Sialadentitis: Symptoms, Diagnosis & Treatment

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Sialadentitis is inflammation of the salivary glands. It has several causes, including infections or obstructions. Sialadentitis can be an acute (short term) condition or a chronic (long term) condition. It is also sometimes further classified by the exact salivary gland that is affected such as submandibular or parotid. 

Acute Sialadentitis

Acute sialadentitis is usually caused by a bacterial infection.

It most commonly affects the parotid gland (located in front of the ear) or the submandibular gland (under the chin). Dehydration or dry mouth are major risk factors leading to sialadentitis. Therefore, this condition is more common in individuals who are already ill or who are on medications that cause dry mouth. In addition, the following medical conditions put you at higher risk of developing acute sialadentitis:

  • diabetes mellitus
  • hypothyroidism
  • Sjorgen's syndrome
  • recent surgery
  • history of radiation treatment of the mouth or oral cavity

Symptoms of acute sialadentitis may include:

  • severe pain and swelling of the affected gland that comes on suddenly
  • pus may come out of the gland especially if the gland is rubbed or massaged
  • redness of the skin over the affected gland
  • fever or chills
  • the gland might feel like a hard lump and be tender to the touch

A diagnosis of acute sialadentitis is based off of your medical history, your symptoms, and a doctor's examination.

If you doctor is able to obtain a sample of pus from the affected gland it can be sent to a laboratory to determine what is causing the infection. This information is useful in deciding the best course of treatment. the most common bacteria that causes acute sialadentitis are Staphylococcus aureus, and various strains of streptococcus.

While more rare, acute sialadentitis can also be caused by a virus. Viruses that may lead to this condition include: the mumps virus, the herpes virus, HIV, and Haemophilus influenzae. Viral infections cannot be treated with antibiotics. In most cases you need to treat symptoms while waiting for the body to fight off the virus on its own. In severe cases, however, anti-viral medications may be used. These medications are not routinely prescribed because many of them are associated with severe side effects.

Acute sialadentitis can be treated with an appropriate course of antibiotics. This is best achieved if a culture is obtained. You should always take antibiotics exactly as prescribed and finish the entire bottle unless otherwise directed by your physician.

Restoring proper saliva flow is also very important in the treatment of acute sialadentitis. This is best achieved by drinking plenty of fluids, and eating, drinking, or sucking on things that stimulate the flow of saliva (e.g., cough drops). If you are taking medications that cause dry mouth you may need to talk to your doctor about switching to a different medication or other ways that you can manage this side effect.

In extreme and rare cases, acute sialadentitis can lead to the formation of an abscess.

If this occurs the abscess may have to be drained surgically.

Chronic Sialadentitis

Unlike acute sialadentits, chronic sialadentitis is more likely to be caused by an obstruction than by an infection. The obstruction can be caused by stones (salivary calculi), scar tissue or in rare cases tumors. Regardless the obstruction leads to decreased flow of saliva and chronic inflammation. Chronic sialadentitis most often affects the parotid gland.

The following are symptoms of chronic sialadentitis:

  • tenderness and mild swelling over the affected gland
  • the gland may initially be enlarged then decrease in size
  • pain in the area of the gland while eating

Chronic sialadentitis is diagnosed in a similar manner to acute sialadentitis but more emphasis might be placed on identifying and treating the underlying cause of chronic sialadentitis. Imaging with ultrasound or a CT scan may be helpful. Also during a doctor's exam if the affected gland is massaged it will usually not produce any saliva.

Once the underlying cause of chronic sialadentitis is diagnosed treatment should focus on reversing the underling cause of the condition. If an obstruction is present it may have to be surgically removed. If no obstruction is found treatment consists of hydration, massage, and sometimes medications that reduce inflammation. Sucking on lozenges or cough drops may also help to restore the flow of saliva. In rare and severe cases of chronic sialadentitis the entire salivary gland may need to be surgically removed.

Other Similar Conditions

There are a few other conditions that are associated with or may cause similar symptoms as sialadentitis. Your doctor will need to rule these out before making a diagnosis of sialadentitis and recommending treatment. 

One condition typically occurs in children and is called recurrent parotitis of childhood. The cause of this condition is not known but it usually only occurs in children who usually grow out of it around the time of puberty. Recurrent parotitis of childhood is characterized by repeated episodes of parotid gland swelling (usually only on one side). The swelling is accompanied by other symptoms including fever and malaise. 

Treatment for recurrent parotitis of childhood is similar to that of sialadentitis. Warm compresses over the affected gland and massage may help to stimulate saliva flow along with proper hydration and things like cough drops or vitamin C drops to suck on. Antibiotics may occasionally be prescribed. Surgery is almost never necessary. It is different for each child but episodes may occur every few months and last a few days to a couple of weeks.

Another related condition is called sialolithiasis or salivary duct stones. As previously mentioned this condition can occur by itself or actually lead to sialadentitis. Stones in the salivary ducts are formed by the minerals found in saliva, namely salts, proteins and calcium carbonate. 

Sometimes salivary duct stones can be palpated (felt by your doctor on examination) but more often they are diagnosed by using ultrasound or CT scan. Stones usually need to be surgically removed.

While more rare than any of the conditions mentioned above occasionally tumors (benign or cancerous) can lead to sialadentitis. These are diagnosed using a needle biopsy where tissue is removed from the tumor and then examined under a microscope to see if the cells are cancerous or not. Most growths found in the salivary glands are benign. Regardless of whether a growth is benign or malignant most growths in the salivary glands or ducts should be surgically removed.

Sources:

Salivary Gland Disorders. American Family Physician. Updated June 2014. http://www.aafp.org/afp/2014/0601/p882.html

Submandibular Sialadenitis/Sialadenosis. Medscape. Updated January 2017. https://emedicine.medscape.com/article/882358-overview​

Sialadenitis. NIH website. Updated November 2016. ​https://rarediseases.info.nih.gov/diseases/7638/sialadenitis

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