Salivary Gland Stones: Symptoms, Causes & Treatment

What Are Salivary Gland Stones?

Salivary gland stones (sialolithiasis) are calcified deposits that form when calcium and other minerals in saliva crystallize and accumulate within the salivary glands or their ducts. These stones block the flow of saliva into the mouth, causing pain, swelling, and discomfort—particularly during meals when saliva production increases.

The human mouth contains three pairs of major salivary glands that produce saliva to aid digestion and maintain oral health. The parotid glands are located in front of each ear, the submandibular glands sit beneath the lower jaw, and the sublingual glands are positioned under the tongue. Each gland has a duct system that carries saliva into the mouth. When stones form in these ducts or glands, they can partially or completely obstruct saliva flow.

Salivary gland stones typically range from 2 to 5 millimeters in diameter, though larger stones occasionally develop. The stones are composed primarily of calcium phosphate and calcium carbite, along with smaller amounts of other minerals and organic compounds. Their formation is similar to kidney stones, though the specific mineral composition differs.

The condition is remarkably common, affecting approximately 1.2% of the population at some point in their lives. Adults between ages 30 and 60 are most frequently affected, while children rarely develop salivary stones. Men and women appear to be affected equally, though some studies suggest a slight male predominance.

Why the Submandibular Gland Is Most Affected

The submandibular gland accounts for 80-90% of all salivary gland stones, despite producing only about 70% of total saliva volume. Several anatomical and physiological factors explain this striking predilection. The submandibular gland produces saliva that is thicker and more alkaline than parotid gland saliva, making it more prone to crystallization. Additionally, the submandibular duct (Wharton's duct) runs upward against gravity from the gland to its opening under the tongue, which slows saliva flow and allows minerals to accumulate.

The parotid gland, located near the ear, accounts for about 10% of salivary stones. Its saliva is thinner and more watery, and the duct runs horizontally, facilitating better flow. Sublingual gland stones are extremely rare, representing only 1-2% of cases.

How Stones Form

Stone formation begins when saliva becomes supersaturated with calcium and other minerals. This can occur due to dehydration, reduced saliva flow, or changes in saliva composition. Initially, tiny crystals form and serve as a nucleus around which additional mineral deposits accumulate layer by layer. The process is gradual, often taking months or years to produce a stone large enough to cause symptoms.

Most people are unaware of stone formation until the stone grows large enough to obstruct saliva flow or moves into a position where it blocks the duct. Many small stones pass through the duct and are swallowed without ever causing symptoms.

What Are the Symptoms of Salivary Gland Stones?

The primary symptoms of salivary gland stones include sudden pain and swelling of the affected gland during eating, a foul or salty taste in the mouth, difficulty opening the mouth fully, and visible or palpable swelling beneath the jaw or in front of the ear. Symptoms typically worsen during meals and subside approximately one hour afterward.

The hallmark symptom of salivary gland stones is meal-related pain and swelling. When you eat—or even think about food—your brain signals the salivary glands to produce saliva. If a stone is blocking the duct, this increased saliva production has nowhere to go, causing the gland to swell rapidly. The pressure creates intense, often sudden pain that patients frequently describe as sharp or cramping.

The location of symptoms depends on which gland is affected. Submandibular stones cause pain and swelling in the floor of the mouth and beneath the jaw, often extending toward the ear. Parotid stones produce swelling in front of the ear and along the cheek, sometimes extending to the angle of the jaw.

Beyond the classic mealtime symptoms, patients may notice a foul or metallic taste in the mouth, especially when the gland partially empties. Reduced saliva flow on the affected side can cause localized dry mouth symptoms. Some patients can feel the stone as a hard lump in the floor of their mouth or may notice pus draining from the duct opening if infection develops.

Types of Reactions to Salivary Duct Obstruction

Intermittent vs. Complete Obstruction

Symptoms can fluctuate significantly depending on the stone's position and degree of obstruction. When a stone partially blocks the duct, saliva may slowly seep past, causing intermittent symptoms that come and go over days or weeks. The stone may shift position, temporarily relieving obstruction before blocking the duct again.

Complete obstruction causes more dramatic and persistent symptoms. The gland becomes progressively swollen and tender as saliva continues to be produced but cannot drain. Without treatment, prolonged complete obstruction can lead to gland inflammation (sialadenitis) and potentially bacterial infection.

When Infection Develops

Blocked saliva provides an ideal environment for bacterial growth. If infection develops (acute sialadenitis), additional symptoms emerge: fever, increasing redness and warmth over the gland, worsening pain even between meals, and possibly pus draining from the duct opening in the mouth. Infected salivary glands are often extremely tender to touch.

What Causes Salivary Gland Stones?

Salivary gland stones form when minerals in saliva—primarily calcium—crystallize and accumulate. Risk factors include chronic dehydration, medications that cause dry mouth (antihistamines, blood pressure medications, antidepressants), autoimmune conditions like Sjögren's syndrome, gout, and reduced saliva production from any cause. The exact trigger remains unknown in many cases.

The formation of salivary stones is a complex process influenced by multiple factors, though the precise mechanism is not fully understood. Fundamentally, stones develop when saliva becomes oversaturated with calcium and other minerals, triggering crystallization. Several conditions create environments favorable for this process.

Dehydration is perhaps the most modifiable risk factor. When fluid intake is inadequate, saliva becomes more concentrated, increasing mineral content relative to water volume. This concentrated saliva is more prone to crystal formation. Chronic mild dehydration—common in many adults—may significantly increase stone risk over time.

Medications that reduce saliva production create similar conditions by decreasing the "flushing" effect of normal saliva flow. Common culprits include antihistamines, many antidepressants (particularly tricyclics and SSRIs), blood pressure medications (especially diuretics), anticholinergic drugs, and some pain medications. Patients taking multiple dry mouth-causing medications face cumulative risk.

Medical Conditions That Increase Risk

Sjögren's syndrome deserves special mention as a significant risk factor. This autoimmune condition attacks moisture-producing glands, dramatically reducing saliva production and altering saliva composition. Patients with Sjögren's syndrome have substantially higher rates of salivary stones and often experience recurrent episodes.

Gout and other conditions affecting mineral metabolism can influence salivary stone formation. The elevated uric acid levels characteristic of gout may alter saliva composition and promote crystallization. Similarly, disorders affecting calcium regulation may increase stone risk.

Other contributing factors include chronic inflammation of the salivary glands, previous radiation therapy to the head and neck region (which damages salivary tissue), and certain dietary factors. While no specific foods are definitively linked to stone formation, diets high in calcium combined with inadequate hydration may contribute.

Why Adults Are More Affected Than Children

The strong age predilection for adults aged 30-60 likely reflects the cumulative effect of risk factors over time. Stone formation is typically a slow process requiring months or years. Children generally have better hydration habits (relative to body size), take fewer medications, and haven't accumulated the years of exposure to risk factors that adults have. Additionally, some research suggests age-related changes in saliva composition may play a role.

What Can I Do to Help Pass a Salivary Stone at Home?

Home treatment focuses on increasing saliva flow to help flush out small stones naturally. Key strategies include staying well-hydrated (8-10 glasses of water daily), sucking on sour candies or lemon to stimulate saliva production, gently massaging the affected gland from back to front, applying warm compresses, and taking over-the-counter pain relievers as needed.

Many small salivary stones pass spontaneously with conservative home treatment. The goal is to maximize saliva flow, creating hydraulic pressure that can push the stone through the duct and into the mouth. This approach is most effective for stones that are small (under 5mm) and not causing complete obstruction or infection.

Hydration forms the foundation of home treatment. Aim for at least 8-10 glasses of water daily, more if you're normally active or live in a warm climate. Adequate fluid intake increases saliva volume and keeps it flowing freely. Avoid alcohol and caffeine during acute episodes, as both can have mild dehydrating effects.

Stimulating saliva production is equally important. The most effective method is sucking on sour or tart foods—lemon wedges, sour candies, or sugar-free lemon drops work well. The sourness triggers a powerful salivation reflex, dramatically increasing flow through the affected duct. Some patients find that simply thinking about or looking at sour foods helps. Do this several times throughout the day, especially before and during meals.

Massage Technique for Salivary Stones

Gentle massage can help move stones along the duct toward the mouth opening. For submandibular stones, place your fingers beneath your jaw where you feel swelling and apply gentle pressure while moving toward the front of your mouth (toward the tongue). The motion should be from the gland toward the duct opening, essentially "milking" the saliva and stone forward.

Massage is most effective when combined with saliva stimulation—try sucking on something sour while massaging. Sessions should last 2-3 minutes and can be repeated several times daily. Stop if massage causes significant pain, as this may indicate the stone is firmly lodged.

Warm Compresses and Pain Management

Applying warm, moist compresses to the affected area for 10-15 minutes several times daily can reduce pain and promote blood flow to the area. The warmth may also help relax the duct tissue, facilitating stone passage. Use a clean washcloth soaked in warm (not hot) water, or a warm water bottle wrapped in cloth.

Over-the-counter pain relievers such as ibuprofen (Advil, Motrin) or acetaminophen (Tylenol) can help manage discomfort. Ibuprofen offers the additional benefit of reducing inflammation. Follow package directions and avoid exceeding recommended doses.

When Should I See a Doctor for Salivary Gland Stones?

Seek medical care if symptoms persist beyond one week despite home treatment, if you develop fever (indicating possible infection), if swelling becomes severe or doesn't improve, or if you experience recurrent episodes. Seek immediate care for difficulty breathing or swallowing, rapidly spreading facial redness, or severe pain unresponsive to over-the-counter medications.

While many salivary stones resolve with home treatment, certain situations require professional medical evaluation. Understanding when to seek care helps ensure timely treatment and prevents complications.

The one-week guideline serves as a reasonable threshold for home treatment. If consistent hydration, massage, and saliva stimulation haven't resolved symptoms within seven days, the stone may be too large to pass spontaneously or may be stuck in a position that prevents passage. Medical intervention can offer more definitive solutions.

Fever is a red flag requiring prompt attention. The presence of fever (typically above 38°C/100.4°F) alongside salivary gland swelling suggests bacterial infection has developed. Infected salivary glands need antibiotic treatment to prevent abscess formation and spread of infection to surrounding tissues. Don't delay seeking care hoping the fever will resolve on its own.

Recurrent episodes deserve medical evaluation even if individual episodes resolve. Some patients experience repeated stone formation, and identifying underlying causes (such as undiagnosed Sjögren's syndrome or medication effects) can help prevent future episodes. Additionally, recurring obstruction can cause progressive damage to the gland.

What to Expect at Your Medical Appointment

Your healthcare provider will begin with a detailed history of your symptoms, asking about timing, triggers, and any previous episodes. Physical examination includes careful palpation (feeling) of the salivary glands and their ducts. Sometimes, the stone can be felt as a firm mass in the floor of the mouth or the duct itself.

If the diagnosis is uncertain or surgery is being considered, imaging studies may be ordered. Ultrasound is often the first choice—it's non-invasive, readily available, and excellent at detecting stones. CT scanning provides more detailed images and is particularly useful for surgical planning. In some cases, sialography (X-ray with contrast dye injected into the duct) or MRI may be used.

How Are Salivary Gland Stones Treated?

Treatment depends on stone size, location, and complications. Options include continued conservative management for small stones, sialendoscopy (minimally invasive endoscopic removal), incision of the duct to extract the stone, lithotripsy (shock wave treatment), or—rarely—surgical removal of the entire gland. Antibiotics are prescribed when infection is present.

The choice of treatment depends on several factors: stone size and location, whether infection is present, the patient's overall health, and available expertise. Modern approaches favor minimally invasive techniques that preserve gland function whenever possible.

Conservative Medical Management

Even under medical supervision, the initial approach for uncomplicated stones often remains conservative—enhanced hydration, sialagogues (medications or substances that stimulate saliva flow), massage, and warm compresses. Medical supervision allows for closer monitoring and faster intervention if conservative measures fail.

If infection is present, antibiotics are essential. The choice of antibiotic depends on likely bacterial pathogens; common choices include amoxicillin-clavulanate or clindamycin. Antibiotics should be started promptly and completed as prescribed even if symptoms improve quickly.

Minimally Invasive Procedures

Sialendoscopy has revolutionized salivary stone treatment over the past two decades. This technique uses a tiny endoscope (1.3-1.6mm diameter) inserted into the duct opening to visualize and remove stones. Small baskets, forceps, or balloons passed through the endoscope can grasp and extract stones. For larger stones, laser or lithotripsy through the endoscope can fragment the stone before removal.

Sialendoscopy offers several advantages: it preserves the salivary gland, requires no external incisions, can be performed under local anesthesia in many cases, and allows quick recovery. Success rates exceed 80% for appropriate cases. The procedure is particularly effective for stones located in the main duct rather than within the gland itself.

Extracorporeal shock wave lithotripsy (ESWL) uses focused shock waves to fragment stones, similar to kidney stone treatment. The fragmented pieces can then pass spontaneously or be removed endoscopically. ESWL is less widely available for salivary stones than for kidney stones but offers a non-invasive option for certain patients.

Surgical Removal

When minimally invasive approaches are not suitable or have failed, surgical options become necessary. For stones near the duct opening, a simple incision into the duct (sialodochoplasty) allows direct stone removal under local anesthesia. This procedure is straightforward and has excellent success rates for accessible stones.

Stones deeper in the duct or within the gland itself may require more extensive surgery. In some cases, the surgical approach involves opening the duct and removing the stone while preserving gland function.

Complete gland removal (sialadenectomy) is reserved for cases where the gland is severely damaged, stones are inaccessible by other means, or recurrent episodes have made the gland non-functional. For submandibular gland removal, the incision is made beneath the jaw. Parotid gland surgery requires careful attention to avoid the facial nerve that passes through the gland.

Removing one salivary gland typically has minimal impact on overall saliva production, as the remaining glands compensate adequately. Most patients notice no significant dry mouth symptoms after single gland removal.

What Complications Can Occur from Salivary Gland Stones?

The main complications of salivary gland stones include bacterial infection of the gland (sialadenitis), abscess formation, chronic inflammation leading to gland damage, and recurrent stone formation. With appropriate treatment, serious complications are uncommon. Untreated or recurring obstruction can lead to permanent gland dysfunction.

Most salivary stones resolve without complications, especially when treated appropriately. However, understanding potential complications helps patients recognize warning signs and seek timely care.

Acute sialadenitis (bacterial infection of the salivary gland) is the most common complication. When saliva flow is blocked, bacteria normally present in the mouth can ascend into the duct and gland, causing infection. Symptoms include fever, increasing pain, redness and warmth over the gland, and sometimes pus drainage from the duct opening. Sialadenitis requires antibiotic treatment and may require hospitalization in severe cases.

Abscess formation can occur if sialadenitis progresses or is inadequately treated. An abscess is a collection of pus that may require surgical drainage in addition to antibiotics. Signs of abscess include a fluctuant (movable, fluid-filled) swelling, severe pain, high fever, and difficulty opening the mouth.

Chronic sialadenitis develops when the gland experiences repeated episodes of obstruction and infection. Over time, the gland becomes fibrotic (scarred) and produces progressively less saliva. Eventually, the gland may become non-functional. Chronic sialadenitis may require gland removal if symptoms persist despite other treatments.

Recurrent stone formation affects some patients, particularly those with underlying conditions predisposing to stone formation. Having one stone increases the risk of developing additional stones in the future. Identifying and addressing modifiable risk factors helps reduce recurrence rates.

Long-term Outlook

The prognosis for salivary gland stones is generally excellent. Most stones resolve completely with treatment, and the gland returns to normal function. Even patients requiring gland removal typically experience no significant long-term effects on saliva production or oral health.

For patients with recurrent stones, ongoing management may be necessary. This might include regular hydration monitoring, avoiding dry mouth-causing medications when possible, treating underlying conditions, and prompt attention to early symptoms.

How Can I Prevent Salivary Gland Stones?

Prevention strategies focus on maintaining adequate saliva flow through good hydration (at least 8 glasses of water daily), minimizing use of dry mouth-causing medications when possible, treating underlying conditions like Sjögren's syndrome, maintaining good oral hygiene, and avoiding dehydration. If you've had one stone, these measures become especially important.

While not all salivary stones can be prevented, several strategies reduce risk—especially for those who have experienced previous episodes.

Hydration is paramount. Aim for at least 8 glasses of water daily; more if you exercise regularly, live in a hot climate, or take medications that cause dry mouth. Distribute fluid intake throughout the day rather than drinking large amounts at once. Carry a water bottle as a reminder to drink regularly.

Review medications with your healthcare provider. If you take multiple medications that cause dry mouth, ask whether alternatives exist. Sometimes dosage adjustments or switching to similar medications with fewer dry mouth effects is possible. Never stop prescribed medications without medical guidance.

Treat underlying conditions. If you have Sjögren's syndrome, gout, or other conditions affecting saliva production or mineral metabolism, working with your healthcare team to optimize management reduces stone risk.

Practice good oral hygiene. While not directly preventing stones, good oral hygiene reduces the bacterial load in the mouth, potentially lowering infection risk if obstruction occurs. Regular dental check-ups also provide opportunities to identify early salivary gland problems.

For previous stone formers: If you've had a salivary stone before, be especially vigilant about hydration and promptly address any early symptoms (meal-related swelling, gland tenderness). Some physicians recommend periodic "gland massage" during saliva stimulation as maintenance therapy.