From the Guidelines
Prevention and treatment of salivary stones (sialolithiasis) should prioritize staying well-hydrated, practicing good oral hygiene, and using conservative approaches like warm compresses and sialagogues to stimulate saliva flow, as these methods can help prevent stone formation and aid in the passage of small stones. To prevent salivary stones, it is essential to:
- Stay well-hydrated by drinking plenty of water daily
- Practice good oral hygiene
- Massage salivary glands gently
- Avoid tobacco and excessive alcohol
- Maintain a balanced diet For treatment, small stones may resolve with conservative measures like:
- Warm compresses
- Gentle massage
- Staying hydrated
- Using sialagogues (lemon drops or sugar-free candies) to stimulate saliva flow, as mentioned in the context of managing facial pain and salivary gland disorders 1. Over-the-counter pain relievers like ibuprofen or acetaminophen can help manage discomfort. For persistent stones, medical interventions include:
- Sialendoscopy (endoscopic removal)
- Extracorporeal shock wave lithotripsy
- Surgical removal (sialadenectomy) for larger stones or recurrent cases, which may be necessary as salivary stones are most frequent in the submandibular gland and can cause intermittent pain, tenderness, and decreased salivary flow 1. Antibiotics may be prescribed if infection is present. Salivary stones form when minerals in saliva crystallize, often due to decreased saliva flow, dehydration, or salivary duct inflammation, which is why maintaining hydration and saliva flow is crucial for both prevention and treatment. Bimanual palpation and imaging, such as ultrasound, can aid in diagnosis, and referral to oral/maxillofacial surgeons may be indicated for further management 1.
From the Research
Etiology of Salivary Stones
- The exact cause of salivary stones (sialolithiasis) is unknown, but it has been suggested that they could be related to an altered saliva composition, the anatomy of the ducts of the salivary gland, and/or the fusion of microsialoliths 2.
- Sialoliths are now shown to be secondary to chronic obstructive sialadenitis, with microscopic stones (sialomicroliths) accumulating during secretory inactivity in normal salivary glands and producing atrophic foci by obstruction 3.
- The formation of salivary stones involves the precipitation of calcium onto degenerating cellular membranes, leading to the formation of a sialolith 3.
Composition of Salivary Stones
- Salivary stones consist mainly of inorganic material, such as hydroxyapatite, carbonate apatite, whitlockite, and calcium phosphate, but they also contain organic components, such as proteins and lipids 4, 2, 5.
- The biochemical composition of salivary stones can vary, with carbonate apatite, phosphate, calcium, magnesium, struvite, oxalate, and carbonate being identified in different stones 5.
Prevention of Salivary Stones
- There is limited information available on the prevention of salivary stones, but maintaining good oral hygiene and stimulating saliva production through the use of sialogogues may help to reduce the risk of developing sialolithiasis 4.
Treatment Options for Salivary Stones
- Conservative management of salivary stones consists of salivary gland massage, the use of sialogogues, and oral analgesics and antibiotics 4, 6.
- Other therapeutic options include removal of the stone, ultrasonic pulverisation, and surgical or sialendoscopical removal of the stone or the affected salivary gland 4, 6, 2.
- The choice of treatment depends on the size and location of the stone, as well as the patient's overall health and medical history 4, 6.