These gems are formed in the saliva discharge channels in big saliva glands underneath the chin.  They block and deadlock and hinder the saliva to discharge and therefore to swell up the salivary gland.  Especially when sour and acidic nutrition is taken saliva secretion escalate. This secretion cannot flow out through this channel and accumulated therefore results in a painful swelling. In general people who drink less water and do inadequate in mouth care, calcium and phosphate existing in saliva structure forms residue and accumulate in the canal.

When the patient arrives in with a painful swelling, primarily the patient is medicated (antibiotics-antispasmodics-antienflamatuars-gargling) and pain and swelling is eliminated.  If the canal is completely blocked these medicines comfort the patient.

Examination and ultrasound is enough for diagnosis.  Gems that completely block the canal are removed without a surgery but with a toothpick sized camera through the mouth or removed together with the salivary gland with a little cut underneath the chin