Diseases of the saliva

The disorders of saliva secretion can be divided into two large groups: Either too much (hypersalivation) or too little (hyposalivation) saliva is produced. An increased production of saliva occurs physiologically after the onset of reflexes that suggest food intake (smell or taste of food), but sometimes also during great arousal. Insufficient saliva production can have various causes: Some diseases are associated with restricted salivary secretion (e.g. Sjögren’s syndrome), but some drugs and therapies have the same effect.In addition to the direct consequences, the resulting dry mouth (xerostomia) usually brings about a deterioration of the tooth status, for example caries (see above).

If the amount of saliva is normal, but the composition is abnormally altered, this is called dyschyria. Salivary stones (sialolithiasis) can be from a few millimeters to centimeters in size. They are usually formed in the parotid gland of the lower jaw, less frequently in the parotid gland of the ear and most rarely in the sublingual gland.

The stones may be a chance finding in an X-ray, or may show clinical symptoms. If the stones are just large enough to fit into the ducts of the glands, they can obstruct the flow of saliva. This can result in inflammation of the salivary gland (sialadenitis).

The patient then has a swollen, painful gland. Salivary stones consist of substances that are also found in saliva. These include above all calcium carbonate and calcium phosphate.

The cause is often too little drinking. However, diseases such as cystic fibrosis or mumps can also be responsible. The composition of the saliva is different and calcium compounds can precipitate.

Therefore, a too high calcium level (hypercalcemia) is also a risk for salivary stones. The first step in treatment is to stimulate the flow of saliva to flush out the stones that are the right size (by increasing salivary production). Of course, drinking a lot helps, but also sucking sweets and chewing gum.

The ENT doctor can try to get stones out of the corridors by massaging them. Sometimes an extracorporeal shock wave therapy (ESWL) is used, as with kidney stones. Stones above a certain size can sometimes only be removed surgically.

If bacterial inflammation is suspected, an antibiotic should be prescribed. Untreated, such an inflammation can turn into an abscess or even blood poisoning. Normal saliva has a pH value of about 7.0 to 7.2.

If the current value is below this, the saliva is too acidic. Common causes are poor nutrition and heartburn (reflux). The stomach acid rises up the esophagus and leads to hyperacidity of the saliva.

There are various reasons for this, for example the altered anatomical structure of the transition from the esophagus to the stomach or obesity. Often this happens at night because the affected person is then lying in a horizontal position. Acidic saliva also attacks the gums and inflammation occurs more frequently.

Foamy saliva has too many mucins and too little liquid. This happens with dry mouth (xerostomia). Often these are older patients who drink too little and take medication that increases the dry mouth.

This can impair the sense of taste and make it difficult to speak. In addition, it can lead to increased tartar formation in those affected. Sticky saliva can occur when one suffers from dry mouth.

The saliva is too viscous and can acquire thread-sucking properties. The saliva can also have such a consistency in the morning, as people generally produce less saliva at night. Sleeping with an open mouth and snoring promote this.