Salivary stone disease accounts for 40–60% of all diseases of the salivary glands. Often, patients find out about the presence of a stone in the salivary duct only in the doctor’s office, where they go with complaints of severe pain when swallowing, radiating to the ear or temple, with swelling in the face and neck. A stone located in the duct of the salivary gland interferes with the normal outflow of saliva and can completely block it. For more information about what a salivary stone is, why it occurs and how to treat it, read on.
What are stones in the salivary glands?
Salivary gland stones are pathological biomineral formations that block the ducts of the salivary glands. They can be single or multiple. Such formations are most often found in the submandibular gland and its excretory ducts, less often in the sublingual and parotid glands.
They are formed as a result of the deposition of organic and inorganic components:
- calcium salts;
- epithelial particles;
- sodium;
- mucin;
- magnesium;
- amino acids;
- potassium;
- iron;
- chlorine, etc.
The weight of salivary stone varies from 3–7 to 20–30 g [1, 2]. Round-shaped stones usually form in the parenchyma of the salivary glands, and oblong stones in the excretory ducts. Salivary stones often have a yellowish color, an uneven surface, and varying density.
Etiology of sialolithiasis
Factors contributing to the development of pathology:
- Mechanical effects on the salivary glands (injuries to teeth and crowns). Inflammation compresses the ducts, where pathological microflora accumulates and pus appears. Over time, the stones increase significantly.
- Abnormal structure of the salivary glands and ducts.
- Disruption of calcium metabolism and, as a result, its deposition in the excretory ducts of the salivary glands.
- Hypovitaminosis, vitamin deficiency.
- Accelerated blood clotting.
- Entry of a foreign object into the gland duct. Bacteria actively multiply around the body, forming stone [2, 3].
The exact reasons for the formation of stones in the salivary gland have not yet been established. Presumably, risk factors are calcium metabolism disorders and vitamin A deficiency. Salivary stone disease most often affects men. Sialolithiasis mainly occurs in people 25–40 years old, and much less often in children.
The formation of salivary stones may be associated with a violation of the outflow of saliva or metabolism, with inflammatory processes in the salivary glands with the participation of microorganisms, poor nutrition, etc. As a rule, they are localized in the submandibular gland and its excretory duct; they are found in the sublingual and parotid glands very rare.
Abdusalamov M. R., Doctor of Medical Sciences, Professor of the Department of Traumatology of the Maxillofacial Region of the Moscow State Medical and Dental University named after A. I. Evdokimov [4]
What causes a lack of saliva?
The list of factors that can cause dry mouth is very wide. Possible reasons include:
- pathological processes in the gland itself: inflammation, tumors, stones in the ducts;
- systemic connective tissue diseases: Sjogren's syndrome, lupus erythematosus, rheumatoid polyarthritis;
- diseases of the endocrine system: thyrotoxicosis, diabetes mellitus, hypogonadism, as well as hormonal changes during pregnancy;
- damage to the nervous system: contusion of the base of the brain, tabes of the spinal cord, peripheral damage to the facial nerve;
- diseases of individual organs and systems: renal failure, gastroenterocolitis;
- acute infectious diseases: botulism, typhoid fever;
- viral hepatitis C;
- undergoing a course of radiation therapy or chemotherapy;
- conditions that lead to inhibition of secretion: fear, anxiety, pain, neurosis;
- side effects of certain drugs: antitumor drugs, diuretics, tranquilizers;
- lack of vitamins A, C, B, as well as iron;
- smoking, alcohol and coffee abuse [1, 2].
The doctor should first find out the cause. The exact diagnosis determines how to stimulate salivation and whether it is necessary to prescribe synthetic saliva substitutes.
Symptoms of a stone in the salivary gland
The onset of the disease occurs unnoticed (from several months to several years). Upon examination, the patient does not show any abnormalities. The first symptoms of the disease appear when the flow of saliva is disrupted during food intake, especially sour or spicy food.
Patients note the periodic appearance of swelling in the area of the salivary gland. Increased pain during eating is associated with difficulty in the outflow of saliva due to the presence of a stone in the duct. After eating, pain and swelling in the gland area gradually decrease.
The following symptoms are observed:
- increased body temperature;
- dry mouth, secretion of a small amount of saliva;
- a feeling of fullness in the part of the oral cavity where the stone has formed;
- difficulty opening the mouth;
- frequent pain when eating;
- swelling and redness on the face;
- discomfort when chewing and swallowing.
Over time, changes in the gland increase: the disease passes into a clinically pronounced and late stage, when clinical signs of chronic sialadenitis are visible. The submandibular salivary gland enlarges, becomes dense and painful.
Is it possible to squeeze out stones yourself?
Trying to remove or dissolve a stone at home is highly discouraged. There is a risk of infection, bleeding and severe pain. Before squeezing out the stone, it should be taken into account that in the case of a purulent complication, the infection can spread to regional lymph nodes and neighboring organs. This can lead to blood poisoning and even encephalitis. As soon as the first alarming symptom appears, you need to go to the doctor. The cause of the disease may be even more serious and will need to be addressed immediately to avoid serious consequences.
Other possible complications:
- transition of the disease into a chronic course with frequent relapses;
- constant pain that intensifies while eating and remembering it;
- tissue scarring that impairs the function of the gland;
- purulent inflammation with the risk of spreading infection;
- halitosis - persistent bad breath;
- transformation of glandular tissue into fibrous and connective tissue.
Diagnostics
If you suspect sialolithiasis, you should consult a dentist.
The following methods are used for diagnosis:
- X-ray examination is currently the main diagnostic method. To identify a stone in the duct, an X-ray of the facial skeleton is taken in a direct projection. If the stone is localized in the anterior part of the duct, an x-ray of the floor of the mouth is shown; if it is located in the posterior part of the duct or in the submandibular gland, an x-ray of the lower jaw in a lateral projection is shown.
- Ultrasound - a study is carried out if there is a discrepancy between clinical manifestations and radiographic data to clarify the diagnosis.
The indicated diagnostic techniques are usually sufficient to establish a diagnosis and determine the location of the stone. There are other methods for studying the salivary glands, which are used less often in practice - CT and MRI. Their diagnostic value for calculus detection is close to 100%, since it allows one to determine the spatial location of the salivary stone.
Treatment of stones in the salivary gland
In order to remove stone from the salivary gland duct, use:
- conservative therapy;
- surgical treatment.
First of all, the following are assigned:
- antibiotics;
- drugs that stimulate saliva production;
- anti-inflammatory drugs.
Re-inflammation often occurs and the process can become chronic. In such cases, the only treatment method that eliminates the root cause of inflammation is surgery.
Removal of a stone in the salivary gland from the duct is carried out under general anesthesia. The stone itself and the capsule surrounding it are excised. This surgical intervention is called sublingual extirpation and lasts 40–60 minutes. The main risk when performing surgery on the salivary glands is due to the fact that the facial, lingual and hypoglossal nerves pass in close proximity to them.
There is a less invasive method - sialoendoscopy. It allows one to penetrate the ducts of the salivary glands through the thinnest endoscopes without dissecting tissue and visualize the salivary system at high magnification. The endoscope is inserted into the opening of the gland duct in the mouth. Next, using micro-instruments, the surgeon examines the ducts, removes the stone, injects medicinal substances into the gland and performs other necessary manipulations.
How is surgery and rehabilitation carried out at our Center?
When seeking a consultation at the Center for Maxillofacial Surgery and Implantology, an experienced doctor will conduct an examination, prescribe an X-ray, ultrasound and sialography. Surgical methods of treating salivary stone disease involve removing the stone using the most modern techniques using ultra-thin endoscopes. This is not only the most progressive, but also the least traumatic and at the same time the most effective technique. The endoscopes used in our Center are so small that they allow us to remove the stone and cure the disease without removing the gland (as was previously used in medicine) and without making external incisions, but performing all manipulations through the natural pathways of the salivary ducts. This significantly reduces the postoperative recovery period - to 1 day - increases the safety of the procedure, and reduces to zero any risk from the intervention.
Treatment of salivary stone disease at the Center for Maxillofacial Surgery and Implantology can be carried out in just one visit and then forget about this problem forever. Surgery is performed in the comfortable conditions of our own hospital, which includes operating rooms equipped with high-precision medical and anesthesiological equipment. The team of doctors has extensive experience and the highest qualifications: surgeons and anesthesiologists with extensive practical experience, including in the field of removal of benign cervical formations and tumors, work here. In addition, the Center for Maxillofacial Surgery and Implantology has comfortable wards where you can undergo rehabilitation after surgery, under constant, attentive and sensitive medical supervision. Care is provided by responsible and highly qualified personnel who will help make the recovery period as fast, comfortable and painless as possible.
Prevention of salivary stone formation
It is worth taking note of a few rules to prevent the occurrence of salivary stones:
- Avoid disruption of mineral and vitamin metabolism.
- Give up bad habits, which will have a beneficial effect on other body systems.
- Protect yourself from maxillofacial injuries.
- Carefully follow the rules of oral hygiene: brush your teeth 2 times a day, follow the dentist’s individual recommendations. Perhaps you need a toothpaste with a certain composition, mouth rinses, or dental floss.
- Choose the right toothbrush (medium-hard bristles with artificial bristles).
- Visit the dentist regularly to monitor the condition of the oral cavity, timely detection of lesions and effective treatment.
Sialolithiasis is a fairly common pathology, for the treatment of which conservative and surgical methods are used. With timely detection of the disease and subsequent proper treatment, the prognosis is favorable. This will also prevent complications and speed up the healing process.
List of sources:
- Gamataev I. I. Study of human salivary stones. New challenges of modern medicine, 2013 // URL: https://moluch.ru/conf/med/archive/86/3883/ (access date: 11/04/2020).
- Dmitrienko E. V., Shashkevich V. A. Algorithm for the diagnosis and treatment of salivary stone disease. Journal "Bulletin of the Smolensk State Medical Academy", 2010 // URL: https://cyberleninka.ru/article/n/algoritm-diagnostiki-i-lecheniya-slyunnokamennoy-bolezni (access date: 11/04/2020).
- Kartashov R. Sialolithiasis: the stumbling block is in the salivary gland. European Medical Center // URL: https://www.emcmos.ru/disease/sialolitiaz-kamen-pretknoveniya-v-slyunnoy-zheleze/ (access date: 12/13/2020).
- Gamataev I. I. Study of human salivary stones. Intl. scientific Conf., 2013 // URL: https://moluch.ru/conf/med/archive/86/3883/ (date of access: December 26, 2020).
Tartar: removal
When you brush your teeth, you can only remove soft plaque from the surface of your teeth. Partially mineralized plaque, as well as hard dental deposits, can no longer be removed by regular teeth cleaning at home. And in this case, only a dentist can clean the tartar.
1) Cleaning the stone at the dentist’s appointment –
The traditional way to remove hard plaque is ultrasonic teeth cleaning. In this case, stone removal is carried out using an ultrasonic scaler. Removing supragingival calculus is a very simple procedure, and 1 hour is enough to remove calculus from all teeth. But to effectively remove subgingival stones, you need several visits and a highly qualified doctor. Therefore, it is best to remove stones not from ordinary dental therapists, but from periodontists (these are dentists who specialize in the treatment of gum inflammation).
Ultrasonic tartar removal –
There is also the “AirFlow” procedure, with which you can remove small dental deposits, pigment plaque, and polish your teeth. In this case, cleaning and polishing of teeth occurs due to a water-air mixture containing granules of an abrasive substance, sprayed under high pressure from a special tip. But AirFlow will not be effective against massive hard dental plaque, which in any case will first have to be removed with ultrasound.
Tartars: photos before and after their removal
On average, the price for tartar removal is about 100-150 rubles per 1 tooth, including polishing.
2) How to remove tartar at home –
Some patients use recipes for removing plaque, which are replete with many unprofessional websites, promising complete relief from tartar. We'll disappoint you, but these methods not only don't work, but also cause harm to tooth enamel and gums. Just for fun, you can check them out at the link above.
It is impossible to remove well-mineralized tartar and dense pigment plaque with any home remedies. However, not too pronounced pigment plaque and only partially mineralized plaque can still be removed with the help of the following modern dental care products. First of all, we are talking about Oral-B electric toothbrushes - in combination with special highly abrasive toothpastes.
Important: Oral-b electric brushes have a round head with bristles that performs 8,800 reciprocating movements per minute, as well as a minimum of 20,000 pulsating movements. Pulsations help loosen dense plaque (even that which may already be partially mineralized), and rotational movements sweep it away and polish the teeth. This brush is a miniature dentist’s tool and is probably familiar to everyone who has gone to the dentist for professional oral hygiene.
The second component is highly abrasive toothpastes, which can help remove pigmented and partially mineralized plaque. They can only be used once a week. If you are using them in combination with an Oral-b electric brush, it is advisable to use the electric brush only at low speed (in the “whitening/polishing” mode). You can find out how this is done correctly and what toothpastes are used at the link below.
You can also purchase professional teeth polishing products, which the dentist uses to finish polishing teeth after ultrasonic cleaning (they are sold in stores that sell consumables for dental clinics). For example, pastes such as “Detartrine” or “Detartrine – Z” (this one is more effective). They are able to remove even small tartar and not too pronounced smoker’s plaque. Used in combination with an Oral-B electric toothbrush (rotation of the nozzle should be at low speed).
→ Scheme for removing dental plaque at home
