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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 unrelated to excessive saliva production from the major salivary glands. Caused by various factors, it can be attributed to poor mouth and tongue control, and inadequate swallowing.

Signs and Symptoms of Excessive Drooling

Excessive drooling is most commonly observed as saliva released beyond the lip line, known as anterior drooling, but can also manifest as posterior drooling when the excess saliva is released from the back of the mouth into the hypopharynx (the entrance to the esophagus). According to the U.S. National Library of Medicine, drooling is considered normal in young children, especially when their baby teeth are erupting. Teething and drooling typically resolve between the age of 16 months and 3 years.

Extreme drooling beyond teething is abnormal and may be problematic. In addition to causing facial irritation and skin breakdown around the child's mouth, the drooling may lead to difficulty swallowing. Excess saliva triggers a coughing reflex meant to keep a person from inhaling food, saliva and other fluids, in order to prevent chronic and severe lung problems. If drooling prevents a person from coughing, this 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

Some health conditions can cause excessive 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), notes the Mayo Clinic. Proper medical care and removal of the adenoids and tonsils, if necessary, will help resolve and reverse the issue. Some medications are also recognised as a trigger, according to Therapeutic Advances in Psychopharmacology.

When excessive saliva is caused by a chronic illness or neurological disorder, the systemic condition needs to be monitored and managed first. Drooling can occur as a result of the muscular difficulties associated with cerebral palsy and Down syndrome. In addition, many adults with Parkinson's Disease, Alzheimer's Disease, stroke victims and patients 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 still developing, and some of them target the source of saliva production: the salivary glands. A study published in the journal Toxins highlights how botulinum toxins (the basis of Botox) can effectively halt sialorrhea with very few side effects. The botulinum toxins are injected 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; he or she may be the first person you talk to about excessive drooling. In the event that any systemic conditions are not resolved, your dentist will refer you to a specialist for further evaluation.

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