Salivary Gland Obstruction
Saliva is produced in various glands in the head and neck. There are three major sets of salivary glands. The first are located on either side of the face extending around the sides of the jaw and in front of the ear, also called the parotid glands. The second set is located underneath the lower jaw on the side of the neck, called the submandibular (under the mandible or lower jaw in Latin) gland. The last set is located right underneath the tongue (can be felt under the chin), called the sublingual (under the tongue in Latin) gland. The saliva then drains through various ducts (pipes) to openings in the mouth. The parotid glands drain into the inside of the cheeks right by the second (one before last) molar tooth. The submandibular glands drain on either side of the front of the tongue. The sublingual glands drain right in the center under th tip of the tongue. The salivary glands are continuously producing saliva, but are stimulated and more active at the sight or smell of food and the presence of something in the mouth. The strongest stimulus for the production of saliva and the propulsion/pumping of the gland and duct are sour foods and liquids.
Just like the pipes in your house, the salivary ducts can become blocked or plugged. When this happens, there is a back up of saliva and the glands become swollen. Once there is a blockage, the bacteria from the mouth can cause an infection of the gland and result in significant pain, swelling and tenderness over the cheek or under the jaw line.
Blockage of the salivary gland is typically from thickening of the saliva, a decrease in salivary flow and/or the presence of a stone. These issues most commonly occur when someone is dehydrated and not taking in enough fluids. The most commonly affected gland is the submandibular gland because it secretes very thick saliva and has a kinked piping (duct) which can easily be clogged. Many medications can lead to a decrease in the production of saliva. An elevation in calcium or other electrolyte abnormalities can also contribute. Occasionally, other underlying medical problems can contribute and may be evaluated by the doctor.
Signs and symptoms that you may have a blocked salivary gland:
- swelling in the cheek or under the jaw line, especially if there are fluctuations related to food intake
- sour or bitter taste in the mouth
Signs or symptoms that you may have an infection of a salivary gland:
- redness or warmth in addition to swelling in the cheek or under the jaw line
- fever, chills
If the gland is blocked +/-infected, pain medications can help alleviate the discomfort and antibiotics may be used to kill the bacteria, but the plumbing must be cleared for the problem to resolve. In order to clear the blockage, you must:
- drink plenty of fluids
- avoid dehydrating situations and foods (saunas, strenuous work outs, caffeine, alcohol, etc…)
- massage the gland to stimulate the flow of saliva
- “milk” the gland from back to front (in the direction of the duct) to plunge the blocked area
- apply warm compresses
- take sour candies, suck on lemons/limes to stimulate saliva production and flow
- anti-inflammatory medications may be prescribed (Advil, Motrin, Ibuprofen, Aleve, Aspirin)
These recommendations can sometimes be uncomfortable to perform but are still necessary to clear the problem. Just like plunging any pipe, a certain amount of pressure needs to be built up to clear the obstruction. Once clear, if proper care is not taken, another obstruction can occur.