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Hypersalivation – Causes, Symptoms & Treatment

Hypersalivation refers to excessive saliva production or a reduced ability to swallow saliva. It can be caused by diseases, medications, or neurological disorders.

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Things worth knowing about "Hypersalivation"

Hypersalivation refers to excessive saliva production or a reduced ability to swallow saliva. It can be caused by diseases, medications, or neurological disorders.

What is Hypersalivation?

Hypersalivation is a condition characterized by an excess of saliva in the mouth, either due to overproduction by the salivary glands or an impaired ability to swallow saliva. It is also referred to medically as sialorrhea. A distinction is made between true hypersalivation, in which the salivary glands produce abnormally large amounts of saliva, and functional hypersalivation, in which normal saliva production cannot be adequately managed due to swallowing difficulties.

Causes

The causes of hypersalivation are diverse and can be grouped into several categories:

Neurological Conditions

Parkinson's disease: Reduced swallowing frequency and impaired swallowing reflex lead to saliva pooling.
Amyotrophic lateral sclerosis (ALS): Progressive paralysis of swallowing muscles.
Stroke: Impairment of oral motor and swallowing functions.
Cerebral palsy: Muscular incoordination in the oral and pharyngeal region.

Medications and Substances

Clozapine (antipsychotic) is one of the most common drug-induced causes.
Cholinesterase inhibitors (e.g., used in dementia treatment)
Ketamine, pilocarpine, and certain insecticides

Local and Systemic Causes

Gum inflammation, teething (especially in infants and toddlers)
Oral infections (e.g., stomatitis, tonsillitis)
Gastroesophageal reflux disease (GERD)
Pregnancy (often in the first trimester, known as ptyalism gravidarum)
Poisoning (e.g., mercury, organophosphates)

Symptoms

The primary symptom of hypersalivation is the excessive accumulation of saliva in the mouth and uncontrolled drooling. Additional complaints may include:

Difficulty speaking and unclear articulation
Swallowing difficulties (dysphagia)
Irritated or chapped skin around the mouth and chin
Social embarrassment and psychosocial distress
Sleep disturbances due to saliva pooling when lying down
Risk of aspiration (inhaling saliva into the lungs)

Diagnosis

Diagnosis of hypersalivation is primarily clinical, based on a thorough medical history and physical examination. The clinician will ask about the onset of symptoms, current medications, and any known underlying conditions. Additional assessments may include:

Saliva flow measurement: Quantitative assessment of saliva volume (e.g., using suction or collection methods)
Swallowing studies: Videofluoroscopic swallowing study or fiberoptic endoscopic evaluation of swallowing (FEES)
Laboratory tests: To rule out systemic causes
Neurological evaluation: If an underlying neurological condition is suspected

Treatment

Treatment of hypersalivation is guided by the underlying cause and the severity of the condition:

Conservative and Behavioral Approaches

Swallowing therapy with a speech-language pathologist
Positioning strategies (e.g., maintaining an upright posture)
Adjusting or discontinuing medications that cause hypersalivation

Pharmacological Treatment

Anticholinergic medications (e.g., scopolamine, atropine, glycopyrrolate): Reduce salivary gland activity by blocking the parasympathetic nervous system.
Botulinum toxin injections into the salivary glands: A highly effective approach for neurologically induced hypersalivation; effects typically last several months.

Surgical Treatment

Salivary duct relocation surgery (redirecting salivary ducts further back in the throat)
Excision (surgical removal) of salivary glands in severe cases
Neurectomy (nerve cutting) to reduce salivary output

References

Meningaud J.P. et al. - Drooling of saliva: A review of the etiology and management options. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology (2006).
Hakel M. et al. - Management of Sialorrhea in Adults: A Systematic Review. Journal of Speech, Language, and Hearing Research (2021).
National Institute of Neurological Disorders and Stroke (NINDS) - Information on Neurological Causes of Sialorrhea, www.ninds.nih.gov.

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