Why do salivary stones form?
Saliva contains calcium salts and proteins. If its outflow slows down and the composition thickens, mineral salts gradually accumulate around the microscopic core - a clot of mucus, cells or microbes. This is how the stone is formed. The submandibular gland is the most vulnerable: its excretory duct is longer than the others, goes from bottom to top against gravity, and the saliva itself is rich in protein and calcium. The parotid gland suffers less frequently, the sublingual gland - very rarely.
- Submandibular gland - the vast majority of cases
- Parotid gland - noticeably less common
- Stones can be single or multiple
- Size varies from a grain of sand to several centimeters
- The stone may be in the duct or in the gland itself
Causes and risk factors
The main mechanism is stagnation and thickening of saliva. This is caused by insufficient water consumption, dehydration during heat and fever, taking diuretics and drugs that reduce salivation, and smoking. Chronic inflammation and cicatricial narrowing of the duct after injury, as well as disorders of mineral metabolism, play a role. Poor oral hygiene and diseased teeth support infection, which serves as the nucleus for stone formation.
- Insufficient drinking regime and dehydration
- Taking diuretics, antihistamines and some psychotropic drugs
- Smoking
- Chronic sialadenitis and narrowing of the duct
- Gout and calcium metabolism disorders
- Tooth decay, gum disease, poor oral hygiene
Symptoms
The typical picture is so recognizable that doctors call it salivary colic: within a few minutes while eating, the gland under the jaw or in front of the ear swells, a feeling of fullness appears and pain radiates to the ear or neck. The swelling subsides 30–60 minutes after eating. Sometimes a person himself feels with his tongue a dense tubercle in the area of the duct or notices that saliva comes out sparingly and his mouth is dry. The addition of an infection changes the picture: the pain becomes constant, the skin turns red, and the temperature rises.
- Swelling of the gland during and after eating
- Bursting pain radiating to the ear, neck, under the tongue
- Dry mouth, unpleasant aftertaste
- Dense formation palpable under the tongue
- Poor saliva secretion from the duct during massage
- In case of inflammation - pus from the duct, temperature, redness of the skin
Diagnostics
The doctor examines the oral cavity and palpates the duct with both hands - a large stone is often identified with a finger. The main imaging method is ultrasound of the salivary glands: it is accessible, safe, shows stones, dilated ducts and signs of inflammation. Computed tomography more accurately identifies small and deep-lying stones. Sialendoscopy allows you to look into the duct with a thin endoscope and simultaneously remove the stone. If the formation does not decrease after eating and grows constantly, the doctor rules out a tumor.
- Inspection and bimanual palpation of the duct
- Ultrasound of the salivary glands
- CT scan of the floor of the mouth and neck
- Sialendoscopy - diagnosis and treatment at the same time
- General blood test for inflammation
- Biopsy for suspected tumor
Treatment and prevention
Small stones in the final part of the duct can often be removed without surgery: the doctor recommends drinking plenty of fluids, acidic foods that stimulate saliva, warm massage of the gland along the duct and sometimes bougienage. Larger stones are removed through a duct incision in the oral cavity or using sialoendoscopy, preserving the gland. Removal of the entire gland is considered as a last resort in case of irreversible changes and repeated suppuration. In case of acute inflammation, the infection is first treated with antibiotics prescribed by a doctor, and then the stone is treated.
- Drink enough water throughout the day
- Sour lemon slices and sugar-free chewing gum to stimulate saliva
- Massage the gland towards the duct as recommended by a doctor
- Endoscopic or intraoral stone removal
- Dental treatment and regular oral hygiene
- Quitting smoking
