Salivary Stones

Overview

Salivary stones are hard deposits made mostly of calcium and other minerals that form inside a salivary gland or the duct that carries saliva into the mouth. The medical name is sialolithiasis. Stones most commonly form in the submandibular glands, which sit beneath the jaw, because their saliva is thicker and their ducts run partly uphill.

When a stone blocks the flow of saliva, it backs up behind the blockage, causing the gland to swell and become painful, often most noticeably at mealtimes when saliva production increases. Small stones may pass on their own with simple measures, while larger or stubborn stones may need a procedure to remove them. Blocked glands can become infected, so prompt care matters.

Symptoms

Symptoms are caused by saliva being trapped behind the stone and typically include:

• Pain and swelling of a salivary gland, often under the jaw or in the cheek
• Symptoms that worsen during or just before eating and then ease
• A gritty feeling or a stone that can sometimes be felt under the tongue
• Dry mouth
• Difficulty opening the mouth or swallowing if swelling is significant

If the blocked gland becomes infected, there may be increasing pain, redness, warmth, pus, fever, and worsening swelling. Spreading redness, high fever, or difficulty breathing or swallowing require urgent medical care.

Causes

Salivary stones form when minerals in saliva crystallize and build up, especially when saliva is thick or its flow is sluggish. Contributing factors include:

• Reduced saliva flow: Dehydration or certain medications that dry the mouth slow the movement of saliva.
• Thick saliva: Changes in saliva composition make minerals more likely to crystallize.
• Gland anatomy: The submandibular gland's uphill duct makes it especially prone to stones.
• Poor hydration or reduced eating: Less saliva flow allows deposits to form.

Risk Factors

• Dehydration
• Medications that reduce saliva, such as some for blood pressure or allergies
• Conditions that decrease saliva, including dry mouth disorders
• Gout, which is associated with certain mineral deposits
• Older age and male sex, which are somewhat more common

Diagnosis

Diagnosis is based on the history of mealtime swelling and an examination, supported by imaging when needed:

• Physical examination: The doctor may feel a stone near the floor of the mouth or note a swollen, tender gland.
• Ultrasound: A common, non-invasive way to detect stones.
• CT scan: Provides detailed images of stones and the gland.
• Sialography or sialendoscopy: Specialized methods to view the duct and locate stones.

Treatment

Treatment aims to remove the stone and restore the flow of saliva, with the approach depending on the stone's size and location.

• Conservative measures: Staying well hydrated, gently massaging the gland, applying warm compresses, and using sour or tart foods to stimulate saliva can help small stones pass.
• Manual or minor procedures: Stones near the duct opening can sometimes be milked out or removed with a small incision.
• Sialendoscopy: A tiny scope passed into the duct can locate and remove stones.
• Surgery: Large or recurrent stones, or a chronically damaged gland, may require surgical removal of the stone or, occasionally, the gland.
• Treating infection: Antibiotics are used if the blocked gland becomes infected.

Prevention

• Stay well hydrated by drinking enough fluids
• Maintain good oral hygiene
• Stimulate saliva flow with sugar-free gum or tart, sour foods if you are prone to stones
• Review medications that dry the mouth with your doctor
• Avoid prolonged dehydration, especially during illness or hot weather

When to See a Doctor

See a doctor if you have recurring pain and swelling of a salivary gland, especially around meals, or if you can feel a stone. Seek urgent care if the swelling becomes red, hot, and increasingly painful, if you develop a fever, or if you have difficulty breathing or swallowing, as a blocked gland can become seriously infected.

Related Topics

Frequently Asked Questions

References

1. MedlinePlus, U.S. National Library of Medicine. Salivary gland stones.
2. American Academy of Otolaryngology-Head and Neck Surgery. Salivary gland disorders.
3. Mayo Clinic. Salivary gland disorders.
4. National Institute of Dental and Craniofacial Research (NIDCR). Salivary gland conditions.