Have you ever been reviewing a panoramic X-ray for a patient, Doctor, and spotted something you just couldn’t quite identify? You might notice small, white, clustered specks appearing above the ramus of the mandible and find yourself wondering. Is this indicative of a bone issue? Perhaps arterial calcification? Or what exactly could it be? Today, we’re diving into one of the most common incidental findings on dental radiographs: Tonsiliths, often simply referred to as tonsil stones.
What Exactly Are Tonsiliths?
The definition of tonsiliths is quite straightforward. They are calcifications that form within the small pockets or crevices, known as crypts, located in the palatine tonsils.
What Do Tonsiliths Look Like on X-rays? (Radiographic Features)
To quickly identify tonsiliths on radiographs, it’s essential to be familiar with their typical characteristics:
Location
On 2D imaging, such as panoramic radiographs, tonsiliths typically project their image superior to the ramus and angle of the mandible. However, their precise location becomes much clearer with CBCT (Cone Beam Computed Tomography), where they usually appear lateral to the airway and medial to the mandibular ramus.
Edge
Their borders are generally well-defined. They can present as either smooth or irregular in outline.
Shape
Tonsiliths may appear as round masses or exhibit an irregular shape.
Internal Composition
Naturally, they are radiopaque.
Other Noteworthy Points
They can manifest unilaterally (on one side) or bilaterally (on both sides). Additionally, they might appear as a single calcification or multiple distinct tonsiliths.
Key Diagnostic Indicators
The most crucial identifier for tonsiliths is the presence of multiple small, radiopaque masses situated within the tonsillar region. More often than not, their discovery is an incidental finding during dental radiography performed for entirely different reasons.
What’s Their Clinical Significance?
While tonsiliths are generally asymptomatic, they can occasionally lead to a persistent sore throat or a sensation of a foreign body being present. They are also notably associated with halitosis (bad breath). In the vast majority of cases, they don’t cause any bothersome symptoms and therefore don’t require specific treatment. For us as dental professionals, their primary significance lies in ensuring we don’t confuse them with other calcifications that might appear in the same anatomical area.
Clinical Presentation (What You See Intraorally)
During a clinical examination, you’ll typically observe tonsiliths as distinct yellow-white stones nestled within the tonsillar crypts. Their size can vary significantly, ranging from just a few millimeters up to several centimeters. If they become dislodged from their location, they are often associated with a remarkably foul odor.
A Final Crucial Point
While we often discover tonsiliths incidentally, it’s absolutely vital to diagnose them correctly to avoid misinterpreting them for other pathological conditions. CBCT offers far more precise localization than 2D radiography. Typically, the management for tonsiliths remains conservative, especially as long as they aren’t causing clear, bothersome symptoms for the patient.
