Sialorrhea

Sialorrhea is a medical term for excessive drooling. Several other terms also describe excessive drooling, including ptyalism, polysialia, sialism and hyperactive salivary flow. Defined as excessive saliva beyond the margin of the lip, sialorrhea is normal in infants up until 15-18 months. Excessive drooling after age four is considered pathologic.

Sialorrhea can result from a limited ability to swallow, excessive saliva production or both.

Sialorrhea is more than a cosmetic problem. These are some of the physical and emotional problems associated with excessive drooling:

• Dehydration
• Foul odors
• Increased dependency
• Infections
• Isolation
• Severely chapped lips
• Social stigma.

Causes of Sialorrhea

A number of possible causes of sialorrhea exist, including the following:

• A limited ability to swallow: The most common cause for the clinical level of excessive drooling seen in sialorrhea is difficulty swallowing and coordinating facial nerves and muscles, which is called neuromuscular dysfunction. In children, neuromuscular dysfunction is usually due to conditions like cerebral palsy and mental retardation. In adults, Parkinson's disease and stroke may lead to sialorrhea.
  
  
  • Excessive saliva production: Hypersecretion, or excessive saliva production, may be caused by the following:
  • Dental cavities
  • Inflammation
  • Medication side effects
  • Oral infection
  • Teething.
  Several medications produce sialorrhea as a side effect. Drugs linked to excessive drooling include clozapine (an anti-psychotic drug), tranquilizers, anti-convulsants and drugs used to treat Alzheimer's disease. Often, when people produce too much saliva they can compensate by swallowing more, but if they have problems swallowing or don't realize they're producing excessive saliva, that doesn't work.
• Exposure to poisons: In some cases, sialorrhea develops after an individual is exposed to toxins, like mercury vapors. Insecticides and nerve gases may also cause excessive drooling.

Treating Sialorrhea

Finding the best treatment for sialorrhea depends on the cause of the excessive drooling. If medication is causing excessive saliva, prescriptions can sometimes be adjusted.

A team approach, which may involve a primary care physician, speech pathologists, occupational therapists, dentists and otolaryngologists, can help patients and their loved ones learn to live with sialorrhea.

Medications like scopolamine and glycopyrrolate provide some relief from excessive drooling, but may cause complications. Injections with botulinum toxin can be helpful, but their ability to control excessive drooling wears off and injections need to be repeated. Surgery can be effective, although it is a more invasive procedure.

In 2010, the U.S. Food and Drug Administration (FDA) approved the use of Cuvposa^™ (glycopyrrolate) Oral Solution to treat chronic severe excessive drooling that is caused by neurologic disorders in children from ages 3 to 16. Previously, this drug was used primarily to reduce excessive saliva in patients under anesthesia.

Resources

FDA. (2010). FDA approves drug for chronic drooling in children. Retrieved October 4, 2010, from http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm220444.htm.

Hockstein, N., Samadi, D., Gendron, K.,