Drooling

Definition

Drooling is saliva flowing outside the mouth.

Alternative Names

Salivation; Excessive saliva; Too much saliva; Sialorrhea

Considerations

Drooling is generally caused by:

• Problems keeping saliva in the mouth
• Problems with swallowing
• Too much saliva production

Some people with drooling problems are at increased risk of breathing saliva, food, or fluids into the lungs. This may cause harm if there is a problem with the body's normal reflexes (such as gagging and coughing).

Causes

Some drooling in infants and toddlers is normal. It may occur with teething. Drooling in infants and young children may get worse with colds and allergies.

Drooling may happen if your body makes too much saliva. Infections can cause this, including:

• Mononucleosis
• Peritonsillar abscess
• Strep throat
• Sinus infections
• Tonsillitis

Other conditions that can cause too much saliva are:

• Allergies
• Heartburn or GERD (reflux)
• Poisoning (especially by pesticides) 
• Pregnancy (may be due to pregnancy side effects such as nausea or reflux)
• Reaction to snake or insect venom
• Swollen adenoids
• Use of certain medications

Drooling may also be caused by nervous system disorders that make it hard to swallow. Examples are:

• Amyotrophic lateral sclerosis, or ALS
• Autism
• Cerebral palsy (CP)
• Down syndrome
• Multiple sclerosis
• Parkinson disease
• Stroke

Home Care

 Popsicles or other cold objects (such as frozen bagels) maybe helpful for young children who are drooling while teething. Take care to avoid choking when a child uses any of these objects.

For those with chronic drooling:

• Caregivers may try reminding the person to keep lips closed and chin up
• Try to avoid sugary foods, as they may increase the amount of saliva
• Watch for skin break down around the lips and on the chin

When to Contact a Medical Professional

Call your health care provider if:

• The cause of the drooling has not been diagnosed.
• There is concern about gagging or choking.
• Your child has a fever, difficulty breathing, or holds his or her head in a strange position.

What to Expect at Your Office Visit

The doctor will do a physical examination and ask questions about your symptoms and medical history.

Testing depends on the person's overall health and other symptoms. 

A speech therapist can determine if the drooling increases the risk of breathing in food or fluids into the lungs. This is called aspiration. This may include information about:

• How to hold your head
• Lip and mouth exercises
• Encourage you to swallow more often

Drooling caused by nervous system  problems can often be managed with drugs that reduce saliva production. Different drops, patches, or pills or liquid medicines may be tried.

If you have severe drooling, the doctor may recommend:

• Botox shots
• Radiation to the salivary glands
• Surgery to remove the salivary glands

References

Lowell MJ. Esophagus, stomach, duodenum. In: Marx JA, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier; 2009:chap 87.

Melio FR. Upper respiratory tract infections. In: Marx JA, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier; 2009:chap 73.

Vanderhoff BT, Carroll W. Neurology. In: Rakel RE. Textbook of Family Medicine. 7th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 54.

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