Sialolithiasis is the medical term used for salivary gland stones. The stones, or calculi are mostly composed of calcium, but they also contain potassium, magnesium and ammonium.
The mouth has three major salivary glands which can develop stones. These are:
- Parotid gland
- Submandibular gland
- Sublingual gland
There are also minor salivary glands located in the lips, cheeks, and throughout the tissue lining the mouth. Having slow salivary flow can make you at risk of developing a salivary gland stone in your submandibular salivary gland.
It is rare for children to develop sialolithiasis and it is most commonly found in men between the ages of 30 to 60.
Although most stones occur in one gland, it is possible to have multiple stones form at once. While submandibular stones account for 80 to 92 percent in all sialolithiasis, parotid stones account for 6 to 20 percent. The minor and sublingual glands have a relatively low risk for development of salivary gland stone.
Function of the Saliva
Saliva is mostly made up of water but it also contains small amounts of electrolytes, phosphate, calcium, antibacterial compounds and digestive enzymes. The antibacterial properties of saliva protect against:
- Oral infections
- Gum disease
- Tooth decay
- Chronic dry mouth
The digestive enzymes in saliva break down food before it is even swallowed and saliva is released in response to the smell and taste of food. Saliva also helps us to talk and swallow.
Saliva is produced by several glands located in the throat and mouth. The major salivary glands transport the saliva through tiny tubes known as salivary ducts which eventually release the saliva into various areas in your mouth.
Causes of Sialolithiasis
Conditions such as dehydration which can decrease water content or cause thickening of the saliva can cause the phosphate and calcium in the saliva to form a stone. The stones form in the salivary ducts and can either partially occlude it or totally obstruct the salivary duct. You may develop sialolithiasis even when you are healthy, and it may be difficult to pinpoint the exact cause. However, there are conditions which may cause thick saliva and subsequent sialolithiasis such as:
- Dehydration
- Use of certain medications or conditions which cause dry mouth (diuretics and anticholinergics)
- Sjogren’s syndrome, lupus and autoimmune diseases
- Radiation therapy of the mouth
- Smoking
- Gout
- Trauma
Small stones which do not block the flow of saliva can occur and cause no symptoms. However, if the flow of saliva becomes completely blocked, it may cause infection to the associated salivary gland.
Symptoms of Sialolithiasis
The symptoms usually occur when you are trying to eat (since that is the time the flow of saliva is stimulated) and may subside within a few hours after attempting to eat or after eating. The symptoms include:
- Difficulty opening the mouth
- Swelling of the affected saliva glands which normally occurs with meals
- Difficulty swallowing
- Painful lump under the tongue
- Gritty or strange tasting saliva
- Dry mouth
- Swelling and pain usually around the ear or under the jaw
Severe infections of a salivary gland may cause profound symptoms including fatigue, fever, and sometimes noticeable swelling, pain and redness around the affected gland.
Diagnosis of Sialolithiasis
An ENT or otolaryngologist is a physician who is qualified to diagnose and treat sialolithiasis. But doctors in other specialities can also be able to diagnose and treat this condition.
Your medical history will be considered and your head, neck and the inside of your mouth examined. A stone can sometimes be felt as a lump. MRI and CT scans are also used to help with the diagnosis.
Treatment of Sialolithiasis
The treatment of sialolithiasis depends on the location of the stone and how large it is.
- Drinking plenty of water or massaging and applying heat to the area can push the small stones out of the duct.
- A doctor can also push the stone out of the duct and into the mouth using a blunt object and gently probing the area.
- Large salivary duct stones can be more complex to remove and can require surgery. An endoscope can be inserted into the duct and if the stone is visible, the doctor inserts another tool that is then used to pull the stone out. Sometimes the removal of the stone can be achieved through a small incision and in severe cases, the entire gland and stone may have to be removed surgically.
- Oral antibiotics may be prescribed in the case of an infected gland.
Next Steps
At King’s College Hospital Dubai, we focus on offering an exemplary service, from initial consultation through to final diagnosis and treatment and beyond. Our team of expert doctors and nurses are here to offer tailored management and treatment of your condition, and to answer any questions that you might have throughout your time with us. Whatever you need us for, we’re only a phone-call away.
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