Sialadenosis is an asymptomatic, bilateral enlargement of salivary glands which most commonly affects the parotid glands. Dental practitioners must be able to differentiate gland enlargement to inflammatory, autoimmune and neoplastic processes to prevent unnecessary management and allow for correct referrals to specialists. Adipose replacement has been recognised as an uncommon feature of sialadenosis that may be linked to several systemic conditions; however, fatty infiltration of the glands to the degree of this case report has been rarely presented. The authors report on an unusual presentation of sialadenosis with extensive adipose replacement in the parotid glands, and review on the current literature for associated causes, clinicopathological features, various diagnostic tools and the appropriate management of sialadenosis.