In today's episode of "strange medical case studies from around the world," doctors in India recently came across a man with tooth pain who was suspected of having an impacted tooth. However, on closer inspection, they realized the unusual structure in his mouth wasn’t actually a trapped tooth, but a colossal salivary gland stone.

Writing in the BMJ Case Reports, the clinicians report that the 37-year-old man arrived at a private dental practice with complaints of acute pain and swelling in his lower jaw. An X-ray revealed the presence of a hard growth below his premolar teeth, which the clinicians initially suspected could be an impacted tooth, a trapped tooth has been blocked from breaking through the gum. 

But when they carried out an ultrasound scan of his jaw, doctors saw a very different picture. The ultrasonography revealed the growth was actually a mass of crystallized minerals that was lodged in his salivary gland, known as a sialolith.

Salivary gland stones are typically just 2 to 10 millimeters in size, rarely larger than a lentil, but this specimen was at least 2 centimeters (0.8 inches) in length. As the study notes, salivary glands stones that measure over 1.5 centimeters are extremely rare and are defined as “giant sialoliths”.

Salivary gland stones are a calcified mass that can gather in the salivary gland of the mouth under the tongue. They can occur for a number of reasons, but they’re typically associated with dehydration, smoking tobacco, or a mouth infection. There’s also some evidence that suggests it can be caused by food debris, bacteria, or foreign bodies becoming stuck in the salivary gland, causing it to produce a calcium abnormally. 

They’re typically no great threat to your health, but they can cause a fair amount of pain, swelling, and occasional infection. 

To remove the sialolith, people are advised to suck on a lemon to stimulate the salivary gland, drink a lot of water, or gently message around the stone. However, if the stone is large, doctors might remove it using a blunt instrument or even surgery. In this case, the man’s salivary gland stone was removed using a blunt instrument. All's well that ends well.