II. Pathophysiology

  1. Normal Submandibular Saliva production 0.10-0.15 ml/min
  2. Ptyalism may result in 1-2 L/day of Saliva loss
  3. Mechanisms of excessive Saliva
    1. Decreased Saliva swallowing and clearance
    2. Excessive Saliva production
    3. Neuromuscular disease
    4. Anatomic abnormalities

III. Causes: Saliva Overproduction

  1. Pregnancy (Ptyalism Gravidarum)
    1. Hyperemesis Gravidarum
  2. Excessive starch intake
  3. Gastrointestinal causes
    1. Gastric distention or irritation
    2. Gastroesophageal Reflux
    3. Acute Gastritis or Gastric Ulcer
    4. Pancreatitis
    5. Liver disease
  4. Medications and toxins
    1. Clozapine (Clozaril)
    2. Potassium Chlorate
    3. Pilocarpine
    4. Mercury Poisoning
    5. Copper
    6. Arsenic Poisoning
    7. Antimony (used to treat Parasitic Infections)
    8. Iodide
    9. Bromide
    10. Aconite (derived from Aconitum napellus root)
    11. Cantharides
  5. Stomatitis and localized Oral Lesions
    1. Aphthous Ulcers
    2. Oral chemical burns
    3. Oral suppurative lesions
    4. Alveolar abscess
    5. Epulis
  6. Oral infectious Lesions
    1. Dental Caries
    2. Diphtheria
    3. Syphilis
    4. Tuberculosis
    5. Small Pox

IV. Causes: Difficulty Swallowing Saliva

V. Management: Non-specific

  1. Treat specific causes as below
  2. General measures to reduce Saliva
    1. Tooth Brushing and mouthwash has drying effect
    2. Reduce starch intake from diet
  3. Orthodontic appliances that aid swallowing
    1. Upper plate to cover Palate with movable beads
      1. Aids lip closure
      2. Directs Saliva toward pharynx
  4. Anticholinergic Medications (if refractory to above)
    1. Glycopyrrolate
      1. Adults: 0.5 to 2 mg PO qd to tid prn
      2. Children: 0.04 mg/kg PO qd to tid prn
      3. Mier (2000) Arch Pediatr Adolesc Med 154:1214-8 [PubMed]
    2. Scopolamine Patch 1.5 mg applied every 72 hours prn
      1. Lewis (1994) Dev Med Child Neurol 36:484-6 [PubMed]
  5. Advanced procedures in severe and refractory cases
    1. Botulinum Toxin A Salivary Gland injection
      1. Performed under Ultrasound guidance
      2. Porta (2001) Psychiatry 70:538-40 [PubMed]
    2. Radiation Therapy
      1. Borg (1998) Int J Radiat Oncol Biol Phys 41:1113-9 [PubMed]
    3. Surgery
      1. Submandibular Gland excision or duct relocation
      2. Parotid duct relocation or ligation
      3. Salivary denervation (transtympanic neurectomy)
      4. Crysdale (2001) Dev Med Child Neurol 43:379-83 [PubMed]

VI. Management: Specific measures

  1. Treat Nausea with Antiemetics
  2. Treat Gastroesophageal Reflux
  3. Neuromuscular causes
    1. Speech pathology (e.g. swallowing Mechanism)
    2. Occupational therapy (e.g. head-back wheelchair)
    3. Neurology Consultation
    4. Biofeedback
  4. Oral diseases including dental malocclusion
    1. Dentist or orthodontist
  5. Macroglossia or Tonsillar Hypertrophy
    1. Otolaryngology

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Ontology: Drooling (C0013132)

Concepts Sign or Symptom (T184)
MSH D012798
SnomedCT 62718007, 139280003
English Drooling, Drool, drooling (physical finding), drooling, dribbles, dribble, drool, drooled, dribbling, Drooling from mouth, Dribbling from mouth, Dribbling from mouth (finding)
French Bave, Bavage
Japanese よだれ, ヨダレ
Portuguese Baba, Hipersialorreia
Spanish Babeo, baba, babear (hallazgo), babear
German Speichelfluß, Sabbern
Czech Slintání, slintání
Hungarian Nyálzás
Italian Sbavare
Norwegian Sikling
Dutch kwijlen, Speekselvloed

Ontology: Sialorrhea (C0037036)

Definition (MSH) Increased salivary flow.
Concepts Disease or Syndrome (T047)
MSH D012798
ICD10 K11.7
SnomedCT 53827007, 162013008, 266424000, 139278009, 267047000, 275295002
English Hypersalivation, Sialorrhea, HYPERSALIVATION, SALIVA INCREASED, Excessive secretion of saliva, SALIVATION, sialosis, excessive saliva, excessive saliva (symptom), ptyalism (physical finding), excessive saliva (ptyalism), ptyalism, sialosis (diagnosis), ptyalism (diagnosis), ptyalism was observed, salivary secretion disturbance: ptyalism, Saliva secretion excessive, Saliva increased, Saliva secretion increased, Increased salivation, Sialorrhea [Disease/Finding], salivation, increased saliva, sialorrhoea, sialism, hypersecretion of saliva, polysialia, increased salivation, salivation excessive, Excessive salivation (& symptom) (finding), Sialosis (disorder), Salivation excess symp., Excessive salivation (& symptom), Excessive salivation (finding), Ptyalism, Sialosis, Hypersecretion of saliva, Hypersecretion of salivary gland, Polysialia, Ptyalorrhea, Sialism, Sialismus, Excessive salivation, Salivary hypersecretion, Sialorrhoea, Excessive salivation - symptom, Excessive salivation (disorder), Hyperactive salivary flow, Ptyalorrhoea, sialorrhea, hypersalivation, hypersecretion; salivary gland, salivary gland; hypersecretion, salivary secretion; excessive, excessive salivation, Excessive;salivation, Excessive salivation - symptom (context-dependent category), Excessive salivation - symptom (finding)
French PTYALISME, Hypersalivation, Salivation augmentée, Salive augmentée, Hypersécrétion salivaire, Sécrétion salivaire augmentée, HYPERSALIVATION, Hypersialie, Sialorrhée, Ptyalisme, Polysialie
Portuguese SALIVACAO, HIPERSALIVACAO, Secreção excessiva de saliva, Sialorréia, Salivação aumentada, Ptialismo, Saliva aumentada, Secreção aumentada de saliva, HIPERSIALORREIA, Sialorreia, Hipersecreção salivar, Hipersalivação
Spanish SIALORREA, HIPERSALIVACION, sialorrea - síntoma (hallazgo), Salivación aumentada, Saliva aumentada, Secreción excesiva de saliva, Secreción aumentada de saliva, Ptialismo, sialorrea - síntoma (categoría dependiente del contexto), flujo salival hiperactivo, hipersecreción salival, ptialismo, ptialorrea, salivación excesiva - síntoma, sialismo, sialorrea (trastorno), sialorrea - síntoma, sialorrea, sialosis, Hipersecreción salival, Sialorrea, Hipersalivación
Italian Ipersecrezione salivare, Secrezione eccessiva di saliva, Saliva aumentata, Ptialismo, Salivazione aumentata, Secrezione salivare aumentata, Ipersalivazione, Scialorrea
Dutch sialorroe, hypersalivatie, speeksel toegenomen, ptyalisme, verhoogde speekselvloed, speekseluitscheiding toegenomen, speekseluitscheiding verhoogd, hypersecretie; speekselklier, speekselklier; hypersecretie, speekselsecretie; overmatig, speekselhypersecretie, Hypersalivatie, Sialorroe
German Ptyalismus, Speichel erhoeht, Speichelsekretion exzessiv, Speichelsekretion erhoeht, erhoehte Speichelbildung, Speichelfluss, HYPERSALIVATION, SALIVATION, SPEICHEL VERMEHRT, Hypersalivation, Sialorrhoe
Japanese 流涎過多, 唾液増加, 唾液分泌亢進, 流涎症, リュウゼンショウ, リュウゼンカタ, ダエキブンピツカタ, ダエキブンピコウシン, ダエキブンピツコウシン, ダエキゾウカ, ダエキブンピカタ, 流ぜん, 唾液分泌過多, 唾液分泌過多(ダエキプンピツカタ), 流涎, 唾液過多
Swedish Spottflöde
Czech sialorea, Zvýšená sekrece slin, Sialorea, Nadměrná sekrece slin, Zvýšená salivace, Ptyalismus, Hypersalivace, Hypersekrece slin, zvýšené slinění, ptyalismus, ptyalizmus, hypersalivace, sialorrhoe
Finnish Sialorrea
Russian SIALOREIA, GIPERSALIVATSIIA, PTIALIZM, ГИПЕРСАЛИВАЦИЯ, ПТИАЛИЗМ, СИАЛОРЕЯ
Polish Ślinotok
Hungarian Fokozott nyáltermelés, Ptyalismus, Sialorrhoea, Nyál hypersecretio, Nyálfolyás, Fokozott salivatio, EXcessiv nyáltermelés, Hypersalivatio
Norwegian Sialorrhea, Hypersalivasjon