Salivary gland stones: symptoms and treatment

Saliva is made in the major glands, the parotids by the ears, the submandibular glands under the jaw and the sublingual glands under the tongue, and flows through small ducts into the mouth. A stone is a small, hard lump that can form in a gland or duct and impede that flow.

The NHS says most stones form below the tongue, in one of the glands supplying saliva to the mouth, and you cannot always see them. They are white and hard and vary in size, but most are as big as a pea.

The NHS adds that it is not clear what causes them, so there is no known way to prevent them, and that they are not usually linked to other health problems.

The NHS lists dull pain in the mouth that comes and goes, swelling in the mouth that flares up from time to time, and an infection around the stone, with pain, redness and a high temperature as signs. If you feel intense pain at mealtimes, the stone could be completely blocking the gland. The NHS says the pain usually lasts 1 to 2 hours.

Eating makes the glands produce saliva, which is why the swelling and pain are so closely tied to meals. NHS Greater Glasgow and Clyde guidance describes this as intermittent swelling and discomfort in the gland on eating, and notes that a duct stone can increase the risk of infection in the gland.

The symptoms will not go away until the stone has gone, the NHS says.

The NHS suggests trying to ease a stone by increasing the amount of saliva in the mouth. That means drinking plenty of water, gently massaging around the stone, and chewing sugar-free gum or sucking sugar-free sweets or lozenges.

If you have pain and swelling, the NHS says to take paracetamol or ibuprofen, and to suck ice cubes or ice lollies. The GP guidance for a swollen gland suggests warm compresses, gland massage and sialogogues, such as lemon juice, which are foods or drinks that stimulate saliva.

The NHS specifies sugar-free gum, sweets and lozenges.

• Drink plenty of water through the day.

• Massage gently around the stone, working towards the opening of the duct.

• Chew sugar-free gum or suck sugar-free lozenges, especially around meals.

• Use paracetamol or ibuprofen for pain, and suck ice cubes or ice lollies for swelling.

The NHS is firm that you should not use anything sharp to try to remove a salivary gland stone. Injury and infection are the risks it names.

It is also unwise to ignore ongoing blockage. A gland that stays obstructed is more prone to infection, which is why persistent or recurring symptoms are a reason to be seen.

The NHS says to see a GP if you are bothered by a salivary gland stone that has not gone away by itself, or if the stone has caused an infection. Signs include pain, redness or pus around the stone, and having a high temperature, or feeling hot, cold or shivery.

A GP will usually ask about the pattern of swelling, look in the mouth and feel for the stone. The Glasgow guidance advises examining with a gloved finger for a ductal stone, noting the parotid duct opens opposite the second upper molar tooth and the submandibular duct lies in the floor of the mouth under the tongue.

If a stone is suspected, referral to ENT is routine according to that guidance. If there is also a lump that stays for more than 3 weeks, the pathway becomes urgent because other causes must be excluded.

Small stones sometimes fall out on their own, and you will continue to have symptoms until the stone falls out or is removed. A GP may attempt to gently remove the stone with a thin, blunt instrument. If that is not possible, the NHS says you may need to have the stone removed in hospital.

If infection is present, the GP guidance suggests warm compresses, gland massage and a course of antibiotics. Treating the infection does not remove the stone, so the underlying blockage still needs attention.

Once removed, stones do not usually come back, the NHS says. If you keep getting them, you might need to have one of your salivary glands removed.

Not every swollen gland has a stone. The NHS lists swollen glands in the cheeks, neck and under the jaw among the features of Sjögren's syndrome, and describes mumps as painful swelling of the cheeks and neck that usually settles within 2 weeks. Tests for Sjögren's include an X-ray of the salivary glands to check whether they are blocked.

A firm, discrete lump that does not come and go with meals is a different pattern, and is the reason for a clinician to consider a tumour, most of which are benign. A swelling that persists beyond 3 weeks should be seen promptly.