Salivary gland stones (sialolithiasis)
Small stones made of calcium salts can build up inside the salivary glands and the ducts that drain them.
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Medicines commonly prescribed for Salivary gland stones (sialolithiasis)
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: ORAL SOLUTION/SUSPENSION, 600 mgActive substance: ibuprofenManufacturer: Kern Pharma S.L.Prescription requiredDosage form: ORAL SOLUTION/SUSPENSION, 20 mg/mlActive substance: ibuprofenManufacturer: Kern Pharma S.L.Prescription not requiredDosage form: ORAL SOLUTION/SUSPENSION, 600 mg ibuprofenActive substance: ibuprofenManufacturer: Industria Quimica Y Farmaceutica Vir S.A.Prescription required
Small stones made of calcium salts can build up inside the salivary glands and the ducts that drain them. While a stone is tiny and saliva flows around it, nothing is felt. Once it plugs the duct, saliva has nowhere to go and the gland swells. The submandibular gland is the usual culprit: its duct is long, it runs uphill, and the saliva it carries is thick. In itself this is not dangerous, and a great many stones come out without any operation. What matters is something else — stagnant saliva becomes infected easily, and at that point the problem stops being one that can wait.
The swelling that comes on with meals
This is the most recognisable sign, and often it is enough to point a doctor straight at the diagnosis. You sit down to eat — especially if the food is sharp or simply smells good — and within a few minutes a tight lump rises under the jaw or in front of the ear. It feels full and tugging, sometimes genuinely painful. Half an hour to an hour after the meal the swelling settles by itself or shrinks noticeably, and nothing bothers you until the next meal. A day or two later it happens again.
The explanation is straightforward. The sight and smell of food set the gland producing saliva, the saliva meets the stone and stretches the gland from the inside. When production stops, the pressure gradually falls.
Alongside this you may notice:
- a dull ache in the mouth or under the jaw that comes and goes;
- a dry mouth, sticky saliva, an unpleasant taste;
- the feeling of grit or a hard seed under the tongue — sometimes the stone can be felt with the tip of the tongue or a finger, right at the duct opening;
- difficulty opening the mouth wide when the gland is badly swollen.
If the lump does not appear at mealtimes, has been there for weeks and never changes size, a stone is unlikely. Those cases are covered further down.
Why stones form
There is no single cause, but it is clear what helps a stone grow: stagnation and thick saliva. The less saliva there is and the more viscous it becomes, the more readily salts drop out of solution and clump around a crumb or a plug of mucus.
The risk goes up with:
- dehydration — drinking too little, sweating heavily, a recent bout of vomiting or diarrhoea;
- medicines that dry the mouth: diuretics, many allergy medicines, blood pressure tablets, antidepressants, treatments for incontinence;
- smoking;
- an earlier infection or injury that has left the duct narrowed;
- conditions that cause a dry mouth, particularly Sjögren's syndrome, and the after-effects of radiotherapy to the neck;
- gout, which can produce stones made of uric acid.
Heredity plays no part, and sialolithiasis cannot be caught from anyone. A stone that has passed does not usually come back, but if the duct was damaged the tendency may remain.
What helps a stone on its way out
Every home measure has the same aim: to make the gland produce more saliva, and thinner saliva, so that it pushes the stone out. This is not folklore — small stones pass this way quite often.
- Something sour. A wedge of lemon, a sugar-free sour sweet, a little lemon juice in water. Sourness is the strongest natural stimulus for saliva. Sugar-free, because teeth already short of saliva do not need the extra insult.
- Chewing. Sugar-free gum several times a day for ten to fifteen minutes. Both the chewing itself and the flavour do the work.
- Fluids. A litre and a half to two litres of water a day, unless your doctor has restricted your fluids. Thick saliva needs diluting.
- Massage. With clean, warm fingers, stroke the gland from its far edge towards the duct opening: the submandibular gland from the angle of the jaw forwards to the chin, the parotid from the ear forwards to the cheek. Gently, for a few minutes, two or three times a day. It works best straight after something sour: the saliva is already flowing and you are simply helping it carry the stone along.
- Warmth. A warm — not hot — compress over the gland for five to ten minutes before the massage. Warmth relaxes the duct.
- Pain relief. Ordinary over-the-counter painkillers help: paracetamol or ibuprofen, taken as the packet directs. Ibuprofen also brings the swelling down.
The sequence of warmth, sourness and massage is repeated several times a day, and it is worth giving it a week or two. Symptoms will keep returning while the stone is still there: that does not mean the method is failing, it means the stone has not come out yet.
What not to do
Do not try to dig the stone out with a needle, a cocktail stick, a paperclip or a pin, even if you can see it under the tongue. The lining of the duct is very delicate, any wound heals with scar tissue, the duct narrows, and the next stone will be stuck fast. It is also a direct route for infection into the gland.
Do not squeeze hard on an inflamed gland hoping to force the pus out. That drives the infection deeper into the tissues of the neck, which is an altogether more serious matter.
Do not apply heat if the skin over the gland has gone red and hot. Warmth helps plain blockage, but it feeds an infection that has already taken hold.
When the gland becomes infected: see a doctor the same day
While the swelling merely feels tight and settles between meals, there is no hurry. But stagnant saliva is a good home for bacteria, and infection of the gland develops fast. Massaging it at that stage is useless and harmful; what is needed is a doctor and, in all likelihood, an antibiotic.
Contact a doctor the same day if any of the following appear:
- the gland feels hot and the skin over it has turned red;
- the pain no longer depends on eating, is constant and is getting worse;
- you have a high temperature, shivering and general aching;
- pus is oozing from the duct opening in the mouth, or you notice a strong foul taste;
- the swelling is growing visibly and spreading down into the neck.
Call an ambulance (in Spain, Italy, Portugal, Poland and Ukraine the single European number is 112) if:
- the swelling is lifting the floor of the mouth and the tongue, and speaking or swallowing has become difficult;
- breathing is hard, the voice sounds muffled, and you have to sit with the neck stretched forward;
- the mouth will not open, the neck is swollen and stiff, and there is a high temperature as well.
These are signs that pus has spread into the tissues of the floor of the mouth and the neck. It is uncommon, but it threatens the airway, and waiting until morning is not an option.
What else causes a lump in the same place
A swelling under the jaw or in front of the ear is not always a stone, and telling them apart matters.
- An enlarged lymph node. A small, mobile bead, common after tonsillitis or a bad tooth. It has no relationship to meals at all.
- Mumps and other viral parotitis. Both parotid glands swell at roughly the same time, the earlobes are pushed outwards, and there is fever and a general feeling of illness.
- A duct narrowed by an old infection. The picture looks exactly like a stone, but there is no stone; only imaging shows the difference.
- A salivary gland tumour. This is the rare cause that matters most, because it is the one that must not be missed. Be concerned about a lump that grows slowly but relentlessly, has nothing to do with meals, feels firm and fixed, with the skin drawn in over it — and above all if part of the face on the same side goes numb or stops moving. Any swelling near a salivary gland that lasts more than three or four weeks and does not behave like a stone deserves a doctor's examination, even if it does not hurt at all.
If the stone will not come out on its own
Home measures buy time, but they do not settle everything. When a stone is large or sits deep, a doctor is needed. The assessment starts with looking at and feeling along the duct from inside the mouth, followed by an ultrasound scan — quick, harmless, and able to show both the stone and the state of the gland. If the picture is unclear, a CT scan or a contrast study of the ducts is added.
Several routes are then available, chosen according to the size and position of the stone:
- a stone sitting at the duct opening can be eased out with a fine blunt instrument in the consulting room, under local anaesthetic;
- sialendoscopy — a very fine endoscope is passed into the duct, the stone is located and retrieved with a basket or broken up, leaving duct and gland intact;
- a small incision in the duct from inside the mouth to release the stone;
- breaking the stone up with ultrasound waves, which is not available everywhere.
Removing the whole gland is now a last resort, kept for glands that have been irreversibly damaged by repeated attacks. It used to be done far more readily; the aim today is to keep the gland, because it is needed to keep the mouth moist and to protect the teeth from decay.
Online consultation
Salivary stones are exactly the kind of problem where talking to a doctor remotely achieves a lot. From your account of when the swelling appears and how quickly it goes down, a doctor already has a clear picture, and can separate ordinary blockage from an infection that needs an antibiotic and a face-to-face examination the same day.
In an Oladoctor consultation the doctor will go through how to massage your particular gland properly, look at which of your regular medicines may be drying your mouth and whether a change is worth discussing, and tell you how long it is reasonable to wait for a stone to pass and when it is time to arrange an ultrasound. If the picture points to infection, or to a lump that is not behaving like a stone, you will be told so plainly, along with which specialist to see and how quickly.
This material is for information only and does not replace medical advice.
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