Why Are My Tonsil Stones Black?

February 14, 2024

Tonsil stones, or tonsilloliths, are small accumulations of hardened calcium, food debris, mucus, and bacteria that form in the pockets in the back of the throat. They typically appear white or yellow, but can also be black and often cause bad breath (halitosis) and sore throat. A black spot on the tonsils can be a symptom of these stones, but is also a sign of chronic caseous strep pharyngitis.

The underlying cause of tonsil stones is a build up of scar tissue from repeated episodes of tonsillitis, bacterial overgrowth within the crevices of the tonsils, and a deposition of inorganic salts on the crypts of the tonsils. The formation of these materials creates a cobblestone pattern on the posterior pharynx, and is referred to as the "cobblestone" appearance.

Most cases of tonsil stone are symptom-free, but they can create other issues such as sore throat, white coating on the tongue, bad breath, difficulty swallowing, or jaw pain. These issues can be treated with over-the-counter pain relievers, a thorough oral hygiene routine, and/or a water flosser device (as described in this article by the Cleveland Clinic).

If symptoms persist, see your ear, nose, and throat doctor. They may recommend a throat culture to determine the type of strep that you have and will prescribe antibiotics. If strep is not the cause, your doctor may recommend treatment for the tonsil stones or surgical removal of the tonsils. Regularly brushing your teeth and flossing can also help minimize the formation of tonsil stones, as it reduces the amount of bacteria and mucus in the mouth and throat.


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