Skip to main content

Does saliva composition affect the formation of sialolithiasis?

  • S A Schrøder (a1), P Homøe (a2), N Wagner (a3) and A Bardow (a4)
Abstract Objective:

Saliva composition may affect sialolithiasis formation; thus, this study compared the salivary inorganic composition of sialolithiasis patients with that of healthy controls, and determined whether salivary inorganic composition changes after sialolithiasis surgery.


The study included 40 patients with sialolithiasis and 40 matched healthy controls. Patients were examined before and after sialolithiasis surgery; controls were examined once. Flow rate and the inorganic saliva composition in unstimulated whole saliva were assessed.


Patients’ salivary flow prior to surgery was significantly lower compared to that of healthy controls, but equalised after surgery. Prior to surgery, patients’ saliva exhibited higher concentrations of calcium, magnesium, phosphorous compared to that of healthy controls. The concentration of most ions remained high after sialolithiasis surgery.


Sialolithiasis patients had increased salivary concentrations of the ions that constitute the main inorganic phase of most sialoliths, and this may confer a risk for developing sialolithiasis.

Corresponding author
Address for correspondence: Dr Stine A Schrøder, Department of Otorhinolaryngology, Nordsjaellands University Hospital, Hillerod, Denmark Fax: +45 4829 3811 E-mail:
Hide All
1 Sherman JA, McGurk M. Lack of correlation between water hardness and salivary calculi in England. Br J Oral Maxillofac Surg 2000;38:50–3
2 Escudier MP, McGurk M. Symptomatic sialoadenitis and sialolithiasis in the English population, an estimate of the cost of hospital treatment. Br Dent J 1999;186:463–6
3 Delli K, Spijkervet FK, Vissink A. Salivary gland diseases: infections, sialolithiasis and mucoceles. Monogr Oral Sci 2014;24:135–48
4 Schroder S, Homoe P, Wagner N, Vataire AL, Lundager Madsen HE, Bardow A. Does drinking water influence hospital-admitted sialolithiasis on an epidemiological level in Denmark? BMJ Open 2015;5:e007385
5 Zenk J, Constantinidis J, Kydles S, Hornung J, Iro H. Clinical and diagnostic findings of sialolithiasis [in German]. HNO 1999;47:963–9
6 Sigismund PE, Zenk J, Koch M, Schapher M, Rudes M, Iro H. Nearly 3,000 salivary stones: some clinical and epidemiologic aspects. Laryngoscope 2015;125:1879–82
7 Lustmann J, Regev E, Melamed Y. Sialolithiasis. A survey on 245 patients and a review of the literature. Int J Oral Maxillofac Surg 1990;19:135–8
8 Wilson KF, Meier JD, Ward PD. Salivary gland disorders. Am Fam Physician 2014;89:882–8
9 Witt RL, Iro H, Koch M, McGurk M, Nahlieli O, Zenk J. Minimally invasive options for salivary calculi. Laryngoscope 2012;122:1306–11
10 Harrison JD. Causes, natural history, and incidence of salivary stones and obstructions. Otolaryngol Clin North Am 2009;42:927–47
11 Marchal F, Kurt AM, Dulguerov P, Lehmann W. Retrograde theory in sialolithiasis formation. Arch Otolaryngol Head Neck Surg 2001;127:66–8
12 Huoh KC, Eisele DW. Etiologic factors in sialolithiasis. Otolaryngol Head Neck Surg 2011;145:935–9
13 Kraaij S, Karagozoglu KH, Kenter YA, Pijpe J, Gilijamse M, Brand HS. Systemic diseases and the risk of developing salivary stones: a case control study. Oral Surg Oral Med Oral Pathol Oral Radiol 2015;119:539–43
14 Yiu AJ, Kalejaiye A, Amdur RL, Todd Hesham HN, Bandyopadhyay BC. Association of serum electrolytes and smoking with salivary gland stone formation. Int J Oral Maxillofac Surg 2016;45:764–8
15 Triantafyllou A, Harrison JD, Garrett JR. Production of salivary microlithiasis in cats by parasympathectomy: light and electron microscopy. Int J Exp Pathol 1993;74:103–12
16 Carter LC. Lumps and bumps–what is that stone? Alpha Omegan 2010;103:151–6
17 Blatt IM. Studies in sialolithiasis. III. Pathogenesis, diagnosis and treatment. South Med J 1964;57:723–9
18 Grases F, Santiago C, Simonet BM, Costa-Bauza A. Sialolithiasis: mechanism of calculi formation and etiologic factors. Clin Chim Acta 2003;334:131–6
19 Nolasco P, Anjos AJ, Marques JM, Cabrita F, da Costa EC, Mauricio A et al. Structure and growth of sialoliths: computed microtomography and electron microscopy investigation of 30 specimens. Microsc Microanal 2013;19:1190–203
20 Rakesh N, Bhoomareddy Kantharaj YD, Agarwal M, Agarwal K. Ultrastructural and elemental analysis of sialoliths and their comparison with nephroliths. J Investig Clin Dent 2014;5:32–7
21 Mimura M, Tanaka N, Ichinose S, Kimijima Y, Amagasa T. Possible etiology of calculi formation in salivary glands: biophysical analysis of calculus. Med Mol Morphol 2005;38:189–95
22 Teymoortash A, Buck P, Jepsen H, Werner JA. Sialolith crystals localized intraglandularly and in the Wharton's duct of the human submandibular gland: an X-ray diffraction analysis. Arch Oral Biol 2003;48:233–6
23 Gopal R, Calvo C, Ito J, Sabine WK. Crystal structure of synthetic Mg-whitlockite, Ca18Mg2H2(PO4)14. Can J Chem 1974;52:1155–64
24 Su YX, Zhang K, Ke ZF, Zheng GS, Chu M, Liao GQ. Increased calcium and decreased magnesium and citrate concentrations of submandibular/sublingual saliva in sialolithiasis. Arch Oral Biol 2010;55:1520
25 Navazesh M, Kumar SK. Measuring salivary flow: challenges and opportunities. J Am Dent Assoc 2008;139(suppl):35S40S
26 Fried R, Hoeflmayr J, Velosy G. A new, highly sensitive method for the determination of chloride in body fluids without protein precipitation [in German]. Z Klin Chem Klin Biochem 1972;10:280
27 Bardow A, Lykkeaa J, Qvist V, Ekstrand K, Twetman S, Fiehn NE. Saliva composition in three selected groups with normal stimulated salivary flow rates, but yet major differences in caries experience and dental erosion. Acta Odontol Scand 2014;72:466–73
28 Lustmann J, Shteyer A. Salivary calculi: ultrastructural morphology and bacterial etiology. J Dent Res 1981;60:1386–95
29 Harrison JD, Triantafyllou A, Baldwin D, Garrett JR, Schafer H. Histochemical and biochemical determination of calcium in salivary glands of cat. Histochemistry 1993;100:155–9
30 Bardow A, Moe D, Nyvad B, Nauntofte B. The buffer capacity and buffer systems of human whole saliva measured without loss of CO2. Arch Oral Biol 2000;45:112
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The Journal of Laryngology & Otology
  • ISSN: 0022-2151
  • EISSN: 1748-5460
  • URL: /core/journals/journal-of-laryngology-and-otology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 16
Total number of PDF views: 84 *
Loading metrics...

Abstract views

Total abstract views: 559 *
Loading metrics...

* Views captured on Cambridge Core between 15th December 2016 - 24th January 2018. This data will be updated every 24 hours.