Salivary Duct Stones
What is a salivary duct stone?
Salivary duct stones (also known as salivary gland stones) are mineral deposits that form in the tubes that shuttle saliva (spit) from your salivary glands into your mouth. (They are known medically as sialolithiasis.)
You have three pairs of major salivary glands: in your cheeks (parotid glands), under your tongue (sublingual glands), and under your chin (submandibular glands). Each salivary gland has a tube (duct) that transports saliva to your mouth.
When salivary duct stones form, the ducts can become blocked. This results in decreased saliva flow as well as pain, swelling, and sometimes infection. Most salivary duct stones are in the glands below the jaw, but some are in the glands in the cheek.
Most common symptoms
You may have no symptoms when stones are small and the duct is not blocked. As stones get bigger, you may notice a hard lump either under the tongue or inside your cheek. You may even be able to see the stone inside your mouth. It looks like a white or yellow, oval or round bump.
When the stone completely blocks a duct (so saliva cannot flow into your mouth), it may be painful to eat or drink. This is because food stimulates the gland to produce saliva, which then has nowhere to go because of the blockage. The pain can range from a dull ache to intense pain.
Infection is also possible, causing increased pain, swelling, redness, warmth, and sometimes pus leaking from the duct. You may have a fever, too.
Many medications can cause a worsening of dry mouth, which can lead to or worsen salivary duct stones. Medications range from antihistamines, antidepressants, blood pressure medications, diuretics, and many over the counter supplements. Discuss your medication list when being evaluated for salivary duct stones. —Dr. David Lee
- Pain inside the cheek or under the tongue that worsens with meals.
- Swelling inside the cheek or under the tongue that may come and go.
- White or yellow, oval or round bump inside your mouth.
Other symptoms you may have
- Redness inside the cheek or under the tongue. Usually redder than surrounding pink tissue.
- Dry mouth.
Salivary duct stone causes
It is not clear what causes salivary duct stones. One explanation is that a duct has narrowed or is damaged (from certain medical conditions or radiation treatment, for example). It leads to saliva not leaving, allowing small amounts of calcium and other minerals that are naturally in your saliva to collect. Eventually, a stone forms and becomes large enough to partially or completely block the duct.
Another theory is that as food and bacteria get into the duct, minerals in the saliva can collect and grow on them to form a stone. This can happen if you also have other systemic disorders, such as gout or kidney disease.
Smoking cigarettes may be a factor. Also if your salivary ducts have become more narrow from radiation treatment or other diseases, you may be more likely to get salivary duct stones.
Some people are at a higher risk for salivary duct stones. If you have any history of kidney disorders, gout, or metabolic disease, it is essential to tell your doctor. In addition, if you have had kidney stones, you may also be at higher risk for salivary duct stones. —Dr. Lee
How do you get rid of salivary duct stones?
If pain and symptoms are not severe, you may be able to coax the stone out through the duct. If it doesn’t improve, make an appointment with your primary care doctor. They can refer you to an ENT (ear, nose, and throat doctor, also called an otolaryngologist) or to an oral surgeon.
If you have symptoms of infection (like pain, pus, redness, swelling), go to an urgent care center. You may need antibiotics.
Go to the nearest ER if you have any of the following, as you may need to be treated right away with oral or IV (intravenous) antibiotics.
- Signs of severe infection (fever of 100.4 or greater, severe pain or swelling)
- Swelling rapidly increases
- Swelling causes difficulty breathing
Most salivary duct stones can be treated with simple at-home measures or an in-office procedure.
- Drink more fluids to encourage saliva flow, which can dislodge the stone.
- Suck on sour candy (often best if lemon-flavored) to increase saliva flow.
- Gently massage the area around the stone to ease it out of the duct.
- Over-the-counter pain relievers, like acetaminophen and ibuprofen, can help treat the pain.
- Antibiotics may be needed if the duct becomes infected. You’ll get an oral antibiotic or, if the infection is severe, you may need to get the antibiotic through an IV.
- Massage: Your doctor may be able to massage the stone out of the duct.
- In-office removal: Your doctor may use special instruments to coax the stone out if a simple massage does not work.
Call your doctor if you try at-home measures and the stone remains. Or if you are prescribed antibiotics and you still have symptoms after 2 to 3 days of taking them.
In some cases, you may need to have surgery and there are several options.
- Shock wave therapy: Shock waves are used to break the stone into smaller pieces, so they are more likely to come out of the duct.
- Sialoendoscopy: Very small cameras and instruments are used to look through the salivary duct and remove stones by flushing them out. Not every ENT may have the equipment or expertise to perform this procedure. Talk with your doctor for the best recommendation.
- Salivary gland removal: In some cases, especially if salivary duct stones keep coming back despite treatment, you may wish to remove the salivary gland and its duct. You still have five other salivary glands to produce saliva and will not notice a difference.
It used to be thought that if a salivary gland becomes infected it is unlikely to work normally again. Luckily, this is not the case. After being treated, most glands go back to working just fine. —Dr. Lee
Salivary duct stones are hard to prevent, as most happen for unknown reasons. If you develop them because your salivary ducts are narrowed or damaged, you can try the following to encourage saliva flow:
- Stay hydrated.
- Massage the areas where salivary glands are located several times a day.
- Suck on hard candy or lollipops. To avoid cavities, try a sugar-free candy, like lemon heads.
- Take medications that increase saliva flow.
Dr. Maina graduated from Princeton University (BA, 2013) with a degree in psychology and received her medical degree from the University of Pennsylvania Perelman School of Medicine. She is currently a resident physician in Otolaryngology at the University of Pennsylvania affiliated hospitals. After graduating from Princeton, she spent a year researching embryonic gene expression with the Center for Research on Reproduction and Women's Health at UPenn. She also received a grant from the National Institutes of Health to study abnormal innate immune responses and taste-related genes in chronic sinus infections. In her free time, she enjoys cooking, reading, listening to podcasts, and finding new DIY décor projects.