Sialorrhea is excessive saliva production that can cause symptoms such as drooling, difficulty swallowing or speaking, and frequent choking.
This condition is also known as hypersalivation. It may be caused by dental problems, such as gingivitis, malocclusion, or cavities.
Sialorrhea can also occur due to neurological conditions, such as cerebral palsy, stroke, or Parkinson’s disease. Identifying the cause is important so that the most appropriate treatment can be started.
Main symptoms
The main symptoms of sialorrhea are:
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Excess saliva, above the normal amount of up to 2 liters per day
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Saliva leaking from the mouth, in the form of drool
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Frequently wet clothing or bibs
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Difficulty swallowing or speaking
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Frequent choking or coughing
According to the American Speech-Language-Hearing Association, swallowing difficulties can lead to complications such as choking and aspiration pneumonia.
Confirming a diagnosis
Sialorrhea is diagnosed by a primary care provider or dentist through an evaluation of symptoms, health history, and a complete physical and neurological exam.
In some cases, the provider may order tests such as a salivary flow test, panoramic X-ray, sialography with contrast, a videofluoroscopic swallow study, nasal endoscopy, or nasopharyngoscopy to check for possible nasal obstructions.
Possible causes
The main causes of sialorrhea are:
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Enlarged tongue
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Gastroesophageal reflux (GERD)
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Dental problems, such as cavities, gingivitis, or dental malocclusion
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Pregnancy, in some cases
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Use of medications, such as sedatives or anticonvulsants
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Mercury poisoning
In addition, sialorrhea may be caused by neurological conditions, such as cerebral palsy, stroke, Parkinson’s disease, multiple sclerosis, or ALS (amyotrophic lateral sclerosis), for example.
It’s important to see a primary care provider or dentist to confirm the diagnosis and start the most appropriate treatment.
Treatment options
Treatment for sialorrhea should be guided by a primary care provider or dentist and varies depending on the cause.
The main treatments for sialorrhea are:
1. Medications
According to the FDA-approved prescribing information for glycopyrrolate oral solution, this medication is indicated to reduce chronic severe drooling in children ages 3 to 16 with neurologic conditions associated with problem drooling, such as cerebral palsy.
Other medications, such as atropine or scopolamine, may also be prescribed to help reduce excessive saliva production.
In cases of mouth infections or GERD, for example, medications may also be prescribed to treat the infection or relieve reflux symptoms.
However, when sialorrhea is caused by medication use, the provider may recommend stopping the medication, changing the dose, or switching to another medication.
2. Dental treatment
If sialorrhea is caused by dental problems, the dentist may treat cavities with a filling or root canal, or treat gingivitis with dental cleaning and plaque removal.
In cases of dental malocclusion, the dentist may recommend braces or surgery, for example.
3. Botulinum toxin injection
Botulinum toxin type A (Botox) may be recommended by a doctor to temporarily block the nerves and muscles in the area where the salivary glands are located, helping to reduce saliva production.
Botulinum toxin is injected locally by the doctor into the affected muscles in a single dose.
4. Speech therapy
Speech therapy may be recommended to strengthen the muscles of the mouth, which can also help reduce drooling.
In addition, speech therapy can help improve speaking ability and difficulties with eating or swallowing, and should be guided by a speech-language pathologist.
5. Surgery
Surgery is usually recommended when other treatment options have not been effective in reducing excessive saliva production.
This surgery is performed by a doctor to modify or remove the salivary glands to reduce saliva production, or to redirect the salivary ducts to make swallowing easier.
6. Radiation therapy
In some cases of sialorrhea, radiation therapy to the salivary glands may be recommended to reduce saliva production.
Because this treatment uses radiation, there is a small risk that cancer could later develop in the treated area. For this reason, it is usually reserved for severe sialorrhea, typically in people with conditions such as ALS or Parkinson’s disease.