Drooling

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: ptyalism; sialorrhea; hyper salivation; hypersalivation

Overview

Drooling is when saliva flows outside the mouth. Drooling is generally caused by excess production of saliva, inability to retain saliva within the mouth, or problems with swallowing.

Some people with drooling problems are at increased risk of inhaling saliva, food, or fluids into the lungs. However, this is unlikely to cause harm, unless the body's normal reflex mechanisms (such as gagging and coughing) are also impaired.

Isolated drooling in infants and toddlers is normal and is unlikely to be a sign of either disease or complications. It may be associated with teething. Drooling in infants and young children may be exacerbated by upper respiratory infections and nasal allergies.

Drooling associated with fever or trouble swallowing may be a sign of a more serious disease including:

• Retropharyngeal abscess
• Peritonsillar abscess
• Tonsilitis
• Mononucleosis
• Strep throat
• Parkinson's disease

A sudden onset of drooling may indicate poisoning (especially by pesticides) or reaction to snake or insect venom or in some cases of a numbed mouth from either orajel, or when going to the dentist office. Some medications can cause drooling as well such as the pain reliveing orajel medication. Some neurological problems also cause drooling. Excess Capsaicin can cause drooling as well, an example being the ingestion of particularly high Scoville Unit chili peppers.

Another form of ptyalism is associated with pregnancy, most common in women with a condition known as Hyperemesis Gravidarium, or uncontrollable and frequent nausea and vomiting during pregnancy which is far worse than typical "morning sickness". With Hyperemesis, ptyalism is a side-effect, which is a natural response to uncontrollable vomiting. With normal vomiting, salivary glands are stimulated to lubricate the esophagus and mouth to aid in expelling of stomach contents. During a hyperemetic pregnancy, many woman complain of excessive saliva and an inability to swallow this saliva. Some women note having to carry around a "spitoon" or using a cup to spit. Swallowing their own saliva has been noted to gag and further nauseate the women making the hyperemesis that much worse.

There are several theories as to the causes of hyperemesis and related symptoms such as ptyalism. Many physicians are reluctant to treat hyperemesis since they don't see it as a true physiological illness but rather "in the patient's mind" [note: this is an old fashioned view and the medical community now considers hyperemesis as a real and serious physiological condition]. Many pregnant women who suffer end up terminating the pregnancy. Others refuse to carry another child. The most frequent act is preparing for the onset of hyperemesis if a subsequent pregnancy is expected.

Causes

Common Causes

• Retropharyngeal abscess
• Peritonsillar abscess
• Tonsilitis
• Mononucleosis
• Strep throat
• Parkinson's disease
• Epiglottitis
• Enlarged adenoids
• Dentures that are new or don't fit well
• Bell's palsy
• Cerebral Palsy

Causes by Organ System

Cardiovascular	No underlying causes
Chemical / poisoning	Mexican tea poisoning , Mercury poisoning , Mayapple poisoning , Marsh marigold poisoning , Jonquil poisoning , Jessamine poisoning Copper , Buttercup poisoning , Bush lily poisoning , Balsam apple poisoning , Arsenic poisoning , Antimony , Amaryllis poisoning, Achillea ptarmica
Dermatologic	No underlying causes
Drug Side Effect	Voriconazole , Radiation Therapy, Pyridostigmine , Procyclidine , Potassium Chlorate, Pilocarpine, Nicotine nasal spray , Loratadine , Iodide, Galantamine , Donepezil, Clozapine (Clozaril), clonazepam (Klonopin), Clobazam, carbidopa-levodopa, Bromide
Ear Nose Throat	Swollen adenoids , Strep throat , Retropharyngeal Abscess , Peritonsillar abscess , Epiglottitis , Enlarged adenoids
Endocrine	No underlying causes
Environmental	No underlying causes
Gastroenterologic	Stomatitis , Sialorrhea , Pancreatitis , Oral suppurative lesions, Oral infectious Lesions , Oral chemical burns , Motion sickness , Macroglossia, Liver disease , Heartburn or GERD (reflux) , Gastroesophageal Reflux , Gastric distention or irritation , Esophageal food bolus obstruction , Esophageal atresia , Endoscopic foreign body retrieval , Aphthous Ulcers , Acute Gastritis or Gastric Ulcer
Genetic	Fragile X syndrome , Down syndrome, Autism
Hematologic	No underlying causes
Iatrogenic	No underlying causes
Infectious Disease	Tuberculosis , Tonsillitis , Syphilis, Small Pox , Sinus infections ,Rabies , Mumps, Mononucleosis , Infection in your mouth or throat , Foot-and-mouth disease , Diphtheria , Chronic sinusitis , Chancre , Botulism , Boston Ivy poisoning , Alveolar abscess , Acute sinusitis , Actinomycosis
Musculoskeletal / Ortho	Sarcoma of the jaw , Jaw Fracture or dislocation , Bone Lesions , Ankylosis of the Temporomandibular Joint
Neurologic	Tonic-Clonic seizure , Tonic seizure , Stroke , Spastic paraplegia , Rolandic Epilepsy , Right parietal lobe syndrome related Alzheimer's disease , Pseudobulbar paralysis , Parkinson disease , Myasthenia Gravis ,Multiple sclerosis , Mixed Cerebral Palsy , Microcephaly , Mental retardation , Juvenile Primary Lateral Sclerosis , Hypotonia , Hypoglossal Nerve palsy , Guillain-Barre syndrome , Familial dysautonomia , Epilepsy and Ataxia Syndrome , Dementia , Cerebrovascular Accident , Cerebral Palsy, Bulbar Paralysis , Bilateral Facial Nerve Palsy , Bell's palsy , Athetoid Cerebral Palsy , Amyotrophic lateral sclerosis
Nutritional / Metabolic	Excessive starch intake
Obstetric/Gynecologic	Pregnancy
Oncologic	Epulis
Opthalmologic	No underlying causes
Overdose / Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	No underlying causes
Renal / Electrolyte	No underlying causes
Rheum / Immune / Allergy	No underlying causes
Sexual	No underlying causes
Trauma	No underlying causes
Urologic	No underlying causes
Dental	No underlying causes
Miscellaneous	Smith-Magenis Syndrome , Segawa syndrome , autosomal recessive , Schwartz-Jampel Syndrome , Pregnancy , Mobius syndrome , Hyperemesis Gravidarum , Foix-Chavany-Marie syndrome , Dog odor , Dentures that are new or don't fit well , Dental malocclusion , Dental implant , Dental Caries , Cantharides , Angelman-Like Syndrome , Allergies

Causes in Alphabetical Order

• Achillea ptarmica

• Actinomycosis

• Acute Gastritis or Gastric Ulcer

• Acute sinusitis

• All signs and symptoms

• Allergies

• Alveolar abscess

• Amaryllis poisoning

• Amyotrophic lateral sclerosis

• Angelman-Like Syndrome

• Ankylosis of the Temporomandibular Joint

• Antimony

• Aphthous Ulcers

• Arsenic poisoning

• Athetoid Cerebral Palsy

• Autism

• Balsam apple poisoning

• Bell's palsy

• Bilateral Facial Nerve Palsy

• Bone Lesions

• Boston Ivy poisoning

• Botulism

• Bromide

• Bulbar Paralysis

• Bush lily poisoning

• Buttercup poisoning

• Cantharides

• carbidopa-levodopa

• Cerebral Palsy

• Cerebrovascular Accident

• Chancre

• Chronic sinusitis

• clonazepam (Klonopin)

• Clozapine (Clozaril

• Copper

• Dementia

• Dental Caries

• Dental implant

• Dental malocclusion

• Dentures that are new or don't fit well

• Diphtheria

• Dog odor

• Donepezil

• Down syndrome

• Endoscopic foreign body retrieval

• Enlarged adenoids

• Epiglottitis

• Epilepsy and Ataxia Syndrome

• Epulis

• Esophageal atresia

• Esophageal food bolus obstruction

• Excessive starch intake

• Familial dysautonomia

• Foix-Chavany-Marie syndrome

• Foot-and-mouth disease

• Fragile X syndrome

• Galantamine

• Gastric distention or irritation

• Gastroesophageal Reflux

• Guillain-Barre syndrome

• Heartburn or GERD (reflux)

• Hyperemesis Gravidarum

• Hypoglossal Nerve palsy

• Hypotonia

• Infection in your mouth or throat

• Iodide

• Jaw Fracture or dislocation

• Jessamine poisoning

• Jonquil poisoning

• Juvenile Primary Lateral Sclerosis

• Liver disease

• Loratadine

• Macroglossia

• Marsh marigold poisoning

• Mayapple poisoning

• Mental retardation

• Mercury poisoning

• Mexican tea poisoning

• Microcephaly

• Mixed Cerebral Palsy

• Mobius syndrome

• Mononucleosis

• Motion sickness

• Mountain Laurel poisoning

• Multiple sclerosis

• Mumps

• Myasthenia Gravis

• Nicotine nasal spray

• Nicotine poisoning

• Oral chemical burns

• Oral infectious Lesions

• Oral suppurative lesions

• Organophosphate insecticide poisoning

• Pallidotomy

• Pancreatitis

• Parkinson disease

• Peritonsillar abscess

• Pilocarpine

• Poisoning (pesticides)

• Potassium Chlorate

• Pregnancy

• Procyclidine

• Pseudobulbar paralysis

• Pyridostigmine

• Rabies

• Radiation Therapy

• Rattlesnake bite

• Reaction to snake or insect venom

• Retropharyngeal Abscess

• Right parietal lobe syndrome related Alzheimer's disease

• Rolandic Epilepsy

• Sarcoma of the jaw

• Sarin

• Schwartz-Jampel Syndrome

• Sea urchin poisoning

• Segawa syndrome, autosomal recessive

• Sialorrhea

• Sinus infections

• Skunk cabbage poisoning

• Small Pox

• Smith-Magenis Syndrome

• Spastic paraplegia

• Split-leaf philodendron poisoning

• Stomatitis

• Strep throat

• Stroke

• Swollen adenoids

• Syphilis

• Tonic seizure

• Tonic-Clonic seizure

• Tonsillitis

• Tuberculosis

• Voriconazole

• X-linked Ataxia Telangiectasia

Achillea ptarmica

Alveolar abscess

Amaryllis poisoning

Amyotrophic lateral sclerosis

Angelman-Like Syndrome,

Ankylosis of the Temporomandibular Joint

Antimony

Aphthous Ulcers

Arsenic poisoning

Athetoid Cerebral Palsy

Autism

Balsam apple poisoning

Bell's palsy

Bilateral Facial Nerve Palsy

Bone Lesions

Boston Ivy poisoning

Botulism

Bromide

Bulbar Paralysis

Bush lily poisoning

Buttercup poisoning

Cantharides

carbidopa-levodopa

Cerebral Palsy

Cerebrovascular Accident

Chancre

Chronic sinusitis

clonazepam (Klonopin),

Clozapine (Clozaril)

Copper

Dementia

Dental Caries

Dental implant

Dental malocclusion

Dentures that are new or don't fit well

Diphtheria

Dog odor

Donepezil (patient information)

Down syndrome

Endoscopic foreign body retrieval

Enlarged adenoids

Epiglottitis

Epilepsy and Ataxia Syndrome

Epulis

Esophageal atresia

Esophageal food bolus obstruction

Excessive starch intake

Familial dysautonomia

Foix-Chavany-Marie syndrome

Foot-and-mouth disease

Fragile X syndrome

Galantamine

Gastric distention or irritation

Gastroesophageal Reflux

Guillain-Barré syndrome

Heartburn or GERD (reflux)

Hyperemesis Gravidarum

Hypoglossal Nerve palsy

Hypotonia

Infection in your mouth or throat

Iodide

Jaw Fracture or dislocation

Jessamine poisoning

Jonquil poisoning

Juvenile Primary Lateral Sclerosis

Liver disease

Loratadine

Macroglossia

Marsh marigold poisoning

Mayapple poisoning

Mental retardation

Mercury poisoning

Mexican tea poisoning

Microcephaly

Mixed Cerebral Palsy

Mobius syndrome

Mononucleosis

Motion sickness

Mountain Laurel poisoning

Multiple sclerosis

Mumps

Myasthenia Gravis

Nicotine nasal spray

Nicotine poisoning

Oral chemical burns

Oral infectious Lesions

Oral suppurative lesions

Organophosphate insecticide poisoning

Pallidotomy

Pancreatitis

Parkinson disease

Peritonsillar abscess

Pilocarpine

Poisoning (pesticides)

Potassium Chlorate

Pregnancy

Procyclidine

Pseudobulbar paralysis

Pyridostigmine

Rabies

Radiation Therapy

Rattlesnake bite

Reaction to snake or insect venom

Retropharyngeal Abscess

Right parietal lobe syndrome related Alzheimer's disease

Rolandic Epilepsy

Sarcoma of the jaw

Sarin

Schwartz-Jampel Syndrome

Sea urchin poisoning

Segawa syndrome, autosomal recessive

Sialorrhea

Sinus infections

Skunk cabbage poisoning

Small Pox

Smith-Magenis Syndrome

Spastic paraplegia

Split-leaf philodendron poisoning

Stomatitis

Strep throat

Stroke

Swollen adenoids

Syphilis

Tonic seizure

Tonic-Clonic seizure

Tonsillitis

Tuberculosis

Voriconazole

X-linked Ataxia Telangiectasia

Aconite

Achillea ptarmica

Home care

Care for drooling due to teething includes good oral hygiene. Ice pops or other cold objects (e.g., frozen bagels) may be helpful. Care must be taken to avoid choking when a child uses any of these objects.

Drooling also is common in children with neurological disorders and those with undiagnosed developmental delay.

The reason for excessive drooling seems to be related to;

1. lack of awareness of the build-up of saliva in the mouth,
2. infrequent swallowing,
3. inefficient swallowing.

Treatment of excessive drooling is related to these causes;

1. increased awareness of the mouth and its functions,
2. increased frequency of swallowing,
3. increased swallowing skill.

Sialorrhea

Sialorrhea is a condition characterized by the secretion of drool in the resting state. It is often the result of open-mouth posture from CNS depressants or sleeping on one's side. In the resting state, saliva may not build at the back of the throat, triggering the normal swallow reflex, thus allowing for the condition.

Treatment

A comprehensive treatment plan incorporates several stages of care: correction of reversible causes, behavior modification, medical treatment, and surgical procedures. Atropine sulfate tablets are indicated to reduce salivation and may be prescribed by doctors in conjunction with behaviour modification strategies. In general, surgical procedures are considered after evaluation of non-invasive treatment options.

External links

• NIH site on drooling

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