Saliva & Salivary Gland Disorders

Overview

Salivary glands are located in the mouth. There are three pairs of large salivary glands. Parotid glands are found in front of and just below each ear. Submandibular glands are below the jaw. Sublingual glands are under the tongue. There are also hundreds of smaller glands. These glands make saliva (spit) and empty it into the mouth through openings called ducts. Saliva makes food moist, which helps chewing and swallowing and the digestion of food. Saliva also keeps the mouth clean and healthy because it contains antibodies that kill germs.

If the salivary glands are damaged or aren’t producing enough saliva, it can affect taste, make chewing and swallowing more difficult, and increase the risk for cavities, tooth loss, and infections in the mouth.

Causes

Multiple medications: Use of multiple medications by older adults can result in dry mouth as a side effect.

Tumors: Tumors usually appear as painless enlargements in one of the salivary glands. Malignant (cancerous) tumors often grow quickly, may or may not be painful, and may cause numbness or loss of movement in the affected side of the face. Although the causes of salivary gland cancers are not known, risk factors include older age, treatment with radiation to the head and neck, some types of chemotherapy, and being exposed to certain substances at work.

Obstruction: Small stones that form in the gland ducts may obstruct the flow of saliva. The gland may swell and become painful and infected. Small constrictions or twists in the duct system of the large salivary glands can also decrease salivary flow.

Infection: When saliva pools behind an obstruction in a duct, the gland can become infected. Infection of the lymph nodes from a sore throat or cold can also cause a secondary infection in the salivary glands.

Other Disorders: Diseases such as HIV-AIDS, and autoimmune disorders such as Sjögren's disease and rheumatoid arthritis, can make the salivary glands inflamed and painful. Diabetes may also cause enlargement of the salivary glands. People with an alcohol use disorder may have salivary gland swelling, usually on both sides of the face.

Symptoms

Problems with salivary glands can cause them to become irritated and swollen. Symptoms may include:

• A bad taste in your mouth.
• Difficulty opening your mouth.
• Dry mouth.
• Fluid draining from the ear.
• Pain in your face or mouth.
• Numbness or weakness in the face.
• Swelling of your face or neck or under your tongue.
• Lump in the area of the ear, cheek, jaw, lip, or inside the mouth.

Diagnosis

A doctor uses your medical history, a physical examination, and laboratory tests to make a diagnosis of a salivary disorder.

If your doctor suspects your pain and inflammation are the result of an obstruction in one of the glands, he or she may order X-rays or an ultrasound to identify where the obstruction is and what might be causing it.

If a mass is found in the salivary gland, your doctor will suggest a CT scan or an MRI to get a better look. Your doctor might also perform a fine needle aspiration biopsy to remove a small amount of tissue or fluid and check for cancer cells. A lip biopsy of minor salivary glands may be needed to identify certain autoimmune diseases, such as Sjögren’s disease.

Treatment

Salivary disorders are treated according to what is causing them. If the salivary disorder is caused by systemic disease (diseases that involve the whole body) then that problem is treated first. This may require a visit to a specialist. If the problem is due to salivary gland obstruction, your doctor might use a local anesthetic to numb the area so that s/he can probe and dilate the duct to remove the obstructive stone.

If a tumor has developed within the salivary gland, your doctor may recommend its removal. You may be referred to an otolaryngologist (commonly known as an ear, nose, and throat doctor) who performs surgery. Most tumors in the parotid gland area are benign (noncancerous). If a tumor is cancerous, it will be surgically removed and the area treated with radiation therapy and/or, in some cases, chemotherapy.

Helpful Tips

Removal of a salivary gland doesn’t affect overall saliva production, but radiation therapy often causes dry mouth, which can increase your risk for cavities and mouth infections. Here are some tips to keep your mouth moist:

• Drink plenty of fluids throughout the day and take a water bottle with you wherever you go.
• Keep your mouth clean. Rinse your mouth before and after meals with plain water and brush your teeth after meals.
• Avoid foods that stick to the roof of the mouth like peanut butter or soft bread.
• Take small bites and chew your food well.
• Suck on sugarless candy or chew sugarless gum to stimulate saliva.
• Avoid commercial mouthwashes, alcoholic and acidic drinks, and tobacco.
• Use over-the-counter saliva substitutes to add moisture to your mouth.

Additional Resources

• MedlinePlus: Salivary Gland Disorders
  The NIH National Library of Medicine's collection of links to government, professional and nonprofit/voluntary organizations with information on salivary gland disorders.
• Salivary Gland Cancer Treatment (Adult) (PDQ®)–Patient Version
  Information from the National Institutes of Health's (NIH) National Cancer Institute about the causes, symptoms, diagnosis, and treatment of salivary gland cancer.
• NINDS Sjögren's Information Page
  A fact sheet from the NIH National Institute of Neurological Disorders and Stroke on treatment and prognosis for people with Sjögren's and current research on the disease.
• NIAMS Sjögren's Information Page
  A fact sheet from the NIH National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) about Sjögren's.
• MedlinePlus: Sjögren's Information Page
  The NIH National Library of Medicine's collection of links to government, professional and nonprofit/voluntary organizations with information on Sjögren's.
• Adenoid Cystic Carcinoma Research Foundation
  The Foundation’s mission is to accelerate the development of improved therapies and a cure for patients with adenoid cystic carcinoma, which is cancer of the secretory glands.
• Sjögren’s Foundation
  This organization provides education, resources, and services for people living with this autoimmune disease, including information about ongoing clinical trials of therapies and links to support groups for patients and families.
• Support for People with Oral and Head and Neck Cancer, Inc.
  This group provides patient and family education, opportunities to connect with cancer patients and survivors, and access to a National Survivor Volunteer Network as well as chapter support groups.