Salivary glands are a unique part of the oral cavity. These glands function in producing and secreting one of the essential components of the mouth – saliva. Typically, three major salivary glands are located around the mouth. These include the parotids, the sublingual, and submandibular salivary glands. Salivary gland disorders constitute a set of salivary gland malfunctions that can have a debilitating effect on the oral health of an individual.
Some of the common salivary gland disorders include infections, tumors and Salivary duct stones. Such conditions are extremely painful and may vastly affect the quality of life. Usually, proper diagnosis is required to identify the underlying cause and plan a prompt treatment. Today’s article will give you an insight into the different types of salivary gland disorders, its symptoms, diagnosis, and treatment.
What are salivary glands?
Salivary glands are considered as the secretory glands of the mouth. The prime function of these glands is to secrete saliva in the mouth. On average salivary gland collectively produces one quart of saliva each day. Saliva is essential for the proper functioning of the mouth. It helps in the following ways –
- Saliva lubricates the oral tissues in the mouth
- It helps in chewing and swallowing
- It flushes out the plaque, food debris and bacteria from the mouth
- It aids in digestion
Typically, there are three major salivary glands –
- Parotid salivary gland – a pair of parotids is usually located on either side of the cheek in front of the ears. (1)
- Sublingual salivary gland – this mucous salivary gland is located near the chin and in front of the submandibular salivary gland.
- Submandibular salivary gland – this gland is usually located beneath the floor of the mouth and contributes to salivary secretion.
Additionally, several minor salivary glands are located under moist oral tissues like the inner lips, cheeks, palate, and back of the throat. Saliva is typically secreted through specialized tubules called salivary gland ducts.
What are salivary gland disorders?
Salivary gland disorders are a group of diseases that affect the functions of the salivary gland. Moreover, these disorders create a lot of pain and discomfort for the patient. Typically, salivary gland disorders can have the following effects –
- A decrease in the production of saliva
- Increased risk of chronic dry mouth
- Blockage of the salivary gland ducts
- Swelling and infection of the salivary gland
What are the types of salivary gland disorders?
There are several types of salivary gland disorders. Each disorder is related to a specific cause and recognized by characteristic symptoms. Some of the typical salivary gland disorders are listed below –
Sialolithiasis is popularly known as salivary calculi or salivary stone. This condition is characterized by the formation of calcified mass within the salivary gland or in the salivary duct. The submandibular salivary gland is most frequently affected by salivary stone formation, followed by parotid and sublingual glands. Typical symptoms of sialolithiasis include pain and swelling of the affected salivary gland. Salivary flow in the mouth may decrease, which gradually supports poor oral hygiene. Dry mouth and dehydration are some of the additional symptoms of sialolithiasis. (2)
Salivary stones are mainly formed by calcium and phosphorous depositions that block the gland and its ducts from secreting saliva into the mouth. Treatment of such conditions can involve surgical removal o manipulation of the stone out of the duct.
As the name suggests, hypersalivation is characterized by excessive production of the saliva in the mouth. One of the prime reasons for hypersalivation is the decreased clearance of the saliva. Often hypersalivation leads to excessive drooling in the mouth. Moreover, in conditions where the patient experiences difficulty swallowing or chewing, excessive saliva can cause spitting. (3)
There are several causes of hypersalivation. Some of the typical reasons include diseases like rabies, pellagra, liver disease, and infections. Additionally, medication like pilocarpine, ketamine, and clozapine can also cause hypersalivation. Some health conditions like pregnancy and gastroesophageal reflux disease are common factors of hypersalivation.
Treatment of hypersalivation commonly includes identification of the underlying cause. Drugs that help to reduce salivary production may be sed for example – anticholinergic drugs, scopolamine, and atropine.
The inflammation of the salivary gland typically characterizes Sialadenitis. Most often, the major salivary glands are affected by sialadenitis – the parotid salivary gland being the prime salivary gland. It is essential to understand the difference between sialadenitis and sialadenosis.
Sialadenosis is a non-inflammatory enlargement of the salivary gland as compared to sialadenitis – the inflammatory enlargement of the gland. Acute sialadenitis is identified as a painful swelling of the salivary gland, which is tender to touch. The salivary gland turns red, and the patient may experience difficulty in chewing and swallowing. (4)
Chronic sialadenitis on the other hand are less aggressive and less painful. However, they are also characterized by progressive inflammation of the affected salivary gland. The most common causes of sialadenitis include bacterial and viral infections. Staphylococcus aureus is the typical culprit that causes sialadenitis in a majority of the cases. Additionally, autoimmune disorder and cancerous overgrowths can also lead to abnormal inflammation of the salivary gland.
Treatment of sialadenitis usually involves symptomatic treatment followed by antibiotic treatment. Surgical intervention may be the last resort to remove the infected parts of the salivary gland.
Tumors of salivary gland
Salivary gland tumors can develop anywhere in the mouth, neck, and throat. The parotid gland accounts for about 85% of the tumor formation, out of which 25% of the tumors may be malignant. Usually, salivary gland tumors are characterized as a lump or swelling in the jaw or neck.
The affected part of the face may be numb with weak muscles. Patients with tumor formation often experience discomfort and pain while chewing and swallowing. Some of the common types of salivary gland tumors are listed below as follows –
Pleomorphic adenoma is the most common benign tumor of the parotid salivary gland. It is a slow-growing tumor that does not involve the vital organs of the mouth or neck. However, it can cause pain and discomfort. Other types of benign salivary gland tumors include –
- Warthin tumor
- Basal cell adenoma (5)
Malignant tumors are more aggressive and invasive as compared to benign neoplasms. Moreover, they require extensive dental therapy to control the progression of cancer and allow complete healing. Some of the malignant salivary gland tumors include –
- Adenoid cystic cell carcinoma
- Acini cell carcinoma
- Mucoepidermoid carcinoma
- Squamous cell carcinoma
Some of the risk factors associated with salivary gland tumors include progressing age and radiation exposure. Treatment usually involves surgical removal of the salivary gland with associated structures that may have been engaged by the tumorous growth.
Salivary gland malfunctions
One of the prime salivary gland malfunctions is an autoimmune disorder called Sjogren’s syndrome. This condition is typically identified by two characteristic symptoms – dry mouth and dry eyes. Sjogren’s syndrome commonly affects the mucous membrane of the secretory glands in the mouth and eyes. Moreover, it affects the production and secretion of saliva and tears. Typical signs and symptoms of Sjogren’s syndrome includes –
- Dryness in the eyes followed by burning, itching, or tingling sensation.
- Dry mouth that makes speaking, chewing, and swallowing painful. Moreover, it causes poor oral hygiene.
- Often Sjogren’s syndrome is associated with rheumatoid arthritis which can cause joint pain and swelling (6)
- Inflammation of the salivary gland is a common site
- Other common symptoms include vaginal dryness, skin rash, dry cough, tiredness and fatigue
Usually, a symptomatic course of treatment is followed to provide moisture to the eyes and the mouth. This includes the use of medications and hydration techniques. Some of the risk factors for Sjogren’s syndrome include progressing age and the presence of an autoimmune disease like lupus and rheumatoid arthritis. Often lack of secretory substance in the eye and mouth can create complications like –
- Dental caries caused by inadequate oral hygiene
- Increased incidence of yeast infection
- Vision problems, for example, increase light sensitivity, corneal damage, and blurred vision
What are the signs and symptoms of salivary gland disorders?
Some of the typical signs and symptoms of salivary gland disorders are as follows –
- Formation of a painful lump under the tongue or cheek and chin
- Difficulty in chewing or swallowing
- Pus drainage in the mouth
- Bad breath
- Raise in temperature
- Difficulty in speaking
- Muscle pain
- Facial swelling
- Dry mouth and eyes
- Tooth decay
- Soreness and burning mouth
- Taste alteration
How are salivary gland disorders diagnosed?
Like any regular examination, the dentist first takes a complete medical and dental history of the patient. This is followed by a thorough oral examination – the dentist checks for the following signs –
- Swelling of the salivary glands and lymph nodes
- The characteristics of the swelling
- Color change
- Associated tooth decay
Once the oral examination has been completed, the dentist confirms the diagnosis by looking at dental x-rays. Dental x-rays help to identify the location, extent, and severity of the salivary gland disorder. Salivary gland stones may not be visible on a dental x-ray film. Therefore, sialography is performed.
Sialography is a radiographic procedure in which the area of concern is first tinted with a medical dye. An x-ray of the injected area is taken to identify salivary gland obstructions and stone by contrast study. Autoimmune diseases like Sjogren’s syndrome may require additional diagnostic tests like a salivary function test and eye test. (7)
MRI and CT scans are also useful in locating the stones. Tumor and cystic lesions of the salivary gland require fine needle aspiration to determine the malignancy of the lesion. Salivary gland tumors may also need a biopsy confirmation.
What is the treatment for salivary gland disorders?
Treatment of salivary gland disorders usually depends on the type of cause. However, the standard treatment plans for salivary gland disorders are listed below –
- Sialolithiasis – stones closer to the opening of the duct can be removed by gently pressing and manipulating the stone out of the ductal opening. While the stones that are located deep inside the duct may require surgical removal.
- Sialadenitis – the mainline treatment includes antibiotic coverage, electrolyte balance, warm compression of the infected gland, and measures to increase salivation in the mouth. Extensive infection abscess may require surgical drainage.
- Viral infections of the salivary gland are treated by antiviral medication, rest, and hydration.
- Cystic lesions require surgical or laser drainage (8)
- Non-cancerous tumors can be surgically removed. However, cancerous tumors require radiotherapy, chemotherapy, and surgical intervention
- Autoimmune disorder – Sjogren’s syndrome is treated by medications that stimulate the salivary flow in the mouth like pilocarpine and cevimeline. Hydration, the use of chewing gum, can also help to increase the salivary flow. Good oral hygiene is mandatory to treat this syndrome.
Overview of salivary gland disorder
Now that you have read the article, you must have understood the importance of salivary glands in the proper functioning of the mouth. Healthy salivary glands are essential for continuous saliva production, which lubricates the oral tissues and helps in maintaining good oral hygiene.
There is a wide range of salivary gland disorders like sialolithiasis, sialadenitis, tumor, and cysts associated with salivary glands and infection of the glands. All of these conditions are treatable. However, it requires a proper diagnosis to identify the underlying cause. (9)
Some of the common symptoms of salivary gland disorders include dry mouth, pain on chewing, difficulty in swallowing, fever and fatigue, swelling of the face, and burning mouth. If you experience any of these symptoms, consult the dentist immediately.