonsils. The stones are usually harmless and asymptomatic. They may be discovered in a casual self-examination in the mirror, or during a diagnostic x-ray or CT scan.

Tonsil stones develop in the natural small folds of the tonsils, or in the pits or crypts that can multiply with frequent infections. Food particles, mucus and post-nasal secretions, and dead cells and skin debris from your oral mucosa collect in these crypts and become calcified or hardened into yellow-white “stones.”

Bacteria attack the decaying material, and can cause infection. The natural process of degradation and the chemical composition of the stones or calculi cause a malodorous process. Halitosis, or bad breath, is the most common symptom. It is highly disturbing, and affects a person’s self-esteem and social function. Additional symptoms of tonsilloliths include sore throat, bad metallic taste in the mouth, swollen tonsils, ear pain, cough, and even difficulty swallowing.

There are many ways to prevent and treat tonsil stones from simple home remedies to the complex and expensive surgery.

1. Oral hygiene

It is important to brush your teeth with a soft brush after every meal, to dental floss daily, and to remember to brush your tongue as part of your oral hygiene. These habits decrease oral inflammation and infection, and dental decay.

2. Proper nutrition

Oral health depends on staying well-hydrated, and drinking about 8 glasses of water a day with decreasing caffeinated and sugared drinks. Some authorities believe that dairy products increase the formation of tonsil stones. Wise eating (low saturated fats, avoiding empty sugar calories, increasing fruits, vegetables and whole grains) is key in fighting infection.

3. Fluid washing

Regular antibacterial mouthwash can prevent or decrease tonsillolith formation. Gargling with saltwater is helpful as a cleanser and pain reducer. Water pic spray into the back of the throat may displace superficial stones.

4. Mechanical removal

If you do not have a very sensitive gag reflex, you can carefully remove a tonsil stone with a cotton-tipped applicator or a plastic meat baster. Care must be taken to avoid further inflammation or injury.

5. Medication

Your doctor may recommend antibiotics for fever and infection. Though very important, this may not remove the stone nor prevent recurrent formation.

6. Surgical removal

The definitive removal of tonsil stones is by an Ear-Nose-Throat (ENT) surgeon or in some cases, by your dentist.

: Local anesthetic with curettage or excision for removal
: Laser vaporization and smoothing of the tonsil
: General anesthetic and tonsillectomy, removing the tonsil

Tonsil stones are common with the most painful symptom being bad breath. There are ways to prevent and treat tonsilloliths that avoid great risk and expense.

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