Excessive Drooling: What's Normal?

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Excessive drooling or sialorrhea refers to an increased amount of saliva in the mouth. It is usually not related to excessive saliva production from the major salivary glands. Instead, it can be attributed to poor mouth and tongue control and inadequate swallowing due to many factors.

Signs and Symptoms of Excessive Drooling

Excessive drooling is most commonly seen as the saliva that exudes beyond the lip line, known as anterior drooling, but can also manifest as posterior drooling where the excess saliva leaves the oropharynx and enters the hypopharynx. (Check out this diagram of the regions of your throat from the National Cancer Institute.) According to the U.S. National Library of Medicine, drooling is considered normal in young children, especially when the baby teeth are erupting. Teething and drooling typically resolve between age 16 months to 3 years.

Extreme drooling beyond teething is abnormal and may be problematic. In addition to the facial irritation and breakdown of the skin around the mouth, there may be difficulty swallowing. The excess saliva triggers a coughing reflex that's meant to prevent a person from aspirating food, saliva and other fluids, preventing chronic lung issues and pneumonia. If someone who drools can't cough, it can be life-threatening. If the cause of excess saliva has not been identified, a visit to your health care provider is recommended.

Causes of Excessive Drooling

Certain infections can cause excess drooling. They can include strep throat, abscesses around the tonsils and tonsillitis. Other causes can be acid reflux, obstructed nasal passages, and less commonly, an enlarged tongue or epiglottis (epiglottitis), writes the Mayo Clinic. Proper medical intervention and removal of the adenoids and tonsils if necessary will help resolve and reverse the issue. Certain medications like clozapine, commonly prescribed for schizophrenia, are also recognized as a cause, according to Therapeutic Advances in Psychopharmacology.

When excess salivation is caused by a chronic illness or neurological disorder, the systemic condition needs to monitored and managed first. Drooling can occur with the muscular difficulties of cerebral palsy and Down syndrome. Additionally, many adults with Parkinson's disease, Alzheimer's patients, stroke victims and those suffering from amyotrophic lateral sclerosis (ALS) can experience excessive drooling. In these cases, the individual's motor skills are affected, causing difficulty swallowing and working the mouth.

Treatment for Excessive Drooling

Treatment options are evolving, and some are focused on going to the source of the saliva production: the salivary glands. A study from the journal Toxins highlights how botulinum toxins (the basis of Botox) can effectively halt sialorrhea with very few side effects. The botulinum toxins are administered by injections into the parotid and submandibular salivary glands.

What does this mean for dental health? Your dentist examines your teeth and oral cavity to help maintain your oral health, and they may be the first person you talk to about excessive drooling. If any systemic conditions don't resolve, your dentist will refer you to a specialist for further evaluation.

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