Causes and risk factors
Normally between the age of 18-24 months the neuromuscular control is very well developed. Prior to this age, dribbling of saliva is a normal phenomenon. Drooling after the age of 4 years is due to some abnormality. Drooling can occur either due to excessive production of saliva by the salivary glands or lack of neuromuscular control. Difficulty in retaining and swallowing can also lead to drooling. Hypersecretion of saliva can also occur as a result of side effects of various medications. Drooling is commonly seen in individuals who suffer from neurological complaints like cerebral palsy or mental retardation or facial paralysis. Diseases of the oral cavity, gingival diseases, and dental caries are the major contributing factors for drooling. Trauma or any surgery on the oral cavity and nasal obstruction can also lead to dribbling of saliva. It is commonly seen during teething disorders, and certain oral conditions like diphtheria, epiglottitis, and other morbid conditions like rabies or neurological condition like Bell’s palsy.
Clinical presentation:
As the name suggests, dribbling of saliva is the main feature seen. The complaints can either range from mild to severe ones. The dribbling of saliva can either be constant, or occasional drooling can occur. The dribbling of saliva can be mild, causing wetting of lips and chin or it can be profuse, leading to wetting of clothes and hands. Halitosis can also occur. Spillage of saliva can cause frequent changes of clothes which can be a tedious task. Constant flow of saliva can lead to breakage of the skin which can cause repeated skin and oral infections. It can also be a matter of social embarrassment. Congested breathing and vomiting can occur due to posterior breathing. Aspiration of saliva into the lungs can lead to pneumonia.
Investigations:
Diagnosis is done on the basis of the symptoms narrated by the parents and the physical examination carried out by the doctor. In order to find out the causation of excessive salivation, certain investigations can be advised by the doctor. It may comprise of radiosialography and barium swallow. Along with this, salivary flow rate is calculated. To rule out diseases of the ear and nose, the patient is referred to an ENT specialist.
Treatment:
The treatment aims at finding out the underlying cause and treating it. Medications which will reduce the secretion of saliva and which will decrease the volume of drooling are started. Botulinum therapy used in recent times has been found to be effective. Certain other techniques can also be adopted. This comprises of administration of radiation therapy to the salivary gland which will reduce the production of saliva. In cases where the conservative method fails, surgical intervention is done. The surgery aims at redirecting or decreasing the salivary flow. Along with this, behavioral therapy and oral motor training is started.
Other Modes of treatment:
Certain other modes of treatment can also be helpful in coping up the symptom. Taking into consideration the symptoms in a holistic way, homoeopathy can offer a good aid for the relief of the symptoms. The Ayurvedic system of medicine which uses herbs and synthetic derivates can also be beneficial in combating the complaints.
