Causes signs and effects of salivary gland stones on the mouth and treatment methods

Have you ever felt a sudden pain under your tongue or near your jaw when you start eating This could be due to a "salivary stone," a common issue in the salivary glands that causes saliva to build up instead of flowing normally. This can lead to pain, swelling, and recurring infections.Salivary glands play a crucial role in keeping your mouth moist and aiding digestion, sometimes mineral deposits form inside them, turning into small stones that partially or completely block the salivary ducts.The good news is that there are many treatment options! These range from natural remedies like massage and drinking plenty of water to medical procedures such as manual removal or surgery for larger stones.

In this Dalili Medical guide, we'll explore the causes of salivary stones, their symptoms, treatment methods, and how you can prevent them before they develop!

How to Know if You Have Salivary Stones?

If you experience pain and swelling in your salivary gland, difficulty eating or opening your mouth, and persistent dry mouth, you might have a salivary stone.

What Should You Do or Avoid if You Have Salivary Stones?

✔ Stay hydrated by drinking plenty of water.
✔ Gently massage the affected gland to help the stone pass.
✔ Apply warm compresses to the swollen area.
✖ Avoid foods that increase saliva production (such as acidic foods).
If the stone causes severe pain or doesn’t pass on its own, you should consult a doctor for the best treatment option.

What Happens if a Salivary Stone Is Left Untreated?

If left untreated, it can lead to infections, severe swelling, persistent pain, and complete blockage of the salivary duct. This could worsen the condition and require urgent medical intervention.

What Are the Best Ways to Manage Salivary Stones?

✔ Drink plenty of water to keep saliva flowing and prevent blockages.
✔ Massage the affected gland to help move the stone.
✔ Use warm compresses to reduce pain and widen the salivary ducts.
✔ Suck on acidic candies like lemon drops to stimulate saliva flow.
In severe cases, surgical removal may be necessary.

Can Salivary Stones Come Back?

Unfortunately, there is about a 30% chance of recurrence within 10 years after the first occurrence.
However, maintaining good oral hygiene, staying hydrated, and avoiding foods that cause dryness can help reduce the risk of recurrence.

Why Are Submandibular Gland Stones the Most Common?

Saliva Composition
This gland produces thicker saliva rich in calcium, making it easier for minerals and salts to deposit, leading to faster stone formation.

Duct Structure (Wharton’s Duct)
Wharton’s duct is long and angled upwards before opening into the mouth. This slows down saliva flow compared to other salivary glands, making it easier for stones to form.

Saliva Flow Direction
Since the duct is tilted upward, gravity makes it harder for deposits to drain out, increasing the chance of stone formation.

That’s why the submandibular gland is the most prone to developing salivary stones compared to other glands!

Causes of Salivary Stones

Dehydration & Low Water Intake

When you don’t drink enough water, your saliva becomes more concentrated, increasing the risk of stone formation.
Dehydration can be caused by hot weather, insufficient water intake, or medical conditions that lead to fluid loss.

Reduced Saliva Production

As you age, your salivary glands become less active, producing less saliva, which contributes to stone formation.
Certain medications like antidepressants and diuretics can reduce saliva flow and increase the risk of stones.

Calcium & Mineral Deposits

Saliva contains minerals like calcium and phosphate. If they start accumulating in the ducts, stones can form.

Salivary Gland Infections

If the gland gets infected or inflamed, saliva becomes thicker and flows more slowly, increasing the risk of stones.
Bacterial infections can also cause inflammation and blockage in the ducts.

Narrow or Abnormal Salivary Ducts

If the salivary ducts are naturally narrow or have congenital issues, saliva can build up, making it easier for stones to form.

Lack of Chewing & Low Saliva Stimulation

Eating mostly soft or liquid foods reduces salivary gland activity, causing saliva to stagnate and increasing the risk of stones.

Smoking & Alcohol Consumption

Smoking makes saliva thicker and affects salivary gland function.
Alcohol causes dehydration, which can speed up stone formation.

Certain Medical Conditions

Autoimmune diseases like Sjögren’s syndrome and cystic fibrosis cause dry mouth, raising the risk of stones.
Diabetic patients are more prone to salivary stones due to the effect of high blood sugar on saliva production.

Types of Salivary Stones

Based on Location in the Salivary Glands

Submandibular Stones

This is the most common type, occurring in 80-90% of cases.
The submandibular gland produces thicker, calcium-rich saliva, which promotes stone formation.
Wharton’s Duct is long and angled upwards, making saliva flow slower and increasing the risk of blockages.
Stones form under the lower jaw, causing pain and swelling, especially during meals.

Parotid Stones

Occur in 5-20% of cases, affecting the parotid gland, which is located near the cheek by the ear.
Stensen’s Duct is relatively wide, making stones less common here.
Pain is usually felt in the cheek area, in front of the ear, with swelling that comes and goes depending on eating habits.

Sublingual Stones

Very rare, occurring in only 1-2% of cases.
The sublingual gland produces very thin saliva, reducing the chances of stone formation.
If stones form, they appear under the tongue, causing pain and difficulty swallowing.

Minor Salivary Gland Stones

Found in the small salivary glands scattered throughout the lips, cheeks, and roof of the mouth.
Extremely rare, but when they do occur, they cause localized swelling and may lead to recurrent infections.

Based on Stone Size

Small Stones (Less than 5 mm)

Usually cause no major problems and may pass naturally with massage and increased water intake.

Medium Stones (5-10 mm)

Cause noticeable pain and swelling.
Often require manual removal using pressure or medical tools.

Large Stones (More than 10 mm)

Can completely block the duct, leading to severe inflammation.
In these cases, surgical removal or extracorporeal shock wave lithotripsy (ESWL) may be necessary to break the stone.

Based on Stone Composition

Calcium Stones

The most common type, made of calcium phosphate or calcium oxalate.
Form due to calcium deposits in salivary ducts, often caused by dehydration or poor saliva flow.

Proteinaceous Stones

Contain a high percentage of proteins and are less common than calcium stones.
Usually occur when saliva becomes thicker and more viscous than normal.

Mixed Stones

A combination of calcium and protein deposits.
Common in chronic cases where ongoing salivary gland inflammation is present.

Symptoms of Salivary Gland Stones

Salivary stones can cause various issues depending on their size, location, and whether they partially or completely block the duct. At first, symptoms might be mild, but they can gradually worsen, leading to severe pain and infections.

Pain That Worsens During Eating (Most Common Symptom)

The first noticeable symptom is pain under the jaw or in the cheek, especially during or right after eating.
This happens because the gland tries to release saliva, but the duct is blocked by the stone. As a result, saliva builds up, creating pressure that causes pain.
Initially, the pain is temporary, but over time, it may become constant, even without eating.

How to Differentiate Between Salivary Gland Pain & Toothache?

Salivary gland pain increases during meals and improves afterward.
You may notice temporary swelling in the gland that disappears when saliva drains out.
Unlike dental issues, there is no tooth sensitivity or pain while chewing.

Swelling in the Affected Gland (Comes & Goes)

One of the key signs of a salivary duct blockage is swelling in the affected gland.
The gland becomes enlarged and painful, especially after eating, as saliva accumulates inside.
At first, the swelling may come and go, but if the stone grows larger and completely blocks the duct, the swelling may become permanent.

Dry Mouth & Difficulty Swallowing

Since the saliva flow is reduced, the mouth may feel dry and not well-moisturized.
Dryness can lead to difficulty swallowing, especially with dry foods.

Pus Discharge or Bad Taste in the Mouth

If the gland becomes infected, pus (discharge) may leak into the mouth, causing an unpleasant taste.
In some cases, the infection may lead to a bad smell in the mouth.

Fever & Severe Inflammation (If Infection Occurs)

If a bacterial infection develops due to a blocked gland, symptoms may include:
Fever
Fatigue & general discomfort
Redness & warmth in the affected area
In severe cases, antibiotics or urgent medical intervention may be necessary.

How to Identify the Swelling Location?

Under the jaw → If the stone is in the submandibular gland (this is the most common location for salivary stones).
In front of the ear → If the stone is in the parotid gland (beside the cheek, near the ear).
Under the tongue → If the stone is in the sublingual gland, you might be able to see it in the mirror.

Persistent Dry Mouth & Constant Thirst

When the duct is blocked, the gland can't release enough saliva, causing continuous dryness in the mouth.
Even drinking plenty of water doesn't relieve the dryness until the stone is removed.
This dryness can lead to:
Bad breath
Difficulty speaking or swallowing

Note:

The longer the stone stays, the worse the dryness becomes.
Chewing sugar-free gum can stimulate saliva production and provide temporary relief.

A Small White or Yellow Spot Under the Tongue

In some cases, if the stone is near the duct opening, it might appear as a tiny white or yellow dot under the tongue.
You might feel it with your finger or the tip of your tongue when touching the area.

This is a sign that the stone is close to the duct opening and may come out on its own or be easily removed by a doctor.

Difficulty Swallowing or Moving Food in the Mouth

When the gland is blocked and saliva flow decreases, food sticks to the mouth, making swallowing harder.
Saliva helps in moving and breaking down food, so when it’s reduced, eating feels dry and uncomfortable.

How to Notice the Difference?

If you’re eating dry foods like bread or nuts, the dryness feels more noticeable.
You may need to drink water after every bite to swallow comfortably.

Strange Taste or Bitterness in the Mouth

When saliva builds up due to blockage, it can lead to gland inflammation, causing an unusual taste or bitterness in the mouth.
This taste is stronger in the morning or after eating.

If you experience this along with pain and swelling, it could be an early sign of gland inflammation.

Pus or Unusual Discharge from the Gland (If Infected)

If the stone fully blocks the duct for a long time, it can cause a bacterial infection, leading to pus or a white/yellow discharge from the duct opening.
This discharge often comes with a bad smell.

This indicates a severe infection that requires immediate antibiotic treatment.

If you notice any unusual discharge, see a doctor immediately to prevent complications.

Fever and High Temperature (If the Infection is Severe)

In severe cases, especially if the gland is highly inflamed, the body may develop a fever as a response to infection.
Symptoms include:
Fatigue and general weakness
Swelling and redness in the affected area

If you experience fever along with severe swelling and pain, seek medical attention immediately.

Stages of Salivary Stone Formation

Salivary stones don’t form overnight—they develop gradually, starting with mineral deposits, which grow over time until they completely block the duct, leading to pain and infection. Let’s break down the stages:

Stage 1: Mineral Deposition

At first, saliva contains minerals like calcium and phosphate.
If saliva becomes too concentrated due to dehydration or low saliva production, these minerals start depositing inside the salivary duct.
Most stones start in the submandibular gland because:
It secretes saliva with high calcium levels.
Its duct is long and has poor drainage.
Symptoms: No noticeable symptoms or mild dry mouth.

Stage 2: Formation of the Stone’s Core

As mineral deposits accumulate, a small core starts forming inside the duct.
Proteins and organic materials in saliva stick to this core, causing it to gradually grow.
Symptoms:
Mild discomfort or slight swelling after meals, but it disappears quickly.

Stage 3: Stone Grows & Symptoms Begin

If the stone continues to grow, it partially blocks saliva flow, causing the gland to swell and become painful.
Symptoms:
Intermittent pain, which worsens during meals when the gland tries to release saliva.
Swelling that comes and goes, depending on how much saliva is being produced.
If the stone is near the duct opening, you might feel it under the skin or tongue.

Stage 4: Complete Blockage of the Duct

At this stage, the stone completely blocks saliva flow, causing it to accumulate inside the gland.
Symptoms:
Persistent pain, not just during meals.
Visible swelling of the gland.
Feeling of pressure or tightness under the jaw or in the cheek (depending on the affected gland).

Stage 5: Infection & Severe Inflammation

If the blockage remains untreated, bacteria may enter, leading to a severe infection.
Symptoms:
Severe swelling and redness in the affected area.
Intense pain that doesn’t go away, even at rest.
Pus or yellow/white discharge from the gland.
Fever and flu-like symptoms in severe cases.

This stage requires urgent medical treatment, possibly antibiotics or surgical removal of the stone.

Diagnosis of Salivary Gland Stones

If you experience pain or swelling in the jaw or under the tongue, especially during eating, your doctor may suspect a salivary gland stone. To confirm the diagnosis, several steps are taken to determine the stone’s location, size, and whether an infection is present. Here’s a detailed breakdown:

Medical History (Questions the Doctor Asks)

The doctor starts by asking a few questions to understand your condition, such as:

Pain and Swelling: Does the pain increase while eating? Does it come and go?
Dry Mouth: Do you often feel that your mouth is dry?
Previous Infections: Have you had any swelling or infections in the salivary glands before?
Medications: Are you taking any medications that reduce saliva production and increase the risk of stone formation?
Daily Habits: Such as water intake, smoking, and dietary habits.

If the symptoms align with salivary gland stones, the doctor proceeds with a physical examination.

Clinical Examination (Physical Inspection)

The doctor examines the affected gland by hand and inspects the mouth, looking for:

Swelling under the jaw or in front of the ear, depending on the affected gland.
Pain when pressing on the gland, especially if the duct is blocked.
A detectable small stone near the duct opening, which is more likely if the stone is large enough.
Saliva flow: If the duct is completely blocked, little to no saliva will be present.

If a stone is suspected, the doctor will request imaging tests or lab work for confirmation.

Imaging and Medical Tests

Imaging helps determine the exact location and size of the stone. The most common tests include:

X-ray

Detects stones that contain calcium, making them visible on the scan.
It is fairly accurate, but not all stones appear, especially if they are small or lack calcium.

Ultrasound

Quick and effective, identifying stones even if they don’t contain calcium.
Very useful when stones are not visible on standard X-rays.
Safe and suitable for all patients.

CT Scan

Provides a highly detailed view of the stone’s size and exact location.
Used when stones are deep or if the blockage is severe.

Sialography (Salivary Gland Duct X-ray with Dye)

A special dye is injected into the salivary duct before taking an X-ray.
Helps detect blockages or narrowing of the duct.
Less commonly used today but still beneficial in complex cases.

MRI (Magnetic Resonance Imaging)

Rarely used but helpful in diagnosing chronic inflammation or issues in surrounding tissues.

Blood Tests (If Infection Is Suspected)

If the doctor suspects a bacterial infection due to the stone, blood tests may be ordered, such as:

White Blood Cell Count (WBC): Elevated levels indicate an infection.
Inflammatory Markers (CRP & ESR): Higher levels suggest chronic inflammation in the gland.

These tests are not always necessary but can be useful if the patient has fever, severe redness, or pus discharge from the gland.

Saliva Flow Test

In some cases, a simple test may be done to check saliva production and whether there is a complete blockage.

If very little or no saliva is produced, this indicates severe obstruction.
Sometimes, thick or pus-containing saliva may be present if an infection is involved.

Once the diagnosis is confirmed, the doctor will decide on the best treatment based on the stone’s size and condition.

Complications of Salivary Gland Stones

If a salivary gland stone is left untreated, it can lead to serious complications. Some are mild, while others may require surgical intervention. Here’s a detailed breakdown:

Recurrent Salivary Gland Infections

The most common issue is gland infection due to saliva buildup and bacterial growth.
The infection may start as mild but can become very painful over time.

Symptoms of infection:

Severe pain in the affected gland.
Noticeable swelling in the jaw or under the tongue.
Redness and warmth in the affected area.
Fever, especially if the infection worsens.
Pus or yellowish discharge from the salivary duct.

If left untreated, the infection may lead to an abscess or a more serious bacterial spread.

Abscess Formation (Pus Collection in the Gland)

If the infection persists without treatment, it can develop into an abscess (a collection of pus inside the gland).
Bacteria multiply inside the gland, causing severe swelling and pain.

Symptoms of an abscess:

Large, painful swelling with a throbbing sensation.
Intense redness and heat over the affected gland.
Feeling of pressure and difficulty opening the mouth.
Foul-smelling pus discharge from the salivary duct.

An abscess does not resolve on its own and requires medical drainage and cleaning of the gland.

Gland Damage and Duct Obstruction

If the stone remains in place for too long, it can cause permanent damage to the gland.
Over time, the gland may develop fibrosis (scarring), leading to a loss of function.

Possible consequences:

Persistent dry mouth.
Repeated infections in the same gland.
Constant discomfort or swelling.

If the gland becomes completely non-functional, surgical removal may be necessary.

Serious Infections and Systemic Spread

Cellulitis: Infection spreading to surrounding tissues, causing severe redness and swelling in the jaw and neck.
Sepsis: If the infection enters the bloodstream, it becomes a life-threatening condition.

If swelling spreads rapidly, or if you experience high fever and extreme fatigue, seek emergency medical help immediately.

Difficulty Eating and Speaking

Swelling in the affected gland can make chewing and swallowing difficult, especially with dry foods.
If the stone is near the tongue, it may cause pain when moving the tongue or affect speech.
This happens due to the pressure the stone exerts on surrounding tissues.

If you have persistent difficulty eating or speaking, stone removal is recommended before the condition worsens.

Recurring Salivary Stones

Some people are more prone to developing salivary stones due to factors such as:

Low water intake.
High calcium levels in saliva.
Medications that reduce saliva flow.
A history of salivary gland stones.

In these cases, patients may experience repeated stone formation even after removal, requiring ongoing medical monitoring.

Salivary Gland Surgery

If salivary gland stones become too large, cause a complete blockage, or if there is chronic infection that doesn’t respond to treatment, surgery may be necessary to remove the stone or the affected gland.

The type of surgery depends on the condition, ranging from a simple procedure to a more complex operation. Here’s a breakdown:

Types of Salivary Gland Surgeries

Small Stone Removal (Simple Surgery)
Sialendoscopy (Endoscopic Surgery)
Salivary Gland Removal (For Severe Cases)

Small Stone Removal (Simple Surgery)

If the stone is near the duct opening under the tongue or inside the cheek, the doctor can remove it through a minor procedure under local anesthesia.

How the procedure is performed:

The doctor widens the duct opening using small surgical tools.
If the stone is visible, it is gently pulled out with fine forceps or a special instrument.
In some cases, a small incision in the duct may be needed for easier removal.
Once the stone is removed, the doctor applies pressure to the gland to ensure saliva flows normally again.

This procedure is very quick (about 10-15 minutes), does not require stitches, and the patient can go home the same day.

Sialendoscopy (Endoscopic Surgery)

If the stone is deeper inside the duct, the doctor may use a sialendoscope, a very thin tube with a tiny camera, to navigate inside the salivary duct and locate the stone.

How the procedure is performed:

A very thin tube is inserted into the salivary duct.
A small camera provides a clear view of the stone and its exact location.
If the stone is small, it can be pulled out using fine instruments or gently pushed toward the duct opening.
If the stone is large, the doctor may use a special device to break it into smaller pieces for easier removal.

Sialendoscopy is a modern and effective solution as it avoids open surgery, and recovery time is very fast.

Salivary Gland Removal (Gland Excision)

In severe cases, if stones keep forming repeatedly, or if the gland has developed chronic infections or an abscess, the doctor may decide to remove the gland completely to eliminate the problem.

How is the Surgery Performed?

The patient is given general anesthesia to ensure they feel no pain.
The doctor makes a small surgical incision in the skin over the affected gland.
The surrounding tissues and muscles are carefully moved aside while taking care to avoid important nerves in the area.
The gland is carefully removed, and the incision is closed with cosmetic sutures to minimize scarring.

This surgery usually requires one to two days of hospitalization, and recovery takes about one to two weeks, depending on the case.

When is Salivary Gland Surgery Needed?

If the stone is too large to be expelled naturally.
If the stone completely blocks the duct, preventing saliva from flowing.
If there are recurrent infections or abscesses in the gland.
If the stones keep returning after treatment.
If there is a tumor in the gland (which is rare but may require surgery).

Recovery After Surgery

After the procedure, the patient may experience:

Mild swelling and pain in the affected area.
If the surgery was minor, the patient may return to normal activities the same day or the next day.
If the entire gland was removed, the patient might need a week of rest before resuming normal activities.

Post-Surgery Care

The doctor may prescribe:

Painkillers if needed.
Antibiotics if there was an infection.
Hydration and chewing gum to stimulate saliva production and prevent dry mouth.

How to Massage the Salivary Gland to Expel a Stone

Massaging the affected gland is an effective way to help move a small stone and push it out naturally, especially if it is not too large or completely blocking the duct. Massage helps to:

Stimulate saliva flow and encourage the stone to move out.
Reduce pain and swelling caused by saliva buildup.
Relieve pressure inside the affected gland.

How to Perform the Massage Properly

Before starting the massage:

Drink warm water or lemon juice to stimulate saliva flow.
Apply a warm compress to the affected area for 5-10 minutes to help open the duct and ease the stone’s movement.

Identify the Location of the Affected Gland

Submandibular gland (below the jaw): You may feel swelling or pain under the jaw on the affected side.
Sublingual gland (under the tongue): Pain or swelling will be under the tongue.
Parotid gland (near the ear): Pain will be felt in the cheek near the upper jaw.

Start Gentle Massaging

Use your thumb or index finger for the massage.
Place your finger behind the stone, closer to the gland.
Apply gentle pressure and push forward towards the duct opening inside the mouth.
Repeat this movement slowly and gently to encourage the stone to move out.

Increase Pressure Gradually (But Avoid Force!)

If the stone is small, it may move easily with continued massage.
If you feel severe pain or resistance, avoid applying excessive pressure to prevent duct injury or infection.
Repeat the massage 3-4 times a day until you notice improvement.

Stimulate Saliva Production During Massage

To help the stone come out faster, chew sugar-free gum or drink lemon juice while massaging.
This increases saliva production and encourages the stone to be expelled naturally.

If the stone does not come out or the pain gets worse, visit a doctor for a safer and more effective medical intervention.

The Right Specialist for Treating Salivary Gland Stones

The most suitable medical specialties for treating salivary gland stones are Otolaryngology (ENT) Surgery or Oral and Maxillofacial Surgery.

1. ENT Specialist (Otolaryngologist)

The primary specialist for diagnosing and treating salivary gland issues.
Manages stone removal, infections, and minimally invasive procedures like sialendoscopy (salivary gland endoscopy).
Can perform minor surgeries if the stone is small and near the duct opening.

2. Oral and Maxillofacial Surgeon

In cases where the stone is large or deeply embedded, this specialist may be involved.
Handles complex surgeries such as removing large stones or performing salivary gland excision when necessary.

When to See a Doctor?

If you have symptoms of a salivary gland stone, it’s best to visit an ENT specialist first. They will diagnose the condition and recommend the appropriate treatment or refer you to a maxillofacial surgeon if surgery is required.