From the Guidelines
To treat tonsil stones, gargle with salt water and maintain good oral hygiene, and consider consulting a healthcare provider for further management if stones are persistent or causing significant problems. The treatment of tonsil stones involves a combination of self-care measures and medical interventions. Gargling with salt water (1/2 teaspoon salt in 8 ounces warm water) several times daily can help loosen and remove the stones 1. Additionally, gently dislodging visible stones using a cotton swab, soft toothbrush, or water flosser on the lowest setting can be effective. Over-the-counter pain relievers like acetaminophen or ibuprofen can help with any discomfort, as recommended by the clinical practice guideline for tonsillectomy in children (update) 1.
Key Considerations
- Maintain good oral hygiene by brushing twice daily, flossing, and using an alcohol-free mouthwash to prevent the formation of new stones.
- Stay hydrated to prevent dry mouth, which can contribute to stone formation.
- If stones are persistent or causing significant problems, consult a healthcare provider who may recommend tonsil cryptolysis (smoothing the tonsil surface) or, in severe cases, tonsillectomy, as outlined in the clinical practice guideline for tonsillectomy in children (update) 1.
- Tonsil stones form when food particles, bacteria, and dead cells get trapped in the crevices of your tonsils and calcify, so regular oral care is key to prevention.
Management Options
- The American Academy of Otolaryngology–Head and Neck Surgery Foundation provides evidence-based recommendations on the pre-, intra-, and postoperative care and management of children under consideration for tonsillectomy, which can be applied to the management of tonsil stones in adults as well 1.
- The guideline emphasizes the need for evaluation and intervention in special populations, improving counseling and education of families, and highlighting management options for patients with modifying factors 1.
From the Research
Tonsil Stone Treatment
- Tonsil stones, or tonsilloliths, are managed expectantly, and small tonsilloliths are common clinical findings 2
- Rarely, surgical intervention is required if they become too large to pass on their own 2
Management of Tonsillitis
- Treatment is focused on supportive care, and if group A beta-hemolytic streptococcus is identified, penicillin should be used as the first-line antibiotic 2
- In cases of recurrent tonsillitis, watchful waiting is strongly recommended if there have been less than seven episodes in the past year, less than five episodes per year for the past two years, or less than three episodes per year for the past three years 2
Post-Tonsillectomy Care
- Oral rinses, mouthwashes, and sprays may be used to improve recovery following tonsillectomy 3, 4, 5
- Lidocaine spray appeared to be more effective than saline spray at reducing the severity of pain until the third postoperative day 3, 4, 5
- Benzydamine spray may cause a burning or stinging sensation in some participants, but not sufficient to discontinue usage 3, 4, 5