Sialorrhea is the inability to control saliva so the saliva extends past the lip margin.  Normally if there is an increase in salivation or the sensation of too much saliva within the mouth we swallow restoring the saliva to a comfortable level. Sialorrhea can be caused by too much saliva being produced (hypersecretion of saliva), inability to recognize the saliva is present (sensory dysfunction), an inability to manage the salivary by swallowing (anatomical or motor dysfunction) or a combination of these factors.

Causes

Hypersecretion of saliva (too much saliva being produced)

• Inflammation eg teething, oral infection, dental issues
• Medication side effects eg clozapine, ketamine
• Gastroesophageal reflux

Sensory dysfunction (inability to recognize the saliva is present)

• Reduced nerve sensitivity or function of oral cavity or lips
• Intellectual disability

Anatomical or motor dysfunction (swallowing issues)

• Orthodontic problems
• Jaw issues
• Parkinson’s disease
• Cerebral palsy
• Stroke
• Enlarged tongue (macroglossia)

Functions of Saliva

Most saliva is produced by six major salivary glands with a small amount secreted by hundreds of minor salivary glands.  The more obvious function of saliva includes lubrication of food as it is swallowed and enzymes within the saliva start to break down starches.  The other important role of saliva is to maintain good health of gums, teeth and mucosa by regulating oral pH, and inhibiting and preventing bacteria and fungal growth.

Complications of Sialorrhea

Sialorrhea causes both physical and psychosocial complications that range from mild to severe enough to negatively impact on the quality of life.  Saliva left on the skin can be irritating and predisposes the skin to chapping, maceration, secondary bacterial or fungal infections.  The amount of saliva produced daily ranges between 15 oz to 50 oz and in sialorrhea if this is not swallowed the patient can become dehydrated.  Social implications of sialorrhea is stigmatization, increased isolation due to embarrassment, and increased level of care required.

Treatments

Appropriate treatment options are dependent on causes and severity of sialorrhea, starting at the least invasive such as postural changes with occupational therapists, and progressing if necessary to medication, radiation therapy and surgical options.

Drugs used to treat Sialorrhea