Tonsillitis vs. tonsil stones: how to tell them apart

Your throat hurts, and you may see something white near your tonsils. But is it an infection or a tonsil stone? The two conditions can share some symptoms, including a sore throat, bad breath and pain when swallowing. Other signs can help you tell them apart. 

What you will learn in this article: 

• Tonsillitis is swelling caused by a viral or bacterial infection. 

• Tonsil stones are hard lumps that form inside folds in the tonsils. 

• Fever and swollen tonsils are more likely to point to an infection. 

• A throat exam or strep test may be needed to find the cause. 

If you’re not sure whether you have tonsillitis or tonsil stones, schedule an appointment with an Aspen Dental provider. They can examine your mouth and help determine whether your symptoms may be related to a tonsil stone or another oral health concern. 

What is tonsillitis? 

Your tonsils sit at the back of your throat, one on each side, and act as an early defense against germs entering through your mouth and nose. 

Tonsillitis is inflammation of this tissue, which can make the tonsils red and swollen. MedlinePlus explains that most cases are caused by a virus. Bacteria, including the bacteria that cause strep throat, can also be responsible.¹ 

What are tonsil stones? 

Tonsil stones are hard lumps that develop inside deep folds in the tonsils. The American Academy of Family Physicians explains that they form when material such as food particles, shed cells and germs collects in these spaces and hardens with minerals. 

Researchers do not fully understand why tonsil stones form. Repeated tonsillitis may play a part, but it is not the only possible reason.² 

Small tonsil stones are common and may not cause any symptoms. Larger stones are much less common.²

What do tonsil stones feel like? 

Possible signs of tonsil stones include: 

• Bad breath 

• A white or yellow lump inside a tonsil fold 

• A feeling that something is stuck in your throat 

• A sore throat that keeps returning 

• Pain when swallowing 

• A hoarse voice 

Some people do not feel their tonsil stones at all. The stones may only be noticed during an examination or on an X-ray.² 

How do you tell tonsillitis and tonsil stones apart? 

Symptoms can overlap, so you may not always be able to tell at home. These differences may offer clues. 

Sore throat

Both conditions can cause a sore throat. Tonsillitis may cause severe pain, while a small tonsil stone may cause no symptoms.¹^,² 

Fever

Fever is a common sign of tonsillitis. It is not a typical symptom of tonsil stones.¹^,² A fever with a sore throat makes an infection more likely, but it does not tell you whether the cause is viral or bacterial.³ A doctor may need to examine your throat or test for strep before deciding what treatment you need. 

Swollen tonsils

Tonsillitis causes inflammation, so the tonsils may look red and swollen. A tonsil stone often looks like a separate lump sitting inside a fold.¹^,² 

White or yellow areas

Tonsillitis may cause a coating or patches on the tonsils. A stone is more likely to look like a firm, separate lump inside a tonsil pocket.¹^,² Do not try to diagnose the problem by appearance alone. Other throat conditions can also cause white spots or lumps.  

Bad breath

Both conditions can cause bad breath. With tonsil stones, bad breath may occur without fever or swollen glands.¹^,² Bad breath alone is not enough to diagnose either condition. A dental provider can check whether your teeth, gums or another oral health problem may be causing the odor. 

Trouble swallowing

Both tonsillitis and tonsil stones can make swallowing painful.¹^,² Severe trouble swallowing or being unable to swallow liquids needs prompt medical care. 

When should you see a dental provider or doctor? 

Contact a dental provider or doctor if you are unsure what is causing a white or yellow area near your tonsils. You should also seek care if: 

• Your sore throat is severe or getting worse 

• You have a fever 

• Your tonsils are red or swollen 

• You have pain or trouble when swallowing 

• You have swollen glands in your neck 

• You have a tonsil stone that keeps returning or causes ongoing discomfort 

Get urgent medical care if you have trouble breathing, start drooling or cannot swallow liquids. 

A clinician cannot always tell whether a sore throat is viral or caused by group A strep just by looking at it. According to the Centers for Disease Control and Prevention, a rapid strep test or throat culture can confirm strep. Antibiotics are used when testing confirms group A strep, but they do not treat a viral infection.³ 

Most small tonsil stones do not need surgery. Brushing your teeth well and gargling with warm salt water may help with bad breath. A very large stone or one that causes ongoing problems may need treatment from a specialist. 

The main difference is that tonsillitis is an inflamed tonsil caused by an infection, while a tonsil stone is hardened material inside a tonsil fold. When the signs are not clear, an examination is safer than guessing. 

If you have a white or yellow area near your tonsils and aren’t sure what’s causing it, talk with a dental provider. They can examine the area and let you know if your symptoms should also be evaluated by a doctor. 

Tonsillitis vs. tonsil stones: how to tell them apart FAQs 

Still have questions about tonsillitis and tonsil stones? These answers cover a few common concerns. 

Can you have tonsillitis and tonsil stones at the same time? 

Tonsil stones may be linked with repeated tonsillitis. A person who has had several tonsil infections may also develop stones. However, finding a stone does not prove that you have an active infection. 

Can a dental provider spot tonsil stones? 

Yes. A dental provider may see a stone while examining the back of your mouth. Tonsil stones may also appear on some dental X-rays. If your symptoms point to an infection, your dental provider may recommend that you also see a doctor. 

Do tonsil stones always need treatment? 

No. Small stones that do not cause symptoms often need only monitoring. Good oral care and salt-water gargles may help with bad breath. 

Do not dig into your tonsils with sharp objects. See a dental provider or doctor if the stone is painful, difficult to remove or keeps coming back. 

Do tonsil stones mean something is wrong with your immune system? 

A tonsil stone by itself does not show that you have an immune system problem. It forms when material collects and hardens inside the folds of a tonsil. 

How can a doctor tell whether tonsillitis is bacterial? 

A rapid strep test gives results in minutes, while a throat culture takes longer but can catch cases the rapid test misses. Either can confirm whether antibiotics are needed. 

Sources 

¹ National Library of Medicine, MedlinePlus: “Tonsillitis.” https://medlineplus.gov/tonsillitis.html 

² American Academy of Family Physicians, American Family Physician: “Tonsillitis and Tonsilloliths: Diagnosis and Management.” https://www.aafp.org/pubs/afp/issues/2023/0100/tonsillitis-tonsilloliths.html 

³ Centers for Disease Control and Prevention, Group A Strep: “Clinical Guidance for Group A Streptococcal Pharyngitis.” https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/strep-throat.html