Published on: March 16, 2021. Updated on: December 18, 2024
If you’ve ever had bad breath that won’t go away, felt something stuck in your throat, or noticed small white or yellow bits in your mouth, you might have tonsil stones (also called tonsilloliths). They are small, hard lumps that form in the tiny pockets of your tonsils. Many people say that tonsil stones smell bad, often like sulfur or mothballs.
In this guide, you’ll learn all about tonsil stones—their causes, symptoms, and how to prevent them. We’ll also share free resources to help you understand, treat and manage them.
What Are Tonsil Stones?
Tonsil stones form when debris like bacteria, food particles, and dead cells get stuck in the small pockets of your tonsils and harden over time. They can be as small as a grain of sand or large enough to see easily.
What are they made of?
Tonsil stones contain sulfur-producing bacteria, which cause their bad smell, as well as minerals like calcium and phosphate.
How big are they?
Most tonsil stones are small, usually between 1 and 7 mm [1]. In rare cases, they can grow as big as 3 cm, which may cause serious symptoms and need medical attention [1]. CT scans often find stones around 3–4 mm, but very tiny stones can also be spotted during tonsil exams [2]. Tonsil stones can also grow over time, increasing in size by an average of 0.61 mm per year [3].
The Tonsil Stone Size Chart below explains that tonsil stones range from tiny (1 mm, like a grain of sand) to larger (7mm, pea-sized).
How common are they?
Tonsil stones are more common than many people realize. Studies in the U.S. show that they are found in about 15% [4] to 45% [2] in patients undergoing CT scans of the head and neck.
Are they contagious?
No worries, tonsil stones are not contagious. They form due to your unique anatomy and oral health, and you cannot “catch” them from someone else.
How Can I Tell If I Have Tonsil Stones?
Tonsil stones don’t always cause symptoms, but when they do, they can be uncomfortable or even painful. Here are some signs you may have tonsil stones [5]:
- Bad breath (halitosis): One of the most common signs, caused by bacteria and debris trapped in the tonsils.
- Throat discomfort: You might feel like something is stuck in your throat, known as a “foreign body sensation”.
- White or yellow specks: Visible on your tonsils, these are the stones themselves.
- Ear pain (otalgia): The nerves in your throat are connected to your ears, which can make the pain spread to your ears [6].
- Trouble swallowing (dysphagia): Larger tonsil stones may make swallowing uncomfortable or even painful.
- Coughing or sore throat: An irritable cough or persistent throat pain can occur. Some people report “coughing up little white balls that stink”, which are often tonsil stones.
In rare cases, tonsil stones can lead to more serious symptoms, such as severe throat or neck pain, and in extreme cases, difficulty breathing [7]. However, these are uncommon and typically associated with larger stones.
Want to know if you have tonsil stones? Take our interactive Tonsil Stones Quiz.
Why Do Tonsil Stones Smell So Bad?
One of the most noticeable and unpleasant signs of tonsil stones is their bad smell. People often say they smell like sulfur, mothballs, or even poop. This odor comes from sulfur-producing bacteria that get trapped in the stones [8].
If you’re wondering, “Why do tonsil stones smell like mothballs?”, it’s because the bacteria break down organic material in the stones. Gargling with salt water or using a water flosser can help reduce the smell.
“ Tonsil stones emit a strong smell due to bacteria producing Volatile Sulfur Compounds (VSC). Sulfur-producing bacteria thrive on the surface of the tongue and in the back of the throat. These bacteria can breakdown proteins at a high rate and release VSC from the back of the tongue, which produces a foul odor. ”
What Can Trigger Tonsil Stones?
Tonsil stones form because of the shape of your tonsils. Small grooves or pockets in the tonsils can trap debris, which hardens into stones over time [9].
Other factors that can make tonsil stones more likely include:
- Poor oral hygiene: More debris in your mouth means a higher risk.
- Chronic dry mouth: Less saliva allows bacteria to grow.
- Frequent throat infections: Swollen tonsils trap more debris.
- Diet: Sticky or sugary foods can leave behind particles that get stuck.
If you have diabetes, you may be more likely to get tonsil stones because dry mouth and a higher chance of infections can cause debris to build up in your tonsils. To learn more about how diabetes affects your oral health, visit our guide: Diabetes and Oral Health.
“ If you do not remove bacteria and debris from your mouth, especially your tongue, this can put you at a higher risk for developing stones.”
How Can I Stop Tonsil Stones from Coming Back?
Preventing tonsil stones means keeping your mouth clean and minimizing debris buildup. Here are some simple tips to help:
- Brush and floss every day: Keep your teeth and gums clean.
- Scrape your tongue: Use a tongue scraper to remove bacteria.
- Drink lots of water: Stay hydrated to avoid dry mouth.
- Gargle with salt water: Rinse out debris from your tonsils.
- Use a water flosser or a tonsil stone removal kit: Gently clean your tonsils to remove trapped particles.
” Consistent use of a water flosser can prevent the formation of tonsil stones by effectively cleaning the tonsil crypts, where these stones typically develop. These crypts are small pockets in the tonsils that can trap food particles, dead cells, and bacteria. When using a water flosser, the pulsating stream of water can reach these areas, dislodging debris that might otherwise remain trapped. This action not only helps to remove potential irritants physically but also minimizes the conditions that favor bacterial growth. Regular flushing of these areas can reduce inflammation and irritation in the tonsils, which is often associated with tonsil stone formation. “
You can usually manage tonsil stones at home by keeping your mouth clean and using simple tools. However, if the stones keep coming back or are causing problems, it’s a good idea to see a dentist. They can check your symptoms and help you find the best way to treat or prevent tonsil stones.
If you want more tonsil stone removal tips, check out our guide How to Get Rid of Tonsil Stones?.
Final Thoughts: What Should I Know Before Treating Tonsil Stones?
Tonsil stones are small, hard lumps that form when bacteria, food and dead cells get stuck in your tonsils. They can cause bad breath, a sore throat, or trouble swallowing, but they aren’t contagious.
To prevent tonsil stones, brush and floss every day, scrape your tongue, drink lots of water, and gargle with salt water. A tonsil stone removal kit can also help you remove stones and stop them from coming back.
If your tonsil stones are painful or keep returning, it’s a good idea to see a dentist or doctor.
If you’re still unsure whether you have tonsil stones, take our Tonsil Stones Interactive Quiz, or if you’re looking for tips on managing them, read our blog on How to Get Rid of Tonsil Stones?.
Frequently Asked Questions About Tonsil Stones
What happens if tonsil stones are left untreated?
Tonsil stones typically aren’t dangerous, as often, they fall out on their own. However, if they are left untreated, there is the possibility that they could keep getting bigger.
The longer you allow tonsil stones to remain, the longer you will have to put up with the uncomfortable side effects, such as bad breath and discomfort.
Why do tonsil stones smell so bad?
One of the key components of tonsil stones is bacteria. This bacteria produces sulfur, which causes the signature bad smell.
Do tonsil stones smell like poop?
Yes, sulfur-producing bacteria in the stones can emit a smell that some describe as fecal. Gargling with salt water can help manage this odor.
Do you need antibiotics to treat tonsil stones?
No, you do not need antibiotics to treat tonsil stones. If you have any concerns about getting rid of tonsil stones or think you might have an infection, see your doctor.
Can you get tonsil stones if you’ve had your tonsils removed?
No, tonsil stones only form in the crypts of tonsils, so their removal eliminates the risk.
What are the best tools to prevent tonsil stones?
Water flossers, tongue scrapers or tonsil removal kits are helpful tools to prevent debris buildup and are available online.
This article offers general oral health info and isn’t a substitute for professional advice. Always consult your dentist or healthcare provider with any medical questions.
References
- Mandel, L. (2008). Multiple bilateral tonsilloliths: case report. Journal of Oral and Maxillofacial Surgery, 66(1), 148-150. https://doi.org/10.1016/J.JOMS.2006.05.047.
- Oda, M., Kito, S., Tanaka, T., Nishida, I., Awano, S., Fujita, Y., et al. (2013). Prevalence and imaging characteristics of detectable tonsilloliths on 482 pairs of consecutive CT and panoramic radiographs. BMC Oral Health, 13(54). https://doi.org/10.1186/1472-6831-13-54.
- Yamashita, K., Oda, M., Tanaka, T., Nishida, I., Wakasugi-Sato, N., Matsumoto-Takeda, S., et al. (2021). Changes in tonsillolith characteristics detected in a follow-up CT study. BMC Oral Health, 21. https://doi.org/10.1186/s12903-021-01426-1.
- Yu, C., Tao, L., Li, X., Yu, Y., & Liu, B. (2017). Prevalence of tonsilloliths and CT diagnosis. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi, 52(8), 604-607. https://doi.org/10.3760/cma.j.issn.1673-0860.2017.08.009.
- Smith, K. L., Hughes, R., & Myrex, P. (2023). Tonsillitis and Tonsilloliths: Diagnosis and Management. American Family Physician, 107(1), 35–41.
- Kim K. S. (2013). Referred otalgia induced by a large tonsillolith. Korean Journal of Family Medicine, 34(3), 221–223. https://doi.org/10.4082/kjfm.2013.34.3.221.
- Lo, R., Chang, K., & Chu, S. (2011). Upper airway obstruction caused by bilateral giant tonsilloliths. Journal of the Chinese Medical Association, 74(7), 329-331. https://doi.org/10.1016/j.jcma.2011.05.011.
- Tsuneishi, M., Yamamoto, T., Kokeguchi, S., Tamaki, N., Fukui, K., & Watanabe, T. (2006). Composition of the bacterial flora in tonsilloliths. Microbes and Infection, 8(9-10), 2384-2389. https://doi.org/10.1016/J.MICINF.2006.04.023.
- Alfayez, A., Albesher, M., & Alqabasani, M. (2018). A giant tonsillolith. Saudi Medical Journal, 39, 412-414. https://doi.org/10.15537/smj.2018.4.21832.
I’m a biomedical engineer turned content writer with over a decade of experience in the healthcare industry and a Master’s Degree in Biological Sciences. I’m passionate about transforming complex scientific research into accessible content to help readers make informed decisions about their health.
