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Sialolithiasis
A small stone blocks the duct of a salivary gland. The leading sign is the link with eating: the gland swells and feels tight during a meal, then settles again. Four out of five stones sit in the submandibular gland.
Also known as: sialolith · sialolithiasis · salivary duct stone · salivary colic · Wharton’s duct · Stensen’s duct · parotid · submandibular gland
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
Saliva is made in three large pairs of glands: the parotid in front of the ear, the submandibular gland below the angle of the jaw and the sublingual gland in the floor of the mouth. Each has a fine duct through which saliva reaches the mouth. If calcium is laid down in that duct around a small core, a stone forms — from a grain of sand to over a centimetre. Four out of five sit in the submandibular gland: its saliva is thicker and richer in calcium, and its duct runs uphill, so the saliva has to climb. The leading sign is the link with eating. As soon as the gland makes saliva and that saliva cannot drain, it backs up: the gland swells within minutes, feels tight and hurts, and eases slowly after the meal. Some feel only a pull under the jaw, others see a clear lump. If the blockage stays, bacteria move in — then redness, warmth, pus at the duct opening and fever are added; that is an inflammation of the gland and needs treating. Unlike kidney stones, the calcium level in the blood says nothing about it, and no lab value shows the stone. It is found by feeling the floor of the mouth and above all by ultrasound. Many small stones pass on their own.
Thinner saliva flows better and is more likely to carry something along. Spread over the day, not in two large servings. This is the simplest lever and the basis for everything else.
Lemon, sour sugar-free sweets, sugar-free chewing gum: they set the gland working, and the pressure can push a small stone forward. It may pull more strongly for a while. With an already inflamed, red gland, hold off.
With two fingers stroke gently over the gland towards the mouth, several times a day, ideally after a warm compress. Always in the direction of flow, never backwards, and never with force.
Small stones near the opening often travel out with the saliva; sometimes there is a crunch and it is over. That takes days to weeks. Whatever does not improve, or quickly worsens, in that time should be checked.
Mouthwash, home remedies and a low-calcium diet do not dissolve a salivary stone. Antibiotics treat the inflammation when there is one — they leave the stone where it is, and the blockage returns once they are stopped.
First feeling the floor of the mouth, then ultrasound — painless, without radiation and usually enough. Some stones are invisible on X-ray, so a normal X-ray rules nothing out.
A very fine endoscope is passed through the duct opening; the stone can be seen, caught with a basket or broken up. The gland is kept. This is today the usual route when the stone does not come out on its own.
Larger stones can be broken up from outside with shock waves; if one sits near the opening, the duct is slit from inside. Removing the gland altogether is the last resort and rarely needed today.
Keep sugar-free lozenges, sage sweets or a piece of ginger in the mouth, several times a day as needed.
From the day after the procedure rinse gently with lukewarm salt water, do not gargle, several times a day.
No drug dissolves a salivary stone. What works is the flow of saliva itself: sour sweets or lemon stimulate it, together with massaging the gland from back to front and warmth — small stones pass this way within days in some people. An antibiotic is needed only if the gland becomes inflamed. If the stone stays, it is retrieved through a scope in the duct or broken up with shockwaves; the gland itself is today only rarely removed.
About eight in ten salivary stones sit in the submandibular gland, because its secretion is thicker and the duct runs upward. The typical pain comes with eating and eases afterwards over minutes to an hour — that rhythm is the identifying mark. About ninety in a hundred stones are smaller than ten millimetres. Under five millimetres many pass by themselves within days with massage and saliva stimulation.
The defining sign. Even the thought of food, then the first bite — and within minutes it tightens under the jaw or in front of the ear. After the meal it slowly recedes. With every meal again, often for weeks.
The place gives away the gland: below the angle of the jaw the submandibular gland, in front of and below the earlobe the parotid. The pain can radiate to the ear. Almost always one side only.
If the stone sits near the opening, it can be felt with the tongue or a finger in the floor of the mouth as a hard lump — beside the frenulum. Such stones are the likeliest to pass by themselves.
Little saliva makes it thicker and slower — both favour deposits. Common reasons: drinking too little, mouth breathing, smoking and medicines that dry the mouth (for allergy, bladder weakness, high blood pressure or low mood, for example).
If the blockage stays, bacteria travel up the duct from the mouth. The swelling then turns red, warm and constant, pus appears at the duct opening, often with fever. This is not something to wait out — it belongs in the surgery straight away.
That does not fit a stone. A lasting, painless swelling of a gland has other causes — from an increase in tissue to an autoimmune disease of the glands to, more rarely, a tumour. It should be looked at, not waited out.
Stones almost always affect one side only. If both parotids swell at once, the cause is more likely a viral infection (mumps), an autoimmune disease of the glands with dry mouth and dry eyes, or a reaction to alcohol, diabetes or disordered eating.
With a persistently dry mouth and dry eyes, Sjögren’s syndrome is looked for.
Gums that bleed at the lightest touch are among the first signs of a lack. It is rare today but occurs with a very one-sided diet and with alcohol.
Recurring mouth ulcers, a smooth burning tongue and cracked corners of the mouth point to a lack — the mouth often shows this before the blood count does.
The jawbone that holds the teeth undergoes the same building up and breaking down as any other bone. What counts for the hip counts for it.
Saliva is the natural protection of teeth and lining. A dry mouth — from medicines, mouth breathing or drinking too little — raises caries, bad breath and fungal growth all at once.
Saliva has to flow so that a small stone comes out. Two to three litres a day, sour sweets or lemon to stimulate, and stroking the gland from back to front are the recognised order — and with small stones it succeeds surprisingly often.
Drinking too little is the main reason, but not the only one: water tablets, many allergy and bladder medicines and some antidepressants dry the mouth measurably. Anyone who keeps getting stones goes through that list once.
Clearly worthwhile and well supported when deficient — vegan, older adults, certain drugs. No energy boost without a deficiency.
Too little fluid makes the saliva thicker, and thicker saliva forms stones more easily. Drinking plenty and sour stimulation — lemon, chewing gum — is therefore part of the treatment, not just a home remedy.
With repeated salivary stones a look at calcium and parathyroid hormone is worth it — an overactive parathyroid drives stones in salivary glands and kidneys alike.
Thick saliva favours stones. 1.5–2 litres a day and something sour such as lemon or sugar-free gum get the flow going — this is also the usual measure to flush out a small stone.
Sourness stimulates saliva flow and flushes out small stones — lemon, sour sweets, sugar-free gum. Together with massaging the gland and drinking plenty this is the usual first measure.