Sialolithiasis Symptoms, Diagnosis, and Treatments

Sialolithiasis is a benign condition where stones form in the salivary ducts. These stones are called calculi and are mostly composed of calcium. They can develop in any of the salivary glands, including the parotid, submandibular, or sublingual, but are most likely to form in the submandibular gland.

Children rarely develop sialolithiasis. They are most commonly found in men between the ages of 30 and 60.

Saliva's Function

Saliva is mostly made up of water but also contains small amounts of electrolytes, calcium, phosphate, important antibacterial compounds, and digestive enzymes. The antibacterial properties of saliva protect against:

• Oral infections
• Chronic dry mouth
• Gum disease
• Tooth decay

The digestive enzymes in saliva begin breaking down your food before you have even swallowed it and saliva is most commonly released in response to the smell and taste of food. Additional functions of saliva include helping us to swallow and talk.

Saliva is produced by several glands located in the mouth and throat. The major salivary glands then transport the saliva through tiny tubes called salivary ducts which eventually release the saliva into various places in your mouth, especially under your tongue and on the floor of your mouth. The three pairs of major salivary glands are called the parotid, submandibular, and sublingual glands.

In addition to the major saliva glands, there are multiple smaller glands, called minor salivary glands, located in your lips, cheeks, and throughout the tissue lining your mouth.

Causes

Conditions such as dehydration which cause thickening, or decreased water content of the saliva can cause the calcium and phosphate in saliva to form a stone. The stones often form in the salivary ducts and can either totally obstruct the salivary duct, or partially occlude it. You may develop sialolithiasis even if you are healthy, and a cause may not always be able to be pinpointed. However, conditions that may cause thick saliva and subsequent sialolithiasis include:

• Dehydration
• Use of medications or conditions which cause dry mouth (diuretics and anticholinergics)
• Sjorgen's syndrome, lupus, and autoimmune diseases in which the immune system may attack the salivary glands
• Radiation therapy of the mouth
• Gout
• Smoking
• Trauma

Submandibular stones account for 80 to 92 percent of all sialolithiasis, while parotid stones account for most of the remaining cases at 6 to 20 percent. The sublingual and minor glands have relatively low risk for development of a stone. Most stones only occur in one gland, but it is possible to have multiple stones form at once.

Small stones that do not block the flow of saliva can occur and cause no symptoms. However, when the flow of saliva becomes completely blocked it may cause the associated salivary gland to become infected

Symptoms of Sialolithiasis

Symptoms usually occur when you try to eat (since that's when the flow of saliva is stimulated) and may subside within a few hours after eating or attempting to eat. This is important to tell your healthcare providersince it may help differentiate sialolithiasis from other conditions. Symptoms of sialolithiasis may include:

• Swelling of the affected saliva glands which normally occurs with meals
• Difficulty opening the mouth
• Difficulty swallowing
• A painful lump under the tongue
• Gritty or strange tasting saliva
• Dry mouth
• Pain and swelling usually around the ear or under the jaw

Severe infections of a salivary gland may cause profound symptoms including fever, fatigue, and sometimes noticeable swelling, pain, and redness around the affected gland.

Diagnosing Sialolithiasis

An otolaryngologist, or ENT, is a physician qualified to diagnose and treat sialolithiasis. Although healthcare providers in other specialties may also diagnose or treat this condition.

Your healthcare provider will consider your medical history and examine your head and neck, including the inside of your mouth. Sometimes the stone can be felt as a lump. Historically a sialograph, where dye is injected into the salivary duct followed by an X-ray, was used, however, this is more invasive than modern MRI or CT scans which are now more likely to be used.

Treatment

The treatment of sialolithiasis depends on where the stone is and how large it is. Small stones may be pushed out of the duct and you may be able to facilitate this by drinking plenty of water, or massaging and applying heat to the area. Sometimes a healthcare provider can push the stone out of the duct and into the mouth by using a blunt object and gently probing the area.

Large salivary duct stones may be more difficult to remove and sometimes require surgery. Sometimes a thin tube called an endoscope can be inserted into the duct. If the stone can be seen with the endoscope the healthcare provider may be able to insert another tool that is then used to pull the stone out. Sometimes removal of the stone can be achieved with a small incision, in severe cases the entire gland and the stone may have to be surgically removed.

In the case of an infected gland, your healthcare provider may prescribe an oral antibiotic. Never take antibiotics without seeing a healthcare provider.