Salivary gland stones, medically termed sialolithiasis, are calcified mineral deposits that form within the ducts or glandular tissue of the major salivary glands, obstructing saliva flow and causing pain, swelling, and potential infection.

Clinical Significance

Saliva plays a critical protective role in neutralizing oral acids, supporting the remineralization of enamel, and maintaining periodontal health. When a stone blocks a salivary duct, these functions are disrupted alongside the immediate symptoms of obstruction. The submandibular gland is the most commonly affected site, accounting for roughly 80–90% of cases, because its secretions are more viscous, alkaline, and calcium-rich, and its duct is longer and oriented against gravity.

Common Symptoms

• Sudden pain and swelling beneath the jaw or in the cheek, characteristically triggered by eating
• A firm, palpable lump along the floor of the mouth or cheek
• Reduced or absent salivary flow from the affected gland
• Swelling that partially resolves between meals but recurs with subsequent eating
• Secondary sialadenitis — infection presenting with fever and purulent discharge — if obstruction is prolonged

Causes and Contributing Factors

Stones are composed primarily of calcium phosphate and hydroxyapatite — the same minerals that accumulate as dental calculus on tooth surfaces. Systemic dehydration, elevated salivary calcium concentrations, and medications that induce xerostomia — including antihistamines, diuretics, and certain antidepressants — are well-established contributing factors that reduce salivary flow and promote mineral precipitation within the ductal system.

Diagnosis and Treatment

Clinical examination combined with ultrasound or cone-beam CT confirms stone location and size. Small stones may pass spontaneously with increased hydration, external gland massage, and sialagogue stimulation such as sour candy or citrus. Larger or impacted stones often require sialendoscopy for minimally invasive endoscopic retrieval, extracorporeal shock wave lithotripsy, or surgical excision of the gland in refractory cases. Untreated obstruction risks chronic sialadenitis, permanent ductal scarring, and progressive gland atrophy.

Persistent jaw swelling or pain that reliably worsens at mealtimes warrants prompt clinical evaluation — early intervention preserves gland function and prevents progression to chronic infection or irreversible damage.