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Sialorrhea – Causes, Symptoms and Treatment

Sialorrhea refers to excessive drooling or the inability to control saliva in the mouth. It is often linked to neurological conditions and can significantly affect quality of life.

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Things worth knowing about "Sialorrhea"

Sialorrhea refers to excessive drooling or the inability to control saliva in the mouth. It is often linked to neurological conditions and can significantly affect quality of life.

What is Sialorrhea?

Sialorrhea (also spelled sialorrhoea; commonly referred to as drooling or hypersalivation) is a condition characterized by an excess of saliva flowing out of the mouth or pooling within the oral cavity due to an inability to swallow it adequately. The term derives from the Greek words sialon (saliva) and rhein (to flow). While occasional drooling is normal -- for example, during sleep or teething in infants -- persistent, uncontrolled sialorrhea is considered a clinical symptom requiring evaluation and, in many cases, treatment.

A clinical distinction is made between true hypersalivation (genuinely increased saliva production) and pseudohypersalivation (normal saliva production but impaired swallowing ability). The latter is far more common in clinical practice.

Causes

Sialorrhea can result from a wide range of causes, broadly categorized as neurological, medication-induced, or local/other:

Neurological Causes

Parkinson disease: One of the most frequent causes; slowed swallowing reflexes lead to saliva accumulation.
Amyotrophic lateral sclerosis (ALS): Muscular weakness in the oral and pharyngeal region impairs swallowing.
Cerebral palsy: Common in children with neuromuscular disorders.
Stroke: Brain lesions can disrupt swallowing control.
Multiple sclerosis (MS)
Intellectual disabilities or developmental disorders

Medication-Induced Causes

Antipsychotics (e.g., clozapine)
Cholinesterase inhibitors (e.g., used in Alzheimer disease)
Certain antiepileptic drugs

Local and Other Causes

Inflammation of the mouth or throat
Teething in infants
Gastroesophageal reflux disease (GERD)
Pregnancy (transient hormonal hypersalivation)
Poisoning (e.g., by organophosphates)

Symptoms

The primary symptom is visible drooling -- saliva flowing out of the mouth uncontrollably. Associated symptoms may include:

Wet or irritated skin around the mouth (maceration)
Bad breath caused by bacterial breakdown of saliva
Difficulty swallowing (dysphagia)
Speech difficulties (dysarthria)
Social withdrawal and psychosocial burden
Risk of aspiration (saliva entering the airway)

Diagnosis

Diagnosis is primarily clinical, based on observation and patient history. Additional assessments may include:

Saliva flow measurement: Quantifying saliva output over a defined time period
Videofluoroscopy: To evaluate swallowing function
Neurological examination: When an underlying neurological disorder is suspected
Drooling severity scales (e.g., the Drooling Severity and Frequency Scale)

Treatment

Treatment is tailored to the underlying cause and severity. A stepwise approach is typically recommended:

Conservative Measures

Speech and language therapy to improve swallowing and oral motor control
Postural correction and physiotherapy
Behavioral therapy approaches

Medical Treatment

Anticholinergic medications: Reduce saliva production (e.g., scopolamine, glycopyrronium). Side effects may include dry mouth, constipation, and cognitive impairment.
Botulinum toxin (type A or B): Injected into the salivary glands (parotid and/or submandibular gland) to reduce saliva output. Effects typically last 3 to 6 months and require repeated administration.

Surgical Treatment

Rerouting of salivary duct openings
Removal of individual salivary glands (gland excision)
Nerve sectioning (chorda tympani neurectomy)

The choice of treatment depends on the patient's general health, the underlying condition, and the degree of impairment. In children with cerebral palsy, for example, a combination of speech therapy and botulinum toxin injections is often used.

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.
Evidente V.G.H. & Adler C.H. - Sialorrhea in Parkinson disease and other movement disorders. Seminars in Neurology, 2001.
National Institute of Neurological Disorders and Stroke (NINDS) - Information page on drooling and sialorrhea. Available at: www.ninds.nih.gov

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