Almond stones • Remove and prevent

Although almond stones have no pathological significance, they can be uncomfortable and responsible for bad breath. There are several ways to remove them.

Almond stones lie in the furrows of the tonsils – sometimes a part of them are visible on the surface of the tonsils.
© iStock.com/Ralf Geithe

Almond stones, also called tonsil stones, tonsilloliths or tonsillar plugs, are solid structures made from food residues, dead mucous membrane cells and white blood cells, which can accumulate in the indentations of the tonsils (tonsils). Almond stones arise when the tonsils do their job as part of the lymphatic tissue. Although harmless, almond stones can become very uncomfortable due to foreign body sensation and bad breath.

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Remove almond stones: what to do about almond stones?

If you want to get rid of an annoying almond stone, also called tonsillolith, you often do not need a doctor. Many almond stones can be removed by simple methods. However, it is important not to handle sharp, sharp-edged or hard, immovable instruments even in the throat, as otherwise serious injuries can occur. Helpful methods are:

  • With your head stretched back, open your mouth wide and close again several times. This creates tension in the palate muscles and the almond stone can be massaged out.

  • Sometimes almond stones can be expressed with the tongue without great gagging.

  • If a finger, cotton swab or the back of the toothbrush is pressed up against the underside of the almond, an almond stone can often be removed.

  • Rinse almond stones with an oral irrigator and clean the almond under low pressure. In this way, almond stones can come loose and the crypt can be rinsed clean.

  • Gargling with mouthwash, chamomile or sage tea, or salt water can also be helpful.

  • A strong cough can often get the tonsils out of the furrows of the tonsils.

If all of these attempts are unsuccessful, an ENT specialist should be consulted. With special tools such as cuvettes or pipettes, he can remove the almond stones, squeeze out or vacuum them up. In the so-called Roeder treatment, cupping glasses are placed on the almonds and the almond stones are sucked out using the negative pressure. Almond stones should not be extracted by yourself.

With all methods that only remove the annoying almond stones, the tonsillar plugs can reappear at any time.

If those affected want to permanently reduce the formation of almond stones, treatment with laser or current pulses is an option. The upper layers of the tonsil tissue are removed under local anesthesia. The surface of the tonsils can also be smoothed by high-energy current pulses. These methods retain the important immunological function of the tonsils. However, new almond stones can still appear – albeit much less frequently.

A permanent removal of tonsils only offers surgical removal of the tonsils (tonsillectomy). From a medical point of view, there is no reason to remove inflammation-free tonsils only because of almond stones, because the removal weakens the immune system. A tonsillectomy can only make sense if the tonsils are the result of very frequent and recurring tonsillitis and the tissue is severely scarred as a result.

What are almond stones?

Almond stones are yellowish-white structures that arise in the crypts (indentations) of the tonsils. They are usually only a few millimeters in size, from firm to crumbly or soft in consistency and are characterized by an unpleasant smell and taste. They arise from leftovers, dead skin cells and white blood cells and have no real disease value. There is a risk that almond stones will be confused with accumulations of pus, as can occur with tonsillitis (tonsillitis).

Almond stones can occur in all people, but children are rarely affected. A common occurrence can be observed in people who have often suffered from tonsillitis (tonsillitis).

What are the causes of almond stones?

As long as a person has tonsils and the immune system works normally, tonsils can appear. The formation of tonsilloliths within the almond crypts is completely normal and occurs in all people. However, it is not clear why they occur more frequently, grow larger or become unpleasantly noticeable in some people.

It is believed that the size of the tonsils could play a role, since large almonds are usually very furrowed and the crypts are deeper. This allows them to fill up easily and the almond stones become particularly large.

Another problem is the disrupted self-cleaning process of the tonsils, which can occur after severe or frequently recurring tonsillitis. There are scars that narrow the exits of the crypts. In this way, the already narrow exits from the furrows are further reduced, which limits the outflow of detritus (cellular breakdown products). Conversely, there is no evidence that frequent occurrence of tonsil stones could increase the risk of tonsillitis.

How are almond stones made?

When chewing, the palate muscles tense, which means that the crypts can normally empty and refill regularly. The mixture of food particles, germs, white blood cells and rejected surface cells then gets into the mouth in the form of small white crumbs and is usually swallowed unnoticed. However, certain lime salts also occur in food and saliva, which can be stored in the crypt content. When this happens, it hardens and can become hard, crumbly or even stone-like. Almond stones are created. These are often deep in the crypts, but can also surface.

Symptoms of almond stones

In the vast majority of cases, almond stones do not cause any complaints. If they reach the surface of the tonsils, they are usually pushed off and swallowed unnoticed, or spit out or blown out by sneezing or coughing violently. If you look closely, you can often see almond stones as small white dots on the almond surface, some of which can also be felt with the tongue.

In rare cases, large almond stones can trigger an unusual feeling on the back of the palate, which is particularly noticeable when swallowing as a foreign body sensation in the neck or in the area of ​​the jaw angle. This can lead to persistent clearing of the throat. In addition, there is occasionally an unpleasant, furry feeling in the throat.

The main problem caused by almond stones is bad breath. Larger tonsilloliths in particular can have a very unpleasant smell and taste due to their mechanism of origin. If parts of the almond stones remain in the mouth or in the tonsillar crypt, the unpleasant bad breath (foetor ex ore) can be very stressful for those affected.

How can you find almond stones?

In most cases, an almond stone is accidentally discovered by the person concerned or by the dentist or ENT doctor. Depending on the size of the almond stone and the distance from the surface, the tonsillar plug shimmers whitish through the mucous membrane or appears as a white layer on the tonsils. A deep-seated almond stone cannot normally be seen with the naked eye.

If you suffer from unclear bad breath, a foreign body sensation, the need to clear your throat or a furry feeling in your throat, the doctor can search the tonsils for almond stones. Although they can be visualized well on x-rays or by means of computed tomography, these examinations are not justified due to the radiation exposure, the high costs and the mildness of the complaints. You can confidently rely on the doctor's eye diagnosis.

In rare cases, it is difficult to distinguish an almond stone from an inflammation-related accumulation of pus. In the event of inflammation, the tonsils would also be extremely red and swollen, and the infection would usually be accompanied by a fever. The disease-causing bacteria can then be detected in the smear.

Course and prognosis for almond stones

There is no drug therapy that counteracts the development of almond stones. Antibiotics in particular have absolutely no effect on the tonsilloliths and their formation.

After removal of the tonsilloliths by own or medical measures, they can reappear at the same or a different place at any time. However, it can also happen that individual crypts are scarred and stones can no longer arise at this point.

The only really safe method against tonsil stones is to remove the tonsils. However, this will always be a restriction of the body's immune defense. The extent to which this affects health varies from person to person and cannot be predicted. Tonsillectomy is therefore only a sensible therapy for recurring tonsil stones for very few sufferers.

Can you prevent almond stones?

There are various precautionary measures that can reduce the incidence of almond stones. Although these methods cannot prevent the formation of tonsil stones, they are often very helpful and reduce the frequency. The following tricks are promising:

  • Brush the almonds very gently with the soft toothbrush.

  • Regular cleaning of the tonsils with an oral irrigator.

  • The extensive elimination of alcohol and dairy products is said to reduce the formation of almond stones in some cases.

  • Intensive oral hygiene with brushing your teeth daily, gargling with salt water, using antibacterial mouthwash, cleaning the tongue with a tongue scraper can also prevent this.

Brush your teeth – but properly!

Brush your teeth - but properly!