Salivary duct stones are accumulations of calcium and phosphate crystals in one of the salivary ducts. These include the parotid, submandibular, or sublingual glands. The parotid glands lie just behind the angle of the jaw, in front of the ears. The submandibular and sublingual glands are deep in the floor of the mouth.
Saliva is formed in response to smell and taste stimuli. It provides a healthy environment for the teeth. Saliva also helps break down complex starches. When the water content of saliva is reduced, the calcium and phosphate in the saliva can form a stone.
The individual may have discomfort and swelling of the affected saliva gland. The pain worsens at mealtimes, when more saliva is produced. It becomes exaggerated when the person eats acidic or sour foods. The saliva may have a gritty feel or unusual taste. The swelling and discomfort often go away over several hours.
Sometimes the stone blocks the draining of saliva and causes a bacterial infection of the gland. If an infection occurs, the gland becomes swollen, very painful, and tender to the touch. The person may have a fever.
Stones are more likely to form when the water content of saliva is lower. A person who is dehydrated is at higher risk. Certain medicines also predispose someone to stones. These include antidepressants, antihistamines, and diuretics.
Certain diseases cause thickening of the saliva and increase the risk for stone formation. One example is Sjögren syndrome, which causes dryness of the mouth and other mucous membranes. In some autoimmune disorders, the body attacks its own salivary glands. This thickens the saliva and increases the risk of forming stones.
Prevention of salivary duct stones focuses on increasing the water content of the saliva. The following measures may be helpful: drinking six to eight glasses of water a daymassaging the salivary gland after meals to clear thickened salivaseeking effective treatment for autoimmune disorderssucking on sour candyusing prescription antihistamines instead of over-the-counter versions
Diagnosis of a salivary duct stone begins with a medical history and physical exam. Stones can often be felt, particularly in the submandibular glands. The healthcare provider may order an X-ray to confirm the diagnosis.
Long-term effects can occur if chronic bacterial infection sets into the gland. Scars form in the area, and removal of the stone is much more difficult.
Salivary duct stones are not contagious and pose no risk to others.
The stone may be squeezed directly out of the duct if it is small enough. For larger stones that cannot completely pass out of the duct opening, a small incision can be made to remove it. Occasionally, the gland and its stone may be completely removed.
Surgical removal of the stone may lead to scarring of the duct opening. This can then cause failure of the gland to drain properly. Other problems may then arise, such as additional stone formation and infection. If the entire gland is removed, complications involve damage to the nearby nerves. This can result in paralysis and loss of sensation in the tongue or face.
After successful stone removal, the condition usually returns to normal. For recurrent acute or chronic infection, gland removal may be needed.
Any new or worsening symptoms should be reported to the healthcare provider.