No, owing to a persistent sore throat, you've been uncomfortable for much of the year, and it's not for want of trying. You've attempted to get more sleep to help your immune system and drank enough water to match Singapore's recent rains. You've swallowed enough lozenges to know how bad sore throats are. You may now have to give up chocolate and other Christmas goodies.

Here is the thing. While you've been working hard to strengthen your immune system against sore throats, your tonsils might be the real villains in this health drama.

That's because tonsil stones can cause sore throats, especially if the irritation persists or lasts more than a month. There may be a persistent unpleasant taste in your mouth, and people have been offering you breath mints.

You may also have difficulty swallowing and a sensation that something is trapped in the back of your throat. When you examine the back of your mouth, you may notice white patches on the tonsils.

What are tonsil stones?

These stones originate in the tonsils, which are two round, fleshy lumps located at the back of your throat. Tonsils are part of your immune system, which means they are responsible for "catching" and destroying pathogens that attempt to enter your body through the mouth and nose.

Tonsils, like kidneys and gallbladders, can produce tiny, hard, calcified pieces that might look white or yellow.

"The tonsils contain natural pockets or tonsillar crypts that can trap various materials, such as food particles, dead cells, bacteria, and mucus," stated Dr. Ben Gee, the founder and main dentist of Delight Dental.

"Over time, these trapped substances combine with minerals like calcium from saliva and harden or calcify, forming tonsil stones."

Tonsil stones are uncommon, according to Associate Professor Raymond Ngo, the chairman and senior consultant of Ng Teng Fong General Hospital's Otolaryngology - chairman & Neck Surgery department.

How can I tell if I have Tonsil stones?

"While smaller tonsil stones may go unnoticed, larger ones can cause noticeable symptoms," Dr Gee noted, alluding to the previously indicated indicators. Most individuals are unfamiliar with tonsil stones, which has led to some unexpected meetings, he added.

"For instance, one patient came in quite distressed, convinced that she had chipped a tooth after coughing up a small, hard, white fragment," Dr. Gee told me. "It turned out to be a tonsil stone that had dislodged on its own."

Dr. Gee has also had patients describe "coughing up or even swallowing small, gritty bits" that they mistook for rice grains or seeds.

"In one particularly memorable case, a patient thought they had accidentally ingested a foreign object after feeling a hard, uncomfortable 'pop' in their throat, only to learn it was a tonsil stone breaking loose."

Why am I prone to tonsil stones?

"We don't know why some people get tonsil stones and others don't," said Assoc Prof Ngo.

However, Dr Gee believes that there may be some tendencies, such as having deeper or larger tonsillar crypts. "These crypts provide the perfect environment for debris such as food particles, mucus and bacteria to accumulate and calcify over time."

Poor dental hygiene is another issue. According to Dr. Gee, not brushing, flossing, and cleaning your tongue on a regular basis can lead to an increased buildup of germs and food debris in the mouth, which may settle in the tonsillar crypts.

Other causes, he continued, include reduced saliva production, repeated bouts of tonsillitis, allergies, sinus problems, and colds. They contribute by reducing microbial flushing, generating inflammation that enlarges the tonsils and traps more debris, or inducing post-nasal drip, which allows mucus to build in the tonsils.

Even your diet may make a difference. According to Dr Gee, foods like milk, cheese, and yoghurt can contribute to the development of calcium-rich waste, which can calcify into stones. Meanwhile, sweet, sticky, or processed meals might "fuel bacterial growth or leave behind small particles that can easily get trapped in the tonsillar crypts".

Do I need the stones removed?

It depends on how much the stones disturb you; if they don't, nothing should be done. According to Assoc Prof Ngo, "patients do not need treatment unless they have bad breath or discomfort from a chronic infection."

Even better news: a doctor can dislodge tonsil stones with a long, blunt-tip device. However, he stated that stones that are displaced in this manner "very quickly reform". "The only way to prevent reformation is to remove the tonsils with surgery."

He offered a warning: "We do not recommend self-removal as it is difficult to do it in front of a mirror and can cause bleeding from local trauma" .

However, if you are convinced and certain that DIY Operation: Tonsil Stone Removal will not harm your mouth or cause infection, Dr Gee recommends utilising an oral water jet on the gentlest setting.

Alternatively, consider "regularly gargling with warm salt water to help loosen the stones, reduce bacteria and soothe any irritation in the throat" . "It's particularly useful for smaller stones or as a preventive measure," he told me.

"You can gently nudge it out using a clean, dampened cotton swab" for obvious stones that are easily accessible, recommended Dr Gee. "It's important to do this with care and avoid applying excessive pressure as the tonsils are sensitive and can bleed or become inflamed."

Who should I see: a dentist or a general practitioner?

According to Dr Gee, if your problem appears to be connected to oral health, such as recurrent bad breath, poor oral hygiene, or debris in the mouth, a dentist can assist.

He recommended seeing a medical practitioner or an ENT (ear, nose, and throat) specialist if you have chronic tonsil stones, recurring throat infections, difficulties swallowing, or persistent problems impacting your throat or general health. "They can provide more advanced options, such as medical procedures to remove the stones or address underlying tonsil issues."

However, he advised seeking care early to guarantee optimal management, decrease discomfort, and avoid problems.