So-called hypersalivation is a condition, usually temporary, in which an excessive amount of saliva is produced. The causes are varied and can range from severe neurological conditions such as Parkinson’s disease to poor diet. In most cases, however, hypersalivation is readily treatable.
What is hypersalivation?
The medical term hypersalivation refers to excessive production of saliva. Often, hypersalivation also results in sialorrhea, the involuntary discharge of saliva from the mouth, commonly referred to as “drooling.” “Drooling” occurs when the mouth cannot be fully closed or swallowing saliva causes difficulty.
Causes
There are multiple causes of increased salivation. Medical experts distinguish between local causes, drug-related causes, general diseases, and neurological diseases. Hypersalivation often occurs during severe nausea, just before vomiting. Temporary hypersalivation can also occur with an improper diet, such as the ingestion of highly spiced, spicy, or very acidic foods. In babies and young children, hypersalivation along with sialorrhea is completely normal. Until a child is about four years old, increased saliva production and drooling is harmless. A local cause of hypersalivation can be, for example, caries or inflammation of the oral cavity. In addition, diseases of the salivary glands can lead to excessive production of saliva. Other causes of hypersalivation may be psychological, such as nervousness or anxiety. Neurological problems, such as Parkinson’s disease, may also be the cause. Certain infections, such as rabies, typically result in greatly increased salivation. Poisoning with certain substances, such as mercury, or taking certain medications, can also trigger this clinical picture.
Symptoms, complaints, and signs
Hypersalivation is primarily manifested by excessive production of saliva. As a result, affected individuals experience drooling, speech problems, and other symptoms. For example, some patients present with dysphagia or problems with food intake. The increased saliva flow can also lead to aspiration if it enters the esophagus. In extreme cases, the affected person chokes on the saliva. The excessive saliva production can also affect the mental state of the affected person. Hypersalivation is perceived as extremely unpleasant and drooling in particular triggers feelings of shame and inferiority complexes in patients. In the worst case, depressive moods or even full-blown depression develop. Externally, hypersalivation is not initially apparent. In the long term, however, drooling can lead to inflammation of the lips and the corners of the mouth. The affected areas often become red and painful to the touch. If the condition is not treated, it can also lead to dehydration, which can be manifested by fatigue, dizziness and physical weakness, among other symptoms. In general, however, excessive saliva production is harmless and the symptoms do not result in any other health problems.
Diagnosis and course
When making a diagnosis, a detailed medical history is first taken by the treating physician. The first thing to determine is whether hypersalivation is present at all. Sometimes there is a disorder of saliva removal, which at first glance looks like excessive production of saliva. Tooth malpositions, for example, can cause drooling, even if the amount of saliva produced is within the normal range. After taking a medical history, a swallowing diagnosis is usually made in order to determine whether a swallowing disorder is present. In addition, the amount of saliva produced is measured. Often an approximate estimate of the amount by the attending physician is sufficient. However, it may also be necessary to analyze the amount of saliva more precisely, also in connection with the amount of saliva discharged per unit of time. For this purpose, there are certain devices with which the salivary flow can be measured very precisely. Depending on which underlying disease is responsible for the hypersalivation, the course of the disease is different.In severe, degenerative diseases, such as Parkinson’s disease, the prognosis is certainly worse than, say, harmless and transient hypersalivation resulting from eating food that is too acidic.
Complications
In most cases, hypersalivation can be treated relatively well, so there are no particular limitations or complications. As a rule, the affected person suffers from a greatly increased salivation, which generally has a negative effect on the quality of life of the affected person. It is not uncommon for social discomfort to occur, as the symptoms of hypersalivation are considered unsightly and unaesthetic. It can also lead to malocclusion of the teeth or difficulty swallowing. In the worst case, the risk of aspiration is increased by hypersalivation, so that death can still occur. Especially elderly patients and people suffering from Parkinson’s disease can suffer from hypersalivation. In any case, the treatment of the disease is causal and depends on the underlying disease. No further complications occur. However, it cannot be predicted whether the hypersalivation can be completely limited or whether a renewed treatment will be necessary. In many cases, treatment of the underlying disease is also not possible. Life expectancy is not limited by the disease.
When should one go to the doctor?
In the case of excessive salivation, a visit to the doctor is not always necessary. If there is a regression of the symptoms after a few hours or days, there is no worrisome condition. Often in these cases the cause is due to emotional reasons that do not last. However, if hypersalivation persists or increases in intensity, a doctor should be consulted. If problems with food intake develop or swallowing difficulties occur, a visit to the doctor is necessary. If the affected person refuses food intake for several days, a clarification of the symptoms is advisable. This applies in particular to children, the elderly or people with a low body weight. There is a threat of undersupply of the organism, which can become an emergency without medical care. If hypersalivation occurs during the child’s growth phase, it can lead to malocclusion of teeth. Therefore, a visit to the doctor is recommended as soon as abnormalities in the position of the teeth appear. Patients suffering from Parkinson’s disease very often show increased salivation as an accompanying symptom. A doctor should therefore be consulted as soon as the symptoms persist or typical signs of Parkinson’s disease are observed. If vomiting occurs more frequently or a sore throat sets in, a doctor should be consulted.
Treatment and therapy
Because there are many different causes of excessive saliva production, treatment must eliminate the underlying disease of which hypersalivation is a symptom. If the cause is local, it may be necessary to correct malocclusions or better adjust braces that are not optimally fitted. Surgical measures may also be necessary. There are drugs that reduce the flow of saliva, including the active ingredient atropine, which is administered in the form of tablets. There is also an active ingredient that is applied as a patch behind the ear. Both agents significantly reduce saliva production. In particularly severe cases, botulinum toxin can also be used. In this case, the doctor injects Botox into the salivary glands in the ear or lower jaw. If medications are the cause of hypersalivation, they must either be discontinued or combined with other medications that have dry mouth as a side effect.
Outlook and prognosis
Hypersalivation can have a variety of causes, on which the prospects for early improvement depend. The prognosis is best for transient triggers. Hypersalivation associated with pregnancy, for example, often occurs in hyperemesis gravidarum and improves as the morning sickness lessens. If the hypersalivation is due to dental problems or other changes located in the mouth, it may also resolve quickly if the cause is treated. If the cause cannot be treated so quickly, then one option is to treat the increased salivation by injecting the salivary glands with botulinum toxin.Whether this is an option for the patient depends on whether the hypersalivation is related to the salivary glands at all or whether it is a swallowing disorder. In the case of dysphagia, this method would tend to be out of the question as long as saliva production is within normal limits. However, if the hypersalivation is actually due to an overproduction of saliva, this can be brought back to a normal level with this method. The patient then no longer suffers from hypersalivation, even if the original cause continues to exist. This option may be considered in degenerative diseases, for example, to alleviate hypersalivation as a symptom of the disease and provide the patient with a better quality of life.
Prevention
There are no specific, universal measures to prevent the development of hypersalivation, as the causes are very diverse. Having a good dental and oral hygiene is already a step in the right direction, because brushing teeth and rinsing the mouth can help keep the mouth drier. In most cases, hypersalivation is not a permanent condition, it only occurs temporarily and is easily treatable once the underlying problem has been identified.
Follow-up
Hypersalivation usually occurs in the context of other diseases as a concomitant condition. For this reason, hypersalivation usually ends when the underlying disease has been successfully treated. Measures for aftercare are therefore directed more at the specific disease and less at the hypersalivation itself. Accordingly, the requirements for responsible aftercare are multifaceted, since hypersalivation occurs in conjunction with a variety of chronic or acute diseases. If the disease is associated with poisoning, aftercare initially focuses on the patient’s physical regeneration as well as close-meshed medical check-ups. For example, the physician analyzes the blood values of the affected person and ensures that the poisoning has been overcome and the triggering substances have been eliminated from the body. If hypersalivation occurs in the context of dental disease, follow-up care includes regular examinations by a dentist. In this way, the patient also prevents renewed diseases of the dental apparatus and, consequently, further hypersalivation. Sometimes hypersalivation also occurs in the case of psychological disorders and stress. In such cases, the patient must ensure that he or she maintains his or her mental equilibrium as part of the follow-up care and quickly contacts his or her psychologist in case of an emergency. A recurrence of hypersalivation may be a helpful indication that a new episode of mental illness is building up.
Here’s what you can do yourself
As an acute measure, hypersalivation should always have a cup ready to absorb saliva. At night, it is best to place a terry cloth towel under the mouth. In addition, suitable lip care products should be used, because the constant flow of saliva causes inflammation and cracking of the lips, which can sometimes cause severe pain. A lip balm avoids irritation of the lip as a result of the constant wiping of saliva. In terms of diet, spicy or otherwise irritating foods and drinks should be avoided. Alcoholic beverages as well as coffee should also be avoided. Bread reduces salivation for a short time and can provide temporary relief. Lemon essential oil soothes the nasopharynx and can be inhaled or inhaled over a cloth, for example. Occasionally, sucking ice cubes for five minutes also helps. Alternatively, some remedies from homeopathy can be used. Among others, the remedies Alumina, Belladonna and Ignatia as well as the preparation Ammonium Carbonicum have proven to be effective. If the symptoms do not subside despite the above measures, or if further complications occur, a visit to the doctor is recommended.
