Scientists now know what causes tonsil stones due to research regarding the constituents of the tonsilloliths, or stones. Causes for the formation of tonsil stones are largely thought to emerge from accumulations of bacteria, dead cells, food particles and mucus collecting in tonsil crypts, or tiny crevices dotting the surface of the tonsils. Because tonsil stones develop within crevices, they are often not discovered until radiological examinations detect their presence.

Tonsil stone calculi are comprised of magnesium and calcium salts such as oxalates, ammonium radicals and hydroxyapatite. Bacterial and fungal growths (specifically, Leptothrix buccalis) also correlate with tonsil stone formation. Additionally, some researchers have discovered that other factors promoting tonsillolith creation are associated with the location of the tonsil stones. For example, when tonsil stones are found in the peritonsillar area, ectoptic tissue and abscessed calcification accumulations may play a more important role in what causes tonsils stones than unchecked mouth debris.

As a result of lying undisturbed within these almost microscopic pockets, this debris hardens and calcifies into miniscule white stone-like pieces that are sometimes visible to the person who has them. They are usually no bigger than two millimeters in thickness and often do not cause any disagreeable symptoms other than extremely bad breath. Other signs that tonsils may harbor tonsil stones include:

• Feeling like something is lying in the throat
• Difficulty swallowing
• Sore throat
• Occasionally ear pain

Chronic halitosis that persists even after employing several different methods to eliminate bad breath and visiting the dentist to rule out gum disease or cavities is the main indicator that tonsils stones may be the culprit for severe bad breath. The explanation for why tonsilloliths cause halitosis originates in the answer to what causes tonsil stones and the fact that sulfurous compounds emitted by anaerobic bacteria produce severe bad breath.

By consuming and putrefying the precursor material responsible for tonsil stone formation, anaerobic bacteria continuously excretes potent amounts of substances smelling like rotting eggs. Individuals suffering from tonsil stones are especially aware of the odor when a tonsil stone disintegrates or is dislodged and inadvertently chewed.

Anaerobic bacteria flourish in low-oxygen conditions, such as the environment found in and around tonsil crypts. When combined with dry mouth, or xerostomia, this type of bacteria grows exponentially within the mouth, since saliva contains oxygen and antibacterial qualities that act as deterrents to oral bacterial growth. Lack of sufficient saliva reinforced with food and mucous debris directly contributes to tonsil stone formation and bad breath.

Function of Tonsils

Tonsils originally performed vital immunological functions in prehistoric humans by effectively filtering various harmful viruses and bacteria from the air before it reached the inside of the body, specifically the lungs. However, millions of years later, these same tonsils are now inundated with 20 times more germs than what once existed. In addition, the diversity of bacteria has greatly expanded in today's global world, a complex environment in which tonsils did not need to adapt to in prehistoric times.

As a result, individuals who still have his or her tonsils can frequently experience tonsillitis, inflamed tonsils and other problems arising from the tonsils inability to cope with such a multitude of bacteria and viruses infecting the air. These tonsil-related illnesses also represent more reasons for what causes tonsil stones.

Anaerobic Bacteria

Besides residing in the mouth and contributing to tonsillolith growth, anaerobic bacteria are also found in the upper respiratory tract and the inner ear canal. The inner ear provides an ideal anaerobic environment conducive to bacterial growth since it is extremely small and difficult to access. The presence of pus-creating infection further promotes bacteria proliferation, since this seepage is rich in proteins on which bacteria thrive. Because ear, nose and throat physiology is closely interconnected, an ear infection rife with anaerobic bacteria may contribute to halitosis.

Some of these anaerobes that are also found in the mouth make an enzyme called β-lactamase which is resistant to penicillin treatments. Additionally, attacking a concentration of anaerobic bacteria is difficult due to the bacteria's polymicrobial quality and ability to rapidly evolve features resistant to antibiotics. For these reasons, fighting tonsil stone formation with antibiotics is generally ineffective.

Dr Katz Video Describing Tonsil Stones

This video by Dr. Katz, founder of ThreaBreath® describes what causes tonsil stones.

Are Tonsil Stones Preventable?

Removing and preventing tonsil stones are applicable but the effectiveness of preventative measures varies. Tonsil stones can be removed at home by gently dislodging them with a toothbrush, a Q-tip or a water pik, These items are commonly used to remove food particles trapped between teeth. Of course, the most drastic method for removing tonsil stones is to have the tonsils (and adenoids) excised surgically. However, when tonsils do not experience repeated infections and only suffer from tonsil stones, some doctors are reluctant to remove them since they still do perform filtering functions conducive to immunological health.

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Things to do that may decrease formation of tonsil stones are:

• Brushing the teeth and tongue twice a day
• Rinsing the mouth with an oxygenating mouthwash
• Drinking water after a meal to wash down food particles that may remain in the throat
• Weekly irrigation of tonsils with an oral irrigator keeps debris and bacteria from accumulating in tonsil crevices
• Post-nasal drip may contribute to what causes tonsil stones. Cleaning nasal passages of mucous drainage could slow down tonsil stone formation
• Avoid a diet high in dairy products. Anaerobic bacteria thrive on protein and dairy products are rich in protein.
• Avoid excessive alcohol consumption, since alcohol is a diuretic and causes dry mouth

On rare occasions, tonsil stones may grow larger than normal and cause painful symptoms. When these abnormal tonsilloliths cannot be removed at home, a physician will apply a local anesthetic and remove them with special surgical instruments in their office or in an outpatient clinic.

While tonsillectomies are usually performed on young children or teenagers who suffer chronic tonsillitis, tonsil stones and repeated ear infections, doctors hesitate to perform them on older adults aged 30+. The reasons for hesitation in performing tonsillectomies on adults include:

• A few adults (about 20 percent of those undergoing a tonsillectomy) may experience excessive bleeding following the procedure due to coughing and elimination of scabs
• Side effects of anesthesia tend to increase as adults age, resulting in longer recovery times, breathing issues and extended confusion
• Occasional injury to the piece of tissue dangling at the back of the throat called the uvula, which can cause pain and bleeding

By understanding what causes tonsil stones, people can realize the importance of maintaining good oral hygiene, brushing twice a day and keeping the mouth as hydrated as possible to eliminate the presence of excessive anaerobic bacteria.