Drooling

Drooling (also known as ptyalism or sialorrhea) 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.

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Common causes

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. Some medications can cause drooling as well. 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 hyperemeis that much worse.

There are several theories as to the causes of hyperemeis 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". 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.

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, and (3) inefficient swallowing. Treatment of excessive drooling is related to these causes: (1) increase awareness of the mouth and its functions, (2) increase frequency of swallowing, (3) increase 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 behavior modification strategies. In general, surgical procedures are considered after evaluation of non-invasive treatment options.