Are you wondering what the painful swelling under your jaw could be? Very tender and with progressive pain whenever you try to eat. It is most likely a salivary gland stone also known as sialoliths. I recently had one, with the most excruciating pain that is capable of driving one crazy.
Types Of Salivary Glands
There are three major salivary glands in humans, these are:
- The parotid glands: located at both sides of the cheeks.
- The sub-lingual gland: Which is located right under the tongue.
- The sub-mandibular glands: These are located at both sides of the floor of the mouth, beneath the jaw lines.
There are other minor salivary glands inside the cheeks, lips, under the tongue, and beneath the palate. The sub-mandibular glands form the majority of stones. This could be due to the thickness of saliva they produce. Salivary stones from the parotid and sublingual glands are less common.
My case was a recurrent one. I had a sub-lingual gland stone about six (6) months ago. However, the stone was small, less painful, and got dislodged at home after a few days.
What Causes Salivary Gland Stones
The actual cause of salivary stone formation is not known. There is, however, a general belief that when the contents of saliva, which mostly contain calcium, accumulate in the salivary gland, they could get calcified and turn into stones. The stones block the ducts of the gland, entrap saliva, leading to swelling and the accompanying pain. Several factors have also been identified to increase stone formation.
Risk Factors Of Salivary Stone Formation
- Reduced Production of Saliva: When the flow of saliva is reduced due to low saliva production, the chemicals in the saliva stay in the glands for longer period of time and could lead to stone.
- Poor Eating Habit: Going long hours without eating will make the glands less active and could block the ducts.
- Dehydration: When your body lacks fluid, your saliva becomes thicker than normal, and this could precipitate stone formation.
- Some Medications such as anticholinergics and diuretics, which reduce saliva production and increase fluid removal respectively, can also lead to salivary stone formation.
- Trauma to the salivary gland.
Symptoms of Salivary Gland Stones/Saloliths
- Painful swelling of the gland.
- Pain getting worse when you are eating or expecting food. This is because there is an increased saliva production while eating.
- Stone can be felt on palpation.
- Inflammation and infection may follow if left untreated.
- Pain gets progressively worse each day.
How To Remove Salivary Stones At Home
Salivary stones that are smaller than the salivary duct/opening, can be successfully dislodged at home by:
- Snacking on sour fruits such as lemon.
- Increasing fluid/water intake.
- Chewing mint gum or candies: The strong mint flavour helps to stimulate saliva production, while the chewing process encourages the flow of saliva from the gland into the mouth. This can help push the stone out as well.
- Massaging the gland: This should be done in the right direction, towards the opening of the gland. You wouldn’t like to push the stone in instead, by massaging wrongly. Check here for a guide on how to massage the different salivary glands.
- Salt water gargle: This serves as a mucolytic that thins your saliva and increases secretion.
Stones that are larger than the opening of your gland will be difficult to remove. You will need help from your doctor, dentist, or ENT (Ear, Nose & Throat) specialist to remove bigger stones. If the means are available, a minimally invasive technique called Sialendoscopy may be carried out to remove the stone. An incision can also be made close to the gland, in minor surgery, to remove the stone.
In my own case, several tiny stones were co-existing with a big one in the sub-mandibular gland. The big stone was quite impacted below the jawline and away from the duct. With a positive history of previous stone formation, a decision was reached to remove the entire gland, due to the high chances of forming more stones soon. This is the treatment plan for people with recurrent stones, or whose salivary gland has been damaged irreversibly.
How to Temporarily Relieve Duct Stone Pain
- Use over the counter medicines for pain management such as Ibuprofen.
- Apply warm/cold compress to the affected site. This was of immense help to me before the surgery. Soak your towel with warm water, press out the excess water and place on the swollen gland. Repeat if the towel gets cold.
- Chewing mint gums or candies. Keeping my jaws moving with gum made eating and speaking less painful for me.
- Suck on ice, cold water or juice. This helped me with immediate relieve from the excruciating pain I felt.
Sub-mandibular Stone Removal; My Experience.
The biggest stone in my gland measured 5mm, and so could not come out of the 1-3mm duct of the gland. The pain was so acute and progressive that I was completely down by the 7th day. On the 12th day, after seeing about six(6) doctors with the same opinion, I had no other option than to accept a surgical intervention.
I was so nervous and scared at the same time. I didn’t ever want to be made unconscious for fear of not waking up, it was my first time undergoing surgery. With all the reassurance from the doctors, I gave my consent and had it removed the next day. The surgery lasted for just an hour, and my recovery has been a quick one.
If your only option is surgery as in my case, you need not panic at all. It’s not going to be that invasive, and you would be back to your feet within a short time. Complete recovery takes about 1-2 weeks, after which you can go about your normal activities.