Drooling

Drooling
Classification and external resources
ICD-10	K11.7
ICD-9	527.7
MeSH	D012798

Drooling (also known as driveling, dribbling, slobbering, or, in a medical context, ptyalism) is when saliva flows outside the mouth. Drooling is generally caused by excess production of saliva, inability to retain saliva within the mouth, or problems with swallowing.

Some people with drooling problems are at increased risk of inhaling saliva, food, or fluids into the lungs. However, this is unlikely to cause harm, unless the body's normal reflex mechanisms (such as gagging and coughing) are also impaired.

Common causes

Isolated drooling in infants and toddlers is normal and is unlikely to be a sign of either disease or complications. It may be associated with teething. Drooling in infants and young children may be exacerbated by upper respiratory infections and nasal allergies.

Drooling associated with fever or trouble swallowing may be a sign of a more serious disease including:

• Retropharyngeal abscess
• Peritonsillar abscess
• Tonsilitis
• Mononucleosis
• Strep throat
• Parkinson's disease
• Rabies
• Mercury poisoning
• Amyotrophic lateral sclerosis
• Tumors of the upper aerodigestive tract

A sudden onset of drooling may indicate poisoning (especially by pesticides or mercury) or reaction to snake or insect venom or in some cases of a numbed mouth from either Orajel, or when going to the dentist office. Some medications can cause drooling as well such as the pain relieving orajel medication. Some neurological problems also cause drooling. Excess Capsaicin can cause drooling as well, an example being the ingestion of particularly high Scoville Unit chili peppers.

Another form of ptyalism is associated with pregnancy, most common in women with a condition known as Hyperemesis Gravidarium, or uncontrollable and frequent nausea and vomiting during pregnancy which is far worse than typical "morning sickness". With Hyperemesis, ptyalism is a side-effect, which is a natural response to uncontrollable vomiting. With normal vomiting, salivary glands are stimulated to lubricate the oesophagus and mouth to aid in expelling of stomach contents. During a hyperemetic pregnancy, many woman complain of excessive saliva and an inability to swallow this saliva. Some women note having to carry around a "spitoon" or using a cup to spit. Swallowing their own saliva has been noted to gag and further nauseate the women making the hyperemesis that much worse.

There are several theories as to the causes of hyperemesis and related symptoms such as ptyalism. Although hyperemesis was once considered a psychological disease, the medical community now considers hyperemesis as a real and serious physiological condition. Some pregnant women who suffer end up terminating the pregnancy. Others refuse to carry another child. The most frequent act is preparing for the onset of hyperemesis if a subsequent pregnancy is expected.

Home care

Care for drooling due to teething includes good oral hygiene. Ice pops or other cold objects (e.g., frozen bagels) may be helpful. Care must be taken to avoid choking when a child uses any of these objects.

Drooling is also common in children with neurological disorders and those with undiagnosed developmental delay. The reason for excessive drooling seems to be related to

1. Lack of awareness of the build-up of saliva in the mouth,
2. Infrequent swallowing,
3. Inefficient swallowing,
4. Impossibility of swallowing by obstructive diseases (tumors, stenosis),
5. Impossibility of swallowing by neurodegenerative diseases (amyotrophic lateral sceroris).

Treatment of excessive drooling is related to these causes:

1. Increased awareness of the mouth and its functions,
2. Increased frequency of swallowing,
3. Increased swallowing skill,
4. Diminishing of saliva production by the local use of botulinum toxin A,
5. Surgical interventions (salivary duct relocalization, resection of salivary glands) in severe cases.

Sialorrhea

Sialorrhea is a condition characterized by the secretion of drool in the resting state. It is often the result of open-mouth posture from CNS depressants or sleeping on one's side. In the resting state, saliva may not build at the back of the throat, triggering the normal swallow reflex, thus allowing for the condition. Moreover, neurodegenerative diseases or physical obstructions like stenosis or tumors of the upper aerodigestive tract can be the reason for excessive drooling states.

It may be more common when resting soon after meals.

Treatment

A comprehensive treatment plan incorporates several stages of care: correction of reversible causes, behavior modification, medical treatment, and surgical procedures. Atropine sulfate tablets are indicated to reduce salivation and may be prescribed by doctors in conjunction with behaviour modification strategies. In general, surgical procedures are considered after evaluation of non-invasive treatment options.

Example of drugs that had been used are glycopyrrolate and botulinum toxin A. ^{[1] [2]}

See also

• Slobbers

References

1. ^ Mier RJ, Bachrach SJ, Lakin RC, Barker T, Childs J, Moran M (December 2000). "Treatment of sialorrhea with glycopyrrolate: A double-blind, dose-ranging study". Arch Pediatr Adolesc Med 154 (12): 1214–8. PMID 11115305. http://archpedi.ama-assn.org/cgi/pmidlookup?view=long&pmid=11115305. 
2. ^ Ellies M, Gottstein U, Rohrbach-Volland S, Arglebe C, Laskawi R (October 2004). "Reduction of salivary flow with botulinum toxin: extended report on 33 patients with drooling, salivary fistulas, and sialadenitis". Laryngoscope 114 (10): 1856–1860. doi:10.1097/00005537-200410000-00033. PMID 15454785. http://archpedi.ama-assn.org/cgi/pmidlookup?view=long&pmid=15454785. 

External links

• NIH site on drooling