Drooling
Encyclopedia
Drooling 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 cough
ing) are also impaired.
. 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:
A sudden onset of drooling may indicate poison
ing (especially by pesticide
s 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 medication
s 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.
. Ice pop
s or other cold objects (e.g., frozen bagel
s) 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
Treatment of excessive drooling is related to these causes:
It may be more common when resting soon after meals.
Example of drugs that had been used are glycopyrrolate
and botulinum toxin A.
Saliva
Saliva , referred to in various contexts as spit, spittle, drivel, drool, or slobber, is the watery substance produced in the mouths of humans and most other animals. Saliva is a component of oral fluid. In mammals, saliva is produced in and secreted from the three pairs of major salivary glands,...
flows outside the mouth
Mouth
The mouth is the first portion of the alimentary canal that receives food andsaliva. The oral mucosa is the mucous membrane epithelium lining the inside of the mouth....
. Drooling is generally caused by excess production of saliva
Hypersalivation
Hypersalivation is excessive production of saliva. It has also been defined as increased amount of saliva in the mouth, which may also be caused by decreased clearance 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
Gag reflex
The pharyngeal reflex or gag reflex is a reflex contraction of the back of the throat, evoked by touching the soft palate or sometimes the back of the tongue. It prevents something from entering the throat except as part of normal swallowing and helps prevent choking...
and cough
Cough
A cough is a sudden and often repetitively occurring reflex which helps to clear the large breathing passages from secretions, irritants, foreign particles and microbes...
ing) 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 teethingTeething
Teething is the process by which an infant's first teeth sequentially appear by emerging through the gums. Teething may start as early as three months or as late, in some cases, as twelve months. The typical time frame for the first teeth to appear is somewhere between six and nine months...
. Drooling in infants and young children may be exacerbated by upper respiratory infections and nasal allergies.
Drooling associated with fever
Fever
Fever is a common medical sign characterized by an elevation of temperature above the normal range of due to an increase in the body temperature regulatory set-point. This increase in set-point triggers increased muscle tone and shivering.As a person's temperature increases, there is, in...
or trouble swallowing may be a sign of a more serious disease including:
- Retropharyngeal abscessRetropharyngeal abscessMost commonly seen in infants and young children, retropharyngeal abscess is an abscess located in the tissues in the back of the throat behind the posterior pharyngeal wall . Because RPA's typically occur in deep tissue, they are difficult to diagnose by physical examination alone...
- Peritonsillar abscessPeritonsillar abscessPeritonsillar abscess , also called a quinsy or abbreviated as PTA is a recognised complication of tonsillitis and consists of a collection of pus beside the tonsil .-Symptoms and signs:...
- Tonsilitis
- Mononucleosis
- Strep throatStrep throatStreptococcal pharyngitis, streptococcal tonsillitis, or streptococcal sore throat is a type of pharyngitis caused by a group A streptococcal infection. It affects the pharynx including the tonsils and possibly the larynx. Common symptoms include fever, sore throat, and enlarged lymph nodes...
- Parkinson's diseaseParkinson's diseaseParkinson's disease is a degenerative disorder of the central nervous system...
- RabiesRabiesRabies is a viral disease that causes acute encephalitis in warm-blooded animals. It is zoonotic , most commonly by a bite from an infected animal. For a human, rabies is almost invariably fatal if post-exposure prophylaxis is not administered prior to the onset of severe symptoms...
- Mercury poisoningMercury poisoningMercury poisoning is a disease caused by exposure to mercury or its compounds. Mercury is a heavy metal occurring in several forms, all of which can produce toxic effects in high enough doses...
- Amyotrophic lateral sclerosisAmyotrophic lateral sclerosisAmyotrophic lateral sclerosis , also referred to as Lou Gehrig's disease, is a form of motor neuron disease caused by the degeneration of upper and lower neurons, located in the ventral horn of the spinal cord and the cortical neurons that provide their efferent input...
- Tumors of the upper aerodigestive tract
A sudden onset of drooling may indicate poison
Poison
In the context of biology, poisons are substances that can cause disturbances to organisms, usually by chemical reaction or other activity on the molecular scale, when a sufficient quantity is absorbed by an organism....
ing (especially by pesticide
Pesticide
Pesticides are substances or mixture of substances intended for preventing, destroying, repelling or mitigating any pest.A pesticide may be a chemical unicycle, biological agent , antimicrobial, disinfectant or device used against any pest...
s or mercury
Mercury (element)
Mercury is a chemical element with the symbol Hg and atomic number 80. It is also known as quicksilver or hydrargyrum...
) or reaction to snake
Snake
Snakes are elongate, legless, carnivorous reptiles of the suborder Serpentes that can be distinguished from legless lizards by their lack of eyelids and external ears. Like all squamates, snakes are ectothermic, amniote vertebrates covered in overlapping scales...
or insect
Insect
Insects are a class of living creatures within the arthropods that have a chitinous exoskeleton, a three-part body , three pairs of jointed legs, compound eyes, and two antennae...
venom or in some cases of a numbed mouth from either Orajel, or when going to the dentist office. Some medication
Medication
A pharmaceutical drug, also referred to as medicine, medication or medicament, can be loosely defined as any chemical substance intended for use in the medical diagnosis, cure, treatment, or prevention of disease.- Classification :...
s 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
Morning sickness
Morning sickness, also called nausea gravidarum, nausea, vomiting of pregnancy , or pregnancy sickness is a condition that affects more than half of all pregnant women. Related to increased oestrogen levels, a similar form of nausea is also seen in some women who use hormonal contraception or...
". 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 hygieneOral hygiene
Teeth cleaning is part of oral hygiene and involves the removal of dental plaque from teeth with the intention of preventing cavities , gingivitis, and periodontal disease. People routinely clean their own teeth by brushing and interdental cleaning, and dental hygienists can remove hardened...
. Ice pop
Ice pop
An ice pop, also referred to in the United States as a popsicle, and in the United Kingdom as an ice lolly, lolly ice or ice lollipop, is a frozen, water-based dessert. It is made by freezing flavored liquid around a stick. Often, the juice is colored artificially...
s or other cold objects (e.g., frozen bagel
Bagel
A bagel is a bread product, traditionally shaped by hand into the form of a ring from yeasted wheat dough, roughly hand-sized, which is first boiled for a short time in water and then baked. The result is a dense, chewy, doughy interior with a browned and sometimes crisp exterior...
s) 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
- Lack of awareness of the build-up of saliva in the mouth,
- Infrequent swallowing,
- Inefficient swallowing,
- Impossibility of swallowing by obstructive diseases (tumors, stenosis),
- Impossibility of swallowing by neurodegenerative diseases (amyotrophic lateral sceroris).
Treatment of excessive drooling is related to these causes:
- Increased awareness of the mouth and its functions,
- Increased frequency of swallowing,
- Increased swallowing skill,
- Diminishing of saliva production by the local use of botulinum toxin A,
- 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
Glycopyrrolate
Glycopyrrolate is a medication of the muscarinic anticholinergic group. It does not cross the blood brain barrier and consequently has no to few central effects. It is a synthetic quaternary amine...
and botulinum toxin A.