Tonsilloliths in Children: Symptoms and Treatments

You may not know what tonsilloliths in children are and how they affect little ones. Find out everything you need to know.
Tonsilloliths in Children: Symptoms and Treatments

Last update: 26 March, 2022

You’ve probably noticed little white bumps on your kid’s tonsils at some time or another. They may be tonsilloliths, a common throat problem in children.

Tonsilloliths are also known as tonsil stones and look like whitish spots on the tonsils. Keep reading and find out everything you need to know about this condition that affects children’s oral health.

What are tonsilloliths in children?

It’s very common during medical check-ups for professionals to ask children to open their mouths and say “ahhhh”. This is to look at the tonsils, two lymphatic glands that are located on each side of the throat.

These organs are part of the immune system and act as a “defense wall” against viruses and bacteria that enter through the mouth. Their structure is covered by oral mucosa, so their surface is irregular, with wrinkles and pits.

On these anatomical irregularities of the tonsils, the remains of food, bacteria, and other debris are trapped. These residues calcify over time and harden, giving rise to so-called tonsilloliths.

To the naked eye, these calcifications look like small yellowish or whitish bumps that look like cheese. For this reason, some authors call them caseum. They’re usually about the size of a grain of rice and are housed in tonsillar crypts.

At the same time, due to the fact that their origin is organic remains, they tend to give off a bad smell.

A boy smelling his own bad breath.

The causes of tonsilloliths in children

The anatomical characteristics of the tonsils are one of the main factors that predispose children to tonsilloliths. Some little ones have deeper crypts and pits, which increases the chances of debris accumulating in them.

Tonsil stone formation is also more common in infants with frequent pharyngitis or large tonsils.

In addition to the above causes, there are other situations that favor the formation of tonsil stones:

  • Poor oral hygiene: Poor oral cleaning favors the proliferation of bacteria in the mouth and, by extension, in the tonsils. In addition, food debris that’s not removed by brushing can end up lodged on the tonsillar crypts.
  • Oral dryness: The low production of saliva and the consequent dry mouth favor the proliferation of bacteria, the accumulation of residues in the tonsils, and the formation of tonsilloliths in children.
  • Low defenses: Having a decrease in white blood cells, which are the cells in charge of fighting infections, favors the formation of tonsil stones.
  • Bacterial or viral infections: Having repeated pharyngeal and oral infections predisposes individuals to the formation of stones.

Symptoms of tonsilloliths in children

Many of the children with tonsilloliths don’t experience any discomfort or pain, they simply have white bumps on their tonsils.

Either way, you need to know that these formations can be responsible for halitosis, the unpleasant smell that the mouth of some children emanates.

Patients with symptoms associated with the presence of stones usually have large tonsilloliths. In these cases, stones in the throat can cause dysphagia or discomfort when swallowing.

Inflammation of the tonsils and a red throat are also often associated with this problem and many children have pharyngeal pain and discomfort in the ears from this cause.

Treatment

Unless they’re observed during a pediatric consultation or cause some discomfort when swallowing, tonsilloliths in children often go unnoticed. In most cases, there’s no reason to worry, as over time, they shed on their own.

However, if your little one complains of discomfort from these calcifications, talk to their pediatrician. The doctor may recommend the use of an anti-inflammatory medication or refer you to the ear, nose and throat doctor.

In more severe cases, tonsil cryptolysis can be used, a laser intervention that removes the superficial layers of the tonsils where stones are formed.

In children with recurrent pharyngeal infections, very large tonsils, or those that cause frequent problems, tonsillectomy or surgical removal of the tonsils may also be considered. In any case, as they’re a defense tissue for the body, this option is only reserved for specific cases that warrant it.

No attempt should be made to remove the stones from the tonsils with a cotton swab, brush, or any other household instrument. This is very dangerous as it could cause injury or damage.

Many times, it’s important to differentiate tonsilloliths in children from bacterial tonsillitis plaques that occur in the same area. But this last condition is usually accompanied by a sore throat, fever, and general malaise.

Prevention is better than a cure

A dad helping his son brush his teeth.

By practicing simple oral hygiene habits, you can reduce the risk that your children will develop tonsilloliths. For this reason, semiannual visits to the pediatric dentist are very important, as they help keep the mouth in good condition.

Take care while brushing children’s teeth, gums, and tongue after every meal and also use fluoride toothpaste to remove food debris and bacteria from the mouth. If the child’s age allows it, dental floss and mouthwashes should also be used to complement oral cleaning.

Drinking plenty of water helps keep your mouth hydrated and thus makes stone formation more difficult. A healthy and balanced diet that’s low in sweets, fat, and highly acidic products also reduces the risk of the accumulation of tonsilloliths in children.

With these simple habits, you’ll avoid the development of oral problems that can spread and complicate.

It might interest you...
Children’s Oral Health: Each Age Requires Specific Care
You are Mom
Read it in You are Mom
Children’s Oral Health: Each Age Requires Specific Care

Adults are responsible of their children's oral health. Follow these tips to take good care of their needs according to their different ages.



  • Dura Gontijo de Moura, M., Fróis Madureira, D., Noman-Ferreira, L. C., Neves Abdo, E., Guimarães de Aguiar, E., & Silva Freire, A. R. D. (2007). Tonsilolito: informe de tres casos clínicos. Med. oral patol. oral cir. bucal (Internet), E130-E133.
  • Donat, F. J. S., Mocholí, A. P., Ferriol, J. E. E., & Mihi, V. M. (2005). Tonsilolito gigante: a propósito de un caso. Medicina oral10(3), 239-242.
  • Barba, L., & Valerio, I. (2020). Halitosis: Principios básicos sobre su origen y tratamiento Revisión narrativa. Odovtos International Journal of Dental Sciences22(1), 47-59.
  • De La Cruz, J. I. O., Angulo, H. B., Villalva, J. N., Huamán, H. O., & Oré, V. (2019). Tratamiento de tonsilolito. Revista Científica Visión Dental22(1), 625-631.
  • López, J. S. A. N., Zaputovich, B. M. V., & González, M. M. AMÍGDALAS Y ADENOIDES: DEFENSA ANTE AGENTES PATÓGENOS Y SU IMPLICANCIA ESTOMATOLÓGICA.
  • Tucta Castro, M. G. (2021). Halitosis: diagnóstico y tratamiento en atención primaria de salud (Bachelor’s thesis, Universidad de Guayaquil. Facultad Piloto de Odontología).
  • Gualapuro Gualapuro, D. I. (2021). Desarrollo de competencias en el manejo diagnóstico y terapéutico de la amigdalitis aguda viral y bacteriana en médicos generales de unidades de primer nivel de atención del Distrito 17D03–La Delicia durante el periodo noviembre 2019 a abril 2020 (Master’s thesis, Quito: UCE).
  • Sonia, D. M. AMIGDALECTOMÍA: INDICACIONES Y CONTROVERSIAS. ACTUALIZACIONES PEDIATRICAS PIBES 2018, 28.
  • Arabolaza, M., Basile, M., & Paoli, B. (2014). Indicaciones y complicaciones de adenoamigdalectomía. Revista faso21(2), 70-78.