From the Guidelines
Tonsil stones can be effectively managed with home remedies, and tonsillectomy should only be considered for severe cases with recurrent tonsillitis or other complications, as recommended by the most recent clinical practice guidelines 1.
Home Remedies for Tonsil Stones
- Gargling with salt water: Mix 1/2 teaspoon of salt in 8 ounces of warm water and gargle for 30 seconds several times daily to help dislodge the stones and reduce inflammation.
- Gentle removal of visible stones: Use a cotton swab, soft toothbrush, or water flosser on the lowest setting to remove visible stones.
- Maintaining good oral hygiene: Brush twice daily, floss once daily, and use an alcohol-free mouthwash to reduce bacteria that contribute to stone formation.
- Staying hydrated: Prevent dry mouth that can worsen tonsil stones by drinking plenty of water.
When to Consider Tonsillectomy
- Recurrent tonsillitis: If you experience severe symptoms like difficulty swallowing, persistent bad breath, or recurrent tonsillitis, consult a healthcare provider who might recommend tonsillectomy for severe cases, as stated in the clinical practice guideline 1.
- Frequency of throat infection: Tonsillectomy may be recommended for recurrent throat infection with a frequency of at least 7 episodes in the past year, at least 5 episodes per year for 2 years, or at least 3 episodes per year for 3 years with documentation in the medical record for each episode of sore throat and 1 of the following: temperature > 38.3°C (101°F), cervical adenopathy, tonsillar exudate, or positive test for group A beta-hemolytic streptococcus 1.
Important Considerations
- Tonsillectomy should only be considered after careful evaluation of the benefits and harms, as stated in the clinical practice guideline 1.
- Home remedies should be tried first, and tonsillectomy should only be considered for severe cases with recurrent tonsillitis or other complications.
- It is essential to consult a healthcare provider to determine the best course of treatment for tonsil stones, as they can provide personalized advice and recommend tonsillectomy if necessary, based on the latest clinical practice guidelines 1.
From the Research
Tonsil Stone Treatment Options
- Tonsilloliths, or tonsil stones, are typically managed expectantly, with small tonsilloliths being common clinical findings 2
- Rarely, surgical intervention is required if they become too large to pass on their own 2
- Large tonsilloliths are sometimes associated with recurrent sore throat and odynophagia 3
Medical Management
- There is no direct evidence of medical management for tonsil stones, but treatment for recurrent tonsillitis may help prevent their formation
- Clindamycin therapy has been shown to be effective in eradicating group A beta-hemolytic streptococci and beta-lactamase-producing bacteria (BLPB) in recurrent inflamed tonsils 4, 5
- Penicillin is the first-line antibiotic for treating group A beta-hemolytic streptococcus infections, but clindamycin may be an alternative for patients with recurrent tonsillitis 4, 5
Biofilm Characteristics
- Tonsilloliths exhibit biofilm structure and the formation of chemical gradients through physiological activity 6
- The morphology and biofilm characteristics of tonsilloliths may stimulate scientists to use limited or targeted remedies in the future 6
- Fluoride has been shown to suppress acid production in the presence of sucrose, which may help prevent the proliferation of anaerobic/acidophilic bacteria in tonsilloliths 6