Drooling
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Synonyms and keywords: ptyalism; sialorrhea; hypersalivation; Polysialia; Salivation excessive; Salivary hypersecretion; Sialism
Overview
Drooling is the uncontrollable flow of saliva outside the mouth. It can occur in either some nervous system disorders or anatomic abnormalities of the oral cavity. Either the production of saliva is excessive, the musculature of the mouth which normally controls the oral opening, is weak and not functioning to the adequate strength to help keep the saliva inside or there is difficulty in swallowing.
Firstly we will discuss the production of saliva, which is carried out by the salivary glands. Upon receiving the excitatory stimulus from salivary nuclei present in the brain stem, saliva is produced, which occurs in response to the taste, and visual stimuli received from the tongue and other parts of the mouth. These are categorized into minor and major salivary glands. The major glands, which are most impressive are present in the base of the mouth, front of teeth, and in the cheeks, known as submandibular, parotid, and sublingual glands. So in total, there are 6 major glands that secrete saliva.
Drooling is a common phenomenon in babies but it usually stops at around 15-36 months, when the baby develops salivary continence. The persistence of Sialorrhea after 4 years of age is therefore considered pathologic at times. It may persist due to hypersalivation, or neurologic disorders like cerebral palsy, Parkinson’s disease, and amyotrophic lateral sclerosis, or as a side effect of medications. The most common cause of sialorrhea in children is Cerebral palsy whereas, in adults, parkinsons disease is the most common cause. 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, Flurazepam, Loxapine |
| 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
- Acute Gastritis or Gastric Ulcer
- Alveolar abscess
- Amaryllis poisoning
- Angelman-Like Syndrome
- Ankylosis of the Temporomandibular Joint
- Aphthous Ulcers
- Athetoid Cerebral Palsy
- Balsam apple poisoning
- Bilateral Facial Nerve Palsy
- Bone Lesions
- Boston Ivy poisoning
- Bulbar Paralysis
- Bush lily poisoning
- Buttercup poisoning
- Cantharides
- carbidopa-levodopa
- clonazepam (Klonopin)
- Clozapine (Clozaril
- Dental Caries
- Dental malocclusion
- Dentures that are new or don't fit well
- Epilepsy and Ataxia Syndrome
- Excessive starch intake
- Gastric distention or irritation
- Gastroesophageal Reflux
- Heartburn or GERD (reflux)
- Infection in your mouth or throat
- Jaw Fracture or dislocation
- Jessamine poisoning
- Jonquil poisoning
- Marsh marigold poisoning
- Mexican tea poisoning
- Mixed Cerebral Palsy
- Mountain Laurel poisoning
- Oral chemical burns
- Oral infectious Lesions
- Oral suppurative lesions
- Organophosphate insecticide poisoning
- Poisoning (pesticides)
- Potassium Chlorate
- 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
- Schwartz-Jampel Syndrome
- Sea urchin poisoning
- Segawa syndrome, autosomal recessive
- Sialorrhea
- Sinus infections
- Skunk cabbage poisoning
- Small Pox
- Smith-Magenis Syndrome
- Split-leaf philodendron poisoning
- Swollen adenoids
- Tonic seizure
- Tonic-Clonic seizure
- X-linked Ataxia Telangiectasia
Ankylosis of the Temporomandibular Joint
Dentures that are new or don't fit well
Donepezil (patient information)
Endoscopic foreign body retrieval
Esophageal food bolus obstruction
Gastric distention or irritation
Infection in your mouth or throat
Juvenile Primary Lateral Sclerosis
Organophosphate insecticide poisoning
Reaction to snake or insect venom
Right parietal lobe syndrome related Alzheimer's disease
Segawa syndrome, autosomal recessive
Split-leaf philodendron poisoning
X-linked Ataxia Telangiectasia
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.
- lack of awareness of the build-up of saliva in the mouth,
- infrequent swallowing,
- inefficient swallowing.
- increased awareness of the mouth and its functions,
- increased frequency of swallowing,
- 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
Template:Oral pathology
de:Hypersalivation
nl:Speekselvloed
fi:Kuolaaminen