Sialadenitis is the inflammation of a salivary gland. The human body contains several major salivary glands responsible for producing saliva, including the parotid glands in front of the ears, the submandibular glands beneath the jaw, and the sublingual glands under the tongue. This condition can manifest in either acute, sudden forms or chronic, recurring episodes.
Causes of Sialadenitis
Sialadenitis can arise from various factors, with infections being a frequent cause. Bacterial infections are common, often involving Staphylococcus aureus, which can ascend from the oral cavity into the salivary ducts. Other bacteria like Streptococcus, Haemophilus influenzae, and various anaerobic bacteria can also contribute. Viral infections, such as mumps, are another well-known cause, especially affecting the parotid glands. Other viruses like influenza, HIV, coxsackie, and parainfluenza can also lead to salivary gland inflammation.
A common mechanical cause is the obstruction of salivary flow, often due to salivary gland stones, known as sialolithiasis. These stones can block the ducts, causing saliva to back up and creating an environment for bacterial growth. Blockages can also result from narrowing of the ducts. Factors that reduce saliva production, such as dehydration, poor oral hygiene, and certain medications, can increase the risk of infection by allowing bacteria to proliferate.
Certain medications, including antihistamines, diuretics, and beta-blockers, can decrease salivary flow, predisposing individuals to sialadenitis. Autoimmune conditions, such as Sjögren’s syndrome, can also lead to chronic inflammation and reduced saliva production, making the glands more susceptible to infection and swelling. Radiation therapy to the head and neck or radioactive iodine treatment for thyroid cancer can also damage salivary glands and contribute to inflammation.
Symptoms to Watch For
Pain and tenderness in the affected salivary gland are primary indicators, often located under the jaw, in front of the ear, or under the tongue. This pain can intensify, particularly when eating or drinking, as these activities stimulate saliva production and put pressure on the inflamed gland. Swelling of the gland is also a common symptom, sometimes accompanied by redness and warmth of the overlying skin.
Beyond localized discomfort, individuals may experience systemic symptoms indicating an infection or broader inflammation. These can include fever and a general feeling of unwellness. A foul taste in the mouth might occur if pus drains from the infected gland into the oral cavity. The swelling and pain can also make it difficult to fully open the mouth. In some cases, the pain and swelling may recur, particularly after meals, which can indicate chronic sialadenitis or an underlying obstruction.
How Sialadenitis is Diagnosed
Diagnosing sialadenitis typically begins with a physical examination. The provider will feel the affected salivary gland to assess for swelling, tenderness, and firmness. They may also check for any discharge from the salivary duct, which can be collected for analysis. A medical history, including recent illnesses, medications, and any predisposing conditions, is also gathered to help determine the potential cause.
Imaging studies are frequently used to visualize the salivary glands and identify potential obstructions or other abnormalities. An ultrasound can help detect salivary gland stones or abscesses within the gland. For more complex cases or to rule out other conditions, computed tomography (CT) scans or magnetic resonance imaging (MRI) may be performed. While MRI provides detailed images, it might not always detect small salivary stones.
Blood tests may be ordered to check for signs of infection, such as an elevated white blood cell count. If pus can be expressed from the gland, it is often sent for Gram stain and culture to identify the specific bacteria causing the infection and determine appropriate antibiotic treatment. If an autoimmune condition is suspected, blood tests for specific antibodies might be considered.
Treatment for Sialadenitis
Treatment for sialadenitis varies depending on the underlying cause, with a primary goal of alleviating symptoms and resolving the inflammation. For bacterial infections, antibiotics are typically prescribed, often targeting common bacteria like Staphylococcus aureus. Cephalosporins or fluoroquinolones are frequently recommended as first-line antibiotics due to their effectiveness and ability to reach high concentrations in saliva. In severe cases, intravenous antibiotics might be necessary to prevent the infection from spreading.
Alongside antibiotics, supportive care measures are important for all types of sialadenitis. Applying warm compresses to the affected area can help reduce pain and swelling. Gently massaging the inflamed gland may also promote saliva drainage and reduce discomfort. Maintaining hydration by drinking plenty of fluids helps to increase saliva flow and flush out any blockages or bacteria. Improving oral hygiene, such as regular brushing and rinsing, also plays a role in managing the condition.
Stimulating saliva production can be beneficial, especially if there’s an obstruction. Sucking on sugar-free candies, lemon drops, or chewing gum can act as sialagogues, encouraging saliva flow and potentially helping to dislodge small stones. Over-the-counter pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs), can help manage pain and reduce inflammation.
If conservative measures are insufficient or if an abscess forms, surgical intervention may be required to drain the pus. For persistent salivary stones, surgical removal of the stone, often through a minimally invasive procedure called sialoendoscopy, may be performed. In chronic cases where other treatments fail, surgical removal of the affected salivary gland might be considered. Consulting a healthcare professional for proper diagnosis and a tailored treatment plan is always recommended.