Your salivary glands are in your mouth. You have three pairs of major salivary glands and hundreds of small (minor) glands. They make saliva (spit) and empty it into your mouth through openings called ducts. Saliva makes your food moist, which helps you chew and swallow. It helps you digest your food. It also cleans your mouth and contains antibodies that can kill germs.

Problems with salivary glands can cause them to become irritated and swollen. You may have symptoms such as

• A bad taste in your mouth
• Difficulty opening your mouth
• Dry mouth
• Pain in your face or mouth
• Swelling of your face or neck

Causes of salivary gland problems include infections, obstruction, or cancer. Problems can also be due to other disorders, such as mumps or Sjogren's syndrome.

Salivary glands are located in the mouth. There are three pairs of large salivary glands. Parotid glands are found in front of and just below each ear. Submandibular glands are below the jaw. Sublingual glands are under the tongue. There are also hundreds of smaller glands. These glands make saliva (spit) and empty it into the mouth through openings called ducts. Saliva makes food moist, which helps chewing and swallowing and the digestion of food. Saliva also keeps the mouth clean and healthy because it contains antibodies that kill germs.

If the salivary glands are damaged or aren’t producing enough saliva it can affect taste, make chewing and swallowing more difficult, and increase the risk for cavities, tooth loss, and infections in the mouth.

Sjogren's syndrome is an autoimmune disease. This means that your immune system attacks parts of your own body by mistake. In Sjogren's syndrome, it attacks the glands that make tears and saliva. This causes a dry mouth and dry eyes. You may have dryness in other places that need moisture, such as your nose, throat, and skin. Sjogren's can also affect other parts of the body, including your joints, lungs, kidneys, blood vessels, digestive organs, and nerves.

Most people with Sjogren's syndrome are women. It usually starts after age 40. It is sometimes linked to other diseases such as rheumatoid arthritis and lupus.

To make a diagnosis, doctors may use a medical history, physical exam, certain eye and mouth tests, blood tests, and biopsies.

Treatment focuses on relieving symptoms. It can differ for each person; it depends on what parts of the body are affected. It may include artificial tears for dye eyes and sucking on sugar-free candy or drinking water often for a dry mouth. Medicines may help with severe symptoms.

Your salivary glands make saliva - sometimes called spit - and empty it into your mouth through openings called ducts. Saliva makes your food moist, which helps you chew and swallow. It helps you digest your food. It also cleans your mouth and contains antibodies that can kill germs.

Salivary gland cancer is a type of head and neck cancer. It is rare. It may not cause any symptoms, or you could notice:

• A lump in your ear, cheek, jaw, lip, or inside the mouth
• Fluid draining from your ear
• Trouble swallowing or opening the mouth widely
• Numbness, weakness, or pain in your face

Doctors diagnose salivary gland cancer using a physical exam, imaging tests, and a biopsy. Treatment can include surgery, radiation therapy, and/or chemotherapy.

Mumps is an illness caused by the mumps virus. It starts with

• Fever
• Headache
• Muscle aches
• Tiredness
• Loss of appetite

After that, the salivary glands under the ears or jaw become swollen and tender. The swelling can be on one or both sides of the face. Symptoms last 7 to 10 days. Serious complications are rare.

You can catch mumps by being with another person who has it. There is no treatment for mumps, but the measles-mumps-rubella (MMR) vaccine can prevent it.

Before the routine vaccination program in the United States, mumps was a common illness in infants, children and young adults. Now it is a rare disease in the U.S.

What is saliva?

Saliva, or spit, is made by your salivary glands. It helps keep you and your mouth healthy. For example:

• It moistens and breaks down the foods you eat, which makes it easier for you to chew and swallow.
• It washes away small food pieces from your teeth and gums, which helps fight against tooth decay.
• It contains minerals such as calcium and phosphate, which can also help fight tooth decay.
• It contains antibodies that can fight against infections of the mouth and throat. Antibodies are proteins that your immune systemmakes to fight foreign substances such as viruses and bacteria.

What is dry mouth?

Having dry mouth, also called xerostomia, means that you don't have enough saliva to keep your mouth wet. Everyone has a dry mouth once in a while, like when you are nervous or stressed. But if you have a dry mouth all or most of the time, it can be uncomfortable. It can make chewing, swallowing, and even talking difficult. It also raises your risk for tooth decay or infections in the mouth.

What causes dry mouth?

There are many possible causes of dry mouth, including:

• Side effects of certain medicines, such as some medicines for high blood pressure, depression, and bladder-control issues
• Diseases such as Sjogren's syndrome, HIV, salivary gland disorders, and diabetes
• Radiation therapy, which can damage your salivary glands if they are exposed to radiation during the treatment
• Chemotherapy, which can make your saliva thicker and cause your mouth to feel dry
• Nerve damage, when it involves the nerves that tell salivary glands to make saliva
• Breathing through your mouth
• Use of alcohol, tobacco, or other substances

What are the symptoms of dry mouth?

The symptoms of dry mouth may include:

• A sticky, dry feeling in your mouth
• Trouble chewing, swallowing, tasting, or speaking
• A burning feeling in your mouth
• A dry feeling in your throat
• Cracked lips
• A dry, rough tongue
• Mouth sores
• An infection in your mouth
• Bad breath

How is the cause of dry mouth diagnosed?

If you have dry mouth, it's important to find out the cause. To do that, your health care provider or dentist will review your medical history, examine your mouth, and ask about any medicines you take. They may also suggest blood tests or a test that measures how much saliva you produce.

What are the treatments for dry mouth?

Treatment for dry mouth depends on the cause. For example, if a medicine is causing dry mouth, your provider or dentist may suggest adjusting the dosage or switching medicines. In some cases, they might give you artificial saliva or a medicine to help your salivary glands work better.

There are also several things you can do to help relieve your symptoms:

• Drink plenty of water
• Avoid drinks with caffeine, which can dry out your mouth
• Chew sugarless gum or suck on sugarless hard candy to stimulate saliva flow
• Avoid spicy or salty foods because they can cause pain if your mouth is dry
• Avoid alcohol and tobacco
• Using a humidifier at night
• Use a mouthwash made for dry mouth

Since dry mouth can raise your risk of tooth decay, it's important to brush and floss your teeth regularly and see your dentist at least twice a year.

The Salivary Glands

Many small salivary glands are housed within the mucous membranes of the mouth and tongue. These minor exocrine glands are constantly secreting saliva, either directly into the oral cavity or indirectly through ducts, even while you sleep. In fact, an average of 1 to 1.5 liters of saliva is secreted each day. Usually just enough saliva is present to moisten the mouth and teeth. Secretion increases when you eat, because saliva is essential to moisten food and initiate the chemical breakdown of carbohydrates. Small amounts of saliva are also secreted by the labial glands in the lips. In addition, the buccal glands in the cheeks, palatal glands in the palate, and lingual glands in the tongue help ensure that all areas of the mouth are supplied with adequate saliva.

The Major Salivary Glands

Outside the oral mucosa are three pairs of major salivary glands, which secrete the majority of saliva into ducts that open into the mouth:

• The submandibular glands, which are in the floor of the mouth, secrete saliva into the mouth through the submandibular ducts.
• The sublingual glands, which lie below the tongue, use the lesser sublingual ducts to secrete saliva into the oral cavity.
• The parotid glands lie between the skin and the masseter muscle, near the ears. They secrete saliva into the mouth through the parotid duct, which is located near the second upper molar tooth (Figure).

Saliva

Saliva is essentially (98 to 99.5 percent) water. The remaining 4.5 percent is a complex mixture of ions, glycoproteins, enzymes, growth factors, and waste products. Perhaps the most important ingredient in saliva from the perspective of digestion is the enzyme salivary amylase, which initiates the breakdown of carbohydrates. Food does not spend enough time in the mouth to allow all the carbohydrates to break down, but salivary amylase continues acting until it is inactivated by stomach acids. Bicarbonate and phosphate ions function as chemical buffers, maintaining saliva at a pH between 6.35 and 6.85. Salivary mucus helps lubricate food, facilitating movement in the mouth, bolus formation, and swallowing. Saliva contains immunoglobulin A, which prevents microbes from penetrating the epithelium, and lysozyme, which makes saliva antimicrobial. Saliva also contains epidermal growth factor, which might have given rise to the adage “a mother’s kiss can heal a wound.”

Each of the major salivary glands secretes a unique formulation of saliva according to its cellular makeup. For example, the parotid glands secrete a watery solution that contains salivary amylase. The submandibular glands have cells similar to those of the parotid glands, as well as mucus-secreting cells. Therefore, saliva secreted by the submandibular glands also contains amylase but in a liquid thickened with mucus. The sublingual glands contain mostly mucous cells, and they secrete the thickest saliva with the least amount of salivary amylase.

Salivary glands The major salivary glands are located outside the oral mucosa and deliver saliva into the mouth through ducts.

HOMEOSTATIC IMBALANCES

The Parotid Glands: MumpsInfections of the nasal passages and pharynx can attack any salivary gland. The parotid glands are the usual site of infection with the virus that causes mumps (paramyxovirus). Mumps manifests by enlargement and inflammation of the parotid glands, causing a characteristic swelling between the ears and the jaw. Symptoms include fever and throat pain, which can be severe when swallowing acidic substances such as orange juice.

In about one-third of men who are past puberty, mumps also causes testicular inflammation, typically affecting only one testis and rarely resulting in sterility. With the increasing use and effectiveness of mumps vaccines, the incidence of mumps has decreased dramatically. According to the U.S. Centers for Disease Control and Prevention (CDC), the number of mumps cases dropped from more than 150,000 in 1968 to fewer than 1700 in 1993 to only 11 reported cases in 2011.

Regulation of Salivation

The autonomic nervous system regulates salivation (the secretion of saliva). In the absence of food, parasympathetic stimulation keeps saliva flowing at just the right level for comfort as you speak, swallow, sleep, and generally go about life. Over-salivation can occur, for example, if you are stimulated by the smell of food, but that food is not available for you to eat. Drooling is an extreme instance of the overproduction of saliva. During times of stress, such as before speaking in public, sympathetic stimulation takes over, reducing salivation and producing the symptom of dry mouth often associated with anxiety. When you are dehydrated, salivation is reduced, causing the mouth to feel dry and prompting you to take action to quench your thirst.

Salivation can be stimulated by the sight, smell, and taste of food. It can even be stimulated by thinking about food. You might notice whether reading about food and salivation right now has had any effect on your production of saliva.

How does the salivation process work while you are eating? Food contains chemicals that stimulate taste receptors on the tongue, which send impulses to the superior and inferior salivatory nuclei in the brain stem. These two nuclei then send back parasympathetic impulses through fibers in the glossopharyngeal and facial nerves, which stimulate salivation. Even after you swallow food, salivation is increased to cleanse the mouth and to water down and neutralize any irritating chemical remnants, such as that hot sauce in your burrito. Most saliva is swallowed along with food and is reabsorbed, so that fluid is not lost.

Obstruction: Small stones that form in the gland ducts may obstruct the flow of saliva. The gland may swell and become painful and infected. Small constrictions or twists in the duct system of the large salivary glands can also decrease salivary flow.

Infection: When saliva pools behind an obstruction in a duct, the gland can become infected. Infection of the lymph nodes from a sore throat or cold can also cause a secondary infection in the salivary glands.

Tumors: Tumors usually appear as painless enlargements in one of the salivary glands. Malignant (cancerous) tumors often grow quickly, may or may not be painful, and may cause loss of movement in the affected side of the face.

Other Disorders: Diseases such as HIV-AIDS, and autoimmune disorders such as Sjögren's syndrome and rheumatoid arthritis, can make the salivary glands inflamed and painful. Diabetes may also cause enlargement of the salivary glands. Alcoholics may have salivary gland swelling, usually on both sides.

Problems with salivary glands can cause them to become irritated and swollen. You may have symptoms such as:

• a bad taste in your mouth
• difficulty opening your mouth
• dry mouth
• pain in your face or mouth
• swelling of your face or neck or under your tongue

A doctor uses your medical history, a physical examination, and laboratory tests to make a diagnosis of a salivary disorder.

If your doctor suspects your pain and inflammation are the result of an obstruction in one of the glands, he or she may order X-rays or ultrasound to identify where the obstruction is and what might be causing it.

If a mass is found in the salivary gland, your doctor will suggest a CT scan or an MRI to get a better look at the problem. Your doctor might also use a fine needle aspiration biopsy to explore further. A lip biopsy of minor salivary glands may be needed to identify certain autoimmune diseases, such as Sjögren’s syndrome.

Salivary disorders are treated according to what is causing them, using medical or surgical treatments. If the salivary disorder is caused by systemic disease (diseases that involve the whole body) then that problem is treated first. This may require a visit to a specialist. If the problem is due to salivary gland obstruction, your doctor might use a local anesthetic to numb the area so that they can probe and dilate the duct to remove the obstructive stone.

If a tumor has developed within the salivary gland, your doctor may recommend its removal. You may be referred to an otolaryngologist (commonly known as an ear, nose, and throat doctor) who performs surgery. Most tumors in the parotid gland area are benign (noncancerous). If a tumor is cancerous, it will be surgically removed and the area treated with radiation therapy afterwards.

Removal of a salivary gland doesn’t affect overall saliva production, but radiation therapy often causes dry mouth, which can increase your risk for cavities and mouth infections. Here are some tips to keep your mouth moist:

• Drink plenty of fluids throughout the day and take a water bottle with you wherever you go.
• Keep your mouth clean. Rinse your mouth before and after meals with plain water and brush your teeth after meals.
• Avoid foods that stick to the roof of the mouth like peanut butter or soft bread.
• Take small bites, and chew your food well.
• Suck on sugarless candy or chew sugarless gum to stimulate saliva.
• Avoid commercial mouthwashes, alcoholic and acidic drinks, and tobacco.
• Use over the counter saliva substitutes to add moisture to your mouth.