An overview of the diagnosis and management of non-neoplastic salivary gland pathologies

Salivary glands are vital to the maintenance of good oral health. They are exocrine glands that produce saliva, which is essential to ensure lubrication of the oral cavity, aid in the digestion of food and act as a buffer to protect the teeth. Anatomically, there are three pairs of major salivary glands, the parotid, submandibular and sublingual glands. Minor salivary glands are numerous and can be found throughout the mucosa lining the oral cavity with the exception of the gingiva. Salivary gland disease can present as a range of pathologies from stones, obstructions and infections through to benign or malignant tumours. This article focuses on non-neoplastic salivary gland pathologies, their diagnosis, management and the role of the general dental practitioner (GDP) in managing patients with salivary gland disease.

Obstructive salivary gland disease is the most common salivary gland pathology to present to general dental practitioners.¹ Patients suffering from obstructive salivary disease may complain of intermittent pain and swelling. There are two patterns. The first is related to a stone that presents classically as an acute swelling at meal times. This is typically intermittent and generally resolves over a 30-minute period after eating, as saliva gently oozes past the stone. The second is obstruction by a mucous plug, which tends to happen at breakfast or after a patient has become dehydrated, that can lead to sluggish saliva flow and plug formation. Commonly known as ‘mealtime syndrome,’ saliva production stimulated by the process or thought of eating causes a build-up of saliva in the affected gland and consequential postprandial swelling. In addition to this, after a period, patients with stones may experience repeated episodes of bacterial infections causing suppuration from the gland duct opening and possible systemic symptoms of fever and malaise. Mucous plugs seldom cause infection.