What Causes White Spots On The Tonsils? - Medical News Today

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Medical News TodaySubscribeCauses and treatments for white spots on the tonsils

Medically reviewed by Nicole Leigh Aaronson, MD, MBA, CPE, FACS, FAAP — Written by MaryAnn De Pietro, CRT — Updated on February 7, 2024

Symptoms
Causes
See a doctor
Diagnosis
Treatments
Home remedies
Prevention
FAQ
Summary

White spots, blotches, or streaks on the tonsils can be a sign of various conditions, including strep throat and oral thrush. Treatment is available for most of these conditions.

The tonsils are part of the lymphatic system and are located on the back of the throat.

Changes to the appearance of the tonsils may be a sign that the body is reacting to an infection. There may also be a sore throat or swollen tonsils. In some cases, the spots may contain pus.

Here, find out about some causes of white spots on the tonsils, when to see a doctor, and which treatment they might prescribe.

Symptoms

Symptoms will depend on the cause, but a person may notice:

white spots, streaks, or blotches on the tonsils or throat
a sore throat
difficulty swallowing
other symptoms, such as a fever, fatigue, or nasal congestion, depending on the cause

Causes

Some of the more common infections that can cause white spots include:

Strep throat

Strep throat is a common bacterial infection caused by Streptococcus. It can cause white streaks or patches of pus on the tonsils.

Additional symptoms that may indicate strep throat include:

pain when swallowing
sore throat that starts quickly
fever
swollen lymph nodes in the front of the neck
headache
inflamed and swollen tonsils

Less common symptoms can include:

stomach pain
nausea
vomiting
headache
rash, or scarlet fever

According to the Centers for Disease Control and Prevention (CDC), it is most common in:

children ages 5–15 years
adults who spend time with school-aged children
those who spend time in crowded settings, such as day care centers and military training facilities

If a person suspects they or someone they are caring for has strep throat, they should seek medical advice.

While rare, complications can arise if the bacteria spreads to other body parts, such as the heart. They include rheumatic fever, ear and sinus infections, and post-streptococcal glomerulonephritis, which affects the kidneys.

Oral thrush

Oral thrush is a fungal infection that can affect the mouth and throat. It can cause white patches to appear in the throat. They can also appear on the inner cheeks, the roof of the mouth, and the tongue.

Possible other symptoms include:

pain when swallowing
difficulty swallowing
redness and soreness
loss of taste
a feeling like cotton in the mouth
cracking at the corners of the mouth

Oral thrush can affect anyone but is most common in those who:

use dentures
have a weakened immune system, as with HIV and some cancers and cancer treatments
have diabetes
use antibiotics or corticosteroids for a long-term condition, such as asthma
use inhale corticosteroids without a spacer
have a dry mouth or use medications to treat dry mouth
smoke

It can affect infants and babies, particularly those younger than 1 month in age.

Viral tonsillitis

Tonsillitis involves inflammation or swelling of the tonsils. It usually results from a viral infection but can occur with strep throat.

Symptoms of viral tonsillitis include:

a white or yellow coating on the tonsils
red and swollen tonsils, possibly with pus
a sore throat
pain and difficulty when swallowing
swollen lymph nodes in the neck
fever
bad breath
mouth breathing or sleep apnea

Viral tonsilitis most commonly occurs as a result of the following viruses:

rhinovirus
adenovirus
coronavirus
respiratory syncytial virus

Infectious mononucleosis

Mononucleosis is a viral infection caused by the Epstein-Barr virus, which affects certain blood cells.

Along with white spots on the back of the throat, symptoms may include:

fever
sore throat
severe fatigue
head and body aches
swollen lymph nodes in the neck and underarms
swollen liver, spleen, or both
a rash

Infectious mononucleosis spreads easily from person to person. Those most at risk are teenagers and young adults.

Tonsil stones

Tonsil stones, also called tonsilloliths, are hard, white stones that form on the tonsils. Many people with tonsil stones do not notice them, but symptoms can include:

bad breath
ear pain
a feeling of having something stuck in the throat
painful swallowing

Tonsil stones, or tonsilloliths, can form when bacteria and debris, such as food and mucus, become stuck in crevices in the tonsils. As the debris hardens or calcifies, white spots can become visible on the tonsils.

Leukoplakia

Some tissue changes can lead to leukoplakia, white or gray areas in the mouth or throat that do not disappear when a person scrapes them.

Smoking can cause leukoplakia on the tonsils.

In rare cases, it can be an early sign of cancer. For this reason, a doctor may recommend a biopsy.

Other causes of white spots on the tonsil

Other possible causes include:

oral herpes
oral cancer
canker sores in the throat

When to contact a doctor

A person should seek medical advice if they have:

severe or persistent symptoms
symptoms that may indicate strep throat
recurrent infections
difficulty breathing
any other concerns about white spots on the throat
hoarseness lasting over 2 weeks
a fever over 101°F (38.3°C)
blood in saliva or phlegm
a lump in the neck
earache

Diagnosis

A doctor will perform a physical examination of the mouth and throat. They will look in the back of the throat, feel around the neck for any swelling, and ask about other symptoms.

They may also take a throat swab or do blood tests for testing in a laboratory. These can show if bacteria are present, in which case they may prescribe antibiotics. These tests can also show viruses or fungi.

Treatments

Treatment will depend on the cause of the white spots.

A doctor may recommend the following:

Treatment	Other notes
Strep throat	A person can take antibiotics, such as penicillin or amoxicillin.	If a person tests positive but has no symptoms, they will not need antibiotics.
Oral thrush	A person can apply antifungal medications in the form of a solution that a person swishes around the mouth and then spits or swallows. They will do this for 7–14 days.Examples include:• toclotrimazole• miconazole• nystatin	For more severe infections, a doctor may prescribe fluconazole.
Viral tonsilitis	A person can manage symptoms through:• rest• drinking fluids• eating soft food• avoiding exposure to smoke• gargling with salt water• acetaminophen for pain relief	Antibiotics will not help with a viral infection; it usually gets better without medical treatment.
Infectious mononucleosis	A person can manage symptoms through:• rest• drinking plenty of fluids• over-the-counter medication, such as acetaminophen for pain and fever	Antibiotics will not help with a viral infection. Symptoms usually go away after 2–4 weeks but can last 6 months or more.
Tonsil stones	For mild cases, a person can try home remedies, such as:• gargling with warm salt water• using something soft, like a cotton swab or soft toothbrush, to gently remove the tonsil stones• practicing good oral hygiene	More severe cases may need the removal of the tonsils.
Leukoplakia	If necessary, options include minor surgery or laser surgery.	Further treatment will depend on the result of a biopsy, if appropriate.

A person who has recurrent infections of the tonsils may need surgery to remove them, known as a tonsillectomy.

Home remedies

Depending on the cause, treatment at home can help manage symptoms.

This may include:

drinking warm liquids to decrease throat pain
eating only soft foods if swallowing is difficult
avoiding smoking or exposure to smoke
eating popsicles to soothe a sore throat
taking over-the-counter pain relievers, such as acetaminophen
getting plenty of rest, which allows the body to fight any infection
using a humidifier
sucking on throat lozenges to ease discomfort

The time it takes for white spots to clear up will depend on the cause, treatment, and individual factors.

Preventing white spots on the tonsils

It is not always possible to prevent white spots on the tonsil, but people can reduce the risk of some conditions that cause them.

Tips include:

washing the hands often to reduce the risk of infections
boosting the immune system through a well-balanced diet, exercise, and regular sleep
covering the nose and mouth when coughing to avoid passing on infections to others
limiting close contact with others who have an infection
practicing good oral hygiene, including regular dental checkups
being aware of how the tonsils usually appear and monitoring any changes
avoiding or quitting smoking
using a spacer when using an inhaler to avoid thrush

Frequently asked questions

Here are some questions people often ask about white spots on the tonsils.

Should I be worried about white spots on the tonsils?

If white spots occur with severe or persistent symptoms or if symptoms do not disappear after 2–3 weeks, it is a good idea to seek medical advice.

Can you have white spots without having strep throat?

Yes, other causes include viral or bacterial tonsillitis, oral thrush, and tonsil stones.

How can I get rid of white spots on my tonsils?

This will depend on the cause. Often, they go away as an infection clears, either with home remedies or with medical treatment. A doctor can advise on specific options.

Summary

White spots can occur on the tonsils for various reasons, including infections, tonsil stones, and oral thrush. Sometimes other symptoms occur, such as a sore throat, bad breath, or difficulty swallowing.

Often, the condition that causes white spots either goes away without medical treatment, but home remedies can help manage symptoms. In some cases, surgery may be necessary.

Anyone who has concerns about white spots appearing on their tonsils should seek medical advice.

Read the article in Spanish.

Ear, Nose, and Throat
Flu / Cold / SARS
Infectious Diseases / Bacteria / Viruses

How we reviewed this article:

SourcesMedical News Today has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical journals and associations. We only use quality, credible sources to ensure content accuracy and integrity. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

About infectious mononucleosis. (2020). https://www.cdc.gov/epstein-barr/about-mono.html
Anderson J, et al. (2023). Tonsilitis. https://www.ncbi.nlm.nih.gov/books/NBK544342/
Candida infections of the mouth, throat, and esophagus. (2021). https://www.cdc.gov/fungal/diseases/candidiasis/thrush/index.html
Master KG, et al. (2023). Anatomy, head and neck, tonsils. https://www.ncbi.nlm.nih.gov/books/NBK539792/
Mohammed F, et al. (2023). Oral leukoplakia. https://www.ncbi.nlm.nih.gov/books/NBK442013/
Sore throats. (2020). http://www.entnet.org/content/sore-throats
Strep throat: All you need to know. (2024). https://www.cdc.gov/groupastrep/diseases-public/strep-throat.html
What are oral cavity and oropharyngeal cancers? (2021).https://www.cancer.org/cancer/oral-cavity-and-oropharyngeal-cancer/about/what-is-oral-cavity-cancer.html

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Medically reviewed by Nicole Leigh Aaronson, MD, MBA, CPE, FACS, FAAP — Written by MaryAnn De Pietro, CRT — Updated on February 7, 2024

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