Salivary Stones (Sialolithiasis)

What are salivary stones?

Sialolithiasis is a condition in which stones (calculi) form in your salivary gland or ducts, blocking the flow of saliva. These stones, usually made of calcium phosphate and hydroxyapatite, can cause facial pain and swelling. Symptoms may occur on one side (unilateral) or both sides (bilateral).

How does this affect my body?

You have three major types of salivary glands, including your:

• Parotid glands. Located in front of each ear, your parotid glands are the largest salivary glands.
• Sublingual glands. These glands are underneath your tongue, on the floor of your mouth.
• Submandibular glands. Located below your jaw toward the very back of your mouth, your submandibular glands produce about 70% of the saliva in your mouth.

Sialolithiasis can affect any of your salivary glands. However, over 80% of all salivary gland stones form in your submandibular gland (submandibular sialolithiasis) and affect the Wharton’s duct (where your submandibular gland empties saliva into your mouth). Parotid sialolithiasis accounts for about 6% to 15% of salivary gland stones, while 2% of cases affect your sublingual and minor salivary glands.

Who does sialolithiasis affect?

Anyone can get sialolithiasis. But the condition is most common in men and people assigned male at birth (AMAB) aged 30 to 60. Sialolithiasis rarely affects children.

How common are salivary stones?

Even though sialolithiasis is the most common reason why people develop sialadenitis (salivary gland swelling), the condition is still rare overall. In fact, salivary gland stones only occur in about 1 in every 30,000 people.

What are the symptoms of sialolithiasis?

Sialolithiasis symptoms typically worsen when you eat and then diminish again a few hours after meals. This is because chewing stimulates your salivary glands to make saliva, which gets backed up in the gland due to the obstruction by the stone. Symptoms may include:

• Salivary gland swelling.
• Difficulty swallowing.
• Trouble opening your mouth.
• Dry mouth (xerostomia).
• Strange taste.
• A painful lump under your tongue.
• Facial pain or swelling, usually under your jaw or around your ear.

In some cases, people with sialolithiasis don’t develop any symptoms at all.

What causes salivary stones?

Any condition that causes thickening of your saliva can result in sialolithiasis, including:

• Dehydration.
• Autoimmune diseases, such as lupus and Sjögren’s syndrome.
• Certain medications, such as diuretics.
• Smoking.
• Trauma to your salivary glands.
• Radiation therapy to your mouth.

Some people develop salivary gland stones even when there isn’t an apparent cause.

Is sialolithiasis contagious?

No, salivary stones themselves aren’t contagious. However, if you have a viral or bacterial salivary gland infection, you could potentially pass it on to other people.

How is sialolithiasis diagnosed?

A healthcare provider can diagnose sialolithiasis during a physical examination. They’ll feel around your face and neck and look inside of your mouth for lumps or other abnormalities. They’ll also review your medical history and ask about your symptoms.

What tests can help diagnose sialolithiasis?

In some cases, your healthcare provider may request imaging tests to confirm your diagnosis or to see the location of any salivary gland stones. These tests may include:

• X-rays.
• CT (computed tomography) scans.
• MRI (magnetic resonance imaging).

Your provider may also request a salivary gland scan. During this test, they’ll inject a radioactive tracer into a vein in your arm. Next, they’ll position you in front of a special device — a gamma scintillation camera — which detects radiation and captures images. About 45 minutes into the test, your provider will give you a lemon drop or other sour substance to stimulate saliva production. As your saliva glands release saliva, your provider will take more pictures to see how much saliva remains in your ducts.

How do you treat salivary stones?

Sialolithiasis treatment depends on the size and location of the stone. Treatments may include home remedies, antibiotics, in-office stone removal or, in some cases, surgery.

Home remedies

Most of the time, salivary gland stones go away on their own with conservative treatment. You might be able to push the stone out of your salivary duct by drinking lots of water, applying heat or massaging the area. You can also try sucking on lemon drops or other sour candy to stimulate saliva production.

Antibiotics

If you’ve developed an infection as a result of a salivary gland stone, your healthcare provider will probably prescribe antibiotics. You should take these exactly as directed.

In-office stone removal

If home remedies aren’t successful, your healthcare provider may try to remove the stone by gently probing the area with a blunt instrument.

Sialolithiasis surgery

Larger salivary gland stones may require surgery. During this procedure, a surgeon inserts an endoscope into your salivary duct to locate the stone. They’ll use a special instrument to remove the stone. In some cases, a small incision is necessary.

Salivary gland removal

In rare instances, you may need to have your salivary gland surgically removed. Healthcare providers reserve this treatment for people with severe, recurring (returning) symptoms, or if the stone is in a location that isn’t amendable to removal by conservative means.

How can I reduce my risk for sialolithiasis?

You can’t prevent sialolithiasis altogether. But you can reduce your risk by staying hydrated, avoiding smoking and practicing good oral hygiene. If you start to feel pain or tenderness around your salivary ducts, try sucking on sour candies and starting gland massage to stimulate the flow of saliva. This could encourage any stones to pass naturally.

What can I expect if I have sialolithiasis?

If you have a blocked salivary gland, you may experience pain or swelling around your salivary ducts during mealtimes. Usually, these symptoms last about one to two hours, then diminish until your next meal.

Does sialolithiasis go away?

In many cases, sialolithiasis goes away on its own or with conservative, at-home treatments, such as heat application, gentle massage and sucking on sour candy. If your symptoms continue after trying these home remedies, you should call a healthcare provider.

What will happen if sialolithiasis is not treated?

Left untreated, sialolithiasis can result in infections or abscesses that can spread to deeper spaces in your neck. It’s important to call a healthcare provider if you have persistent facial pain and swelling.

When should I see my healthcare provider?

If your symptoms continue for more than two weeks with no improvement or if you develop severe pain and redness of the skin overlying the gland, you should call a healthcare provider for further instructions.

Sialolithiasis vs. sialadenitis: What’s the difference?

“Sialolithiasis” refers to calculi, or salivary gland stones. “Sialadenitis” refers to inflammation or infection of your salivary gland. Salivary gland stones can result in sialadenitis, though this isn’t always the case.

A note from Cleveland Clinic

Sialolithiasis occurs when your salivary duct becomes blocked by a stone (calculi). In general, the condition isn’t a cause for concern and usually goes away on its own with conservative treatment. If you have facial pain and swelling that gets worse around mealtimes, you could have sialolithiasis. Schedule an appointment with your healthcare provider to determine the cause and explore appropriate treatment.