Bacterial Parotitis
A bacterial infection of the parotid salivary gland
Quick Facts
- Type: Salivary gland infection
- Location: Parotid gland, in front of and below the ear
- Common triggers: Dehydration, reduced saliva flow
- Typical signs: Painful, swollen, tender cheek and jaw
Overview
Bacterial parotitis is an infection of the parotid gland, the largest of the salivary glands, located in front of and just below each ear. Saliva from this gland normally flows through a small duct into the mouth and helps wash away bacteria. When saliva flow slows or the duct becomes blocked, bacteria can travel up into the gland and cause infection.
The condition often appears suddenly with painful swelling over the cheek and jaw. It is most common in older adults, people who are dehydrated, and those recovering from surgery or serious illness. With prompt treatment, most cases improve, but untreated infection can sometimes form an abscess or spread, so timely care is important.
Symptoms
Symptoms usually develop quickly over hours to a day or two. They include:
- Painful swelling over the cheek and jaw in front of or below the ear, often on one side.
- Tenderness, warmth, and redness over the gland.
- Fever and chills and feeling unwell.
- A bad taste in the mouth or pus draining from the duct inside the cheek.
- Difficulty opening the mouth or pain when chewing.
- Dry mouth.
Gently massaging the gland may push pus from the duct opening inside the cheek, which helps point to a bacterial cause.
Causes
Bacterial parotitis happens when bacteria from the mouth travel up the salivary duct and infect the gland. This is much more likely when saliva flow is reduced, because saliva normally helps flush bacteria away. Common contributing factors include:
- Dehydration: A major trigger, often after surgery, illness, or in older adults.
- Reduced saliva production: From certain medications, dry mouth conditions, or radiation.
- Blockage of the duct: Such as from salivary stones.
- Poor oral hygiene.
The infection is usually caused by bacteria normally found in the mouth.
Risk Factors
- Dehydration, including after surgery or during serious illness
- Older age
- Medications that reduce saliva
- Dry mouth conditions, such as Sjogren syndrome
- Salivary duct stones or blockage
- Poor oral hygiene
- A weakened immune system
Diagnosis
Diagnosis is usually based on the examination and history, sometimes with additional tests.
- Physical examination: Checking for a tender, swollen gland and looking for pus at the duct opening inside the cheek.
- Imaging: Ultrasound or CT can confirm the infection, look for an abscess, and check for stones.
- Cultures: Of pus from the duct to identify the bacteria and guide antibiotics.
- Blood tests: To assess the severity of infection.
The clinician will also consider other causes of gland swelling, such as mumps or a blocked duct.
Treatment
Treatment focuses on clearing the infection and restoring saliva flow.
- Antibiotics: To treat the bacterial infection, chosen and adjusted based on the likely or confirmed organisms.
- Hydration: Drinking plenty of fluids to restore saliva flow.
- Stimulating saliva: Sour candies, citrus, or chewing gum, plus warm compresses and gentle gland massage.
- Pain relief and oral care: Pain medicine and good mouth hygiene.
- Drainage: If an abscess forms, it may need to be drained.
Treatment usually combines these measures, since restoring saliva flow and clearing the bacteria work together. People who are very unwell, dehydrated, or have a spreading infection may need to be treated in the hospital with intravenous antibiotics and fluids. Most people improve within a few days of starting treatment, especially when dehydration is corrected and saliva flow returns. Prompt care also lowers the risk that the infection will form an abscess or spread to nearby tissues.
Prevention
- Stay well hydrated, especially when ill or after surgery
- Maintain good oral hygiene
- Stimulate saliva flow with sugar-free gum or sour candies if your mouth is dry
- Treat salivary stones and duct blockages promptly
- Manage conditions and medications that cause dry mouth with your clinician
When to See a Doctor
See a doctor promptly if you develop a painful, swollen, tender area over the cheek and jaw, especially with fever or pus in the mouth. Seek urgent care if you have:
- Rapidly spreading swelling of the face or neck
- Difficulty breathing or swallowing
- Trouble opening the mouth
- High fever and feeling very unwell
These can signal a spreading infection or abscess that needs immediate treatment.
Frequently Asked Questions
What causes bacterial parotitis?
It happens when bacteria from the mouth travel up the salivary duct and infect the parotid gland. This is most likely when saliva flow is reduced, often from dehydration, certain medications, dry mouth, or a blocked duct.
How is bacterial parotitis different from mumps?
Bacterial parotitis is caused by bacteria and often produces pus that can be expressed from the duct, while mumps is a viral infection that usually causes swelling of both parotid glands. Testing and history help tell them apart.
How is bacterial parotitis treated?
Treatment includes antibiotics, generous fluids to restore saliva flow, and measures to stimulate saliva such as sour candies, warm compresses, and gentle massage. An abscess, if it forms, may need to be drained.
Can bacterial parotitis be prevented?
Staying well hydrated, maintaining good oral hygiene, and stimulating saliva when your mouth is dry all lower the risk. Treating salivary stones and managing dry mouth conditions also help prevent infection.
When should I seek urgent care for parotitis?
Seek urgent care if the swelling spreads rapidly, you have trouble breathing or swallowing, you cannot open your mouth well, or you have a high fever and feel very unwell. These can signal a spreading infection or abscess.
References
- MedlinePlus, U.S. National Library of Medicine. Salivary gland infections.
- StatPearls, National Library of Medicine. Parotitis.
- Mayo Clinic. Salivary gland infections.
- American Academy of Otolaryngology–Head and Neck Surgery.