Tonsil stones (aka tonsilloliths) are calcifications of debris inside the cracks of the tonsils.
When not calcified, the mass of debris is called chronic caseous tonsillitis (CCT). It is a common finding at St. Lawrence Dentistry. The primary purpose of tonsils is to catch inhaled microbes. In addition, proteins called antibodies generated by the tonsils destroy bacteria and help limit throat and lung contaminations. Tonsilloliths occur in up to 10% of the population, frequently due to episodes of tonsillitis. While small concretions in the tonsils are common, authentic stones are less so. They commonly occur in older adults and are rare in children. Bad breath may result from the presence of tonsil stones. Usually, there is no discomfort, though there may be the perception of something existing or an odd feeling on the side of your throat.
Dr. Hawryluk finds that recurrent throat infections can increase the incidence of tonsil stones. The stones hold a biofilm comprised of various microbes. While they generally reside in the palatine tonsils, they may additionally happen in the lingual tonsils. There are instances of tonsil stones weighing as much as 42 g. Detection is regularly during medical or dental imaging for non-related purposes.
If tonsil stones don’t disturb someone, no intervention is usually needed. Otherwise, mechanical removal or swishing with salt water is the first conservative treatment step. We sometimes suggest our Mississauga patients use chlorhexidine as it can be effective. Medical therapy may involve partial or total tonsil extraction. Up to 10% of us possess tonsil stones. They occur equally among genders. However, the incidence of tonsil stones increases with age.
Signs and symptoms
Tonsil stones may give no signs, or they can correlate with bad breath. The smell may be that of rotting eggs. Tonsil stones tend to appear frequently in those with chronic inflammation in the tonsilar areas. Sometimes there can be discomfort upon swallowing. Even when the stones are extensive, some tonsil stones are only identified unexpectedly on X-rays or CAT scans. Other signs include a metal taste, pharynx closing or contracting, coughing, and gagging. More enlarged tonsil stones may lead to repeated incidences of bad breath, which commonly co-occurs with tonsil infection, inflamed throat, white debris, unpleasant taste, trouble swallowing, earache, and tonsil inflammation. A foreign body perception may also exist. However, sometimes, the condition may not be symptomatic and only have discovery upon touching.
There is not 100 percent consensus concerning the mechanism by which these calcifications arise. Nevertheless, Dr. Hawryluk says they seem to result from the collection of debris grasped within the tonsil crypts and by the growth of microbes and fungi – sometimes linked with persistent pus-forming tonsillitis. In 2009, researchers showed an association between films of microbes and tonsilloliths. Fundamental to the biofilm theory is the premise that microbes form a 3-D composition, quiescent bacteria being in the middle to serve as a continuous nidus of contagion. This impermeable formation makes the biofilm resistant to antibiotics. In addition, the bacteria in tonsilloliths is frequently comparable to dental biofilms we remove during routine cleanings at St. Lawrence Dentistry.
Classification
Tonsilloliths or tonsil stones are rigidified structures that develop in crypts of palatal tonsils. Also, they are sometimes in the throat and the top of the mouth. Tonsils have fissures where microbes and other debris, including necrotic cells and mucus, can become caught. When this occurs, the debris concentrates in white structures that reside in the pockets. Tonsilloliths form when this captured debris collects and exudes from the tonsil. Dr. Hawryluk explains they are commonly soft, sometimes rubber-like. They often happen in those who experience chronic inflammation in their tonsils or continuous periods of tonsillitis. Also, they correspond with nasal dripping. Much more extraordinary than the average tonsil stones are “giant” tonsilloliths. They may frequently be mistaken for other conditions of the mouth, such as “peritonsillar abscesses”.
Some people can eliminate tonsil stones by applying a cotton swab or finger. Oral irrigators are also helpful. However, many electric oral irrigators are inappropriate for tonsil stone elimination since they are too powerful and can create discomfort and break the tonsils surface, causing further complications such as infection. Irrigators that attach directly to a faucet are more fitting for tonsil stone removal and daily lavage of the tonsils. In addition, they can stream water at low-pressure levels that the user can easily adjust, facilitating a spectrum of pressures to accommodate each user’s conditions. Talk to our friendly staff at St. Lawrence Dentistry to see which method is suitable for you.
There are also manually pressurized tonsil stone removers that are in the marketplace. They can alter the water flow by adjusting the number of pumps, allowing for the efficient removal of tonsil stones. In addition, St. Lawrence Dentistry recommends rinsing with lukewarm saline may help mitigate the ache of tonsillitis, which frequently co-occurs tonsil stones. Vigorous swishing can also help maintain clear tonsil crypts. More comprehensive tonsil stones may need elimination by curettage or excision combined with thorough irrigation.
Another option is to decrease the surface area (crypts, crevices, etc.) of the tonsils via laser resurfacing. The procedure is called laser cryptolysis. and is accomplished using a local anesthetic. A scanned carbon dioxide laser selectively vaporizes and smooths the surface of the tonsils. This technique flattens the edges of the crypts and crevices that collect the debris, preventing trapped material from forming stones. There may be a consideration for Tonsillectomy if bad breath due to tonsillar stones persists despite other measures.
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References:
Ferguson, M; Aydin, M; Mickel, J (October 2014). “Halitosis and the tonsils: a review of management.” Otolaryngology-Head and Neck Surgery. 151 (4): 567–74.
White, Stuart C.; Pharoah, Michael J. (2014). Oral Radiology – E-Book: Principles and Interpretation. Elsevier Health Sciences. p. 527.
Wong Chung, JERE; van Benthem, PPG; Blom, HM (May 2018). “Tonsillotomy versus tonsillectomy in adults suffering from tonsil-related afflictions: a systematic review.” Acta Oto-Laryngologica. 138 (5): 492–501.
“Tonsil Stones (Tonsilloliths)”. WebMD.com. Retrieved 6 March 2016.
Stoodley, P; Debeer, D; Longwell, M; Nistico, L; Hall-Stoodley, L; Wenig, B; Krespi, YP (September 2009). “Tonsillolith: not just a stone but a living biofilm.” Otolaryngology-Head and Neck Surgery. 141 (3): 316–21. doi:10.1016/j.otohns.2009.05.019.
Silvestre-Donat F, Pla-Mocholi A, Estelles-Ferriol E, Martinez-Mihi V (2005). “Giant tonsillolith: report of a case”(PDF). Medicina Oral, Patología Oral y Cirugía Bucal. 10 (3): 239–42. PMID 15876967.
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