Pathogenesis (disease development)
Disturbance of salivary electrolyte balance results in altered viscosity. Tougher saliva leads to mucus obstruction, resulting in outflow obstruction. As a result, sialoliths (salivary stones) are formed by precipitation of calcium compounds, as inorganic material increasingly accumulates on an inorganic core. Consecutively, there is remodeling of the ductal system, ductal ectasia (dilatation) and inflammation, proliferation and metaplasia of the ductal epithelia, ultimately atrophy of the glandular parenchyma and interstitial fibrosis.
Because the seromucous saliva produced by the submandibular gland is physiologically higher in viscosity, this gland is most commonly affected by sialolithiasis.
Etiology (Causes)
Biographic causes
- Anatomic variants – congenital gangetic ectasia possible as a predisposing factor.
- Age of life – increasing age
Behavioral causes
- Nutrition
- Nutritional disturbance of the salivary electrolyte balance.
- Too little fluid intake
Causes related to disease
- Disease-related disturbance of the electrolyte balance.
- Metabolic disorders
- Diabetes mellitus
- Diabetes insipidus – hormone deficiency-related disorder in hydrogen metabolism, resulting in extremely high urine excretion (polyuria; 5-25 l/day) due to impaired concentration capacity of the kidneys.
- Diarrhea (diarrhea)
- Marasmus – malnutrition and is also called protein-energy malnutrition (PEM).
- Nausea (nausea)
- Metabolic disorders
Medication
- The use of xerogenic drugs for long periods of time favors the development of sialadenitis due to hyposialia (decreased salivation) and secondary ascending (ascending) infection. About 400 such drugs are known. They belong to the following groups:
- Antiadiposita
- Anoretics
- Antiarrhythmics
- Anticholinergics
- Antiepileptic drugs
- Antidepressants
- Antihistamines
- Antihypertensives
- Antiparkinsonian drugs
- Antipsychotics (neuroleptics)
- Anxiolytics
- Ataractics
- Diuretics
- Hypnotics
- Muscle relaxants
- Sedatives
- Spasmolytics
