Sialoliths, also known as salivary duct stones or calculi, are clumps of crystallized mineral deposits that form in the salivary gland ducts. These slender tubes carry saliva from the glands where it is secreted through openings and into your mouth. Although the exact cause is unknown, changes in salivary flow, dehydration and certain medications may all increase your chances of developing these stones in a condition called sialolithiasis.
Signs of a Salivary Stone
Stones most commonly develop in the submandibular gland duct, known as the Wharton's duct, reports Teach Me Anatomy. According to The American Journal of Medicine, sialoliths may also occur in the parotid gland (located on the sides of the face) and other smaller salivary ducts.
The main sign of a salivary problem is usually pain in your neck, face or mouth that worsens before or during meals. This is because your salivary ducts secrete more saliva when you eat to aid digestion. If a duct is blocked, the saliva cannot flow properly and backs up in the gland, causing pain and swelling.
Other indicators of stones include:
- Dry mouth
- Difficulty swallowing
- Difficulty opening your mouth
- Redness in the area of the duct
- Bad taste in the mouth
- Fever (if the ducts become infected due to the buildup of saliva)
Causes of Sialolithiasis
Calculi form when certain minerals naturally found in saliva, like calcium phosphate and calcium carbonate, crystallize and form clumps, explains the University of California, Irvine School of Medicine. The size of the stones vary from a few millimeters up to 2 centimeters.
Although the cause of salivary stones is unknown, a few factors can increase your risk for developing one. They include certain drugs like blood pressure medications and antihistamines whose side effects reduce salivary flow, poor diet, not drinking enough water and certain autoimmune disorders, such as Sjögren's syndrome. According to the Journal of Orofacial Sciences, sialoliths can very rarely develop as a direct side effect of certain medications.
How Are Sialoliths Found?
Your dentist or dental hygienist will likely sweep their fingers along your head and neck area during a routine checkup. These intra- and extraoral palpations (feeling inside and outside the mouth) help your provider detect swellings and other abnormalities, including the early signs of oral cancer.
If your dental professional suspects you may have sialolithiasis, they may prescribe more imaging to provide a more definitive diagnosis. This can include X-rays, ultrasound or a computed tomography (CT) scan of the face and neck area.
Your dentist may suggest some simple steps at home as a first attempt to resolve a salivary stone. Home remedies include increasing your water intake, sucking on sour candies or lemon slices, applying warm compresses and massaging the affected area. If the stone isn't forced out of the duct with treatment at home, your dentist can attempt to remove it by "milking," or pressing on both sides of the duct.
If the stone is too large or located deeper in the duct, it may need to be removed surgically with local anesthesia. The journal ACTA Otorhinolaryngologica Italica reports that in rare instances, high-energy shock waves can be used to break up the stone into smaller pieces, allowing it to pass through the duct. This procedure is more commonly used for stones in other parts of the body like the bladder and kidneys and is usually performed under local anesthesia.
If you suffer frequent salivary stones or infections, your dentist may recommend removal of the affected gland. The other salivary glands in your mouth will compensate for normal flow.
A sialolithiasis diagnosis usually has a positive outcome. The key to preventing it is recognizing the need for a healthy lifestyle and regular dental checkups, and contacting your dentist right away if you suspect you have developed the condition.