From the Guidelines
Tonsil stones can be managed through regular oral hygiene practices and simple home remedies, with a focus on preventing stone formation and reducing symptoms. The management and prevention strategies for tonsil stones include:
- Brushing teeth twice daily, flossing once daily, and using an alcohol-free mouthwash to reduce bacteria that contribute to stone formation 1
- Gargling with salt water (1/2 teaspoon salt in 8 ounces of warm water) several times daily to help dislodge existing stones and prevent new ones
- Gentle removal using a cotton swab, soft toothbrush, or water flosser for visible stones, but avoiding aggressive poking which may cause bleeding or infection
- Staying hydrated to prevent dry mouth that can worsen stone formation
- Considering the use of a tongue scraper daily and avoiding dairy products, which can increase mucus production, for persistent cases
- Smoking cessation, as it reduces inflammation in the throat If stones cause significant discomfort or recur frequently despite these measures, medical interventions like tonsil crypt cleaning by a healthcare provider or, in severe cases, tonsillectomy may be considered, as recommended by the American Academy of Otolaryngology–Head and Neck Surgery Foundation 1. Tonsil stones form when food particles, bacteria, and dead cells become trapped in the crevices of the tonsils and calcify, so regular cleaning of these areas prevents accumulation. It is essential to educate patients and caregivers about the importance of managing posttonsillectomy pain and the potential for obstructive sleep-disordered breathing to persist or recur after tonsillectomy, as highlighted in the clinical practice guidelines 1. Overall, a comprehensive approach to managing tonsil stones should prioritize prevention, symptom reduction, and patient education, with medical interventions reserved for severe or persistent cases.
From the Research
Management Strategies for Tonsil Stones
- Tonsil stones are managed expectantly, and small tonsilloliths are common clinical findings 2
- In some cases, surgical intervention may be required if the tonsil stones become too large to pass on their own 2
- Coblation tonsil cryptolysis is a novel approach in the treatment of tonsil stones, which can be performed in adult patients without sedation using only local anesthesia 3
- Laser tonsil cryptolysis is another alternative to tonsillectomy in selected cases of persistent tonsilloliths with cryptic infections, which can be performed in the office under local anesthesia 4
Prevention Strategies for Tonsil Stones
- Good oral hygiene practices, such as regular brushing and flossing, may help prevent the formation of tonsil stones
- There is no direct evidence on prevention strategies for tonsil stones, but maintaining good oral health may help reduce the risk of developing tonsil stones
Treatment Options for Recurrent Acute Pharyngo-Tonsillitis
- Antibiotic treatment is an option in patients with recurrent acute pharyngo-tonsillitis (RAPT), who have contraindications for tonsillectomy 5
- Clindamycin and amoxicillin with clavulanate are superior to penicillin in preventing future attacks of acute pharyngo-tonsillitis in patients with RAPT 5
Patient Education for Tonsil Stones
- Patient education on good oral hygiene practices and the importance of regular dental check-ups may help prevent the formation of tonsil stones
- Patients with tonsil stones should be educated on the available treatment options, including expectant management, surgical intervention, and less invasive techniques such as laser cryptolysis or Coblation tonsil cryptolysis 3, 4, 6