Salivary Stones: Why Do They Happen and What Can You Do About Them?
You sit down to eat, and within a minute or two the area under your jaw swells and aches. By the time you have finished the meal it has started to settle again, and by the evening it may have gone completely. If that pattern sounds familiar, there is a good chance a salivary stone is behind it. Salivary stones are common, they are not cancer, and most can be managed well once they are properly identified.
What is a Salivary Stone?
A salivary stone, known medically as a sialolith, is a small deposit of calcified material that forms inside a salivary gland or the duct that carries saliva from that gland into the mouth. Stones range from smaller than a grain of rice to more than a centimetre wide.
Most stones form in the submandibular glands, which sit under the jaw on each side and drain through ducts opening under the tongue. These glands are more prone to stones than the parotid glands in the cheeks because their saliva is thicker and travels upwards against gravity to reach the mouth.
Why Do Salivary Stones Form?
Saliva contains minerals, including calcium salts. When saliva becomes thicker or flows more slowly than usual, those minerals are more likely to settle out and gradually build up in layers around a small nucleus of debris.
Several things make this more likely. Dehydration and reduced saliva flow are common contributors, as are medications that cause dry mouth, such as some blood pressure medicines, antidepressants and antihistamines. Previous inflammation or scarring in a duct can narrow it and slow flow. Smoking and some medical conditions also play a part. In many people no single cause is ever identified, which is normal and does not mean anything has been missed.
What Does a Salivary Stone Feel Like?
The classic pattern is swelling and discomfort that comes on with eating, particularly with foods that stimulate saliva strongly, such as anything sour. Saliva is produced in response to the meal, the stone partly or fully blocks its exit, and pressure builds up behind the blockage. Once the meal is over and production settles, the saliva drains past the obstruction and the swelling subsides.
Some people notice a gritty lump under the tongue, a bad taste, or a sudden release of salty fluid when the stone shifts. If the blocked gland becomes infected, the picture changes: the swelling stops settling between meals, the area becomes warm, red and tender, and you may develop a fever or feel generally unwell. That situation needs prompt attention.
How is a Salivary Stone Diagnosed?
Assessment starts with your history, since the mealtime pattern is a useful clue. Your clinician will examine the area, feel along the floor of the mouth and the duct, and check whether saliva can be expressed from the duct opening.
Imaging is usually needed to confirm the diagnosis and locate the stone. Ultrasound is often the first choice because it avoids radiation and shows both the gland and many stones well. A plain radiograph may pick up stones with a high mineral content, while CT or a sialogram, which uses contrast to map the duct system, may be used when the picture is unclear or when planning treatment.
What Can Be Done About a Salivary Stone?
Treatment depends on the size of the stone, where it sits and whether the gland has been damaged by repeated episodes.
Small stones near the duct opening will often pass on their own with conservative measures. Stones that will not pass may be removed through the duct opening under local anaesthetic, or retrieved using minimally invasive techniques such as sialendoscopy, where a very fine endoscope (small camera) is passed into the duct. Larger or more awkwardly placed stones may need a surgical approach, and in a small number of cases where a gland has been repeatedly infected and no longer functions well, removal of the gland is considered. Antibiotics are used when infection is present, though they treat the infection rather than the stone itself which means it can recur.
Can I do anything at home to help?
Conservative measures are often the first step and are worth doing well. Drink plenty of water through the day, since well hydrated saliva is thinner and flows more freely. Stimulate saliva flow with sugar free chewing gum, sugar free sour lollies or a squeeze of lemon, which encourages the gland to push saliva past the stone. Gently massaging the gland from the back towards the duct opening after stimulating flow can help move a small stone along. Warm compresses over the swollen area may ease discomfort.
Do not try to dig a stone out yourself, and do not persist with home measures if the area becomes warm, red or increasingly painful, or if you develop a fever.
Can Salivary Stones Come Back?
Yes. Having had one stone increases the likelihood of forming another, particularly if the underlying tendency towards reduced or thickened saliva flow remains. Staying well hydrated, reviewing dry mouth causing medications with your prescriber where appropriate, and keeping up good oral hygiene all reduce that risk. Ongoing review is sometimes recommended if you have had repeated episodes.
When should I seek help?
Book an assessment if you have recurring swelling around the jaw or under the tongue with eating, a persistent lump, or a gland that stays swollen between meals. Seek urgent care if the swelling is warm and painful, if you have a fever, or if the swelling is making it difficult to swallow or breathe, as these suggest infection that needs treating.
To learn more, call us on (08) 9376 6789.
IMPORTANT: This content is for general information purposes only. It does not constitute medical or dental advice. Readers should consult a qualified health professional regarding any personal health concerns.
