The Characteristics and Treatment of Sialorrhea

13 October, 2020
Today, we'll discuss the characteristics and treatment of sialorrhea, or the involuntary passive loss of saliva from the mouth.

Sialorrhea – or ptyalism – is what we refer to in common language as “drooling.” Of course, this condition is very normal among children between 15 and 36 months of age. However, it’s considered abnormal if it occurs after the age of four. Today, we’ll take a closer look at the characteristics and treatment of sialorrhea.

Although sialorrhea seems to be a condition that only affects appearance, it can also have to do with serious health conditions. These include cerebral palsy or Parkinson’s disease, for example. It can also result from pregnancy or from taking certain medications.

What is sialorrhea and what causes it?

Sialorrhea is a condition characterized by the inability to retain saliva inside the mouth and direct it toward the digestive tract. It’s excessive production of saliva or an anomaly in its processing.

The most frequent causes of sialorrhea are neurological diseases. Among them are, as we mentioned, cerebral palsy and Parkinson’s disease. However, it also occurs in those who suffer from amyotrophic lateral sclerosis (ALS), Riley-Day syndrome, or the effects of cerebral infarction.

Additionally, this condition is also common in those who take antipsychotic, hypnotic, or tranquilizing drugs. Likewise, it’s common for a sudden increase in saliva production to occur during pregnancy between the second and fourth week of gestation.

A baby drooling.
Drooling in young children is part of development and is considered normal.

Read more: Thick Saliva: Why Does It Happen?

The characteristics of this disorder

The salivary glands are responsible for producing saliva. There are three of them: the parotid, submandibular and sublingual glands. The first one produces watery saliva, while the other two generate a thicker liquid continuously. This is the type of saliva that often produces choking.

Each day, they produce about 50 ounces of saliva, of which 70% comes from the submandibular and sublingual glands. As such, sialorrhea is not a disease that evolves into another more serious condition. However, it does severely affect a person’s quality of life.

There’s no specific doctor who specializes in the treatment of sialorrhea. Therefore, if you suspect this disorder, you should see your general practitioner. He or she will refer you to a specialist, depending on the cause that gives rise to the problem.

Classification of sialorrhea

From the point of view of its origin, there are two types of sialorrhea:

  • Anterior sialorrhea: Originates from a neuromuscular deficiency coupled with excessive production of saliva. It leads to the liquid spilling from the corners of the mouth or the lower lip.
  • Posterior sialorrhea: When the problem originates in the flow of saliva from the tongue to the pharynx.

According to the Thomas-Stonell and Greenberg rating scale, it’s also possible to classify sialorrhea according to its severity or frequency. From that point of view, the graduation is as follows:

  • Dry mouth
  • Mild (wet lips)
  • Moderate (wet lips and chin)
  • Severe (wet clothes)
  • Profuse (clothes, hands, and utensils are wet)

Depending on the frequency, the scale is as follows:

  • Never drooling
  • Occasional drooling
  • Frequent sialorrhea
  • Constant drooling
  • Consequences of sialorrhea

Sialorrhea is a relevant medical problem. It not only causes a noticeable disability but also additional difficulty in the management of patients with neurological problems. In general, this condition has consequences. For example, this may include peeling lips, muscle fatigue, dermatitis, changes in the sense of taste, and voice difficulties.

However, from a physical point of view, the greatest risk is aspiration pneumonia, due to difficulties in swallowing food. These patients are also more prone to oral infections.

At the same time, the psychosocial consequences can be very severe. Drooling generates social rejection, even in caregivers. This also limits the normal performance of daily activities.

Treatment of Sialorrhea in Parkinson's disease
Neurological diseases, like Parkinson’s, include sialorrhea among their symptoms.

Find out more: https://steptohealth.com/what-are-the-causes-of-dysphagia/

The treatment of sialorrhea

There are three ways to treat sialorrhea: Speech therapy, pharmacology, and surgery. The approach through speech therapy involves performing a series of exercises to inhibit the pathological reflexes. To be more specific, the aim is to improve the closing of the lips and the suction or swallowing of saliva. Continuous training can bring about improvement.

As for the pharmacological treatment, it involves anticholinergics, which help to decrease the secretion of saliva. However, these medications must go hand in hand with exercises. Unfortunately, some people experience intolerance to this type of medication.

It’s also possible to treat sialorrhea through the injection of botulinum toxin type A (TBA). This is applied directly to the salivary glands and also reduces the production of saliva. The most positive thing is that it generates very few side effects.

Finally, if none of these measures work, the specialist will likely decide to perform a surgical intervention. In any case, each patient is different and sometimes a combination of measures is required to achieve effectiveness.

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