Strictly speaking, hypersalivation / drooling or sialorrhea, as it is formally known, is defined as the excessive production and/or flow of saliva outside of the oral cavity. Patients that deal with drooling typically suffer from one or more of the following conditions:
- Overproduction of saliva (hypersalivation)
- Difficulties with swallowing (dysphagia)
- Jaw issues
- Inability to effectively close the mouth (malocclusion)
Chronic drooling is a frustrating and often laborious condition for patients to live with. Physical complications of this condition as well as psychosocial concerns can significantly impact the quality of life of these patients.
Associated Conditions
Chronic drooling can be of particular concern to the following patient groups:
Neurological Disorders
- Cerebral palsy (CP)
- Parkinson’s disease
- Stroke patients
- Amyotrophic lateral sclerosis (ALS)
- Multiple sclerosis (MS)
Temporary or transient drooling can accompany the following conditions:
- GERD
- Oral infections
- Tonsil abscess
- Strep throat
- Tonsillitis
- Medication side effects
Hypersalivation Diagnosis
It is recommended that drooling be evaluated by a salivary gland specialist. These subspecialty trained physicians are adept at recognizing and treating rare conditions that affect the salivary gland system. These physicians understand that drooling can be due to a variety of conditions, medication side effects, or injuries. Recognition of the inciting condition is paramount to formulating a customized and effective treatment plan.
Comprehensive evaluation of hypersalivation consists of the following components:
- Meticulous medical history analysis
- Review of medications, supplements, and herbal therapies
- Focused physical examination
- Endoscopic salivary duct evaluation (Sialendoscopy)
- Objective measurement of salivary flow (Sialometry)
- Discussion of treatment avenues and long term goals
The hypersalivation patient frequently has a complex medical history and accompanying medication regimen. It is the responsibility of the salivary gland specialist to analyze preexisting medical conditions, ongoing medications, and any new undiagnosed symptomatology. These physicians must determine what is causing hypersalivation in order to formulate an appropriate treatment plan.
Focused physical examination enables the physician to further confirm or disprove a working diagnosis. The focused physical examination evaluates the integrity of the salivary gland system as well as adjoining anatomy for telltale signs of associated conditions. Although non-invasive, the exam assists the physician in determining what more specific procedures are required to further workup the patient’s symptoms.
Hypersalivation Treatment
Treatment for hypersalivation is highly dependent on its etiology and contributing factors. Consequently, a treatment plan must be customized for each patient’s individual case.
Hypersalivation treatment can be described as falling into one or several of the following categories:
- Avoidance of inciting factors
- Treatment of an underlying medical condition
- Symptom management
- Botox injections
- Behavioral/Postural modification
- Speech Therapy
- Minimally invasive surgical interventions
Avoidance of inciting factors is not typically possible for all patients, especially those with chronic conditions that predispose them to severe hypersalivation. Treatment of an underlying condition is typically helpful but not always possible. In these cases, symptom management can provide welcome relief, significantly increase the patient’s quality of life, and decrease dangerous complications.
Excessive or untreated hypersalivation can lead to a variety of complications especially in those with decreased or limited motor function. Of particular concern are the following issues:
- Pulmonary aspiration
- Choking
- Skin breakdown
- Psycho-social stigma
Frequently Asked Questions
What is Hypersalivation?
Hypersalivation is the excess production of saliva. Hypersalivation can lead to drooling or flow of saliva outside of the oral cavity in patients with impaired clearance or swallowing capacity.
What conditions are associated with drooling/hypersalivation?
Chronic drooling can be associated with the following conditions:
Neurological Disorders
- Cerebral palsy (CP)
- Parkinson’s disease
- Stroke patients
- Amyotrophic lateral sclerosis (ALS)
- Multiple Sclerosis (MS)
Temporary or transient drooling can be associated with the following conditions:
- GERD
- Oral Infections
- Tonsil Abscess
- Strep Throat
- Tonsillitis
- Medication side effects
What factors are associated with drooling/hypersalivation?
The following factors are associated with increased risk of drooling:
- Overproduction of saliva (hypersalivation)
- Difficulties with swallowing (dysphagia)
- Jaw issues
- Inability to effectively close the mouth (malocclusion)
How is drooling/hypersalivation evaluated?
Hypersalivation is best evaluated by a salivary gland specialist. These physicians are experts in diagnosis and treatment of rare and complicated disorders that affect the salivary glands.
A comprehensive evaluation for drooling/hypersalivation should include the following components:
- Meticulous medical history analysis
- Review of medications, supplements, and herbal therapies
- Focused physical examination
- Endoscopic salivary duct evaluation (Sialendoscopy)
- Objective measurement of salivary flow (Sialometry)
- Discussion regarding treatment avenues and long term goals
How is hypersalivation treated?
Hypersalivation treatment can be described as falling into one or several of the following categories:
- Avoidance of inciting factors
- Modifying medications that promote saliva overproduction
- Treatment of an underlying medical condition
- Symptom management
- Botox injections
- Behavioral/Postural modification
- Speech Therapy
- Minimally invasive surgical interventions
Glossary
Endoscope: A device with a camera and light source that is used to examine areas inside the body. A miniaturized endoscope is used to look inside the duct network of the salivary glands during sialendoscopy.
Hypersalivation: The excess production of saliva. Commonly referred to as drooling.
Salivary Glands: The salivary glands consist of discrete structures responsible for the production of saliva. The salivary glands include the parotid, submandibular, and sublingual glands.
Sialendoscopy: A procedure used to diagnose and treat salivary gland disease. Very small instruments and cameras are passed through the natural opening of the salivary gland to evaluate and treat issues related to the salivary gland.
Sialochemistry: The chemical analysis of saliva to determine its composition.
Sialometry: The collection and measurement of saliva for objective determination of salivary gland function.
Sialorrhea: The formal medical term for drooling or excessive salivation.
Xerostomia: A term used to refer to dry mouth.
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