If you are getting sudden pain inside your mouth when meal times reach or have a lump under your tongue that is very painful; then you may have an obstruction in the “pipe” running from the salivary gland to the mouth (salivary duct) caused by a stone. This condition is called Sialolithiasis (salivary gland stones).
Salivary glands are structures that produce saliva. In the human being, we have 3 major salivary glands; namely
They may get obstructed by stones that form within the glands. The submandibular glands are the commonest site for stone deposition, followed by the parotid and finally the sublingual glands.
Salivary gland stones can occur at any age; however, most cases occur in patients in their third to sixth decade of life (20 – 60 years of age), with the risk increasing as one gets older. Males seem to be more commonly affected than women. This condition rarely occurs in children.
While the cause is not yet generally accepted upon, certain risk factors for developing stones include dehydration, medications that reduce saliva production such as antihistamines and blood pressure drugs, kidney diseases, radiation therapy to the head and neck region, age, mouth injuries, gout, Sjogrens syndrome, etc.
The stones are formed from calcium, carbonate and phosphate ions as well as other organic substances found within the salivary glands. They usually appear white / cream colored and are hard. Their size varies from less than 1 mm to a few cm in largest diameter.
The stones obstruct salivary outflow through the salivary duct, causing saliva to flow backwards and eventually stagnate, leading to swelling, pain and infection in the gland. Sometimes pus may develop within the gland and if the infection spreads to the rest of the body, one may develop a fever.
The dentist may take an x-ray to see the location of the stone better and plan for management. Small stones may resolve on their own spontaneously, or they may be “milked” out in the clinic by the dentist. You may be advised to take a painkiller such as acetaminophen (Panadol™) to moderate the pain as well as antibiotics if the infection has spread to the rest of the body.
Prevention of salivary gland stones involves drinking a lot of water, eating healthy and having regular dental checkups to aid early detection.
Dr Biren Yajnik
The writer is the Vice President of the Uganda Dental Association.