What are tonsil stones? How concerned should a parent be if a child is getting them repeatedly?

The technical name for tonsil stones is tonsiliths, says Dr. Mark Shikowitz, vice chairman of Ear, Nose and Throat for Long Island’s Northwell Health system. What they are is actually food that gets stuck in a crevice of the tonsil and rots, and then the substance becomes calcified by exposure to the bacteria, fungi and calcium that exist in saliva, he says.

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Adults and children can get them. They don’t indicate illness — although they are sometimes associated with chronic tonsillitis — and they aren’t tumors, he says.

The putrefied combination is challenging to remove. “These things sit in the deep crypts of people’s tonsils,” Shikowitz says. A tonsil stone will be visible when you look into the child’s mouth. “It looks like a little white stone,” he says, hence the nickname.

Though they are harmless healthwise, they can smell terrible and cause bad breath, Shikowitz says. They can also feel annoying. Parents can try to use a water pik to blast them out, have a child gargle with mouthwash or home remedies such as apple cider vinegar, or employ a soft toothbrush to try to dislodge them, he says. The latter, however, is likely to cause a gag reflex, he says.

“You can have a bad episode,” he says, and then not have a stone again. “Then it’s not a big deal,” he says. But if tonsil stones are a steady or recurrent problem, then parents might want to consider visiting a pediatric otolaryngologist (ear, nose and throat doctor) to discuss having the tonsils shaved down or removed, he says. “If they’re already starting as a child, it’s best to have the tonsils removed,” Shikowitz advises, so that it’s not a problem throughout adulthood.