Thursday, July 6, 2006

Dear Dr. Mady: My father is now sixty-seven years old and was recently told that he may have something known as sialolithiasis. He is experiencing constant pain and swelling under his tongue and a panorex x-ray was taken and something white was seen on it. Could you tell me exactly what this means, if it is cancerous and what can be done if he does have this?-Nelson in River Canard

Dear Nelson: Sialolithiasis is a medical term for a stone or stones in a salivary gland or it’s duct. There are three pairs of these glands that each one of us possesses. The submandibular and sublingual types are found in the floor on the mouth and the parotid are the larger ones found in the cheeks.

This condition occurs when there is the formation of calcium concretions within the duct or it’s gland. The submandibular glandular system develops this problem most often because it’s saliva has increased amounts of minerals such as calcium and phosphate salts (compared with the others), the saliva is more viscous (thicker) and the gland itself is situated beneath it’s orifice, so it is flowing upward against gravity.

The stones may partially or completely block the salivary flow from these glands and as a result pain and swelling in the affected gland may be experienced. This occurs especially when eating because saliva flow is most stimulated at this time. This swelling may show under the chin if the submandibular or sublingual glands are involved or in front of the ear if the parotid gland is swollen.

Individuals with salivary gland stones may suffer from xerostomia or dry mouth due to diminished saliva but some cases are almost absent of symptoms. A dentist or oral surgeon can usually confirm diagnosis by palpation (feeling) over the orifice of the ducts in your mouth and palpation of the glands themself in combination with x-rays. If these tests are unremarkable, other imaging techniques are routinely used including sialography, ultrasound and CT scans.

Although there is no real known prevention for sialolithiasis there are treatments that usually result in success. Manual manipulation of the stone by a dentist or oral surgeon may relieve the obstruction by pushing or squeezing the stone out of the duct. In some cases this is not possible and surgical incision may be recommended for removal. If the stone is directly inside of the gland or if these stones become a severe and recurrent problem, surgical removal of the gland itself may be indicated.

There is no known prevention for salivary duct stones. They can be uncomfortable but not usually dangerous and are not related to cancer, although this disease could separately affect a salivary gland in certain individuals. I think that if your dad does not get it treated he may face the increased risk of gland infection, which could lead to further prolonged complications.


This column is reprinted with the permission of the author and The Windsor Star. "Ask the Dentist" is written by Windsor dentist (and ECDS member), Dr. David Mady Jr.. The column appears the first Thursday of each month in the Windsor Star. Readers with questions can write to "Ask The Dentist", c/o The Windsor Star, 167 Ferry St., Windsor Ontario, N9A 4M5



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