I'm a 35-year-old female. I've had white spots on my tonsils on and off for years, but now I seem to have them constantly. One sometimes will shed itself, then another will re-appear. What are these? Should I be concerned and see a doctor? Sometimes my throat gets sore, but not very often.

C.

Tonsils have pits, known as "crypts." The outer surface of the tonsil, including the crypts, is covered by a "skin" called mucosa. Mucosa is the tissue that lines your mouth, nasal cavity, sinuses and gastrointestinal tract. This lining sheds (just as your skin sheds constantly, usually without your awareness). In some individuals, shed tonsil mucosa can build up within the crypts. This accounts for the white spots. In some unfortunate folks, this material hardens and forms "stones," or "tonsilloliths." These can be quite irritating, enough so that a tonsillectomy may be warranted to get rid of the problem. In your case, the white spots don't even rise to the level of annoyance, so tonsillectomy is out of the question.
You should see a doctor, however. There is a small chance that you are getting recurrent strep throat (throat infection caused by Streptococcus bacteria). I think this is unlikely, because you state that your throat is only occasionally sore, and strep throat is typically very painful. Nevertheless, it would be worthwhile to have a doctor take a throat culture at a time when the white spots are very prominent. To take a throat culture, your doctor will quickly swab the suspicious area and send the swab to a microbiology lab, where they will determine whether or not you are having a strep infection. Rapid, in-office test kits can determine the same thing.

It is very important to eliminate the possibility that you are having recurrent strep throat infections, because a small percentage of people with untreated strep throat will develop kidney disease or heart disease (rheumatic fever) as a complication of their strep infection. Either problem can be devastating.

So, to set your mind at ease, have a doctor take a throat culture when the spots are thick as thieves, and perhaps also when your throat is sore.