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Sialorrhea
Description
Sialorrhea or hypersalivation is abnormally increased production of the saliva by the salivary glands usually due to an underlying condition or an anatomical abnormality. Increase saliva in the mouth may lead to drooling of saliva from the mouth. Sialorrhea has two types:
- Anterior Sialorrhea: Excess saliva spills out of the mouth (drooling).
- Posterior Sialorrhea: Excess saliva spills into the airways.
Both, anterior and posterior Sialorrhea can occur simultaneously or separately. Sialorrhea in babies under 4 years of age is considered non-pathological.
Causes
Sialorrhea can be caused by many reasons, some common ones are:
- Trauma or injury to salivary glands (special glands that produce saliva)
- Nausea in pregnancy.
- When a person eats too much starchy (sweet) foods.
- Some injury in mouth e.g. tongue-biting or burns also causes increased saliva formation as a natural process.
- Ulcers in the mouth.
- A swollen or large tongue causing incomplete mouth closure.
- In mouth breathers because of a blocked nose or asthma.
- Jaw pain or jaw dislocation (disturbed position) can affect swallowing.
- Eating chewing gums with a high content of strong mint or cinnamon flavor produces more saliva.
- Smoking (nicotine) is a causing factor.
Risk factors
The risk of getting sialorrhea is high if the following conditions are present:
- A person having gastric disturbance with a feeling of nausea, vomiting, and acidity.
- Gastric reflux disease (GERD) where the stomach contents and acid comes into the mouth causing bad taste and heartburn.
- Patients with anxiety disorders (specific phobia or fear) complain of drooling.
- Stroke patients get paralysis that causes swollen tongue and open mouth.
- Down syndrome or cerebral palsy patients.
- Viral disease e.g. rabies (caused by dog-bite) and mumps (swelling of parotid glands that produce saliva)
- Infections of the mouth e.g. Sores (viral), thrush (fungal infections).
- Pellagra (caused by a nutritional deficiency of vitamin B3)
- Radiation treatment for cancer often affects the salivary glands and they produce more saliva or sometimes none.
- When there is difficulty in swallowing due to a Sore-throat as in tonsillitis, or a cancer of mouth or throat.
- Liver disease also causes altered taste of mouth and increases saliva formation.
- Neurologic diseases (disease of nerve damage) e.g. Parkinson’s disease, facial nerve palsy (nerves of the face are damaged and the facial muscles don’t function).
- Bacterial infection of Tetanus causes a Jaw lock situation due to muscle tightness in the neck.
- Side effects of using medicines like antipsychotic drugs (aripiprazole and clozapine) and pilocarpine for glaucoma (eyesight problem).
- Certain toxic materials like mercury, copper, arsenic, nicotine.
Symptoms
The main features of this condition are:
- Frequent Spitting and swallowing.
- Drooling or leaking of saliva from mouth.
- Dry and chapped lips due to constant wetting of lips which over-soften them and cause skin damage.
- Difficulty in speaking.
- The taste of mouth is changed.
Sometimes complications may arise:
- Due to over-wetting, corners of the mouth catch an infection and become red, sore and crusty known as angular cheilitis.
- The swallowing of saliva can cause Gagging or coughing if it goes into the airway, at times the saliva may go to lungs and cause
Diagnosis
For diagnosing this condition, a doctor will:
- Take a complete history by asking questions about possible pregnancy, other disease history causing nausea and bad taste, any accident that caused injury to the mouth, medicines in use.
- Perform examination of mouth and nose for signs of breathing problems, tonsils, injured or infected mouth, feel the glands for any pain and swelling, pain in the jaw.
- Measuring saliva levels by specific tests (asking the patient to spit in a measuring cup).
- Neck X-rays to check tonsillitis.
- Specific x-rays of saliva producing glands (sialography).
Management
Treatment options include:
- Therapy for correction of mouth closure, head, and neck posture, swallowing and speech therapy.
- Medicines for saliva production control like atropine, muscle relaxants for neck spasms, antiemetics for nausea and vomiting.
- Surgery when there is some injury or cancer of neck or mouth, affecting the saliva glands.
- Home remedies like drinking water, tooth-brushing and mouthwashes can help in drying the mouth.
When to consult a doctor?
Infections, breathing problems, psychological conditions, liver and stomach disease and cancers of mouth and neck require expert advice and treatment. If simple tips and tricks don’t help, visit the doctor for further help.
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