Salivary duct stone, a calcified structure that forms in the salivary duct, cause blockage of the salivary duct and prevents the free flow of saliva. It also causes pain, swelling, etc. Salivary duct stones majorly affect the submandibular duct and, in some cases, the parotid gland duct.

Home remedies to flush out salivary duct stone include sucking of lemon and drinking a lot of warm water to increase the formation of saliva.

On the other hand, Sialolithotomy, Lithotripsy, etc. are conventional treatment options to get rid of blocked salivary gland duct.

In this article, we will discuss the formation of salivary duct stone in the submandibular and parotid gland along with the symptoms and treatment procedures.

Formation of salivary duct stone

Salivary glands are responsible for producing saliva. Humans have three major salivary glands as the parotid gland, the submandibular gland, and the sublingual gland. There are many other minor salivary glands in addition to these major glands.

Salivary duct stone is referred to as a sialolith. A sialolith comprises organic and inorganic components. Organic components include collagen, amino acids, and carbohydrates.

Inorganic components include hydroxyapatite, calcium carbonate and calcium phosphate. (1) Submandibular gland is affected more than parotid glands whereas sublingual is the least affected.

Stones in the submandibular gland are found in the Wharton’s duct (submandibular gland duct) whereas parotid stones are present in the gland and not the parotid duct.

Causes of salivary duct stone

The exact cause of stone formation is not known but salivary stone forms due to the accumulation of saliva in the salivary duct.

Thickened saliva or less saliva production are potential risk factors. Certain medications reduce the quantity of saliva such as antihistamines, blood pressure drugs, etc.

Dehydration decreases the amount of saliva and also changes the consistency or thickness of saliva. Trauma to the salivary glands and habits, such as smoking, also increases the risk of a salivary stone formation.

Symptoms

In the initial stages, the stone doesn’t obstruct the duct and hence the patient doesn’t feel any pain or swelling. Only when the stone is big enough to block the flow of saliva, a person start feeling pain during meals.

Other symptoms of salivary duct stone include –

  • Pain while eating since saliva is blocked by the stone and unable to flow.
  • Sialolith obstructs the flow of saliva during eating, causing a sudden swelling accompanied by pain and discomfort.
  • In case of complete obstruction of the gland, patient feel stabbing type of pain.
  • In case of infection, the patient has a fever, lymph node inflammation, and pus discharge. Chronic infection causes ulceration.

Over time, affected glands stop producing saliva and the person may not feel pain. The gland might become enlarged and firm with mobility.

Diagnosis

Physical examination of the gland includes palpation. During palpation, the dentist can feel the stone in the submandibular duct when the stone lies in the anterior portion of the duct.

Pain while eating and sudden enlargement of the gland is a symptom as well as a diagnostic feature. There are couple of imaging modalities available for correct diagnosis and they are –

Conventional radiographs

Around 80% of submandibular stones and 60% of parotid stones can be detected using conventional radiograph. Conventional x-rays are cheap and good as a preliminary diagnostic procedure.

Sialoendoscopy

Sialoendoscopy is a diagnostic and therapeutic tool. This method helps to visualize polyps, foreign bodies, and stenosis which are typically missed by imaging methods of diagnosis.

Sialography

Sialography is the gold standard for diagnosis of duct stones. A contrast material instilled in the duct is visualized using sialography. The contrast material will not be able to pass the calculi or even if it does there will be a filling defect which will help the dentist determine the location of the stone.

Contraindications –

  • If the person is allergic to iodine (the contrast medium used).
  • When the stone lies very close to the duct opening.
  • In the case of acute infection.

Ultrasonography

Noninvasive alternate and painless diagnostic method but ultrasonography cannot differentiate a cluster of stones from a single stone. CT scan can also be used to detect duct stones.

Home remedies to deal with salivary duct stone

Lemon

Suck on a piece of lemon. Lemon stimulates the salivary gland, and if the stone is less than 2mm and lying near the duct opening, the flow of saliva can flush out the stone. You can also suck on any sour candy.

Warm water

Drink lots of warm water to hydrate yourself which in turn will increase saliva production. While saliva tries to escape, it takes the calculi along with it too.

If your pain and swelling persist after a week, you should visit your dentist for definitive treatment.

Conventional treatment

Various treatment includes antibiotics and anti-inflammatory medications in case of infection and swelling.

Sialolithotomy

The procedure involves removal of the stone transorally and is done for anterior submandibular stones less than 2mm in size or stone. (2)

In the case of posterior stones, sialadenectomy (surgical removal of stone) remains the preferred choice.

Therapeutic sialoendoscopy

Sialoendoscopy helps perform surgical procedures such as endoscopic stone removal, stricture dilatation, and salivary gland lavage. This procedure is minimally invasive and better than invasive surgical procedures.

Lithotripsy

This procedure uses sound waves to break the stone into small pieces. Salivary duct stones are crushed using high-intensity sound waves, and the portions are eliminated spontaneously from the duct by the flow of saliva.

Side effects include pain, swelling, and self-limiting duct bleeding.

Over to you

A major cause of duct stone is not drinking enough water. So, drink a lot of water so that the situation doesn’t arise for a salivary stone to form.

Visit the dentist if you suspect salivary duct stone. Earlier detection of salivary duct stone can make the treatment process easier.

Salivary duct stone, a calcified structure that forms in the salivary duct, cause blockage of the salivary duct & prevents the flow of saliva