From the Guidelines
Treatment options for salivary gland disorders should be guided by the specific condition, with a focus on minimizing morbidity, mortality, and improving quality of life. For inflammatory conditions like sialadenitis, initial treatment involves hydration, warm compresses, salivary massage, and sialogogues (substances that stimulate saliva production) such as sugar-free lemon candies 1. Antibiotics are prescribed for bacterial infections, with amoxicillin-clavulanate (875/125 mg twice daily for 7-10 days) being a common first-line choice.
Key Considerations for Treatment
- For autoimmune disorders like Sjögren's syndrome, artificial saliva substitutes (such as Biotène or Xylimelt) and pilocarpine (5-10 mg three times daily) or cevimeline (30 mg three times daily) may be prescribed to stimulate saliva production 1.
- Salivary stones (sialoliths) might require removal through minimally invasive techniques like sialendoscopy or, in some cases, surgical intervention.
- For salivary gland tumors, surgical excision remains the primary treatment, ranging from superficial parotidectomy to complete gland removal depending on tumor characteristics, as recommended by the ASCO guideline 1.
- Radiation therapy may be used for malignant tumors, either as primary treatment or adjuvant therapy, with considerations for systemic therapy in metastatic disease 1.
- The most recent and highest quality study, published in 2023, emphasizes the importance of MRI in the staging and post-therapy assessment of head and neck cancer, including salivary gland tumors, due to its superior soft tissue contrast resolution 1.
Lifestyle Modifications
- Lifestyle modifications, including adequate hydration, avoiding tobacco and alcohol, and maintaining good oral hygiene, are important supportive measures for all salivary gland disorders to promote gland function and prevent complications.
- Botulinum toxin injections (typically 15-75 units) can effectively treat conditions like sialorrhea (excessive salivation).
By prioritizing the most recent and highest quality evidence, the primary approach to treating salivary gland disorders should focus on a multidisciplinary strategy that includes medical, surgical, and lifestyle modifications, tailored to the specific condition and patient needs.
From the FDA Drug Label
Pilocarpine hydrochloride tablets are indicated for 1) the treatment of symptoms of dry mouth from salivary gland hypofunction caused by radiotherapy for cancer of the head and neck; and 2) the treatment of symptoms of dry mouth in patients with Sjogren’s Syndrome. The treatment options for salivary gland disorders include pilocarpine hydrochloride tablets, which can increase secretion by the exocrine glands, including the salivary glands.
- Key benefits of pilocarpine hydrochloride tablets include:
- Relief of dry mouth symptoms
- Increased salivary flow
- Improvement in global assessment of dry mouth
- Important considerations:
- Dose-related smooth muscle stimulation of the intestinal tract may cause increased tone, increased motility, spasm, and tenesmus
- The most common adverse events related to drug, and increasing in rate as dose increases, were sweating, nausea, rhinitis, diarrhea, chills, flushing, urinary frequency, dizziness, and asthenia 2 2 2
From the Research
Treatment Options for Salivary Gland Disorders
The treatment options for salivary gland disorders vary depending on the underlying cause and severity of the condition. Some of the treatment options include:
- Conservative management, such as oral analgesics and antibiotics, for asymptomatic or minimally symptomatic salivary stones 3
- Surgical management, including salivary lithotripsy, basket retrieval, and sialendoscopy, for larger stones or those that cause significant symptoms 3
- Sialendoscopy, a gland-sparing technique, for obstructive and nonobstructive disorders 4
- Removal of the stone or surgical removal of the whole salivary gland in some cases 5
Management of Salivary Stones
The management of salivary stones is focused on removing the stone and preserving salivary gland function, which depends on the size and location of the stone. Some of the therapeutic options include:
- Conservative management, such as salivary gland massage and the use of sialogogues 5
- Removal of the stone or surgical removal of the whole salivary gland in some cases 5
Salivary Gland Dysfunction
Salivary gland dysfunction can be caused by various diseases and medications, leading to oral problems such as xerostomia, dental caries, and fungal infections 6. Diagnosis and management of salivary gland tumors are also important aspects of salivary gland disorders, with guidelines available for the workup and management of tumors of the major and minor salivary glands 7
Underlying Causes and Risk Factors
Salivary gland disorders can be caused by various underlying factors, including: