Salivary Gland Stones
Mineral deposits that block the flow of saliva
Quick Facts
- Type: Salivary gland disorder
- Most affected gland: The submandibular (under-jaw) gland
- Classic symptom: Gland pain and swelling at mealtimes
- Main risk: Blockage leading to infection
Overview
Salivary gland stones, also called sialolithiasis, are hardened deposits of minerals that form inside a salivary gland or the duct that carries saliva into the mouth. The salivary glands produce saliva to help with chewing, swallowing, and protecting the teeth. When a stone blocks the duct, saliva cannot drain freely, leading to backup, swelling, and pain.
Most stones form in the submandibular glands, located under the jaw, because their saliva is thicker and their ducts run uphill. The condition is the most common disorder of the salivary glands. Many stones can be managed with simple measures, while larger or stubborn ones may need a procedure to remove them.
Symptoms
Symptoms are often linked to eating, when saliva production increases and pressure builds behind the blockage. They include:
- Pain and swelling of the affected gland, classically worsening just before or during meals.
- A gland that swells and then gradually goes down between meals.
- A hard lump that can sometimes be felt in the floor of the mouth or along the duct.
- Dry mouth.
- Signs of infection if the gland becomes infected, including redness, warmth, fever, and pus.
Some small stones cause few or no symptoms and may pass on their own.
Causes
Salivary stones form when minerals in saliva, mainly calcium salts, crystallize and build up over time. Several factors make this more likely:
- Reduced saliva flow: From dehydration, certain medications, or dry mouth conditions, which allows minerals to concentrate.
- Thicker saliva: Particularly in the submandibular gland.
- Duct narrowing or injury: That slows the flow of saliva.
The reduced flow and mineral buildup can feed each other, since a partial blockage further slows saliva and encourages more deposit to form.
Risk Factors
- Dehydration
- Medications that reduce saliva, such as some blood pressure and allergy drugs
- Dry mouth conditions
- Gout or certain metabolic conditions
- Older age and male sex, in which it is somewhat more common
- A history of salivary gland problems
Diagnosis
Diagnosis is based on the history and examination, supported by imaging.
- Physical examination: Feeling for a swollen gland and a stone in the duct or floor of the mouth.
- Ultrasound: A common first imaging test to locate the stone.
- CT scan: Detailed imaging that clearly shows most stones.
- Sialendoscopy: A tiny camera passed into the duct that can both find and sometimes remove stones.
The clinician will also check for signs of infection, since a blocked gland can become infected.
Treatment
Treatment depends on the size and location of the stone and whether infection is present.
- Conservative measures: Staying hydrated, applying warm compresses, gently massaging the gland, and stimulating saliva with sour candies to help small stones pass.
- Manual or minor procedures: Pushing or milking a stone out through the duct opening when it is near the surface.
- Sialendoscopy: A minimally invasive technique to retrieve stones from inside the duct.
- Surgery: For large or deep stones, or when the gland is repeatedly affected, removal of the stone or, rarely, the gland may be needed.
- Antibiotics: If the gland is infected.
The least invasive option that is likely to work is usually tried first. Many people pass small stones with simple measures over a few days, while stones that keep coming back or repeatedly cause infection may lead a clinician to recommend a more definitive procedure. After treatment, staying well hydrated and keeping saliva flowing helps reduce the chance that new stones will form.
Prevention
- Drink plenty of fluids to keep saliva flowing
- Stimulate saliva with sugar-free gum or sour candies if your mouth is dry
- Maintain good oral hygiene
- Review medications that cause dry mouth with your clinician
- Seek early treatment for gland swelling to prevent infection
When to See a Doctor
See a doctor if you have recurring pain or swelling of a salivary gland, especially around meals, or if you feel a lump in the floor of the mouth. Seek urgent care if you develop:
- Increasing redness, warmth, and swelling with fever, suggesting infection
- Pus draining into the mouth with significant pain
- Rapidly spreading swelling of the face or neck
- Difficulty breathing or swallowing
Frequently Asked Questions
Why do salivary gland stones hurt most at mealtimes?
Eating triggers the glands to produce more saliva. When a stone blocks the duct, the extra saliva cannot drain, so pressure and swelling build up in the gland during and just before meals, then ease afterward.
Which salivary gland gets stones most often?
Most stones form in the submandibular glands under the jaw. This is because their saliva is thicker and their ducts run uphill, which makes blockage more likely.
Can salivary gland stones pass on their own?
Yes, small stones often pass on their own, especially with good hydration, warm compresses, gentle massage, and saliva-stimulating measures like sour candies. Larger or stubborn stones may need a procedure to remove them.
How are salivary gland stones removed?
Options range from milking the stone out through the duct opening to minimally invasive sialendoscopy and, for large or deep stones, surgery. The approach depends on the stone's size and location and whether infection is present.
Can salivary gland stones cause infection?
Yes. A blocked gland can become infected because saliva, which normally flushes away bacteria, cannot drain. Increasing redness, warmth, swelling, fever, or pus signals infection and should be treated promptly.
References
- MedlinePlus, U.S. National Library of Medicine. Salivary duct stones.
- Mayo Clinic. Salivary gland disorders.
- StatPearls, National Library of Medicine. Sialolithiasis.
- American Academy of Otolaryngology–Head and Neck Surgery.