include partial or complete tonsil removal. Some people are able to remove tonsil stones using a cotton swab. Oral irrigators are also effective. Most electric oral irrigators are unsuitable for tonsil stone removal because they are too powerful and are likely to cause discomfort and rupture the tonsils, which could result in further complications such as infection. Irrigators that connect directly to the sink tap via a threaded attachment or otherwise are suitable for tonsil stone removal and everyday washing of the tonsils because they can jet water at low-pressure levels that the user can adjust by simply manipulating the sink tap, allowing for a continuous range of pressures to suit each user's requirements. There are also manually pressurized tonsil stone removers which are available. A manual pump-type tonsil stone remover can adjust the water pressure depending on the number of pumps, effectively removing tonsil stones. More simply still, gargling with warm, salty water may help alleviate the discomfort of tonsillitis, which often accompanies tonsil stones. Vigorous gargling each morning can also keep the tonsil crypts clear of all but the most persistent tonsilloliths. Curettage Larger tonsil stones may require removal by curettage (scooping) or otherwise, although thorough irrigation will still be required afterward to effectively wash out smaller pieces. Larger lesions may require local excision, although these treatments may not completely help the bad breath issues that are often associated with this condition. Laser Another option is to decrease the surface area (crypts, crevices, etc.) of the tonsils via laser resurfacing. The procedure is called a laser cryptolysis. It can be performed using a local anesthetic. A scanned carbon dioxide laser selectively vaporizes and smooths the surface of the tonsils. This technique flattens the edges of the crypts and crevices that collect the debris, preventing trapped material from forming stones. Surgery Tonsillectomy may be indicated if bad breath due to tonsillar stones persists despite other measures. Epidemiology Tonsilloliths or tonsillar concretions occur in up to 10% of the population, frequently due to episodes of tonsillitis. While small concretions in the tonsils are common, true stones are less so. They commonly occur in young adults and are rare in children. References Medical signs Oral hygiene Wikipedia medicine articles ready to translate