Salivary Gland Problems

Your salivary glands make as much as a quart of saliva each day. Saliva is important to lubricate your mouth, help with swallowing, protect your teeth against bacteria, and aid in the digestion of food. The three major pairs of salivary glands are:

• parotid glands on the insides of the cheeks
• submandibular glands at the floor of the mouth
• sublingual glands under the tongue

There are also several hundred minor salivary glands throughout the mouth and throat. Saliva drains into the mouth through small tubes called ducts.

When there is a problem with the salivary glands or ducts, you may have symptoms such as salivary gland swelling, dry mouth, pain, fever, and foul-tasting drainage into the mouth.

Causes of Salivary Gland Problems

Many different problems can interfere with the function of the salivary glands or block the ducts so they can't drain saliva. The following are some of the more common salivary gland problems:

Salivary stones, or sialoliths. The most common cause of swollen salivary glands, salivary stones are buildups of crystallized saliva deposits. Sometimes salivary stones can block the flow of saliva. When saliva can't exit through the ducts, it backs up into the gland, causing pain and swelling. Pain is usually off and on, is felt in one gland, and gets progressively worse. Unless the blockage is cleared, the gland is likely to become infected.

Salivary gland infection, or sialadenitis. Bacterial infection of the salivary gland, most commonly the parotid gland, may result when the duct into the mouth is blocked. Sialadenitis creates a painful lump in the gland, and foul-tasting pus drains into the mouth.

Sialadenitis is more common in older adults with salivary stones, but it can also happen in babies during the first few weeks after birth. If not treated, salivary gland infections can cause severe pain, high fevers, and abscess (pus collection).

Infections. Viral infections such as mumps, flu, and others can cause swelling of the salivary glands. Swelling happens in parotid glands on both sides of the face, giving the appearance of "chipmunk cheeks."

Salivary gland swelling is commonly associated with mumps, happening in about 30% to 40% of mumps infections. It usually begins approximately 48 hours after the start of other symptoms such as fever and headache.

Other viral illnesses that cause salivary gland swelling include the Epstein- Barr virus (EBV), cytomegalovirus (CMV), Coxsackievirus, and the human immunodeficiency virus (HIV).

Bacterial infections generally cause one-sided salivary gland swelling. Other symptoms such as fever and pain will accompany the swelling. The bacteria are typically those found normally in the mouth, as well as staph bacteria. These infections most often affect the parotid gland. Dehydration and malnutrition raise the risk of getting a bacterial infection.

Cysts. Cysts can develop in the salivary glands if injuries, infections, tumors, or salivary stones block the flow of saliva.Some babies are born with cysts in the parotid gland due to a problem with the development of the ears. It can appear as a blister or soft, raised area. Cysts may interfere with eating and speaking.

Tumors. Several different types of tumors can affect the salivary glands. They can be cancerous (malignant) or noncancerous (benign). The two most common tumors are pleomorphic adenomas and Warthin's tumor.

Pleomorphic adenomas most commonly affect the parotid glands, but can also affect the submandibular gland and minor salivary glands. The tumor is usually painless and grows slowly. Pleomorphic adenomas are benign (noncancerous) and are more common in women than men.

Warthin's tumor is also benign and affects the parotid gland. Warthin's tumor can grow on both sides of the face and affects more men than women.

While most salivary gland tumors are benign, some can be cancerous. Malignant tumors include mucoepidermoid carcinoma, adenocystic carcinoma, adenocarcinoma, low-grade polymorphous adenocarcinoma, and malignant mixed tumor.

Sjögren's syndrome. This is a chronic autoimmune disease in which cells of a person's immune system attack the salivary and other moisture-producing glands, leading to dry mouth and eyes.

About half of people with Sjögren's syndrome also have enlargement of the salivary glands on both sides of the mouth, which is usually painless.

Treatment for Salivary Gland Problems

Treatment for salivary gland problems depends on the cause.

For stones and other blockages of the ducts, treatment often begins with measures such as manual removal of stones, warm compresses, or sour candies to increase the flow of saliva. If simple measures don't relieve the problem, surgery may be required to remove the blockage and/or the affected gland.

Surgery is usually required to remove benign and malignant tumors. Some benign tumors are treated with radiation to keep them from coming back. Some cancerous tumors require radiation and chemotherapy. Surgery may also be needed to treat large cysts.

Other problems may be treated with medications. For example, bacterial infections are treated with antibiotics. Medications can also be prescribed for dry mouth.

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