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    FAQ Tip #2: Tonsilliths and Cryptic Tonsils
    Rod Moser, PA, PhD posted:
    People are often puzzled by white accumulations in their tonsils. Some feel they have Strep, yet they do not really have a red, sore throat. Some people are shocked when these "chunks" fall out, because they can have a terrible smell and taste. What are they?

    Some tonsils have holes (crypts) in them, just like the craters on the moon. Food particles and other debris will become trapped, calcify (become hard), decompose (hence the bad taste and smell), and dislodge from time to time. They can also cause your tonsils to enlarge and become inflamed. Many people end up getting antibiotics for these mysterious chunks, but antibiotics do not help.

    Other than physically dislodging these "tonsilliths" (the name for those white chunks), and gargling after EVERY meal, the only definitive cure is the surgical removal of the tonsils — a drastic and definitive measure that is not usually necessary.

    Unlike the days when tonsils would be surgically removed at your doctor's discretion, insurance companies now have strict surgical criteria that need to be met. Tonsils that become frequently infected (often with Strep), and those that are obstructing the airway or ability to swallow may need to be surgically removed, but it may be more difficult to get the surgical "okay" for tonsilliths.

    If you do have a severe and recurrent problem, cryptic tonsils may qualify for surgery if your ENT becomes your advocate.
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    18 of 26 found this helpful
    coricam responded:
    My name is Corina Mella and I am an ENT specialist in Romania (Europe).
    For the situation you described (tonsilliths) I use the laser to close the crypts and also to diminish the tonsillar tissue. Of course except of focal infection and positive inflamatory tests (ESR, ASLO, fibrinogen, RF) - conditions which are treated by tonsillectomy.
    Rod Moser, PA, PhD replied to coricam's response:
    Thank you for your expert input, Dr. Mella. Laser treatments for tonsilliths are not routinely done in the U.S., but I can see this that may be a therapy that is more cost-effective than a routine tonsillectomy.

    A question for you: Is it commonplace for all or most ENTs in Romania to have lasers, or are you associated with a large medical group where this instrument is shared?
    mint1234 replied to coricam's response:
    I am surprised that you need a laser. Seems a bit over kill. Good oral hygiene will probably take care of the issue. That doesn't mean using a mouthwash and simply brushing. You must floss, and most importantly clean your tongue!!! Not with a toothbrush! All you do with a toothbrush is re-arrange bacteria on the tongue. You must use a tongue cleaner. Scrape the surface to tongue gently (it does not hurt) daily. You will wipe away bacteria that build up and cause inflammation which leads to tonsilliths. Most of these issues are caused by laziness in oral hygiene, a laser is simply a band aid that does not correct the underlying problem.
    Rod Moser, PA, PhD replied to mint1234's response:
    If you have a laser, an ENT may find a reason to use it, but I agree that tonsilliths do not need this type of intervention. Most of the accumulated debris is FOOD (and other debris), and food can be prevented from forming those stinky stones by gargling after meals, and of course, maintaining a good program of oral hygiene (like mentioned above).
    sangmu12 replied to mint1234's response:
    As someone who has tonsil crypts I can say with certainty that your judgmental attitude towards this condition is wrong. I have "impeccable" oral hygiene. I eat a diet of fresh fruits and vegetables with a little meat and no dairy. I cannot eat bread, sugar or any refined food because of this problem. Ever. I have to gargle after every meal with special mouth wash. I spend about 35 minute each day on oral hygiene- not many people can say that. And guess what? After all of this, I STILL have tonsil stones. They are not *as* bad of course- but still bad.

    "laser is simply a band aid that does not correct the underlying problem."

    Actually, this procedure would change my life.

    The doctor is misinformed for agreeing with you. This is a very time consuming condition that people should not have to deal with on their own.
    sangmu12 replied to mint1234's response:
    And yes. I do everything you outline here as good oral hygiene- and more. I still have tonsil stones.
    sangmu12 replied to Rod Moser, PA, PhD's response:
    As someone who has tonsil stones, and does everything she humanly can to prevent them (besides never eating again), I can tell you that this procedure would change my life.
    Rod Moser, PA, PhD replied to sangmu12's response:
    I don't know if this procedure will change your life or not. Find an ENT that is willing to use a laser on your tonsils or convince an ENT (and your insurance company) that a complete tonsillectomy is warranted.

    If you have no will not have a place for stone formation. This is not a judgmental attitude. This is the really the only answer.
    lms41163 replied to Rod Moser, PA, PhD's response:
    "Most of the accumulated debris is FOOD (and other debris), and food can be prevented from forming those stinky stones by gargling after meals, and of course, maintaining a good program of oral hygiene (like mentioned above)."

    These are your words. Good oral hygiene does not take care of the problem.
    Rod Moser, PA, PhD replied to lms41163's response:
    Perhaps not for everyone, but it can prevent some NEW stones from forming. The only permanent cure for tonsillar stones is to remove the tonsils, but this may be a bit drastic for thse innocent (albeit, annoying) stones (tonsilliths).
    dora001 replied to Rod Moser, PA, PhD's response:
    I take good care of my mouth, regular visit at the dentist, tooth brush but still have an awful breath. I had a tonsillectomy as well, but still I can notice the white spots at the back of my thoat. why is this so? This bad breath problem is a very demorolising one. People mock at you yet you cannot talk about it openly
    atti_editor replied to dora001's response:

    Have you been to see your doctor about your bad breath problem? It would be a good idea to have him/her rule out any underlying medical condition that could be the cause. He/She will also be able to better identify what the white spots at the back of your throat may be. If you doctor does not know what could be the cause, making an appointment with an ENT would be a good idea as they specialize in matters of the ear, nose and throat.

    In the meantime, here are some tips on how to reduce or eliminate bad breath (in addition to the oral hygiene measures you are already taking). Please let us know how you are doing!

    Best wishes,
    dora001 replied to atti_editor's response:
    Hi there,

    Since the number of years am having this problem, I have seen about 5 ENT specialist n followed their treatments but nothing has cured me. Even after tonsillectomy I can still notice white spots at the back of my throat. I will be taking another appointment with a specialist soon to identity what is the root cause of these white spots... is it accumulation of bacteria? I hope to get cured of this soon.
    Really surprising despite medical science has advanced so much yet we people are still suffering this trauma. I am so fed of this that I times I feel its better would have been dead instead of facing people's comments like... I brush my teeth everyday unlike others,i have fresh breath unlike some, whenever there is a foul smell comparison is made to one's breath.
    I would have been ready to give all my money for a good breath
    an89duck responded:
    I had my tonsils removed because I had cryptic tonsils. My surgery was about ten years ago. Having cryptic tonsils was terrible, but the surgery was even worse. Not sure if I would choose to do that again if given the choice.

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