Association of tonsillolith characteristics with periodontal bone loss and dental pathologies: A retrospective study based on cone-beam computed tomography

Tonsilloliths are frequently detected as incidental findings, and their microbial similarity to periodontal biofilms suggests potential clinical significance, although robust CBCT-based evidence supporting this association has been limited. This retrospective study evaluated the association between the presence, size, and number of tonsilloliths detected on cone-beam computed tomography (CBCT) images and periodontal bone loss, furcation involvement, and other dental pathologies. CBCT scans of 342 systemically healthy patients obtained between November 2020 and October 2024 were retrospectively evaluated. Participants were divided into two equal groups (n = 171) according to the presence of tonsilloliths, and each scan was assessed for tonsillolith characteristics and dental findings. Periodontal bone loss was determined from cementoenamel junction-alveolar crest distances and categorized into three severity levels. Tonsilloliths were most frequently located on the right side or bilaterally, with a mean size of 3.98 ± 1.78 mm. The tonsillolith group had a significantly higher mean number of missing teeth (p = 0.040), while no significant differences were noted for decayed, restored teeth, or apical periodontitis. Bone loss between 1/3 and 2/3 of the optimal bone height and bone loss more than 2/3 of the optimal bone height were more prevalent in the tonsillolith group (p < 0.001). Tonsillolith size positively correlated with bone loss severity (ρ = 0.274, p < 0.001), and larger tonsilloliths were significantly associated with furcation defects (p < 0.001). Tonsillolith presence and size may be linked to advanced periodontal bone loss and tooth loss, highlighting the potential role of CBCT in interdisciplinary periodontal assessment.