Salivary Gland Stones (Sialolithiasis) by Gland

How salivary stones form

You have three pairs of major salivary glands, plus hundreds of tiny minor glands in the lips and cheeks:

• Submandibular glands under the jaw, draining through Wharton's duct to openings under the front of the tongue
• Parotid glands in front of the ears, draining through Stensen's duct to openings inside the cheeks next to the upper molars
• Sublingual glands under the tongue

Stones form when saliva slows or thickens and calcium salts crystallize around debris, bacteria or mucus. Risk factors include dehydration, medicines that reduce saliva (diuretics, antihistamines, some antidepressants), smoking, gout, and previous gland inflammation. Stones are more common in men and in adults aged 30 to 60. They are not caused by a high-calcium diet. See also our general page on salivary stones.

Submandibular vs parotid stones

Sublingual and minor gland stones are rare and usually cause a small, firm lump in the floor of the mouth or lip.

Symptoms

• Swelling and pain in the gland just before or during meals, when saliva production surges
• Swelling that eases within 1 to 2 hours after eating
• A hard lump felt under the tongue or in the cheek
• A bad taste or gritty material in the mouth
• Dry mouth on the affected side
• With infection (sialoadenitis): constant swelling, redness, warmth, fever and pus from the duct opening

How they are diagnosed

1. Examination: feeling along the duct inside the mouth while pressing from outside (bimanual palpation), and checking for pus.
2. Ultrasound: the first-line imaging test. It detects most stones over about 2 mm and shows the gland.
3. CT scan without contrast: very sensitive for small or deep stones.
4. Sialendoscopy: a tiny camera passed into the duct can both diagnose and treat.
5. Plain X-rays show many submandibular stones but miss most parotid ones.

Treatment options, step by step

1. Conservative measures

Many small stones pass on their own.

• Drink plenty of water to keep saliva thin.
• Suck on sour candy or lemon wedges to stimulate saliva flow and flush the stone.
• Massage the gland from back to front toward the duct opening several times a day.
• Apply warm compresses.
• Pain relief: ibuprofen or acetaminophen (paracetamol) at the label dose.
• Antibiotics if there are signs of infection.

2. Transoral removal

A stone near the front of Wharton's duct can be removed through a small cut in the floor of the mouth under local anesthetic. Larger stones further back in the submandibular duct can often also be removed through the mouth by an experienced surgeon.

3. Sialendoscopy

A miniature endoscope, about 1 mm wide, is passed through the natural duct opening. Small stones (often up to about 4 to 5 mm) are grabbed with a tiny basket or forceps. Larger stones can be broken with a laser first. A combined approach, using the endoscope plus a small incision inside the mouth or over the parotid, handles larger stones. This preserves the gland.

4. Lithotripsy

Shock waves from outside the body can fragment stones, mainly in the parotid. It is used in some countries and centers but is not widely available in the US.

5. Gland removal

Removal of the submandibular gland (or, rarely, part of the parotid) is reserved for stones that cannot be removed otherwise or for repeated infections that have damaged the gland. Because of gland-preserving techniques, this is now needed much less often. Risks include injury to nerves supplying the lower lip, tongue or face.

Complications

• Recurrent or chronic sialoadenitis
• Abscess formation
• Narrowing (stricture) of the duct
• Rarely, spreading infection of the floor of the mouth and neck

Prevention

• Stay well hydrated, especially in hot weather and during illness.
• Review medicines that cause dry mouth with your doctor.
• Practice good oral hygiene.
• Stop smoking.

Frequently asked questions

Which salivary gland is most likely to get stones?

The submandibular gland under the jaw, in about 80 to 90% of cases. Its saliva is thicker and richer in calcium, and its long duct runs upward against gravity, so saliva flows more slowly. Parotid stones are much less common.

Can a salivary stone come out on its own?

Yes, small stones often pass with plenty of fluids, sour candy to boost saliva, gland massage and warm compresses. Larger stones, or those deep in the gland, usually need removal through the mouth or with sialendoscopy.

What is sialendoscopy?

Sialendoscopy is a minimally invasive procedure in which a tiny camera is passed into the salivary duct through its opening in the mouth. Stones can be seen and removed with miniature baskets or forceps, sometimes after laser fragmentation, without removing the gland.

Why does my gland swell when I eat?

Eating triggers a surge of saliva. If a stone partly blocks the duct, saliva builds up behind it, stretching the gland and causing swelling and pain within minutes. The swelling usually settles over an hour or two as saliva slowly drains past the stone.

Do salivary stones come back?

They can. Recurrence is more likely if the underlying causes, such as dehydration or medicines that dry the mouth, continue, or if small stone fragments remain. Keeping well hydrated and using sour candy regularly can reduce the risk.