Salivary stones: symptoms, causes, and treatments

Do you feel pain under your jaw while eating, a feeling of swelling, or a strange taste in your mouth? These signs could point to what's known as a salivary stone, also called salivary stone disease.

This problem is quite common and, while it's generally harmless, it can become really uncomfortable. There are of course solutions, which we explain in this article.

Salivary stone disease is the formation of a small stone made up of calcium and minerals found in saliva. It can lodge either in a salivary gland or in the ducts that carry saliva to the mouth. And when it grows, it can block the flow. Saliva then builds up in the gland, especially during meals.

These stones are usually a few millimetres, but can reach several centimetres. It mainly affects adults between 30 and 60 years old, and slightly more often men.

The one most often affected by salivary stones is the submandibular gland, just under the jaw. About 80 to 90% of stones form here.

It's more prone to problems for several reasons:

• Its saliva is thicker and richer in calcium,

• Its duct is longer,

• Saliva has to flow slightly against the current.

Pain then appears under the chin or jaw, especially during meals.

The parotid glands, meanwhile, are located in front of the ears. They can also be affected, but it's less common.

When that happens, the bulge tends to appear in the cheek area, and the pain can radiate towards the ear.

Finally, the sublingual glands, under the tongue, are rarely affected. Stones there are often smaller, but they can interfere with tongue movement or swallowing.

This is the most typical sign. When you eat, saliva flows more. If a stone blocks the duct, pressure builds up in the gland. The pain can therefore:

• Appear suddenly,

• Be throbbing,

• Ease off after meals,

• Come back as soon as saliva production is stimulated.

The swelling shows up mainly around the jaw, under the chin and in the cheek. At first it can be occasional, then become more regular as it grows.

Other symptoms can also appear:

• Dry mouth,

• Bad taste in the mouth,

• Difficulty opening your mouth,

• Pain when swallowing,

• Sensitivity to touch,

• Pus discharge if an infection sets in,

• Bad breath.

If you have a fever or significant swelling, it's best to see a doctor quickly.

Saliva naturally contains calcium, phosphate and other minerals. When they're too concentrated, they can gradually crystallize and form a stone.

When you don't drink enough, it becomes thicker and flows less easily. It then stagnates more easily, which increases the risk of a stone forming.

Certain situations increase this risk:

• Not drinking enough water,

• Sweating a lot,

• Have a fever,

• Taking certain medications,

• Have Sjögren's syndrome.

If a salivary duct is a bit narrowed or inflamed, it flows less easily. This stagnation gives minerals time to settle.

Several factors seem to be linked to the appearance of these stones:

• Smoking,

• Poor oral hygiene,

• Infections that drag on,

• Certain medications such as antihistamines or antidepressants,

• Adulthood,

• Having already had salivary stones before.

The healthcare professional starts by asking you questions: Do you feel pain when you eat? Does the gland swell? Have you already had infections there?

Next, they perform a palpation of the gland, to feel the stone and check whether it's near the opening of the salivary duct.

It's often the first test that's done. It shows the stones and checks the condition of the salivary gland. Plus, it's quick, painless and non-invasive.

The CT scan is very useful for spotting stones that are deep or very small. It gives a very precise image of the salivary ducts.

MRI can be used in more complex cases, especially to examine the tissue around the glands.

As for sialendoscopy, it involves inserting a mini-camera into the salivary duct. This makes it possible to precisely locate the stone and, sometimes, remove it on the spot.

For small stones, simple steps can sometimes be enough, such as:

• Drink more water,

• Gently massage the gland,

• Apply a local heat source,

• Stimulate saliva with acidic foods,

• Keep up good oral hygiene.

Some people even manage to pass it spontaneously.

In case of inflammation or infection, the doctor may prescribe painkillers, anti-inflammatories, or antibiotics if a bacterial infection is present.

Today, sialendoscopy is one of the most common techniques for removing a salivary stone. It's a minimally invasive procedure that makes it possible to:

• Insert a tiny camera into the duct,

• To pinpoint exactly where it is,

• To remove it without needing major surgery.

Recovery is usually quick and complications remain limited.

When the stone is too big or hard to access, surgery may be necessary. In the most severe cases, removing part or all of the salivary gland may be considered. But thanks to modern techniques, this remains fairly rare today.

When saliva stops flowing because of the blockage, bacteria take the opportunity to multiply. An infection called sialadenitis can then set in. The signs are usually:

• Really strong pain,

• Fever,

• Noticeable swelling,

• Sometimes pus draining out.

This infection shouldn't be confused with a mucocele, another benign condition linked to a blocked salivary gland.

Sometimes it can go further: a pocket of pus forms around the gland. In that case, medical drainage is usually needed to get rid of it.

Painful flare-ups repeat, especially at meal times. Over time, this can become disruptive in daily life.

From being blocked so often, the gland eventually gets damaged and produces less saliva in the long run. This can lead to:

• Dry mouth,

• More cavities,

• Bad breath,

• General discomfort in the mouth.

A few really simple habits can be worked in:

• Drink water regularly throughout the day, without waiting until you're thirsty,

• Take care of your teeth and mouth every day,

• See your doctor quickly if you feel unusual pain,

• Stimulate saliva production regularly.

Also, using an electric toothbrush can help maintain good oral hygiene and avoid certain inflammation.

Some foods are real allies for saliva production: citrus fruits, apples, crunchy vegetables (carrots, celery, etc.), or even chewing sugar-free gum after a meal.

With fluid saliva, minerals are less likely to stagnate in the salivary ducts.

On the other hand, it's strongly recommended to limit smoking, dehydration, excess alcohol, as well as overly sugary drinks.

Some signs shouldn't be taken lightly. It's best to see a doctor quickly if you notice:

• Strong pain while eating,

• Swelling that doesn't go away,

• Fever,

• Pus draining out,

• Difficulty swallowing,

• Problems that keep coming back.

Your GP is a good starting point. If needed, they'll refer you to an ENT doctor or a maxillofacial surgeon. These specialists have everything they need to make an accurate diagnosis and offer you the most suitable treatment.

Reading patient feedback, you often see real, quick relief after treatment, especially following a sialendoscopy. The pain that appears during meals usually disappears quickly once the stone has been removed.

Once treatment is done, quality of life clearly improves: meals become enjoyable again, the swelling doesn't come back, the mouth is better hydrated, and you feel less stressed by pain that keeps coming back.

Of course, recurrences are always possible, but you can often limit them by adopting a healthy lifestyle and getting regular check-ups.