As a kid, I often felt like there was something stuck in the back of my throat. One day in my early 20s, after spending 10 minutes trying to dislodge whatever was back there with a finger, I jabbed the back of my toothbrush into a tonsil and was surprised—and a little grossed out—when a hard white rock popped out. It smelled horrible. So naturally I kept at it, and with each poke a new piece emerged. Eventually, I had a handful of stinky gravel, but I felt much better. Unfortunately, it didn’t last, and I found myself repeating the same tonsil-poking routine every month or two. Finally, in frustration, I saw an ear, nose, and throat (ENT) doctor who suggested removing the tonsils. I never mentioned this to anyone but the doctor, so you can imagine my surprise when my HealthyWay editor asked me to write an article about a major cause of bad breath: tonsilloliths (tonsil stones). Until then, I never knew that those nasty things that lived in my tonsils had a name—or that that I was far from alone in having them. Turns out that up to 25 percent of us have stones in our head.
What are they?
In case you didn’t know, tonsils are those roundish lumps on either side of the back of your tongue. They’re actually part of your body’s lymphatic system and help you fight infection. At first glance, the tonsils look smooth, but they’re actually covered tiny pits called crypts, kind of like a golf ball. Saliva in our mouth starts breaking down the food we eat and washes it down the throat and into the stomach for digestion. But in some lucky people, food particles, bacteria, mucus, dead cells, and other gunk collects in those crypts. Over time this matter hardens and becomes tonsil stones.
In most cases, tonsil stones are pretty harmless, causing some minor discomfort and, as with me, an annoying sensation of something stuck in the throat. In more severe cases, though, they can cause severe pain in the throat or ears and difficulty swallowing. And let’s not forget about the really bad breath that persists no matter how many times you brush your teeth, scrape your tongue, floss, or gargle with mouthwash. Many people discover that they have tonsil stones after a particularly vigorous cough dislodges one. Others are able to see whitish spots on their tonsils.
Preventing tonsil stones is possible with good dental hygiene, including regular brushing, flossing, and gargling with salt water or hydrogen peroxide and water to keep as much bacteria as possible out of your mouth. But if you’re predisposed to getting tonsil stones, even the most careful prevention strategy may not work. Once you’ve got them, there are a variety of ways to deal with tonsil stones. Vigorous gargling with salt water can sometimes knock them loose. It’s also possible to dislodge them as I did, by poking the tonsils (if you decide to go that route, be very gentle and use a clean object so you don’t shove even more dirt into those crypts) or by blasting the tonsils with a Waterpik. If none of those approaches works, you and your medical provider may wish to explore a few medical options, which include antibiotics and using lasers to get rid of those tonsil crypts. However, the only guaranteed permanent solution is to remove the tonsils entirely. But be prepared: Plenty of doctors have never heard of tonsilloliths. The surgeon who did my tonsillectomy was one of them, and I still have vivid memories of the procedure. They didn’t knock me out completely, so I could feel the doctor tugging in my throat and hear him chatting with the nurses. The part that sticks in my mind, though, was when the doctor—who must have squeezed one of my tonsils—gasped and announced, “Oh, my God, that’s disgusting,” and invited one of his colleagues over. “Bob,” he said, “You’ve really got to see this.” Not the kind of bedside manner one generally hopes for in a doctor. The good news is that in the decades since, I haven’t had a single tonsil stone.