Salivary glands are one of the most essential parts of our body. Spread around the mouth and the throat, salivary glands secrete saliva which helps in maintaining the health of the gums and teeth.
Saliva helps us to swallow and speak. It contains digestive enzymes that breakdown the food before swallowing it. The antibacterial properties of saliva prevent bacterial overload and prevent the mouth from oral infections.
Blockage of the salivary gland is a common occurrence that can happen to anyone. Usually, salivary glands get blocked by a calcified stone that may develop within the ducts of a specific salivary gland.
Such calcified stones are clinically termed as sialoliths, and the condition is called as sialolithiasis.
Most often, it is the submandibular salivary gland that is affected on the floor of the mouth. Parotid glands are next in line to get affected by salivary duct stone. (1)
Swelling of the salivary gland and impede the release of saliva are the characteristic symptoms of sialolithiasis. Inflammation is often associated with pain.
This article is all about sialolithiasis, its causes, symptoms, and treatment. So, let’s read further to learn in detail about sialolithiasis.
What is sialolithiasis?
Sialolithiasis in simple terms is a condition associated with salivary stone or salivary calculi. In this condition, the calcified mass called sialolith forms within the salivary gland, usually in the duct.
The salivary stone is a calcified mass of calcium, magnesium, potassium, and ammonium. (2)
Submandibular salivary gland is more commonly affected by salivary duct stone, with a prevalence of 80 – 92%. Parotid and sublingual salivary glands are less frequently affected.
Sialolithiasis is a common condition among men between the age of thirty and sixty. Children rarely develop sialoliths.
What causes sialolithiasis?
The exact cause of sialolithiasis is unknown. However, certain factors contribute to the formation of salivary gland stones –
- Dehydration – Thickening or decreased water content in saliva often causes the calcium and phosphate to form a stone. These stone wither completely obstruct the duct or partially blocks it. (3)
- Oral conditions and medications that cause dry mouth
- Autoimmune diseases like lupus and Sjogren’s syndrome affect the secretions of saliva
- Radiation therapy of the mouth
- Habit of smoking
- Trauma to the salivary gland
- Gout disease
What are the symptoms of sialolithiasis?
Characteristic symptoms of sialolithiasis come into action while eating as the salivary flow gets stimulated during this time. The symptoms subside as the person stops eating.
This pattern is essential for the dental professional to differentiate sialolithiasis from any other oral condition.
Symptoms of sialolithiasis may include –
- Swelling of the affected salivary gland while eating
- Difficulty in swallowing
- Difficulty in opening the mouth
- Presence of a painful lump or swelling under the tongue
- Alteration of taste
- Dry mouth
- Pain around the ear and under the jaw
Infected sialolithiasis can produce added symptoms like fever, fatigue, swelling, and redness around the affected salivary gland.
How is sialolithiasis diagnosed?
A thorough medical history and examination of the head and neck will rule out other conditions.
A complete oral examination of the mouth will help to locate the swelling. Stones are often felt as lumps in the floor of the mouth.
X-rays and CAT scans can detect the calcium deposits in the salivary gland or duct. Sialography is a unique diagnostic tool which uses the injection of dye into the salivary duct, followed by a series of x-rays to detect the stone. (4)
Sialography may accurately locate the stone but are an invasive approach to diagnose sialolithiasis. MRI and CT scans are the modern means used for detection of sialolith.
What are the treatment modalities?
The treatment of sialolithiasis depends on the location, size of the stone and the degree of salivary gland swelling.
Small stones can be removed easily by –
- Drinking plenty of water
- Massaging the gland or duct
- Applying heat to the affected area
Gentle probing and pressing of the salivary duct can be done by a dental professional to push the stone out and allow proper salivary flow in the patient’s mouth.
Large salivary duct stones are often difficult to remove manually and may require surgery. A small incision is made on the affected salivary duct at the location of the stone, and the stone is pulled out. The duct is then sutured back and allowed to heal.
In severe cases of sialolithiasis, the entire salivary gland along with the stone may be removed surgically to prevent the spread of infection to other parts of the oral cavity.
An advanced method to remove sizeable salivary duct stones is endoscopy. In this method, an endoscope is inserted into the duct. If the dentist successfully locates the stone, he can remove it by pulling the stone out with the help of a dental instrument. (5)
Take away message
Sialolithiasis is a condition caused due to the formation of calcified masses in the salivary gland or salivary gland ducts.
These calcified mass or stones are a collection of calcium, phosphate, potassium, and ammonium that forms as a result of dry mouth or dehydration.
Our mouth has three salivary glands namely submandibular, parotid and sublingual salivary gland. Out of the three, the submandibular gland is most commonly affected by salivary duct stones.
The large size of the gland, long salivary duct, and slow salivary flow are the three main reasons for the submandibular gland to develop salivary stones.
Typical symptoms of sialolithiasis include pain and swelling of the affected gland on chewing.
If you experience similar symptoms, consult a dental professional for an appropriate diagnosis. Follow a good oral healthcare routine and drink plenty of water to hydrate your mouth.