Salivary calculus – Sialolith

Calculus is medically meant for any abnormal concretion of mineral salts formed inside the body. ‘Sial’ refers to salivary gland and ‘Sialolith’ refers to salivary gland calculus. Tendency to salivary calculus or formation of salivary calculus is termed as ‘Sialolithiasis’. Stone formation can obstruct the pathway and cause infection and pain in the glands. The obstruction can be complete or partial.

Three pairs of salivary glands produce saliva persistently and dispense them into the mouth through ducts almost continuously, i.e., even at night time (during sleep) to keep the mouth moist. Saliva constitutes mainly water, salts, electrolytes, waste products of body (urea, uric acids, acetone, etc.) and epithelial cells. It is the first digestive juice of the digestive tract which helps to breakdown the food particles to get dissolved and digested easily. It also makes the food bolus to swallow easily. Salivary calculus is a type of salivary gland disorder where normal saliva flow is interrupted (partially or totally) to cause dryness of mouth, pain in salivary gland with or without altered taste in the mouth.

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Incidences – The incidence of stone formation in the salivary glands seems to be more in males than females. The reason is unknown. The commonest age group which suffers most frequently is 30-50. The salivary calculus is most commonly seen in Wharton’s duct (draining duct of submandibular gland which opens to the floor of the mouth). The stone formation in submandibular gland or duct is more common because of its thick saliva and its draining way (i.e., against gravity) compared to other glands (parotid and sublingual glands).

Causes - The major constituent of salivary calculus is calcium. Calculus commonly forms in the glands and gets obstructed in the ducts. The exact reason why a stone forms is really unknown. Anyhow, researchers can find out various factors which can favour the formation of stones. They are:

• Thick saliva - highly concentrated saliva (concentrated more with calcium, mucin, magnesium, etc.) – may be because of dehydration or super-saturation or salivary gland diseases.

• Changes in saliva PH (saliva PH gets altered in infections or diseases or tumours)

• Saliva inadequate drainage – slowness in flow and stagnation with obstructive flow or in case of infection, will encourage precipitation of salivary salts to form stones.

Symptoms – Many a time, most of the salivary stones remain asymptomatic. Usually, symptoms occur when stone(s) happen to move and block a duct. Mostly stone(s) do not block a duct completely. So there won’t be any need for emergency attention. Even if it blocks completely, saliva from remaining glands cope up with the need / digestion in the mouth. So complaints arise only when the affected gland swells more drastically or gets infected. The common symptoms of salivary calculus are:

• Swelling of the affected gland(s) – usually follows more after food intake or while chewing since additional amount of saliva is often produced in salivary glands to break down the intake of food materials in the mouth. Swelling may be persistent or vary in size from time to time.

• Pain – occurs mostly because of swelling and pressure. So, as like swelling, which increases after food or taking citrus fruits (which induces more saliva production / flow and swelling), pain also increases with food intake or taking citrus fruits.

• Dryness of mouth (occasionally) – due to lack of saliva

• Halitosis – due to drying of thick saliva

• Altered taste in mouth

Diagnosis - Perfect diagnosis can be made from

• Clinical examination

• Radiological imaging studies with the help of X-rays / ultrasound / CT or MRI scans

• Sialoangiography – radiography of duct after injecting radio opaque materials.

• Sialoendoscopy can aid for diagnosis as well as for removal

• Chemical analysis of calculus (which have been expelled on their own or removed by surgery) can provide a clue in identifying the underlying causative factor and can aid in preventing it in future.

Complications

• Chronic infections

• Recurrence of stones

• Fibrosis of the gland

Preventive measures and management

Drink

• Plenty of water – good hydration often helps to ease the condition and further helps to stop stone formations

Avoid

• High sources of calcium diets - meat, dairy products, cheese, poultry, fish, calcium supplements, ice creams, chocolates, tea.

• Citrus fruits like orange, lemon, tomato, etc. – These items can increase saliva production, which in-turn can cause swelling and pain in the blocked gland.

General treatment - Treatment varies depending on size and location of the stone. Rarely, stone gets expelled on its own into the mouth. Otherwise sialolithotomy (removal of salivary calculus) will be tried with any of the following according to the condition:

• Lithotripsy (shock wave treatment) – to break stones to expel them easily in parts.

• Sialoendoscopy can aid in removal – if necessary, (in case of big stone whose size exceeds the duct size) intracorporeal lithotripsy aid can also be sought for breaking stones to force easy removal.

• Sialolithectomy – total removal of gland will be advised in case of multiple stones or recurrent infections.

• Intraoral open surgery to remove obstructed (big and adhered) stone.

In case of salivary stones, Allopathy mostly directs everyone to opt for surgical solution. Allopathy mode of treatment mostly prescribes a course of antibiotics with analgesics during the initial, infective and painful condition i.e. for temporary palliation / to ease the condition and then simply go for elective surgery to avoid an emergency surgery in future. The advantageous endoscopic surgery without scar and minimal hospital stay makes every patient opt for removal of salivary calculus by surgical option.

Homoeopathic approach - These days, people keep worrying about their health and go for surgery sometimes even unnecessarily. Even for minor ailments, they get admitted to a hospital to rule out all (?) risk factors. Removing just stones or the salivary gland cannot be taken as elimination of the whole disease since stones are only the effects of the disease and not the disease itself. So, the stone-forming tendency will be there in the body and the disease will move or proceed to other places/parts. The best way to stop occurrence/recurrence of stones is to treat the condition and to prevent the formation of stones in future.

Calculus formation in salivary glands, like renal stones/gall stones, can arise to form tendencies. Homoeopathic medicine can stop this stone-forming tendency by enforcing salivary gland to work properly and more efficiently, so that it can produce good quality (composition) saliva and have good flow. Homeopathy treats patient with its constitutional approach considering the characteristic symptoms of the patient and the disease. Surgery can be avoided in many cases of salivary stones if one follows homeopathic medicines regularly for the prescribed period as per the direction of the Homeopath but in advanced conditions, where stone is enormously large and adhered, surgery may be the only way.

Simply put, the earlier you treat, you get easy, speedy and complete cure. There are many drugs in Homoeopathy which can help relieve pain, expel stones and associated complaints. The most commonly used homeopathic drugs in case of salivary calculus are Alumen, Apis mel, Ars alb, Baryta mur, Belladona, Beri beri vulgaris, Borax, Bryonia, Calcarea Carbonica, Cantharis, China, Colocynthis, Hydrastis, Lachesis, Lycopodium, Mag phos, Nat Sulph, Nux mos, Nux Vom, Pulsastilla, etc. These medicines should be taken under the advice and diagnosis of a Qualified Homeopath.