Sialadenitis and Sialadenosis: Causes, Diagnosis, and Oral Management

Introduction

Submandibular salivary glands are important glands in the mouth that can get inflamed for different reasons. Sialadenitis and sialadenosis are the two common causes of this inflammation. But they have different causes and treatments. This article explains the differences in their causes, diagnosis, and how they are treated.

What Is the Difference Between Sialedenitis and Sialadenosis?

Sialadenitis and sialadenosis are both salivary gland conditions characterized by glandular swellings in the orofacial region. They differ in several factors:

Nature of the Condition:

• Sialadenitis is an inflammatory condition that leads to the inflammation and enlargement of one or more salivary glands. It can manifest as an acute or chronic condition.

• Sialadenosis, conversely, is a non-inflammatory and non-neoplastic enlargement of the salivary glands, often linked to an underlying systemic disorder.

Causes:

• Bacterial or viral infections primarily cause sialadenitis. Also, salivary stones or blockages in the salivary gland ducts can trigger acute infections. Chronic inflammation may block the proper functioning of the salivary gland.

• Sialadenosis arises from systemic issues rather than infections. It is commonly associated with underlying health conditions.

Disease involvement:

• Sialadenosis typically affects the salivary glands bilaterally, meaning both sides are involved.

• While sialadenosis usually presents as bilateral, there have been rare chances of unilateral sialadenosis.

What Are the Types of Sialadenitis?

Sialadenitis is a salivary gland condition that presents in two distinct forms, each with its own characteristics:

• Acute Sialadenitis: Acute sialadenitis involves the inflammation of the salivary glands and is most commonly associated with the parotid gland. This form of sialadenitis is marked by a sudden, intensely painful onset, typically due to bacterial or viral infections. Patients with acute sialadenitis often experience rapid swelling and oral pain, typically within a few days of infection.

• Chronic Sialadenitis: Chronic sialadenitis is characterized by persistent or recurring infections of either the parotid or submandibular glands. Its recurrent nature is often linked to underlying obstructions within the glands themselves, such as calculi (salivary stones) or strictures. Clinically, chronic sialadenitis primarily presents as swelling without the oral inflammation or erythema commonly seen in the acute form.

How Sialadenitis Can Be Distinguished From Sialadenosis?

Sialadenosis distinguishes itself from sialadenitis in the following ways:

• Sialadenosis is notable for the absence of pain and inflammation associated with gland swelling.

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• Patients with sialadenosis typically present with bilateral, non-tender swelling of the salivary glands.

What Is the Prevalence Rate of Sialadenitis?

The exact prevalence of submandibular sialadenitis is not well-defined in current medical research. It accounts for roughly 10 percent of sialadenitis cases and affects about 0.001 to 0.002 percent of hospital admissions worldwide. It can occur in people of all ages and genders but is more common among the elderly and those with dehydration.

What are the Causes of Sialadenitis?

The causes of sialadenitis are:

Bacterial Infections:

• Anaerobic infections, including prevotella, fusobacterium, and peptostreptococcus.

• Polymicrobial infections, often with staphylococcus aureus as a common culprit.

• Hemophilus influenza.

• Gram-negative aerobes like Enterobacteriaceae.

Viral Induced:

• Mumps infection.

• HIV Infection.

Bacterial Infections:

• Actinomyces.

• Orofacial tuberculosis.

Obstructive Lesions:

• Sialolithiasis (salivary stones).

• Ductal strictures.

• Ductal foreign bodies, such as fish bones, hair, or glass blades.

• External compression of gland ducts, like from obstructive denture flanges.

Inflammatory Origin:

• Post-radiation therapy-induced sialadenitis.

• Contrast imaging-induced sialadenitis.

• Radioiodine treatment-induced sialadenitis.

Drug-Induced Causes:

• Medications like Phenylbutazone, Clozapine, Valproic acid, and L-asparaginase, often associated with conditions like:

  • IgG4-related disease.

  • Granulomatous sialadenitis (granulomatous inflammation of salivary tissues of the salivary gland).

  • Sarcoidosis (a systemic inflammatory disease causing the immune system to overact and make nodules).

  • Xanthogranulomatous sialadenitis (a rare chronic inflammation of organs and Systems associated with infection or obstruction).

  • Sjogren syndrome (an autoimmune disorder characterized by dry eyes and dry mouth).

Nutritional Origin:

• Bulimia nervosa (an eating disorder where secretly bench or eating large amounts of food at a time and get rid of calories in unhealthy methods) and certain eating disorders.

• Vitamin deficiencies.

• Nutrient malabsorption syndromes.

Endocrine Diseases:

• Diabetes mellitus (commonly).

• Hypothyroidism.

Metabolic Disorders:

• Central obesity.

• Liver cirrhosis (a condition in which the liver is permanently scarred and damaged affecting the proper functioning of the liver).

What Are the Causes of Sialadenosis?

Sialadenosis has distinct causes compared to sialadenitis. It often results from underlying systemic or metabolic conditions, reduced salivary secretions, or ductal obstruction.

Sialadenosis can be linked to:

• Hyposalivation: Reduced salivary flow, commonly seen in dehydrated individuals, postoperative cancer patients, those undergoing chemotherapy or radiotherapy, and individuals who are immunocompromised or undernourished.

• Systemic Medications: Certain medications like antihistamines, diuretics, beta-blockers, and others have the potential to obstruct salivary glands, leading to either sialadenitis or sialadenosis.

• Oral Hygiene: Poor oral hygiene and pre-existing dental or periodontal infections may also contribute to salivary gland obstruction, as suggested by current dental research.

What Are the Methods Used in Oral Examination and Diagnosis?

In patients affected by sialadenitis, the initial symptom preceding oral manifestations is often fever or pyrexia. During oral examination, dentists commonly observe indurated, painful, and swollen salivary glands. In many cases, cervical lymph nodes may also become inflamed (cervical lymphadenitis). Oral surgeons routinely perform glandular massage to expel any purulent saliva at the duct orifice. The diagnostic methods include:

• Diagnostic Imaging: Around 70 to 80 percent of submandibular lesions or salivary gland stones are easily detectable as radioopaque lesions. Computed tomography (CT) scans and ultrasonography are valuable tools for identifying glandular obstructions or sialoliths.

• Digital Subtraction Angiography (DSA) Sialography: For chronic or recurrent bacterial infections of the salivary glands, the preferred method is DSA (digital subtraction angiography) sialography. It helps detect sialoliths, ductal strictures, and any loss of glandular parenchyma integrity, which are characteristic features of chronic sialadenitis.

• Differential Diagnosis: It is needed to differentiate sialadenitis from more serious acinar or glandular malignancies affecting the salivary glands, typically through magnetic resonance imaging (MRI) for suspected neoplasms.

What Are the Management Options for Sialadenitis and Sialadenosis?

In most cases of sialadenitis, conservative medical treatment proves effective. Patients should avoid certain medications that can affect their salivary glands, like anticholinergic drugs or diuretics. When dealing with chronic sialadenitis, it is important to prioritize treating any other health problems, such as hypothyroidism or liver cirrhosis.

Conservative treatment approach includes:

• Hydration to ensure adequate fluid intake.

• Glandular massage aids in the expulsion of purulent saliva.

• A hot compress can be applied to the affected area.

• Symptomatic pain relief using analgesic drugs like non-steroidal anti-inflammatory drugs (NSAIDs) and sialogogue medications.

• Broad-spectrum antibiotics like Amoxicillin, Clavulanate, or Clindamycin are preferred for bacterial sialadenitis.

For chronic or recurrent cases, particularly those involving sialolithiasis:

• Salivary Gland Stone Removal: Considered through interventional sialendoscopy or direct surgical removal of the stones.

• Gland Excision: The oral and maxillofacial surgeon may recommend excision of the infected salivary gland as a last resort.

• In severe cases with persistent clinical severity (more than three episodes in a year).

For sialadenosis:

• Treatment of Underlying Cause: Addressing the root cause is key to alleviating painless swellings.

• Oral Health Education: Patients should receive guidance from their oral surgeons or dentists on proper oral hygiene practices.

Conclusion

Accurate diagnosis and proper management of glandular swelling in both sialadenitis and sialadenosis by oral surgeons are essential steps to reduce oral discomfort and distress in patients. Also, dentists and oral surgeons must distinguish benign salivary gland obstructions, as seen in sialadenitis and sialadenosis, from potentially more serious salivary gland cancers.