Oral and maxillofacial surgery, the surgical arm of dentistry, is best known for wisdom teeth extractions and dental implants, but these highly trained specialists are also experts in treating everything from fractures of the jaw and facial bones to infections of the mouth, face, and neck.

Oral surgeons also treat salivary gland blockages, often caused by small stones that form in the gland and obstruct the flow of saliva, leading sometimes to swelling, pain, and infection.

“Salivary stones do not usually cause symptoms when they are forming, and they can sometimes disappear on their own. However, these stones can result in pain and swelling in the affected gland if the flow of saliva in the gland is blocked. The affected gland can get infected. This is called sialadenitis,” explains the AAOMS Journal of Oral and Maxillofacial Surgery.

The Important Role of Your Salivary Glands

Like a lot of things associated with our bodies, we do not give our salivary glands much thought unless they are not functioning properly.

Each person has three pairs of major salivary glands which secrete saliva into the mouth:

• The parotid glands which are found in front of the ear.
• The submandibular glands which are below the lower jaw.
• The sublingual glands which are found under the tongue.

In addition, we have hundreds of smaller minor glands in our mouth.

These glands -- which make saliva (spit) and empty it into the mouth through openings called ducts -- have an important role to play in our health, including:

• Saliva makes food moist, which helps with chewing and swallowing and the digestion of food.
• Saliva also keeps the mouth clean and healthy because it contains antibodies that kill germs.

Salivary gland blockage can cause problems.

“If the salivary glands are damaged or aren’t producing enough saliva, it can affect taste, make chewing and swallowing more difficult, and increase the risk for cavities, tooth loss, and infections in the mouth,” says the NIDCR.

Causes of Salivary Gland Blockage

The AAOMS says that the cause of salivary stones is not known but many factors contribute to their formation, including the following:

• Advancing age.
• Having radiation therapy on the head or neck.
• Mouth injuries or trauma.
• Taking medications that affect saliva production.
• Sjogren's syndrome.
• Having kidney problems.
• Not drinking enough water.

The disease is also more common in men and 80 percent of salivary gland stones occur in the submandibular gland (under the side of the jaw).

“A stone can form from salts contained in the saliva. Stones are particularly likely to form when people are dehydrated or take drugs that decrease saliva production. People with gout are also more likely to form stones. Salivary gland stones are most common among adults. About 25 percent of people with stones have more than one,” explains the Merck Manual.

Symptoms of Salivary Gland Blockage

Salivary stones create problems when they block the tube (duct) that carries saliva from the gland to the mouth, explains Merck.

“Blockage makes saliva back up inside the duct, causing the salivary gland to swell painfully. A blocked duct and gland filled with stagnant saliva may become infected with bacteria,” says the Merck Manual.

The AAOMS says that problems with salivary glands can cause them to become irritated and swollen. Symptoms may include:

• A bad taste in your mouth.
• Difficulty opening your mouth.
• Dry mouth.
• Fluid draining from the ear.
• Pain in your face or mouth.
• Numbness or weakness in the face.
• Swelling of your face or neck or under your tongue.
• Lump in the area of the ear, cheek, jaw, lip, or inside the mouth.

“A typical symptom of a blocked salivary duct is swelling and pain over the gland that is affected. The pain and swelling worsen after eating, particularly when people eat something that stimulates saliva flow (such as a pickle or lemon juice) because when the duct is blocked, the saliva has no place to go and the gland swells. The swelling may go down after a few hours, and the duct may release a gush of saliva. Some stones do not cause any symptoms,” says the Merck Manual.

Diagnosis and Treatment of Salivary Gland Blockage

The NIDCR says that your doctor will use your medical history, a physical examination, and/or laboratory tests to make a diagnosis of a salivary disorder.

“If your doctor suspects your pain and inflammation are the result of an obstruction in one of the glands, he or she may order X-rays or an ultrasound to identify where the obstruction is and what might be causing it,” says the NIDCR.

Other actions your oral surgeon may take:

• If a mass is found in the salivary gland, your doctor will suggest a CT scan or an MRI to get a better look.
• Your doctor might also perform a fine needle aspiration biopsy to remove a small amount of tissue or fluid and check for cancer cells.
• A lip biopsy of minor salivary glands may be needed to identify certain autoimmune diseases, such as Sjögren’s disease.

“Management of these stones is usually done with conservative measures,” explains AAOMS.

These measures may include:

• Applying moist heat and gentle massage to the salivary gland.
• Staying well hydrated.
• Using lemon drops or other sour candies to help stimulate salivation.
• Ibuprofen or other nonsteroidal anti-inflammatory drugs to reduce pain and swelling.
• Antibiotics if your surgeon notices evidence of infection.

“For larger, harder-to-remove stones, the oral and maxillofacial surgeon can make a small incision in the mouth to remove the stone,” says AAOMS. “Another treatment option involves a less invasive technique called sialendoscopy. This technique uses small lighted scopes inserted into the gland's opening in the mouth to visualize the salivary duct system and locate the stone. Then, using small instruments, the surgeon can remove the stone.”

Finally, for patients with recurrent or large stones, surgical removal of the gland may be necessary.

Contact the board-certified surgeons at Northwest Oral & Maxillofacial Surgery today for diagnosis and treatment of salivary gland disorders such as blockage due to salivary stones.