Excessive salivation: what is it and what to do about it

Causes of drooling

Physiological factors

The symptom is observed in most women in the first trimester of pregnancy. The appearance of drooling is associated with reflex irritation of the nerve centers that control the production of saliva. The intensity of the manifestations varies: from single nighttime episodes of sialorrhea to constant and uncontrolled flow of saliva, when a woman loses up to 3-5 liters of fluid per day. Drooling is normal in infants and children during the eruption of primary and permanent teeth.

Mechanical irritation of the oral cavity

Hypersalivation, with saliva flowing from the corners of the mouth, is a common problem for people who start wearing removable dentures. Over the course of several months, adaptation to the foreign body occurs, and the amount of saliva released gradually decreases. Short-term sialorrhea is observed during dental procedures, the use of chewing gum or sucking candy. Drooling occurs in many smokers.

Dental diseases

Sialorrhea often develops with stomatitis, gingivitis, and dental caries. The symptom is associated with irritation of M-cholinergic receptors in the mucosa. Drooling is moderate and appears more often at night. During the day, there may be a slight leakage of saliva, which accumulates in the corners of the mouth. In addition to increased salivation, patients complain of soreness and burning in the mouth, pain when chewing and swallowing, and bad breath.

Gastrointestinal diseases

Sialorrhea is possible when the stomach and initial parts of the intestines are affected. Its most typical appearance is in chronic pancreatitis, cholecystitis, and peptic ulcer. The symptom occurs at any time of the day and is often accompanied by heartburn and an unpleasant taste in the mouth. A combination of drooling with abdominal pain, nausea and vomiting, and stool disorders is typical.

ENT diseases

The flow of saliva is typical for people who have difficulty breathing through their nose and sleep with their mouth open. It occurs in patients with sinusitis, chronic rhinitis, and in children with adenoids. Drooling develops primarily during sleep. Due to the constant drying of the mucous membrane, a small amount of viscous saliva is released, accumulating on the skin of the perioral zone or leaving marks on the bed linen.

Worm infestations

The reproduction of helminths in the gastrointestinal tract causes irritation of peripheral receptors, reflexively activating the secretion of saliva. A specific sign of helminthiasis is salivation, which is disturbing at night. A person will know that there is a problem by wet spots on the pillowcase and pajamas. Dried crusts of saliva are visible in the corners of the mouth after waking up. Symptoms are supplemented by abdominal pain, dyspeptic disorders, and itching in the anal area.

Neurological pathologies

The symptom occurs in pathological processes affecting the centers of regulation of salivation. Drooling is one of the first signs of Parkinson's disease, a cerebral tumor. In such conditions, saliva is produced in large quantities and must be constantly swallowed. As problems with swallowing later arise, saliva begins to flow from the corners of the mouth.

Drooling can be caused by impaired innervation of the facial muscles and the inability to completely close the mouth. The manifestation is pathognomonic for facial nerve paralysis and residual effects of a stroke. Saliva always drains from one side of the mouth, where sagging cheek muscles and insufficient lip closure are noted. Drooling increases when a person tilts his head to the side towards the affected side of the face.

In bulbar syndrome, sialorrhea is caused by impaired swallowing and the inability to retain saliva in the mouth. The functioning of the salivary glands remains at the same level or even decreases. Patients feel the saliva present in the mouth, but the automatic act of swallowing does not occur. Drooling is a constant concern, regardless of the time of day. Later, speech disturbances and difficulty swallowing solid and liquid foods appear.

Complications of pharmacotherapy

Most often, salivation increases during treatment with M-cholinomimetics. The drugs affect peripheral receptors and stimulate the functions of the salivary glands. In this case, severe uncontrollable drooling occurs, in which saliva flows copiously down the chin. The symptom is determined from the first days of taking medication. There are other medications that cause drooling:

• Iodine-containing preparations.
• Barbiturates.
• Benzodiazepine derivatives: nitrazepam, phenazepam.
• Neuroleptics: triftazine, haloperidol, moditene-depot, clopixol.

Rare causes

• Congenital forms of drooling
  : Glaser syndrome, Cray-Levy syndrome.
• Mental illnesses
  : schizophrenia, bipolar disorder, catatonic syndrome.
• Poisoning
  : organophosphorus substances, metals (lead, mercury), poisonous mushrooms and plants.
• Hormonal disorders
  : hyperestrogenism, menopause, thyroid disease.

Causes of sore throat

Most often, a sore throat is associated with a viral infection (ARVI, influenza, Coxsackie virus, new coronavirus infection, chickenpox, measles). A sore throat caused by a bacterial infection (such as streptococcal infection) is less common. Other causes of sore throat include:

• tonsillitis (tonsillitis);
• epiglottitis;
• mononucleosis;
• paratonsillar, parapharyngeal, retropharyngeal abscesses;
• allergies (to pollen, mold, dust, animal hair and epidermis);
• dry air, air pollution (tobacco smoke, chemicals);
• breathing through the mouth with nasal congestion;
• spicy food, alcohol;
• overstrain of the muscles of the larynx and pharynx (during shouting, the habit of speaking loudly, lecturing);
• gastroesophageal reflux disease (GERD);
• malignant tumors of the tongue, throat, larynx;
• HIV infection.

Risk factors for a sore throat include: childhood and adolescence (usually bacterial infections), smoking (including second-hand smoke), frequent or chronic sinus infections (sinusitis), seasonal allergies or prolonged exposure to allergens such as mold, dust, pet hair, exposure to chemicals, weakened immunity (due to illness or treatment, for example, chemotherapy drugs).

Diagnostics

With the problem of drooling, patients turn to a dentist, or less often to a therapist. Given the variety of causes of pathology, the doctor is required to take a detailed medical history and clarify related complaints. The diagnostic search begins with an examination of the oral cavity to identify signs of inflammation or caries. To establish the causes of drooling, the following instrumental and laboratory diagnostic methods are used:

• Biochemical analysis of saliva.
  The study evaluates the amount of fatty acid metabolites formed during the life of bacterial flora. Based on the results of the analysis, it is possible to determine the presence of dysbacteriosis and determine the level of damage to the digestive tract.
• General clinical studies.
  Patients with drooling undergo a general blood test, changes in which indicate the presence of an inflammatory or infectious process. To exclude helminthic infestations, a coprogram is prescribed, a fecal examination for helminth eggs. According to indications, a clinical urine test and studies according to Nechiporenko and Zimnitsky are performed.
• Instrumental techniques.
  If a patient suffering from drooling has complaints about the functioning of the digestive system, an ultrasound of the abdominal organs and plain radiography are necessary. To exclude neurological diseases, CT or MRI of the brain is recommended. Electroneuromyography is effective for assessing the functions of peripheral nerves.

When should you see a doctor if you have a sore throat?

You should consult a doctor if the sore throat is severe and lasts more than 4-5 days, there is difficulty swallowing (breathing), difficulty opening your mouth, a rash on the skin, blood in saliva or sputum, temperature exceeds 38.3˚C, swelling is observed tongue or neck, pain in muscles and joints. A child needs to consult a pediatrician if his sore throat is accompanied by difficulty breathing or swallowing, stridor (noisy wheezing), or excessive salivation.

Diagnosis of a sore throat includes anamnesis, physical examination, if necessary, the doctor takes a culture from the throat (bacteriological examination), and conducts a universal rapid test for the presence of group A beta-hemolytic streptococcus in the throat.

A viral sore throat does not require treatment. To relieve associated symptoms, you can take ibuprofen or paracetamol (caution, do not give aspirin to children!), use anesthetic sprays or lozenges, gargle with warm salt water, drink plenty of fluids, and get plenty of rest. If a sore throat is caused by a bacterial infection, antibacterial drugs are prescribed, it is important to follow the doctor's recommendations regarding the duration of their use and dosage. For sore throat associated with allergies, GERD and other diseases, appropriate drug therapy is prescribed (antihistamines, antacids, proton pump inhibitors).

Treatment

Help before diagnosis

Moderate drooling does not pose a threat to health and does not require emergency treatment. With nocturnal sialorrhea, patients are advised to sleep on their side so that saliva does not enter the respiratory tract. To prevent maceration of the skin around the mouth, you need to maintain hygiene and use nourishing and moisturizing creams. Since there is a risk of dehydration with excessive drooling, you should increase the amount of fluid you drink per day.

To reduce saliva production, doctors advise avoiding sweets, carbonated drinks and foods rich in extractive substances. Hygienic oral care is best done with slightly foaming toothpastes. For swallowing disorders and perioral muscle dysfunction, motor exercises are prescribed to help control drooling. Special massage and physiotherapy are used less frequently.

Conservative therapy

In most situations, drooling can be completely eliminated after treatment of the underlying pathology. The therapeutic regimen is selected by a doctor of the appropriate profile: gastroenterologist, otolaryngologist, neurologist. If drooling is caused by acute poisoning, an intensive detoxification program is carried out in a hospital setting. With massive sialorrhea, pathogenetic therapy is required, which includes:

• M-anticholinergics
  . Medicines inhibit the secretion of the salivary glands, quickly eliminating salivation. In addition to standard tablet products, there are skin patches. Solutions with anticholinergics are also used to rinse the mouth.
• Tricyclic antidepressants
  . An additional effect of medications is a decrease in the functional activity of glandular tissue. They are primarily prescribed for psychogenic salivation.
• Botulinum toxin
  . Botulinum toxin temporarily blocks the nerve impulses that stimulate salivation. It is used in the form of local injections in the absence of effect from standard conservative treatment.

Elimination of hypersalivation

The best way to get rid of hypersalivation is to eliminate its cause. In many cases, changing medications or treating the underlying condition will help stop excess salivation. However, there are other methods that can help you reduce the amount of saliva your body produces.

For example, avoiding foods and drinks that can stimulate saliva production may help. Such irritants are different for everyone, but citrus fruits and alcohol, as a rule, temporarily increase salivation. Use an alcohol-free mouthwash because alcohol dries out your mucous membranes, which can signal your body to produce more saliva. In addition, it is useful to drink more liquid: this will make the saliva less viscous and easier to swallow.

Excessive salivation makes it difficult to speak, eat, and interact with others. Having eliminated the cause of hypersalivation, you can again look at mouth-watering foods without fear.