Sialolithiasis

Salivary Gland Stones

Three major salivary glands
Three major salivary glands. Encyclopaedia Britannica/UIG/Getty Images

Sialolithiasis is the technical term for salivary gland stones. In order to understand sialolithiasis you need to understand how and where your saliva, more commonly referred to as "spit" is produced and what can happen when it's production and excretion is inhibited.

Saliva's Function

Saliva is mostly made up of water but also contains small amounts of electrolytes, calcium, phosphate, important antibacterial compounds, and digestive enzymes.

The antibacterial properties of saliva protect against:

  • oral infections
  • chronic dry mouth
  • gum disease
  • tooth decay

The digestive enzymes in saliva begin breaking down your food before your have even swallowed it and saliva is most commonly released in response to the smell and taste of food. Additional functions of saliva include helping us to swallow and talk.

Saliva is produced by several glands located in the mouth and throat. The major salivary glands then transport the saliva through tiny tubes called salivary ducts which eventually release the saliva into various places in your mouth, especially under your tongue and on the floor of your mouth. The three pairs of major salivary glands are called the parotid, submandibular, and sublingual glands.

In addition to the major saliva glands there are multiple smaller glands, called minor salivary glands, located in your lips, cheeks, and throughout the tissue lining your mouth.

Causes of Sialolithiasis 

Conditions such as dehydration which cause thickening, or decreased water content of the saliva can cause the calcium and phosphate in saliva to form a stone. This most commonly occurs in the submandibular saliva gland; stones can also occur in less frequency in the parotid gland and even more rarely in other saliva glands.

The stones often form in the salivary ducts and can either totally obstruct the salivary duct, or partial occlude it.

Sialolithiasis is much more common in adults than children but can occur at any age. People who develop sialolithiasis are often otherwise healthy and the cause can not always be pinpointed. However, conditions that may cause thick saliva and subsequent sialolithiasis include:

  • dehydration
  • use of medications or conditions which cause dry mouth
  • Sjorgen's syndrome, lupus, and autoimmune diseases in which the immune system may attack the saliva glands
  • radiation therapy of the mouth

Small stones which do not block the flow of saliva can occur and cause no symptoms. However, when the flow of saliva becomes completely blocked it may cause the associated salivary gland to become infected. 

Symptoms of Sialolithiasis

Symptoms usually occur when you try to eat (since that's when the flow of saliva is stimulated) and may subside within a few hours after eating or attempting to eat. This is important to tell your doctor since it may help differentiate sialolithiasis from other conditions.

Symptoms of sialolithiasis may include:

  • swelling of the affected saliva glands which normally occurs with meals
  • difficulty opening the mouth
  • difficulty swallowing
  • a painful lump under the tongue
  • gritty or strange tasting saliva
  • dry mouth
  • pain and swelling usually around the ear or under the jaw

Severe infections of a saliva gland may cause profound symptoms including fever, fatigue, and sometimes noticeable swelling, pain and redness around the affected gland.

Diagnosing Sialolithiasis

An otolaryngologist, or ear, nose, and throat doctor is a physician qualified to diagnose and treat sialolithiasis. Although doctors in other specialties may also diagnose or treat the condition. Your doctor will consider your medical history and examine your head and neck, including the inside of your mouth. Sometimes the stone can be felt as a lump. Some stones may be visible with an x-ray and some doctors may order other tests such as an MRI or CT scan.

Treatment of Sialolithiasis

The treatment of sialolithiasis depends on where the stone is and how large it is. Small stones may be pushed out of the duct and you may be able to facilitate this by drinking plenty of water, or massaging and applying heat to the area. Sometimes a doctor can push the stone out of the duct and into the mouth by using a blunt object and gently probing the area.

Large salivary duct stones may be more difficult to remove and sometimes require surgery. Sometimes a thin tube called an endoscope can be inserted into the duct, if the stone can be seen with the endoscope the doctor may be able to insert another tool that is then used to pull the stone out. Sometimes removal of the stone can be achieved with a small incision, in severe case the entire gland and the stone may have to be surgically removed.

In the case of an infected gland, your physician may prescribe an oral antibiotic. Never take antibiotics without seeing a physician.

Sources:

Advanced Otolaryngology & Audiology. Salivary Duct Stones. Accessed: March 18, 2014 from http://advancedotolaryngology.com/patient-education/salivary-duct-stones/

American Academy of Otolaryngology - Head and Neck Surgery. Salivary Glands. Accessed: March 18, 2014 from https://www.entnet.org/HealthInformation/salivaryGlands.cfm

Cedars - Sinai. Salivary Gland Disease and Tumors. Accessed: March 18, 2014 from http://www.cedars-sinai.edu/Patients/Health-Conditions/Salivary-Gland-Disease-and-Tumors.aspx

Medscape. Salivary Duct Stones. Accessed: March 18, 2014 from http://www.nlm.nih.gov/medlineplus/ency/article/001039.htm

National Institute of Dental and Craniofacial Research. Dry Mouth. Accessed: March 18, 2014 from http://www.nidcr.nih.gov/oralhealth/topics/drymouth/drymouth.htm

Patient. co.uk. Salivary Gland Stones (Salivary Calculi). Accessed: March 18, 2014 from http://www.patient.co.uk/health/salivary-gland-stones-salivary-calculi

Salivary Stone Center of Excellence. Sialolithiasis. Accessed: March 18, 2014 from http://salivarystonesmd.com/sialolithiasis-treatment/

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