From the Research
Tonsil stones, also known as tonsilloliths, are hard, calcified deposits that form in the crevices of the tonsils due to biofilm formation, as supported by the most recent study 1.
Definition and Formation
Tonsil stones are communities of microorganisms that adhere to surfaces and are embedded in a self-produced matrix of extracellular polymeric substances. In the case of tonsil stones, bacteria, food particles, dead cells, and mucus accumulate in the tonsillar crypts (small pockets in the tonsils) and form a biofilm. Over time, this biofilm calcifies and hardens into visible white or yellowish stones.
Symptoms and Management
These stones can cause bad breath, sore throat, difficulty swallowing, and a feeling of something stuck in the throat. To manage tonsil stones, gargling with salt water (1/2 teaspoon salt in 8 ounces of warm water) several times daily to help dislodge them is recommended, as well as gentle removal with a cotton swab, water flosser on low setting, or the back of a toothbrush 1. Good oral hygiene, including regular brushing, flossing, and tongue cleaning, helps prevent their formation by reducing bacteria in the mouth.
Prevention and Treatment
For persistent or problematic tonsil stones, a healthcare provider might recommend tonsil cryptolysis (smoothing the tonsil surface) or, in severe cases, tonsillectomy. It is essential to note that biofilms are recalcitrant to antibiotic treatment due to multiple tolerance mechanisms, and understanding the interplay between phenotypic and genetic resistance mechanisms acting on biofilms is required to optimize the antibiotic treatment of biofilm infections 2. However, the primary approach to managing tonsil stones should focus on prevention and mechanical removal, rather than relying on antibiotic treatment.
Key Points
- Tonsil stones form due to biofilm formation in the tonsillar crypts
- Symptoms include bad breath, sore throat, and difficulty swallowing
- Management involves gargling with salt water, gentle removal, and good oral hygiene
- Prevention is key, and antibiotic treatment should not be the primary approach