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SIALOLITHIASIS

Salivary stones are made up of an indefinite mineralized nucleus, followed by layers of organic (glycoprotein, dead cells) and inorganic substances (calcium phosphate, calcium carbonate). It is one of the most common salivary gland diseases. There are four types of salivary glands, which include parotid gland, submandibular

Sialolithiasis is the formation of stones or calculi in the salivary duct. Among the four salivary glands, sialolithiasis of submandibular gland is the most common type. The stones in the salivary gland are formed due to bacteria, virus and also the saliva that gets saturated with calcium and mucous content. Salivary stones are mostly seen in males than females and rarely seen in children. The person may experience pain and swelling in the affected gland. As the flow of saliva is blocked, the mouth becomes dry and causes difficulty in chewing and swallowing food.

Signs and Symptoms 

The signs and symptoms of sialolithiasis are as follows:

  • Pain and swelling of the mouth, face or neck
  • Difficulty swallowing food
  • Redness of affected gland
  • Unusual saliva (gritty)
  • Stone in the mouth
  • Dry mouth
  • Bad taste
  • Fever

Causes 

Sialolithiasis occurs due to the formation of crystals of certain substances in the saliva, such as calcium carbonate and calcium phosphate. Altered salivary composition (increased alkalinity) and still saliva cause salivary stones. Thus, formed stones block the salivary duct which prevents flow of saliva, making the gland swell. It may also occur when the salivary gland is infected or subjected to physical trauma. Majority of the salivary stones are formed in the submandibular gland (wharton's duct). However, there are also cases of the parotid gland stones. The submandibular gland stones are bigger than the parotid gland stones.

The submandibular gland secretes saliva which is more alkaline, rich in mucous, calcium and phosphorous when compared to other glands. This increases the probability of formation of submandibular gland stones. The size of the salivary stones varies from 1 millimetre to few centimeters.

Risk Factors 

The following are the risk factors of sialolithiasis:>

  • Sjogren syndrome (causes dryness of mouth and membranes)
  • Unhealthy eating habits
  • Lack of dental hygiene
  • Blood pressure drugs
  • Anti-allergic drugs
  • Antidepressants
  • Dehydration
  • Diuretics

Complications 

Complications of sialolithiasis include sialadenitis (salivary gland infection), salivary gland inflammation and duct narrowing (stricture).

If this condition is left untreated, it may further lead to fibrosis and eventually causes degeneration of the gland parenchyma.

Diagnosis

Diagnosis of sialolithiasis is first done by performing a physical examination. Upon examination with the fingers, stones can be felt.

magnetic resonance imaging (MRI), computed tomography (CT), plain radiograph, sialography and ultrasound. Sialography is carried out by injecting small amount of contrast medium into the salivary duct in order to generate x-ray projections. The imaging tests help in identifying the size and location of the stones.

Treatment 

The main objective of the treatment is to expel the stone.

Home remedies:

  • Sour foods such as lemon (increase salivation)
  • Over-the-counter pain relievers
  • Application of moist warm heat
  • Intake of plenty of water
  • Massaging the gland

Non surgical treatment:

When the home remedies fail to expel the stone, the dentist may press the affected area with fingers and remove the stone (stones present at duct opening). Stones which are present deep inside cannot be flushed out by this method and thus may require surgical removal of the stone.

Surgical treatment:

Endoscopy: It is a minimally invasive procedure and do not affect other structures such as the tongue and adjacent nerves. Stones that are present along the length of the duct are treated endoscopically.

Surgical removal of gland/stone: Prior to the surgery the patient is given general anesthesia and the stone is removed. Stones that are present in gland parenchyma are treated with surgical removal of the gland.

Salivary stone is broken down in to small pieces before clearing it.

In case of any bacterial infection suitable antibiotics are used to treat the infection.

Side effects:

After surgical removal of the stone, duct opening may have scars. There may be chances of infection and additional stone formation post-surgery. Therefore, it is always important to follow medical advises and medications after surgery. Paralysis may develop in cases where the salivary gland is removed. Sensitivity on the face and tongue may be affected.

Prevention 

Sialolithiasis can be prevented by following ways:

  • Using toothpaste, gargles, chewing gums that have ingredients capable of producing saliva
  • Increasing water intake (8 glasses per day)
  • Massaging salivary glands after meals
  • Taking the prescribed medication
  • Maintaining dental hygiene
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