What is it?
A salivary gland stone is a small hard lump that forms when the minerals in your saliva settle along the duct and harden. When the stone narrows the duct, saliva cannot empty into the mouth and builds up inside the gland. That is why the symptoms are not steady through the day; they appear at the moments when saliva production rises.
Most stones are found in the submandibular gland under the jaw. The saliva this gland makes is thicker, and its duct runs upwards, against gravity. Stones are less common in the parotid gland in front of the ear. A gland may hold a single stone, or more than one.
The classic description is this: when you start eating, or when you taste something sour, the area under your jaw swells quickly, feels tight and aches; a while after the meal the swelling settles on its own. This cycle can repeat for weeks. If the blockage carries on, the stagnant saliva collecting in the gland can prepare the ground for infection.
Signs
You will not necessarily have all of these at once.
Why does it happen?
- 01
Saliva becoming thicker
When you do not drink enough water, or your body loses fluid, saliva becomes more concentrated. As its flow slows, the minerals it carries become more likely to settle on the duct wall.
- 02
Medicines that reduce saliva flow
Medicines that dry the mouth lower the rate of secretion. Saliva that sits in the duct for a long time makes a favourable setting for a stone to grow. Whether the medicine can be changed is decided by the doctor who prescribed it.
- 03
The anatomy of the gland under the jaw
The duct of this gland is long, it runs upwards, and its saliva is thicker than that of the other glands. This structural feature is the reason stones are most often seen here.
- 04
Past inflammation and narrowing of the duct
Inflammation of the gland in the past can leave scarring and narrowing in the duct wall. Flow is disturbed at the narrowed point; mineral build-up often begins at exactly that spot.
How does it progress?
- 1
A silent stone
The stone is small and does not close off the flow completely. It may cause no symptoms at all, and may be seen by chance on an X-ray taken for another reason.
- 2
Swelling that comes with meals
When saliva production rises the gland swells and feels tight, and as production slows the swelling goes down. Pain often goes with the swelling, and its link to eating is clear.
- 3
The blockage becoming constant
The swelling no longer settles fully between meals. Less saliva comes from the duct opening and it becomes thicker; the area feels full all day.
- 4
Infection added on top
Bacteria can multiply in the stagnant saliva. The area turns red, hurts when touched, cloudy discharge may come from the duct opening, and a fever may go with the picture.
How is it treated?
The assessment starts inside the mouth. Your dentist looks at the duct opening, feels the gland with two hands, one outside and one inside the mouth, and checks whether the saliva coming from the duct opening is clear. An ultrasound or CT scan may be needed to show where the stone is and how big it is; requesting and interpreting those scans falls to the ear, nose and throat department.
Small stones that sit very close to the duct opening and can be felt by hand may be removed through the mouth by oral and maxillofacial surgery. For deeper stones, procedures carried out inside the duct and other options aimed at saving the gland are assessed in ear, nose and throat clinics. Which route is suitable is set by where the stone sits and how large it is.
For small stones, measures to increase the flow may be tried first: drinking plenty of water, stimulating saliva with sour tastes, and supporting the gland with a warm compress and gentle massage along the line of the duct. These measures do not work for every stone. If the swelling is not settling, if the pain is increasing, or if a fever is added, waiting is not the right course.
- Swelling that grows quickly and is clearly painful to touch
- Fever, shivering and tiredness added to the picture
- Pus coming from the duct opening, or a foul taste spreading into the mouth
- Difficulty opening your mouth or swallowing
How is it prevented?
- Drink water regularly through the day; saliva becoming thicker is the first step that makes a stone easier to form.
- If you take a medicine that dries your mouth, tell your dentist, and do not stop the medicine on your own decision.
- Stimulate your saliva flow during the day with sugar-free gum or sour tastes.
- In a gland that has already had a stone removed the symptoms may come back; if you notice swelling with meals again, do not put off a check-up.
Frequently asked questions
- Can a stone come out on its own?
- Small stones near the duct opening may be washed out on their own with the saliva; plenty of water, a warm compress and gentle massage support that possibility. If the stone is large, or sits deep in the duct, this is not expected. If the symptoms keep coming back, the position of the stone needs to be shown with imaging.
- Can this swelling be confused with a swollen lymph node?
- It can be, because both are felt under the jaw. The clue that tells them apart is timing: with a stone the swelling comes on with a meal and settles a while later, whereas a swollen lymph node has no link to meals and usually appears after an infection. The definite distinction is made by examination and, where needed, by imaging.
- Is the gland taken out when the stone is removed?
- The priority is to keep the gland in place. Removing the stone opens the route for the saliva, and the gland is expected to carry on working. If repeated bouts of inflammation have left lasting damage in the gland, further options may come up; that decision is made by the doctor assessing the gland.
This content is for general information and does not replace an in-person examination. Symptoms overlap between conditions, and a diagnosis can only be made clinically.