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Salivary stone

introduction

In the ducts of the salivary glands (glandula parotidea, glandula submandibularis, glandula sublingualis) hard concretions can form, which are called salivary stones (Sialolite) are designated. This salivary stone can clog the ducts of the salivary glands, lead to the backlog of saliva and thus trigger a painful feeling of pressure in the area of the salivary glands. A salivary stone usually only occurs on one side.

Salivary glands

The oral cavity is lined with moist mucous membrane. The constant moisture is guaranteed by the saliva produced by the salivary glands. Basically we have 3 salivary glands arranged in pairs in the mouth. It is the parotid gland (Parotid gland), the sublingual salivary gland (Sublingual gland) and the mandibular salivary gland (Submandibular gland). Small tongue salivary glands (Lingual gland) play no role in stone formation. The saliva produced by the individual glands varies in consistency. This ranges from viscous to thin. Saliva is not only used for humidification, it also has other functions. It contains calcium and fluoride (see also: Fluoridation) to remineralize and harden the tooth enamel and a digestive enzyme that initiates the breakdown of carbohydrates. Finally, it also makes the food slippery so that it is easier to swallow.

Salivary stone

A salivary stone usually only occurs on one side. The probability that a salivary stone has formed is different for the 3 glands. The occurrence of salivary stones is rather rare, there are around 40 cases for every 1,000,000 inhabitants. Men are affected more frequently than women. Salivary stones mainly appear in middle age. However, salivary stones can very rarely form in childhood. The sizes of the salivary stones are between 1 and 5 millimeters. They grow relatively slowly, about 1 millimeter per year. Due to the composition of the saliva, the stones consist of both organic and inorganic components.

Salivary stone on the parotid gland: Salivary stones in the parotid gland are less common. In more than 80% of cases, the stone is located in the lower jaw salivary gland. In only 10% of the cases, the stone is in the large parotid gland.
Find out more about the topic: Salivary stone of the parotid gland
Salivary stone on the palate: In the palate area there are many small ducts of small salivary glands. As a rule, they are seldom clogged because they mainly contain liquid secretion. In most cases, pain in the roof of the mouth is a small amount of inflammation. They are either caused by bacteria or are due to minor injuries. There is also the risk of small cysts in the palate, which can be found in the area of the excretory ducts of the glands. Tension pain in the roof of the mouth can also come from sinus inflammation.
Salivary stone under the tongue: Under the tongue is the duct of the sublingual and mandibular salivary glands. More often it happens that the stones are located in the lower jaw. In the sublingual gland, the additional liquid secretion helps that the rather slimy saliva is more easily expelled. A stone seldom forms under the tongue. However, if the stones of the submaxillary gland migrate and they lie in the excretory duct, it is not initially possible to understand where the stone comes from. It is only noticeable when the corresponding gland swells.

Symptoms

Painful feeling of pressure: As soon as the salivary gland produces saliva, there is a painful feeling of pressure in the area of the salivary glands. The pain is either in front of the ear, under the tongue, or under the back of the lower jaw. This happens when the food comes into contact with receptors on the oral mucosa, through movement of the chewing muscles or even when smelling or thinking about a delicious food. The increased saliva produced cannot flow away through the blocked salivary gland duct. This is how pressure builds up in the gland. The gland swells and hardens.
Temporomandibular joint pain
a headache
often pain only on one side of the face
Obstruction of the mouth opening
Inflammation: The signs are swollen, red-colored ducts in the mouth. The skin on the cheeks can also turn red. It is typical of inflammation that the skin becomes warm.
Read more on the topic: Inflammation of the salivary gland
Abscess Formation: If this inflammation is left untreated, an abscess can develop. This encapsulates pus and other secretions from the gland, swells and causes further discomfort because it presses on the salivary gland and surrounding structures.

Find out more at: This is how you can recognize a saliva stone

causes

Thick saliva: If the body contains too little water, it saves by wasting as little water as possible. This makes the saliva more viscous. Substances such as calcium phosphate, calcium carbonate, proteins or carbohydrates are then contained in higher percentages in the saliva. If they are not washed away, these are deposited on the walls of the duct and form a stone. Regular drinking can prevent the formation of a saliva stone. Because if there is enough water in the body, the saliva is also more fluid. The ratio between water and substances that are deposited as stones in the salivary gland duct is better.
Consequences of a disease: In some cases, a disease leads to thickened saliva. For example with mumps or cystic fibrosis.
Too high calcium content in saliva: On the other hand, if there is too much calcium in the saliva, for example in the case of bone metastasis, gout or diabetes mellitus, then gallstones and kidney stones can also occur more frequently.
Taking medication: The lack of saliva can also be influenced by medication. Water tablets, blood pressure lowerers for the heart or antidepressants lead to reduced salivation.
Consequences of radiation: After radiation of a tumor in the head and neck area, so-called radiogenic sialadenitis occurs. This is an inflammation of the salivary gland which results in less saliva being produced.
Sjörgen syndrome: In rheumatic Sjörgen syndrome, the formation of salivary stones is also promoted.

More on this: Causes of a salivary stone

inflammation

A salivary stone that persists in the gland duct for a long time harbors the risk of developing salivary gland inflammation (technical term: Sialadentitis).
The cause of this phenomenon is the blockage of the duct caused by the salivary stone and an associated increase in bacteria and viruses. The salivary gland is a perfect place where bacteria and viruses can multiply. The temperature is at body heat and enough nutrients get in via the blood. Such an inflammation is favored by poor oral hygiene.

The bacteria that are in the mouth can also migrate through the duct into the salivary gland and trigger inflammation there. Over time, pus may form, which will leak into your mouth, causing an unpleasant taste and smell. If an inflammation is triggered by a salivary stone, it mostly happens in the parotid gland. Due to the close relationship to other structures, bacteria can enter the parotid gland and cause inflammation. Only when inflammation has emerged from the salivary stone will the medication start. The inflammation can usually be treated well with antibiotics. The salivary stone can also dissolve as a result.

An inflammation of the salivary gland caused by salivary stones is mainly shown by the sudden, one-sided appearance of local swellings in the area of the affected gland. In addition, an inflammation of a salivary gland manifests itself through sometimes severe pain and reddening of the mucous membranes.
Many patients report that the pain mainly occurs while eating or is increased in intensity by eating. This fact is due to the fact that the saliva production of the inflamed salivary gland increases while eating. In many cases the thought of food is enough to trigger this phenomenon. In addition, inflammation of a salivary gland is manifested by the appearance of a high fever and pronounced sensitivity to pressure in the area of the affected gland.
An inflammation of the salivary gland caused by a salivary stone requires prompt medical treatment.

Read more on this topic at: Inflammation of the salivary glands

therapy

The therapy for salivary stones depends on the size of the stone and its location. It is most favorable if the saliva stone is at the end of the execution passage and is not too large.
Then you can try to remove the stone by massage. If this does not succeed, a small incision can make it easier to push out. If the stone is too big or too far within the passage, however, you can try to smash the stone with ultrasound and remove the fragments by increasing the flow of saliva.

Acidic foods or juices can be used to stimulate the flow of saliva. If none of these measures lead to success, only surgery is an option. This can lead to the loss of the entire salivary gland, especially if there is chronic inflammation

Read more on the topic: Salivary stone therapy

Different treatments are available depending on the location of the salivary stone. A distinction is made between a location near the gland and a location far from the gland. Salivary stones distant from the gland are located near the opening of the excretory duct, here the salivary stones can be massaged out. For this purpose, acidic lozenges are often prescribed during therapy, which are intended to stimulate saliva production so that the saliva stone is shifted as far as possible in the direction of the opening of the excretory duct. The practitioner then massages the stone manually through the opening into the Oral cavity.

If this therapy is unsuccessful, as is the case with large salivary stones, for example, there is another possibility in the form of duct slitting. This is where the execution gear is after local anesthesia slotted with a scalpel level with the stone. The salivary stone can then be easily removed. Then the newly created opening of the duct is sutured to the oral cavity. This creates a new, widened opening that is intended to avoid possible new salivary stones.

Remove the salivary stone yourself

Before considering surgical removal if a salivary stone is present, an attempt should be made to remove the stone using measures that are gentle on the glands.
Targeted, light massages of the salivary gland can help remove a small salivary stone yourself. In addition, regular sucking of lemon wedges should help to flush the stone out of the glandular duct by increasing the flow of saliva.

Many doctors also recommend chewing gum more or sucking candy. In addition, a patient suffering from a salivary stone stuck in the gland duct should be careful to drink plenty of fluids.
Many treating physicians also recommend their patients to exercise more.
In general, all measures that increase the flow of saliva are considered a sensible method of removing the saliva stone yourself. If the stone does not come off despite the above measures and / or symptoms such as fever, malaise and fatigue occur, a doctor should be consulted urgently become.

surgery

If removal of the salivary stone by conservative therapy does not have the desired effect, the only option is surgery. Before the operation, it should be discussed with the doctor whether anticoagulant medication, if taken, should be discontinued. These are e.g. Aspirin, Reflundan or Marcumar.

The oral cavity should be cleaned thoroughly, i.e. brush your teeth, use mouth rinse, etc. Either the operation is performed under general anesthesia or only with local anesthesia, which depends on the individual situation and the patient.
If local anesthesia is used, smoking and eating is prohibited several hours in advance. Liquids can be consumed up to 2 hours beforehand. The chances that the operation will be successful are high and the problem-causing saliva stone is removed.

Read more on the topic: This is how you can effectively remove a saliva stone

The removal procedure begins with an incision in the duct of the salivary gland. This allows the stone to be taken out. It is usually not necessary to sew the opened execution passage. This is the approach for a more problematic treatment. However, if there is severe inflammation or if the salivary stone has grown together with the surrounding tissue, a larger incision must be made in the skin so that the gland can be exposed and removed.
The respective gland is completely removed, but this is rare.

The actual surgical procedure must be carried out with great care. On the one hand, this caution is necessary in order to be able to remove the salivary gland as gently as possible, on the other hand, there is also the risk of injuring various facial nerves during such an operation (Facial nerve, lingual nerve, hypoglossal nerve).
Since the nerve that is responsible for supplying the facial muscles (nervus facialis) is also at risk, an injury to this nerve can lead to paralysis.
There is also a risk of injury to the tongue nerve during surgery to treat a salivary stone (Lingual nerve), which primarily serves to convey different taste sensations. If this nerve is injured, it can lead to disturbed taste sensations (sweet, salty and sour) in the front two thirds of the tongue.

As one of the 12 cranial nerves, the Hypoglossal nerve as motor nerve signals to the muscles of the tongue and the floor of the mouth.
If this nerve is accidentally damaged, paralysis can occur in the supply areas just mentioned. Even after a problem-free surgical removal of a salivary gland, it is advisable for the affected patient to remain in inpatient care for at least a few days. In this way, if bleeding or wound infections occur in the area of the operating room, action can be taken effectively and, above all, promptly.
The surgical removal of a salivary gland due to a salivary stone is generally well tolerated by most patients. The function of the extracted salivary gland can be well compensated for by the remaining glands.

After the operation, the patient needs to consider a few things to ensure a good healing process. First of all, strong physical stress such as sporting activities should be avoided.
Smoking should be avoided until completely healed, as this can lead to wound healing disorders. The external cooling of the wound has a pain-relieving effect and helps in healing,

On the other hand, heat is more harmful. In the first few days after the operation, I should limit my food intake to water and tea or pulpy foods or soups. Only when the cut has healed can you slowly adjust the diet to the usual level. However, coffee or alcohol should not be drunk.
Maintain adequate oral hygiene after eating to remove any leftover food that could cause infection. Brushing your teeth should be done with a soft toothbrush and caution should be exercised around the operated area. Right after the operation, the wound will be painful. Bleeding or bruising can occur, as can an abscess. Infections are also possible, which is why the right aftercare should keep the risk of them as low as possible. Brief numbness is also possible. If complications arise, you should consult the responsible doctor.

Salivary stone fragmentation

The shattering takes place via shock wave treatment. It is carried out from the outside through the skin. No anesthesia is required and there is no surgery. The stone is found with an ultrasound or sonography. Correct adjustment requires a lot of experience and precision, which is why it should be carried out by an oral and maxillofacial surgeon. The shock waves are directed at the stone with continuously increasing intensity. After about 2000-4000 shock waves the stone is shattered. The treatment usually has to be carried out 3 times at an interval of 4-12 weeks

Removal by massage

Another option is a targeted massage of the affected salivary gland. During the massage, the stone is massaged in the direction of the gland outlet. This can be done by the doctor or at home. Usually this is a method that is combined with sucking something sour in order to try it without surgery for the time being. Massaging is usually associated with pain, for which you can take painkillers in order to be able to massage well at all. However, this often only has an effect if the stone is still relatively small.

Home remedies for a salivary stone

It is important to drink plenty of fluids regularly. Because when the saliva is more fluid, no solids are deposited in the passage. Food that additionally stimulates the flow of saliva is best. Citrus fruits, apples or vegetable broth apply to this. During the day, chewing gum and sour candy also stimulate the salivary glands. You should just make sure that the chewing gum is sugar-free, so that the teeth are spared. Myrrh is considered a remedy. It works effectively when you massage the myrrh tincture onto the duct. Alternatively, you can dilute the tincture with water and rinse your mouth with it. Other medicinal herbs are chamomile, sage, thyme or bertram. These herbs can be infused as tea or as a cream on the skin. In addition, horseradish and onion are considered helpful. However, they have a negative aftertaste.

Read more on the topic: Home remedies for salivary stones

homeopathy

In addition to herbal remedies, there are also homeopathic remedies that fight against a salivary stone. Common preparations are Mercurius solubilis D12 or Kalium bromatum D6. 5 globules are taken three times a day without liquid. If you have an acutely occurring salivary stone, you should urgently consult an ear specialist or dentist. However, if the tendency to salivary stones has existed for years, therapy using homeopathic globules makes sense to fundamentally prevent salivary stones. Preparations such as “Wobenzym” or “Grapefruit Extract” stimulate the flow of liquid saliva. Therapy with the extracts should be carried out over a period of 6-8 weeks in order to observe any chances of recovery.

diagnosis

The patient will report the swelling and pain, especially when eating. This is already an indication for the examining dentist. In most cases, the doctor can make the final diagnosis by means of buttons and an X-ray. Further diagnostic options are examinations with ultrasound and, if possible, endoscopy. But the manual examination and the X-ray should suffice to make the diagnosis "salivary stone". A tumor must be excluded from the differential diagnosis. Also read our topic dental diagnostics

Which doctor treats the salivary stone?

Depending on where the stone is located, it can either be treated by an oral and maxillofacial surgeon or an ear, nose and throat doctor. The ENT doctors are more likely to visit if the stone comes from the parotid gland, because then it can also lead to ear pain. The more common salivary stones of the lower jaw salivary gland lead to swelling of the tissue on the jaw. In these cases, the dentist will refer you to an MKG colleague. The two different doctors sometimes use different techniques to remove the stone because they have different scientific approaches. The surgeons are more likely to remove the stone as a whole, while the ENT surgeons prefer to use techniques such as shock wave therapy to move the stone. Basically, it doesn't matter which doctor you go to, the only thing that matters is that you consult a doctor before the inflammation spreads.

forecast

With the removal of the salivary stone and possibly the entire gland, the disease is eliminated and sufficient saliva is available due to the remaining glands. However, there is a risk of a new salivary stone appearing again because these patients have a tendency to develop new salivary stones.

prophylaxis

To prophylaxis you should strive for a sufficient supply of fluids, so that a constant good irrigation of the salivary glands is guaranteed. Basic diseases that could promote stone formation such as diabetes or gout, should of course be treated.

Bad breath

Bad breath does not come directly from the saliva stone. On the other hand, it is possible, for example, that there is an inflammation in the mouth due to poor oral hygiene. This inflammation promotes the development of inflammation in the salivary gland and a salivary stone. Salivary stones can also form when viruses or bacteria get into the glands. These bacteria can cause putrefaction in the mouth, which then leads to bad breath. If the inflammation solidifies in the salivary gland, pus forms. The pus can flow into the mouth through the excretory ducts, creating an unpleasant taste and smell. A salivary stone also leads to dry mouth. The saliva lacks to neutralize the acids in food, which can lead to bad breath.

Summary

Salivary stones are rather rare compared to kidney and gall stones. They occur when the saliva is thickened as a result of insufficient fluid intake or crystallization nuclei have formed that are not flushed out and gradually enlarge. Diagnosis is made by palpation, x-rays, or ultrasound. In the best case, therapy consists of massaging or smashing with ultrasound. If the stones are very large or in an awkward location, surgery to remove the gland is the method of choice. The prognosis is good, as the remaining salivary glands produce enough saliva.