Salivary gland inflammation (sialadenitis): symptoms, salivary stones, treatment and when swelling needs urgent help

Where are the salivary glands, and what can go wrong with them?

Salivary glands are glands that produce saliva and carry it through ducts into the mouth. We have three pairs of major salivary glands, the parotid, submandibular and sublingual glands, plus several hundred to a thousand minor salivary glands in the lining of the mouth and throat, as described by Medycyna Praktyczna (a Polish medical reference).

The parotid gland lies in front of and slightly below the ear, and its duct opens on the inside of the cheek, opposite the upper second molar. The submandibular gland lies beneath the lower jaw, and its duct opens under the tongue, next to the frenulum. The sublingual gland drains mainly through many small ducts in the floor of the mouth, and only sometimes also has a larger duct that opens together with the submandibular duct.

The most common diseases of the major salivary glands are infections, that is salivary gland inflammation, and salivary stones, that is deposits in the ducts. According to Medycyna Praktyczna, salivary stones are the second most common salivary gland disease after mumps. The position of the swelling suggests which gland is affected: with the parotid, the cheek in front of the ear swells; with the submandibular gland, the area beneath the jaw.

What are the symptoms of salivary gland inflammation?

Salivary gland inflammation usually causes a painful swelling of the cheek, of the area in front of the ear or beneath the jaw, pain when chewing and sometimes a fever. Cleveland Clinic also lists a dry mouth, an unpleasant taste or a gritty feeling in the mouth, and pus draining into the mouth from the opening of the duct.

The picture depends on the cause. With a stone, swelling and pain build up during a meal and ease afterwards; with mumps, the swelling usually starts on one side and spreads to the other after a few days; and with a bacterial infection the gland is swollen and tender, and pus may drain from the opening of its duct. Medycyna Praktyczna adds that an infection is often accompanied by enlarged lymph nodes.

Swelling of both parotid glands, especially when it keeps coming back, calls for a search for other causes. Doctors answering readers’ questions on the Medycyna Praktyczna website then mention, among others, Sjögren’s syndrome, sarcoidosis and saliva that is too thick, and besides an ear, nose and throat (ENT) specialist, a rheumatologist and an ophthalmologist are sometimes involved in the diagnosis.

What causes salivary gland inflammation?

A common cause of sudden salivary gland inflammation is a bacterial infection, and according to Cleveland Clinic it is most often caused by Staphylococcus aureus. Bacteria get into the gland more easily when saliva flows poorly, for example with dehydration or when the duct is blocked by a stone or a narrowing.

Cleveland Clinic lists as risk factors age over 50, especially in people with salivary stones, a dry mouth, including one caused by medicines, dehydration, malnutrition and a recent illness or operation. Salivary gland inflammation is also caused by viruses, among them the mumps virus, influenza and the Epstein-Barr virus, and the salivary glands are also damaged by Sjögren’s syndrome, an autoimmune disease.

Mumps (epidemic parotitis) is a viral illness in which, according to Medycyna Praktyczna, a fever of 38 to 39.5°C lasts 3 to 4 days, and swelling of the parotid glands appears first on one side and, after 1 to 3 days, often on both. In 20 to 40% of those infected it causes no symptoms, and treatment only relieves symptoms, because antibiotics do not work against the virus.

The NHS advises that a person with mumps should stay off work, school or nursery for at least 5 days after the swelling appears. The combined vaccine against measles, mumps and rubella (MMR) protects against mumps; complications such as inflammation of the testicles or meningitis are more common in teenagers and adults.

Salivary gland stone: why does the gland swell when you eat?

A salivary gland stone is a calcified deposit that blocks the duct and traps saliva in the gland, which is why the gland swells and hurts just when it should be producing the most saliva: during meals. Medycyna Praktyczna reports that pain and swelling may appear even at the smell or the thought of food, and the NHS that severe pain at mealtimes usually lasts 1 to 2 hours.

The 2014 review by Kraaij et al. reports that 84% of stones form in the submandibular gland and 13% in the parotid gland, and about 90% of submandibular stones sit in the duct rather than in the gland itself. The duct of the submandibular gland runs upwards to the floor of the mouth, and its saliva is thicker, which encourages stagnation and the build-up of deposits.

Salivary stones are more common in men and in adults over 30, and they are rare in children. Medycyna Praktyczna lists among the contributing factors a narrowing of the duct, changes in the composition of saliva, dehydration, chronic inflammation of the gland and Sjögren’s syndrome, although in many people no direct cause can be found.

A stone that does not come out encourages repeated infections. The NHS describes how an infection with pain, redness, pus and fever may develop around the stone, and a doctor’s appointment is then needed.

How does a doctor diagnose a salivary gland disease?

Diagnosis of a salivary gland disease starts with a history and an examination: the doctor looks at and feels the gland, checks the opening of the duct in the mouth and assesses whether saliva or pus comes out of it. A stone in the submandibular duct can sometimes be felt with a finger under the tongue.

According to Medycyna Praktyczna, an ultrasound scan is done most often, which also shows the state of the gland itself, although it may miss very small deposits. Most stones are visible on an X-ray, and when there is doubt computed tomography or magnetic resonance imaging is used; sialography, an X-ray of the ducts with contrast, is rarely done today.

With recurrent swelling of the parotid glands, the doctor also orders blood tests for inflammation and, when needed, tests for Sjögren’s syndrome. If imaging shows a tumour, the diagnosis is made on the basis of a biopsy, and the work-up usually begins with a visit to an ENT specialist.

How are salivary gland inflammation and salivary stones treated?

Treatment of salivary gland inflammation depends on the cause: mumps is treated by relieving symptoms, a bacterial infection is treated by a doctor with an antibiotic chosen for the situation, and a stone usually has to be removed. Whatever the cause, staying hydrated matters, because thick, slow-flowing saliva favours both infection and the formation of deposits.

For a salivary gland stone, the NHS advises drinking plenty of water, gently massaging the area around the stone, and chewing sugar-free gum or sucking sugar-free sweets, which stimulate the flow of saliva. Cleveland Clinic adds warm compresses, which ease the pain and may help the stone to move. Never try to dig a stone out with anything sharp.

A small stone sometimes comes out by itself, or the doctor eases it out of the duct with a blunt instrument. A stone in the submandibular duct is usually removed by cutting open the duct from inside the mouth, and with stones in the gland itself or repeated episodes, removal of the whole gland is considered; shock wave lithotripsy, which breaks stones up, is also used.

Sialendoscopy is a procedure in which a thin endoscope inserted through the opening of the duct is used to remove a stone or widen a narrowing. The systematic review by Strychowsky et al. (2012), covering 29 studies, reports a success rate of 86% in 1,213 patients treated with sialendoscopy alone and 93% in 374 patients treated with a combined approach including a surgical incision; removal of the gland was rarely needed.

When does salivary gland swelling need urgent help?

Salivary gland swelling with breathlessness, difficulty swallowing or rapidly increasing swelling of the neck needs a call to 112, the emergency number, or a visit to the hospital emergency department (SOR). Cleveland Clinic stresses that a salivary gland infection spreading to the tissues of the neck and making breathing difficult is an emergency.

A lump near a salivary gland that does not hurt but does not go away is not an emergency, but it does need to be investigated. Cancer Research UK lists it among the possible symptoms of salivary gland cancer and notes that such symptoms are often caused by benign tumours and other conditions too; the NHS advises showing a doctor any lump that grows or lasts longer than 2 weeks.

• Breathlessness, difficulty swallowing or rapidly increasing swelling of the neck: 112 or SOR.
• With mumps, a severe headache, a stiff neck, vomiting, sensitivity to light, confusion or seizures: 112 or SOR.
• A high fever, red skin over the gland or pus draining into the mouth: a doctor’s appointment at the earliest possible time.
• Sudden drooping of the corner of the mouth or weakness on one side of the face can be a sign of stroke: call 112 or 999 (ambulance) at once, even if the symptom passes. Facial weakness that develops gradually alongside a salivary gland lump needs urgent medical assessment.
• In a boy or man with mumps, a painful, swollen testicle or abdominal pain: an urgent medical consultation.
• A lump or swelling of a salivary gland that does not hurt but grows or lasts longer than 2 weeks: a doctor’s appointment.

How it works at DentalBlue

At DentalBlue in Białystok, swelling near a salivary gland is assessed by a dentist during a “Wizyta bez bólu” (visit without pain), which includes a panoramic X-ray, a consultation, an examination and a written treatment plan; in the clinic’s price list it costs 300 zł. The clinic has its own radiology unit with a panoramic X-ray machine, intraoral X-rays and CBCT scanning. The item “Wyłuszczenie kamienia z przewodu ślinianki” (removal of a stone from a salivary duct) costs 300 zł in the price list. Surgical procedures are carried out under local anaesthesia or, for patients who qualify, under general anaesthesia. The final scope and cost are set by the dentist, and prices may change. When the symptoms point to mumps, an autoimmune disease or a tumour, further diagnosis is handled by a family doctor, an ENT specialist or a maxillofacial surgeon.