BackgroundRecent studies suggest that tonsilloliths are clinically related to halitosis and tonsillar abscess. Based on our empirical knowledge, tonsilloliths are relatively commonly encountered in daily clinical practice. It has been reported that the detection rate of tonsilloliths was under 24% in previous reports, although experience suggests otherwise. The purpose of the study was to evaluate the prevalence and characteristics of tonsilloliths using computed tomography (CT). In addition, the possible causes of low detection rates on panoramic radiographs were evaluated based on comparisons between CT images and panoramic radiographs in order to elucidate the limitations of visualizing the area around the palatine tonsils on panoramic radiographs.Methods482 pairs of CT images and panoramic radiographs were retrospectively assessed with respect to the presence and characteristics of tonsilloliths. In addition, the causes in cases of disagreement between the two modalities were analyzed.ResultsThe detection rate of tonsilloliths was 46.1% using CT scans, unlike previous reports. The characteristics of tonsillolith were dot-like figures with about 300-500 Hounsfield units within the palatine tonsil under the soft palate. The most common length of tonsilloliths was about 3 or 4 mm. As the subjects aged, the detection rate increased gradually. A significant difference in the tonsillolith detection rate was found between the over and under 40-year-old groups (p < 0.0001). However, the detection rate of tonsilloliths was only 7.3% on panoramic radiographs. A significant correlation was observed between the detection rate of tonsilloliths on panoramic radiographs and CT number (Spearman r = 0.429), size, (Spearman r = 0.318), and number of tonsilloliths (Spearman r = 0.333).ConclusionThe present results suggest that tonsilloliths are relatively more common than previously suggested. However, panoramic radiographs detect only a small percentage of palatine tonsilloliths. The low detection rates on panoramic radiographs might be related to the degree of calcification, size, and number of tonsilloliths.

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Supersaturated solution of calcium carbonate ([Ca2+] = 1.2 mmol/L, [HCO3-] = 3.2 mmol/L, pH = 8.8, T = 30 +/- 0.5 degrees C), a scale forming component, was irradiated by an ultrasonic homogenizer (24 kHz, 15-250 W/cm2) to study the factors that affect its precipitation rate. The factors of (1) depth of horn immersion, (2) ultrasonic intensity and horn tip size and (3) cavitation, which can affect the precipitation rate were investigated in this study. Ultrasonic irradiation was observed to accelerate the precipitation of calcium carbonate and it was found that there exists an optimum range of horn immersion depth for maximizing the precipitation rate. The experimental data also established that the precipitation rate was proportional to ultrasonic intensity and diameter of horn tip. These findings were correlated to the effects of physical mixing, that arises due to ultrasonic irradiation. However, the effect of cavitation in accelerating the precipitation rate was found to be small. Thus it is forwarded that the physical mixing effect, especially macrostreaming is the main factor that accelerates the precipitation rate of calcium carbonate during ultrasonic treatment. Further, neither the morphology nor the size of the calcium carbonate crystals formed were found to be affected by the ultrasonic irradiation.

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