Causes and risk factors
Calculi are formed when calcium phosphate gets deposited on the matrix of cellular debris and mucus. The chemicals in the saliva may crystallize to form a stone. Some recent studies suggest that stones are formed due to changes in the flow of saliva through the gland. Risk factors for salivary calculi include dehydration, poor eating, medicines like antihistamines, antihypertensives, psychiatric drugs, drugs to control bladder functions. Trauma to salivary gland is also a predisposing factor. The size of stones may vary from a few millimeters to centimeters in diameter. It is common in people over the age of 40 years.
Clinical presentation
The salivary calculi obstruct the flow of saliva through the gland and duct. This causes painful swelling of the salivary gland. The pain begins soon after starting the meal. The condition becomes worse if there is any infection inside the oral cavity. Calculus may be palpable in the duct or slightly visible at the opening of the duct. If the stone is embedded in the gland and not blocking the salivary duct, the symptoms present are dull pain in the affected gland and swelling of the gland. There may be pus formation in the gland.
Investigation
Medical history by the patient and clinical examination by the doctor helps in diagnosis. Imaging studies such as x-ray of the gland, ultrasound, CT scan, and MRI are useful for evaluation of radiopaque stones. Siaolography may be performed for radiolucent stones. Sialendoscopy may be required.
Treatment
No treatment is required for asymptomatic patients. Some stones may come out from mouth eventually. Increasing salivation by sucking a lemon can cause small stones to pass away. In larger stones, the doctor may massage the salivary duct to push the stones out. Excision of the calculus under local anesthesia may be required. Sialendoscopy may be required. Sialadenectomy is advised for unpalpable or recurrent stones. Shock wave treatment [lithotripsy] will also help in managing salivary gland calculus. Prevention of salivary gland calculi is possible by drinking plenty of water or fluids, healthy and adequate diet with regular exercise.
Other Modes of treatment
The other modes of treatment can also be effective in treating salivary gland calculi. Homoeopathy is a science which deals with individualization and considers a person in a holistic way. This science can be helpful in combating the symptoms. Similarly, the Ayurvedic system of medicine which uses herbal medicines and synthetic derivates are also found to be effective in treating salivary gland calculi.
