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Salivary gland obstruction or infection

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Brief description of the condition

Blockage of salivary duct due to obstruction or infection. Inflammation of the salivary glands (sialadenitis) can be caused by bacterial or viral infections, salivary stones or autoimmune diseases, with risk factors including immunosuppression, certain medical conditions such as diabetes, and dehydration.

Key signs and symptoms

  • Pain located in a major salivary gland
  • Swelling
  • History of xerostomia (dry mouth)
  • Dehydration
  • Fever

Initial management

Determine if the patient has a salivary gland obstruction or infection, which may represent or be associated with systemic infection, or whether the patient might have mumps.

If there is infection, indicated by acute gland pain or acute episode of chronic persistent gland pain (does not fluctuate with meal times), erythema, severe symptoms, systemically unwell, bilateral or unilateral parotid swelling with fever (this also may be associated with mumps):

  • Recommend optimal analgesia (see Analgesia).
  • Advise the patient to seek urgent medical or dental care.

If mumps is suspected, i.e. a young patient (less than 21 years of age) experiencing swelling at the side of the face under the ear(s), systematically unwell and has a raised temperature:

  • Recommend optimal analgesia.
  • Advise the patient to avoid spread of infection by staying at home.
  • Refer for urgent medical care (mumps is a notifiable disease).

If there is obstruction without infection (major salivary glands), indicated by intermittent pain and swelling, typically within an hour of meal times, then subsiding without erythema or fever (suspected salivary gland calculus):

  • Recommend optimal analgesia (see Analgesia).
  • Advise the patient to drink plenty of fluids if experiencing dry mouth.
  • Advise the patient to seek urgent dental care.

If there is obstruction without infection (minor salivary glands), usually a small, localised swelling as a result of trauma (mucocele) that often discharges spontaneously:

  • Advise the patient to seek non-urgent dental care.

In all of the above cases, if the patient is systemically unwell or there is a history of diabetes, advise the patient to seek urgent medical care.

If there is unexplained swelling of the parotid gland or other major salivary glands present for 3 weeks or more, refer the patient for urgent care via the local Urgent Suspicion of Cancer (USC) referral pathway (oral and maxillofacial surgery) to investigate potential malignancy.37

  • Note that criteria for suspected cancer referrals may differ across the UK.
  • Healthcare professionals who are unable to make an Urgent Suspicion of Cancer referral should direct patients to a dental or medical healthcare professional who can.

Subsequent care

Refer to an oral surgeon or oral and maxillofacial surgeon, as appropriate to the condition, if symptoms persist.

If additional symptoms emerge (e.g. enlarging mass, facial weakness), refer the patient for urgent care from an oral and maxillofacial surgeon.

Consider referral for further investigation to identify the underlying cause of dry mouth.

Consider surgical removal of persistent mucoceles or referral to an oral surgeon or an oral and maxillofacial surgeon.