Salivary stones (sialolithiasis)

Salivary stones, or sialolithiasis, are small calcified lumps that form inside a salivary gland or its duct and block it. They typically cause swelling and pain under the jaw or in the cheek when you eat, which settle after a while. They are one of the most common problems of the salivary glands.

What are salivary stones?

We have several salivary glands that make saliva and carry it into the mouth through fine ducts. The main ones are the parotid glands (in the cheek, in front of the ears), the submandibular glands (under the jaw) and the sublingual glands (under the tongue).

Sometimes the calcium salts in saliva clump together and form a stone that blocks the duct. Saliva builds up behind it and the gland swells. The submandibular gland is the most often affected, and the parotid less so.

What are the symptoms?

• Swelling and pain under the jaw or in the cheek that come on when you eat, or even think about food, and settle within an hour or two.
• A hard lump you can feel under the tongue or on the floor of the mouth.
• A salty taste or pus in the mouth.
• With infection: constant pain, redness, warmth and sometimes a fever.
• Episodes recur whenever you eat until the blockage clears.

Why do they happen?

In many cases the cause is unknown. They may be encouraged by:

• Dehydration or thick saliva.
• Some medicines that dry the mouth.
• Previous infections or inflammation of the gland.
• A narrow or damaged duct.

How are they diagnosed?

1. History and examination: we feel the gland and the floor of the mouth. Sometimes the stone can be felt with the fingers.
2. Ultrasound: the most widely used test. It is quick, painless, uses no radiation and usually shows the stone and the swollen gland.
3. CT or MRI: if ultrasound is not enough or there is doubt.
4. Sialendoscopy: a very fine camera passed along the duct lets us see and sometimes treat the stone at the same time.

How are they treated?

Treatment depends on the size and position of the stone.

Conservative treatment

For small stones close to the opening of the duct, conservative treatment often gives good results. It includes drinking water, heat, massaging the gland and stimulating saliva with sharp-tasting foods. It is all in self-care for salivary stones.

Painkillers help with the pain. Antibiotics are used only if there is infection.

If the stone does not pass with these measures

When the stone is not cleared by conservative treatment, there are other options:

• Sialendoscopy: a very fine endoscope is passed along the duct. It allows the stone to be removed or broken up with a laser, preserving the gland.
• Removal through the mouth: if the stone is near the opening of the duct.
• Other surgery on the salivary ducts or glands, in specific cases.

The most suitable option depends on the size and position of the stone.

Advice

• Drink water through the day.
• Massage the gland gently towards the mouth.
• Keep your mouth clean: brush your teeth and tongue.
• Do not try to remove the stone with needles or objects.
• Do not ignore repeated episodes: a lasting blockage can infect the gland.
• Tell us which medicines you take, in case one dries the mouth.

When should I seek urgent help?

Call 112 (in Spain) or your local emergency number, or go to A&E, if:

• The floor of the mouth or the neck swells quickly and you have difficulty swallowing or breathing.
• You have a high fever with severe pain, redness and marked swelling.
• You cannot open your mouth normally.

Book an appointment soon if:

• The swelling does not go down after several hours or lasts more than 2 weeks.
• Episodes recur or pus comes out.
• You notice a lump in the neck or cheek that does not change with meals.
• Your mouth is very dry.

Frequently asked questions

Are salivary stones serious? Not usually, but they can become infected. It is worth treating them if they keep recurring.

Do they go away on their own? Small ones sometimes pass with water, massage and saliva stimulation. Larger ones usually need a procedure.

Does sialendoscopy hurt? It is done under local or general anaesthetic, depending on the case. Afterwards there may be mild discomfort.

Do I have to have the gland removed? Almost never. Nowadays the gland is preferably kept, and removed only in specific cases.

Can they come back? Yes, in some people. Drinking water and good oral hygiene help.

Is it the same as mumps? No. Mumps is a viral infection of the parotid gland and causes fever and swelling in both cheeks. With a stone, the swelling appears when you eat.

Could it be a tumour? Almost always not. But a fixed lump that does not change with meals needs to be investigated.

References

1. Badash I, Raskin J, Pei M, Soldatova L, Rassekh C. Contemporary review of submandibular gland sialolithiasis and surgical management options. Cureus. 2022;14(8):e28147.
2. Chiesa-Estomba CM, Saga-Gutierrez C, Calvo-Henriquez C, et al. Laser-assisted lithotripsy with sialendoscopy: systematic review of YO-IFOS Head and Neck Study Group. Ear Nose Throat J. 2020;100(1_suppl):42S-50S.
3. Rahmati RW. Office-based sialendoscopy. Otolaryngol Clin North Am. 2025;58(4):731-742.

For general information only. It does not replace a medical consultation and cannot be used for diagnosis. In an emergency in Spain, call 112.

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