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Sialadenitis - Causes, Diagnosis, and Treatment

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Can the salivary glands swell? How do you know if the salivary gland is infected? Read the below-given article to get an insight into sialadenitis.

Medically reviewed by

Dr. Sneha Kannan

Published At March 30, 2022
Reviewed AtSeptember 19, 2022

Overview:

Sialadenitis refers to an infection in the salivary gland. It develops when harmful bacteria or viruses build up in the salivary glands. Sialadenitis can also stem from a blockage in the salivary duct, causing inflammation. Salivary gland infections are most commonly developed in the parotid gland that is in front of the ear and the submandibular gland, which is located under the chin.

What Is Sialadenitis?

Sialadenitis refers to a condition that is characterized by inflammation of one or more of the salivary glands. The term “sial” refers to saliva, “aden” refers to a gland, and “itis” refers to inflammation. Sialadenitis can be acute or chronic and is usually associated with pain, tenderness, and localized swelling of the affected area.

Sialadenitis usually affects a single parotid gland and is most commonly reported in individuals between the ages of 50 to 60 years. However, it can occur at any age. It can even be seen in a newborn. It is otherwise known as salivary gland inflammation or adenitis.

Acute sialadenitis is usually caused by a bacterial infection which is characterized by rapid onset of pain and swelling, and chronic sialadenitis is characterized by intermittent recurrent episodes of tender swelling.

What Causes Sialadenitis?

What exactly causes sialadenitis is still not clear. The following conditions play a role in causing sialadenitis:

Salivary Gland Stone Formation:

The condition is mostly associated with the formation of salivary gland stones. Salivary glands secrete saliva through the small ducts present in the mouth, helping with the lubrication inside of the mouth, and it also moistens and softens the food. The antibacterial properties of the saliva and its speedy flow nature through the ducts help in preventing infections. And there are a plethora of factors such as dehydration, illnesses, or certain medications that can reduce the salivary flow causing the deposits to settle on the walls of the salivary duct blocking the path of the salivary flow, thereby slowing down the flow of saliva. Eventually, these deposits result in the formation of salivary stones; a condition referred to as sialolithiasis.

These salivary stones, over time, can block the duct allowing the bacteria to move from the mouth into the salivary ducts causing inflammation of the salivary ducts.

Drugs that reduce the salivary flow are:

  • Antihistamines.

  • Diuretics.

  • Psychiatric medications.

  • Beta-blockers.

  • Barbiturates.

Bacteria or Viruses:

Sialadenitis is usually caused by bacteria or viruses. And most commonly, sialadenitis is caused by bacterial infections caused by Staphylococcus aureus. Other bacteria that contribute to the development of sialadenitis include Streptococci, Coliforms, and various other anaerobic bacteria.

Sialadenitis is less commonly caused by viruses compared to bacteria. Some of the viruses that can play a role in the development of sialadenitis include mumps virus, HIV (human immunodeficiency virus), coxsackievirus, parainfluenza type I and type II, herpes, and influenza virus.

The risk factors that increase the risk of developing sialadenitis include:

Symptoms of sialadenitis

How Do I Know If I Have Sialadenitis?

The following signs and symptoms are noticed in the case of sialadenitis:

  • Swelling of one or more salivary glands, which represents swelling in the cheek and the neck region.

  • Tenderness and redness in the affected area.

  • Fever, particularly when the inflammation leads to infection.

  • Chills.

  • Decreased saliva.

  • Dry mouth (xerostomia).

  • Pain while chewing.

  • Pus discharge into the mouth.

How Is Sialadenitis Diagnosed?

Sialadenitis is diagnosed by a combination of thorough medical history and complete physical examination. In most cases, sialadenitis is diagnosed during the physical examination of the face and neck. However, a few diagnostic tests may be recommended to determine the underlying cause. Some of these include:

  • Complete Blood Count (CBC):

This diagnostic test is done to examine the presence of infection.

  • Culture Sensitivity Tests:

The discharge from the salivary duct is cultured, and an antibiotic sensitivity test is done to check if there is a bacterial infection.

  • Sialendoscopy:

This is an endoscopic procedure done to examine the salivary gland ducts.

  • Dental X-rays:

Dental X-rays help determine obstruction in the salivary gland.

  • Computed Tomography (CT) or Ultrasound:

This helps determine blockages in the salivary gland due to salivary stone formation or tumors.

How Is Sialadenitis Treated?

Sialadenitis is treated based on the underlying cause of the infection.

  • If the infection is caused by bacteria, then antibiotics will be the treatment of choice. When the infection does not respond to antibiotic therapy, then the abscess is drained.

  • If the virus is the underlying cause, then the treatment includes antiviral medications.

  • Besides that, since sialadenitis is caused due to decreased salivary flow, the patients are requested to drink plenty of fluids or eat foods that increase the salivary flow, like candies or lemon juice.

  • Warm compresses and gland massage are recommended to improve the flow of saliva.

  • In recurring cases of sialadenitis or in case of a chronic condition, or when the infection does not start to respond to hydration and intravenous (IV) antibiotic therapy, surgery is recommended. Surgical incision, drainage of the salivary gland will be done, and if salivary stones are blocking the glands, then the stones will also be removed surgically. Sialendoscopy is a minimally invasive procedure used to manage small salivary stones, whereas in the case of large salivary stones open surgery procedure is suggested. In a few cases, surgical removal of the entire gland or superficial parotidectomy or submandibular gland excision is recommended.

What Is the Outlook for Sialadenitis?

The overall prognosis of sialadenitis depends on the etiology. However, with proper treatment, the symptoms of acute sialadenitis resolve within a week. And in most cases, sialadenitis resolves with conservative medical management, and the complications are not very common but can occur.

Conclusion:

Sialadenitis can be in different forms: acute or chronic, and the symptoms may vary from person to person depending on the severity of the condition. So contact a dentist when your symptoms do not respond to home care treatment and interfere with eating, chewing, and swallowing. However, acute sialadenitis rarely causes additional complications.

Frequently Asked Questions

1.

What Is Submandibular Gland Sialadenitis?

The salivary gland produces saliva to help swallow and digest food. There are three types of salivary glands: parotid, submandibular, and sublingual glands. The submandibular gland is present under the chin. Its inflammation is referred to as submandibular gland sialadenitis. It leads to swelling, tenderness, redness in the neck region, fever, chills, pain while eating, and dry mouth.

2.

How Do I Know if It Is Chronic Sialadenitis?

The inflammation of one or more salivary glands due to an infection is called sialadenitis. The parotid and submandibular glands are more commonly affected. It is of two forms:
- Acute Sialadenitis: It is an inflammation of the salivary glands caused mainly due to bacterial infection. It causes sudden tenderness, swelling, and redness (erythema) over the affected area.
- Chronic Sialadenitis: The swelling of the salivary gland occurs in episodes; less painful than in acute form, and erythema is not usually observed. It happens due to underlying conditions such as salivary gland stone, changes in the fluid and electrolyte levels in the gland, etc.

3.

What Can Be Done to Reduce Sialadenitis?

Sialadenitis is caused by a viral or bacterial infection or other conditions (salivary gland stone). The management depends on the etiology of sialadenitis, and it includes the following:
- Warm compresses and massage are given over the affected area.
- Hydration- Drinking plenty of water and fluids or sucking a candy aids in increasing the salivary flow.
- Antibiotics are suggested to decrease the swelling and pain in case of bacterial infection.
- Antiviral drugs are provided to manage viral infection.
- Surgery is planned if the inflammation does not subside with medications. It includes- incision of the gland and draining of the infection; removing salivary gland stone if present.

4.

Is Sialadenitis Serious?

Sialadenitis causes swelling, pain, redness, fever, chills, and pain in chewing. It usually resolves with conservative or medical management within one week. Rarely, if left untreated, it leads to the following:
- Salivary gland abscess- The salivary gland infection leads to pus formation if not treated properly. It is then treated with incision and drainage.
- Cellulitis- The bacterial infection spreads to the surrounding skin to cause cellulitis.
- Ludwig’s angina- The infection from the glands rarely spreads to the floor of the mouth. It causes pain, swelling under the tongue, and difficulty swallowing and breathing.

5.

Is Sialadenitis Treated With Antibiotics?

Sialadenitis is the enlargement and inflammation of the salivary gland. A bacterial infection more commonly causes the acute form. The chronic form of sialadenitis is recurrent and is caused by conditions like salivary gland stone and decreased salivary flow. Sialadenitis is most often treated with antibiotics to reduce swelling and pain. Drinking plenty of fluids, lemon juice, and sucking a hard candy also increases the salivary flow. However, antibiotics do not help treat sialadenitis caused by a virus.

6.

When Does Sialadenitis Heal?

The swelling of the salivary glands due to a bacterial infection requires antibiotic treatment to heal quickly. The swelling usually subsides with gentle massage and warm compresses over the active region. Drinking plenty of fluids also improves salivation and decreases the symptoms. The acute form of sialadenitis resolves in one week. The sialadenitis caused by viral infection requires seven to 10 days to subside with medication.

7.

How Is Sialadenitis Caused?

The inflammation of the salivary glands occurs due to the following factors:
- Bacterial or Viral Infection- Bacteria like Staphylococcus aureus and Streptococci are more commonly involved in causing salivary gland infection. Rarely viruses like paramyxovirus (mumps), influenza, and human immunodeficiency virus (HIV) also cause sialadenitis.
- Salivary Gland Stone- The salivary gland secretes saliva to the oral cavity via duct. Specific factors like medication and dehydration decrease the salivary flow and cause the formation of deposits in the salivary glands. Later the deposits get hardened to form stones in the gland. It leads to a dry mouth, and the bacteria enter the gland via the blocked duct to cause infection.

8.

How Do You Get Rid of Sialadenitis?

The sialadenitis is managed as follows:
- Conservative treatment- Gentle massage and warm compress is given over the affected area. Lemon juice and candies are taken to increase the salivary flow. Drinking excess fluids is also essential in managing sialadenitis.
- Medical treatment- Antibiotic therapy is considered the first line of treatment to manage sialadenitis. If a virus causes the salivary gland infection, antiviral medications are suggested.
- Surgical treatment- Incision of the salivary gland to drain the abscess is considered if it does not resolve with medications. Rarely the removal of the whole gland is also done.

9.

What Are the Risk Factors for Sialadenitis?

The inflammation of salivary glands is caused by bacteria, viruses or salivary gland stones, and other conditions. It causes pain, swelling, and redness in the affected region. The factors that increase the risk of developing sialadenitis are listed down:
- Sjogren’s syndrome is an immune disorder that causes dry mouth and dry eyes. In addition, the decreased salivary flow increases the chances of sialadenitis.
- When given to treat certain conditions, prolonged radiation therapy also causes dry mouth, thus predisposing to sialadenitis.
- Chronic conditions like HIV (human immunodeficiency virus) and diabetes also increase the risk of salivary gland infection.
- Increased age- Individuals over 60 can develop salivary gland infections.
Poor oral hygiene.
Dr. Chithranjali Ravichandran
Dr. Chithranjali Ravichandran

Dentistry

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