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Drooling
Aka: Drooling, Ptyalism, Ptyalorrhea, Sialism, Sialismus, Sialorrhea, Hypersalivation, Hyperptyalism, Excessive Salivation- Pathophysiology
- Causes: Saliva Overproduction
- Pregnancy (Ptyalism Gravidarum)
- Excessive starch intake
- Gastrointestinal causes
- Gastric distention or irritation
- Gastroesophageal Reflux
- Acute Gastritis or Gastric Ulcer
- Pancreatitis
- Liver disease (including Hepatic Encephalopathy)
- Medications and toxins
- Clozapine (Clozaril)
- Potassium Chlorate
- Pilocarpine
- Mercury Poisoning
- Copper
- Arsenic Poisoning
- Antimony (used to treat Parasitic Infections)
- Iodide
- Bromide
- Aconite (derived from Aconitum napellus root)
- Cantharides
- Stomatitis and localized Oral Lesions
- Aphthous Ulcers
- Oral chemical burns
- Oral suppurative lesions
- Alveolar abscess
- Epulis
- Oral infectious Lesions
- Causes: Difficulty Swallowing Saliva
- Infections
- Bone Lesions
- Jaw Fracture or dislocation
- Ankylosis of the Temporomandibular Joint
- Sarcoma of the jaw
- Neuromuscular disorders
- Miscellaneous Causes
- Radiation Therapy
- Macroglossia
- Dental malocclusion
- Management: Non-specific
- Treat specific causes as below
- General measures to reduce Saliva
- Tooth Brushing and mouthwash has drying effect
- Reduce starch intake from diet
- Orthodontic appliances that aid swallowing
- Anticholinergic Medications (if refractory to above)
- Glycopyrrolate
- Adults: 0.5 to 2 mg PO qd to tid prn
- Children: 0.04 mg/kg PO qd to tid prn
- Mier (2000) Arch Pediatr Adolesc Med 154:1214-8 [PubMed]
- Scopolamine Patch 1.5 mg applied every 72 hours prn
- Glycopyrrolate
- Advanced procedures in severe and refractory cases
- Botulinum Toxin A Salivary Gland injection
- Performed under Ultrasound guidance
- Porta (2001) Psychiatry 70:538-40 [PubMed]
- Radiation Therapy
- Surgery
- Submandibular Gland excision or duct relocation
- Parotid duct relocation or ligation
- Salivary denervation (transtympanic neurectomy)
- Crysdale (2001) Dev Med Child Neurol 43:379-83 [PubMed]
- Botulinum Toxin A Salivary Gland injection
- Management: Specific measures
- Treat Nausea with Antiemetics
- Treat Gastroesophageal Reflux
- Neuromuscular causes
- Speech pathology (e.g. swallowing mechanism)
- Occupational therapy (e.g. head-back wheelchair)
- Neurology Consultation
- Biofeedback
- Oral diseases including dental malocclusion
- Dentist or orthodontist
- Macroglossia or Tonsillar Hypertrophy
- Otolaryngology
- References