Excessive salivation is an uncommon complaint as compared to other complaints that are associated with salivary glands such as dry mouth, salivary gland obstruction, and bacterial infections, and inflammation. Excessive salivation can be a transient or a chronic problem depending on the etiology. In the medical and dental literature, the terms that are used to describe excessive salivation is sialorrhoea, hypersalivation, and ptyalism. The patients with excessive saliva usually present with the complaint of difficulty in swallowing and dribbling of the saliva.
Causes of Excessive Saliva
The excessive salivation is either due to increase formation of saliva by the salivary glands or due to a decrease in the clearance of saliva from the oral cavity due to compromised swallowing reflex. When the symptoms of excessive salivation are due to reduce clearance of saliva from the oral cavity it is referred to as false hypersalivation or false sialorrhoea.
Therefore, the causes of excessive salivation are broadly classified into two types:
- Hypersecretion
- Neuromuscular dysfunction or compromised swallowing
Hypersecretion
The hypersecretion of saliva is also referred to as true sialorrhoea. Numerous factors that may produce excess saliva such as wearing of an intraoral dental prosthesis or device such as dentures, orthodontic retainers or other orthodontic appliance for the first time, infected or ulcerated lesions of the oral cavity, early pregnancy, teething, drugs such as pilocarpine, mercury poisoning, and rabies.
Neuromuscular dysfunction or compromised swallowing
The salivary secretion is optimal but there is a problem in clearance or swallowing of saliva. This is also referred to as false sialorrhoea. Factors that produce neuromuscular dysfunction are carcinoma of the oral cavity, cerebral palsy, Parkinson’s disease, and cancerous or non-cancerous obstructions within the pharynx or esophagus. One of the physiological reasons that are sometimes misinterpreted by the parents as excessive salivation is in infants due to their developing swallowing reflex that results in the drooling of saliva.
Diagnosis of Excessive Saliva
The diagnosis of excessive salivation is usually based on the patient’s past medical history and intraoral examination. Sometimes confirmation of the excessive salivation is required. Excessive salivary secretion can be confirmed with a test called sialometry which demonstrates the salivary flow per minute.
Management of Excessive Saliva
For the management of any disease including excessive salivation it is important to address or eliminate the causative factor. Treatment of excessive salivation is also according to the underlying cause. Anticholinergic drugs are sometimes prescribed to suppress the salivary flow but these drugs may produce the symptoms of dry mouth and results in other complications such as dental caries and microbial infections.
In rare cases, through surgery, the opening of the major salivary ducts is redirected into the pharynx. Reassurance and patient and patient’s attendant education is important for every patient especially those with false sialorrhoea such as in infants.
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