How to get rid of tonsil stones?

Management of Tonsil Stones

The most effective approach to get rid of tonsil stones is through adequate fluid intake to naturally flush debris from tonsillar crypts, combined with gentle mechanical removal using tools like cotton swabs, water irrigators, or oral syringes for immediate relief. 1

Conservative Management Options

• Hydration: Drink plenty of water daily to help naturally flush debris from tonsillar crypts and provide relief from discomfort associated with tonsil stones 1

• Mechanical removal methods:

  • Gentle pressure with a cotton swab, soft toothbrush, or water irrigator can dislodge visible stones 1, 2
  • Oral syringes can be used to direct water streams into tonsillar crypts to flush out stones 2
  • Gargling with warm salt water can help loosen and remove smaller stones 1

• Antimicrobial rinses:

  • Honey can be used as an adjunctive therapy due to its antimicrobial properties and ability to soothe the throat 1
  • Alcohol-free mouthwash may help reduce bacterial load that contributes to stone formation 2

When to Consider Procedural Interventions

• Coblation tonsil cryptolysis: A novel approach that can be performed under local anesthesia for adults with recurrent tonsil stones 3

  • Advantages include:
    • Can be performed without sedation using only local anesthesia
    • Pain is significant for only a few days
    • Most adults can resume normal diet and activity within 1 week
    • Avoids disadvantages of laser use (airway fire risk, retinal damage, plume issues)
    • Can potentially eliminate tonsil stones after a single session 3

• Tonsillectomy: Should be considered only for severe cases with:

  • Recurrent large tonsil stones causing significant symptoms 1, 4
  • Stones associated with recurrent tonsillitis meeting Paradise criteria (≥7 episodes in past year, OR ≥5 episodes per year for 2 years, OR ≥3 episodes per year for 3 years) 1
  • Giant tonsilloliths that cannot be removed by other means 4, 5

Prevention Strategies

• Oral hygiene practices:

  • Regular brushing and flossing to reduce bacterial load in the mouth 2
  • Use of tongue scrapers to remove bacteria from the tongue surface 2
  • Avoiding smoking and alcohol which can contribute to dry mouth and increased bacterial growth 2

• Dietary considerations:

  • Adequate hydration throughout the day 1
  • Avoiding dairy products if they seem to worsen symptoms 2

Important Caveats

• Most tonsil stones are small and asymptomatic, requiring no intervention 2
• Spontaneous improvement is possible in many cases, making observation a reasonable approach 1
• Surgical interventions carry risks including bleeding, pain, dehydration, and rarely more serious complications 1
• A 12-month period of observation is usually recommended prior to consideration of tonsillectomy for recurrent cases 1
• Tonsilloliths are common findings and often the cause of bad breath (halitosis), but development of large tonsillar stones is rare 4, 6