Salivary Gland Stones: Symptoms, Self-Care and Treatment

01Basics

What are salivary gland stones?

The NHS describes salivary gland stones as small stones that form in the salivary glands in the mouth and can block the flow of saliva. They are white and hard, vary in size and are mostly about as big as a pea. MedlinePlus calls them salivary duct stones: mineral deposits in the ducts that drain the salivary glands. The medical term is sialolithiasis.

The NHS says they are not usually serious and sometimes go away on their own, but symptoms continue until the stone has gone.

02Glands

The salivary glands and how a blockage happens

MedlinePlus describes three pairs of major salivary glands:

• the parotid glands, the largest, in each cheek over the jaw in front of the ears
• the submandibular glands, under both sides of the jaw, which carry saliva to the floor of the mouth under the tongue
• the sublingual glands, under the front of the floor of the mouth

Chemicals in saliva can form a hard crystal that blocks a duct. When saliva cannot get out, it backs up into the gland, which can cause pain, swelling or infection. Both sources say most stones affect the glands below the tongue (the submandibular glands); they can also affect the parotid glands. You cannot always see them.

03Symptoms

Pain and swelling at mealtimes

Symptoms described by the NHS and MedlinePlus include:

• a dull pain in the mouth that comes and goes, or pain in the face
• swelling in the mouth, face or neck that flares up from time to time
• symptoms that are worse when eating or drinking
• problems opening the mouth or swallowing
• a dry mouth

The NHS explains that intense pain at mealtimes can mean the stone is completely blocking a gland, and that this pain usually lasts 1 to 2 hours. Pain in the jaw area has many other causes; our guide on jaw pain on one side covers some of them.

04Infection

Infection and when to get it checked

MedlinePlus says most of the time salivary stones cause only pain or discomfort, but they sometimes become infected. The NHS lists signs of infection around the stone: pain, redness or pus, and a high temperature, or feeling hot, cold or shivery.

The NHS advises seeing a GP if a stone is bothering you and has not gone away by itself, or if it has caused an infection. MedlinePlus advises contacting your provider if you have symptoms of salivary duct stones. A high temperature with rapidly spreading swelling, or difficulty opening the mouth, swallowing or breathing, needs urgent care.

05Causes

What causes them

The NHS says it is not clear what causes salivary gland stones, so there is no known way to prevent them, and they are not usually linked to other health problems. MedlinePlus explains the mechanism, chemicals in saliva forming a hard crystal, without naming a specific cause.

If you take regular medicines and wonder whether they play a role, ask your doctor; do not stop any prescribed treatment on your own.

06Diagnosis

How they are diagnosed

MedlinePlus explains that a health care provider or dentist examines the head and neck to look for enlarged, tender salivary glands, and may be able to feel the stone under the tongue. Tests such as x-rays, ultrasound, MRI or CT scans of the face can confirm the diagnosis.

Which test, if any, is needed depends on the examination and is decided by the clinician.

07Self-care

Gentle self-care

Both sources suggest increasing saliva to help a stone move. Things you can try include:

• drinking plenty of water
• gently massaging around the stone
• chewing sugar-free gum or sucking sugar-free sweets, lemon drops or lozenges

For pain and swelling, the NHS suggests simple over-the-counter painkillers and sucking ice cubes or ice lollies. The NHS notes that small stones sometimes fall out on their own. Neither source gives a typical time for a stone to pass, so if it does not, see a professional.

08Safety

What not to do at home, and professional removal

The NHS is clear: do not use anything sharp to try to remove a salivary gland stone, because it could cause injury and infection. That includes needles, pins, tweezers and trying to cut or squeeze the stone out by force. Gentle massage is as far as self-care should go.

If a stone does not come out, the NHS says a GP may try to remove it gently with a thin, blunt instrument, and if that is not possible it may be removed in hospital. MedlinePlus describes options including a provider massaging the gland with heat to push the stone out, sialendoscopy (tiny cameras and instruments passed into the duct), shock waves to break the stone up, and surgery to cut it out. The right option depends on the stone and is decided by the specialist.

09Sources

Where the sources differ

Seriousness. The NHS says stones are not usually serious and sometimes go away on their own. MedlinePlus adds that they can become infected and lists problems opening the mouth or swallowing. Both agree that persistent or infected stones need attention.

Treatment detail. The NHS describes a stepwise approach: self-care, removal by a GP with a blunt instrument, or hospital removal. MedlinePlus lists more techniques, including shock waves and sialendoscopy. Availability varies between health systems.

Recurrence. The NHS says stones do not usually come back once removed, but people who keep getting them may need a gland removed. MedlinePlus says gland removal may be needed if stones become infected or come back often.

10Summary

In summary

Salivary gland stones are small mineral deposits that block saliva, most often from the glands under the tongue. They cause pain and swelling that come and go, often at mealtimes, and can become infected. They are not usually serious, and small stones sometimes come out on their own.

Water, gentle massage and sugar-free sweets may help; never use anything sharp. See a doctor if a stone persists or shows signs of infection, and get urgent care for fever with spreading swelling or trouble swallowing or breathing. In our ENT practice in Bilbao we assess persistent salivary gland pain and swelling in adults (consultations are in Spanish).