Submandibular Glands

The submandibular glands are the second-largest pair of major salivary glands in the human body, located bilaterally in the submandibular triangle of the neck, inferior to the mylohyoid muscle and the body of the mandible. Each gland produces a mixed serous and mucous secretion that is delivered into the oral cavity through the submandibular duct, also known as Wharton's duct, which traverses the floor of the mouth and opens at the sublingual caruncle near the lingual frenum. The submandibular glands are responsible for producing approximately 60 to 70 percent of the total unstimulated salivary output, making them the dominant contributors to the resting salivary flow that continuously bathes the oral tissues.

The submandibular glands are clinically relevant in dental practice because of their susceptibility to several pathological conditions. Sialolithiasis, the formation of calcified stones within the salivary duct or gland parenchyma, occurs most frequently in the submandibular gland due to the upward course of its duct against gravity and the higher mineral content of its secretion. Stones can cause intermittent painful swelling that intensifies during eating when salivary flow increases, and complete obstruction can lead to secondary infection known as sialadenitis. Other conditions affecting the submandibular glands include benign and malignant neoplasms, autoimmune sialadenitis associated with conditions such as Sjogren syndrome, and medication-induced hypofunction contributing to xerostomia. Palpation of the submandibular glands during the extraoral examination is a standard component of the complete dental evaluation.

For billing and practice management teams, conditions of the submandibular glands identified during dental examinations may generate additional diagnostic and referral activity. When a patient presents with submandibular swelling or pain, the evaluation is typically coded as a limited problem-focused examination rather than a periodic or complete evaluation, as the visit is driven by a specific chief complaint. Diagnostic imaging ordered to evaluate the gland, such as cone beam computed tomography or panoramic radiographs, is billable with documentation of the clinical indication. Referral to an oral and maxillofacial surgeon for stone removal, gland excision, or biopsy should be documented in the patient record along with the clinical findings that prompted the referral. Practices that conduct thorough extraoral examinations including gland palpation at every evaluation visit are better positioned to identify salivary gland pathology early and demonstrate complete diagnostic care in the clinical record.