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Excessive Salivation: Causes and Treatment

Excessive salivation, also known as hypersalivation or sialorrhea, refers to an overproduction of saliva. Learn about causes, symptoms, and treatment options.

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Things worth knowing about "Excessive salivation"

Excessive salivation, also known as hypersalivation or sialorrhea, refers to an overproduction of saliva. Learn about causes, symptoms, and treatment options.

What is excessive salivation?

Excessive salivation, medically termed hypersalivation or sialorrhea, occurs when the salivary glands produce more saliva than usual or when a person is unable to swallow saliva effectively. In adults, a saliva volume exceeding approximately 1 litre per day is considered elevated. The condition can be temporary or chronic and often points to an underlying medical condition or a side effect of medication.

Causes

The causes of excessive salivation are diverse. A distinction is made between true overproduction of saliva (true hypersalivation) and an impaired ability to swallow, which leads to pooling of saliva in the mouth (pseudo-hypersalivation).

Common causes

Neurological conditions: Parkinson's disease, amyotrophic lateral sclerosis (ALS), stroke, or cerebral movement disorders (e.g., cerebral palsy) can impair swallowing.
Medications: Certain drugs such as clozapine (an antipsychotic), pilocarpine, lithium, or cholinesterase inhibitors can stimulate saliva production.
Dental and oral infections: Gum disease, mouth ulcers, or other oral inflammations can stimulate the salivary glands.
Pregnancy: Hormonal changes, particularly in the first trimester, can lead to increased salivation (also known as ptyalism gravidarum).
Poisoning: Mercury, arsenic, or pesticide poisoning can trigger hypersalivation.
Gastroesophageal reflux disease (GERD): Acid reflux from the stomach can reflexively increase saliva production.
Infectious diseases: Rabies, measles, or tonsillitis can be associated with excessive salivation.

Symptoms

The main symptom is a noticeable excess of saliva in the mouth. Affected individuals may need to swallow frequently or spit out saliva. Additional complaints can include:

Drooling or uncontrolled salivation, especially during sleep or when speaking
Cracked corners of the mouth (angular cheilitis) due to constant moisture
Unpleasant sensation in the mouth
Difficulty swallowing (dysphagia)
Speech difficulties (dysarthria)
Social embarrassment due to visible drooling

Diagnosis

Diagnosis is usually made clinically. The doctor takes a thorough medical history and performs a physical examination. Depending on the suspected cause, the following investigations may be required:

Blood tests (e.g., to rule out infections or poisoning)
Measurement of saliva volume (sialometry)
Swallowing studies (e.g., videofluoroscopy)
Neurological assessment
Dental examination

Treatment

Treatment is directed at the underlying cause. The goal is to normalise saliva production and improve the quality of life for those affected.

Medication-based treatment

Anticholinergics (e.g., scopolamine, glycopyrrolate): Reduce saliva production by blocking muscarinic receptors.
Botulinum toxin (Botox): Injections into the salivary glands can reduce saliva production for several months.
Adjustment or substitution of causative medications in consultation with the treating physician.

Non-medication-based treatment

Speech and language therapy: Swallowing and oral motor exercises are particularly helpful for neurological causes.
Biofeedback and behavioural therapy: Training of conscious swallowing.
Dental devices: E.g., specialised palatal plates.

Surgical options

In severe, treatment-resistant cases, surgical repositioning or removal of salivary gland ducts may be considered. However, this is only indicated in exceptional circumstances.

When to see a doctor?

Persistent or sudden, severe salivation without an obvious cause should be assessed by a doctor. A medical consultation is strongly recommended, especially if additional neurological symptoms such as swallowing or speech problems are present.

References

Meningaud J.-P. et al. - Drooling of saliva: A review of the etiology and management options. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 2006.
Bavikatte G., Bhakta B. - Management of drooling of saliva. British Journal of Medical Practitioners, 2012; 5(1).
National Institute of Neurological Disorders and Stroke (NINDS) - Neurological complications and swallowing disorders. Available at: www.ninds.nih.gov

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