What does this mean?
Salivary glands empty what they make into the mouth through fine ducts. The duct of the large gland in front of the ear opens through your cheek, at a small bump level with your upper back teeth; the duct of the gland under the jaw opens under your tongue. Cloudy, yellowish or thick fluid coming from that point instead of clear saliva is a direct sign that the contents of the gland have become inflamed.
What tells this finding apart from an abscess coming from a tooth is where the pus appears. With an abscess from a tooth or the gum, the pus drains from a small blister that forms on the gum beside the tooth involved; pressing on the cheek from the outside makes no difference to it. With a salivary gland, the pus comes each time from the same anatomical point, the opening of the duct, and it appears when the gland is stroked gently from the outside. This often goes with a salty or unpleasant taste in the mouth, a fullness in front of the ear or under the jaw on the same side, and pain that grows as you open your mouth.
Underneath this picture there are usually two things at once: reduced saliva flow, and the contents of the duct not being carried out. When the flow slows, bacteria from the mouth can travel up the duct. That is why it is seen more often in people who are short of fluid, who take a number of medicines, who have recently had an operation or who are older, and why it can get worse within hours. If there is a stone in the duct, the inflammation may settle with treatment, but because the blockage stays where it is, the symptoms are expected to come back.
Pus coming from the opening of the duct is proof of inflammation in itself; the real questions are why it started and whether there is a blockage underneath it. The headings below are where those two questions are pursued.
Likely causes
What helps at home?
- Drink more water; being short of fluid is the most common companion to this picture, and a flow that stays slow sets the ground for the inflammation to carry on.
- Do not squeeze the gland hard to empty it, and do not try to open the mouth of the duct with a needle or a toothpick; this injures the duct and can carry the inflammation into the surrounding tissues.
- Do not start leftover antibiotics at an incomplete dose; they may not be enough, and they blur the picture that the examination needs to see.
- Note down which side it is on, when it started, your temperature and, if there is swelling, where its edges are; this picture can change within hours, so being able to compare matters.
- If you have a high temperature, particularly one that rises with shivering
- If the skin over the swelling has turned red, tight and hot
- If you cannot open your mouth two fingers' width
- If you are having difficulty swallowing, your voice has changed, or you are struggling to breathe
- If you have diabetes or are on treatment that suppresses your immune system, or if it has clearly got worse within a few hours
Frequently asked questions
- Could this be a dental abscess?
- It could be, but where the pus comes from settles most of the question. With an abscess from a tooth, the pus comes from a blister on the gum at the base of the tooth involved, and that tooth hurts when you bite on it. With a salivary gland, the pus comes from the opening of the duct, a fixed point inside the cheek or under the tongue. Both can be present at the same time; the definite answer comes from an examination and an X-ray.
- Will starting an antibiotic be enough?
- The decision about medication rests with the doctor and depends on how severe the inflammation is. Where relying on medication alone causes trouble is when there is a stone or a narrowing in the duct; the inflammation then settles, but because the blockage carries on, the symptoms come back. That is why the assessment is expected to look not only at the inflammation but also at the blockage underneath it.
- Who should I see about this?
- A dentist can see the opening of the duct from inside the mouth, assess the fluid coming from it and tell whether the source is a tooth or the gland. Examining the gland itself, any scans and managing the inflammation with medication belong with an ear, nose and throat specialist. If there is a high temperature, swelling that is growing quickly, a limit on opening your mouth or difficulty swallowing, you should go to an emergency department without waiting your turn.
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.