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`Something prickly` beneath the tongue

9th December 2011
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Rohas Sadimoti, to be referred as Roh for all purpose of this column, is a 26 year old young male of Asian origin who came into the Dental Clinic for ‘something weird and irritating’ that he wanted to show to the Dental Surgeon (DS).

As he sat in the Dental chair Rohas said, “Doctor in reality I have no pain or any major complaint. It looks as if the under side of my tongue is constantly rubbed against. It is a prickly feeling.” The DS instructed Rohas, “Take the tip of your tongue to the left side.”

The patient tilted his tongue to reveal its right lateral side. With the same angular slant on the right side the tongue the left lateral side came into view. The DS said, “The lower side surfaces of your tongue are normal”.

The DS raised the tip of tongue to check the front ventral area. A calculur mass yellowish brown in colour was seen attached to the mucosa below the tongue about the floor of the mouth. It was a concretion possibly formed by the deposition of calcium salts. The composition of the calculus resembles that of tartar found on the surfaces of teeth.

Rohas however had a calcular deposit, also called salivary duct stone, which must have been expelled from the duct and remained attached to the mucosa.

The DS tried to extricate the salivary duct stone carefully with the tweezers. The stone partially broke into pieces, The DS took hold of the stone with two tweezers in two hands. The stone was removed without any dramatic effect.

The DS said, “This condition is also referred to as sialolithiasis. This simply means occurrence of calcareous deposits in the salivary gland. There are patients with involvement of a duct of a major salivary gland.

These patients may complain of moderately severe pain if the duct is blocked. The blockage of the duct prevents free flow of saliva. The saliva, stagnating in the duct may create pressure and produce pain and swelling. Fortunately there is no such obstruction in your case.

It is a clear cut case of expulsion of the stone. In some individuals a large number of small stones may be found blocking the salivary duct system. In your case palpation has been done of the area and there are no more stones”.

Deposits of calculus in the salivary ducts may occur at any age, but is most common in middle aged adults. About 64 per cent of cases are associated with the sub maxillary gland and duct, 20 percent with the parotid gland and duct, and about 16 percent are connected with the sublingual gland and duct.

The sialoleith or salivary duct stone removed from Rohas’s mouth was elongated and rough. It measured about 0.5 cm by 0.3 cm. The average composition of the calcular deposit consists of calcium phosphate 74.3%, calcium carbonate 11.1%, soluble salts 6%, organic matter 6.2% and water 2.2%.

Rohas’s case was unique in that the DS had not seen a sialolith in his clinical dental practice since 1973. He had carried out supragingival and subgingival scaling (cleaning) and polishing of complete mouths of more than 2,500 patients. Removal of tartar and stains was the focused aim of this procedure.

With cleanliness and hygiene of the patients restored they went about their daily chores with equipoise but conscious of the fact that this would have to be an annual routine.

Rohas’s mucosa from which the salivary stone was removed was tinged with a mild dabbing of iodine. The area was covered with a little gauze. Rohas was told to discard the gauze after five to seven minutes placement in the mouth so that iodine would not spill all over the mouth.

Rahas was told, “If you have anything as weird and irritating fitting your original description of the sialolith please do not hesitate to call the Dental Surgery”.

It is about one year now. Rohas Sadimoti is totally freed of sialolithiasis.

SOURCE: THE GUARDIAN
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