Causes of drooling
Drooling is considered normal up to the age of four. Drooling is a common presenting symptom of many neurological diseases, (e.g., cerebral palsy, amyotrophic lateral sclerosis, Parkinson’s disease, etc.), and otolaryngologic diseases (tumor of the upper digestive tube). Side effects of a few drugs and complications of a few surgical procedures of the oral cavity may lead to drooling.
Drugs that may produce drooling are anticonvulsants, tranquilisers, etc. Drooling occurs due to excessive production of saliva that is accompanied by poor control of oral and facial muscles with dysfunction of the swallowing.
Complications
Drooling in adults may lead to social embarrassment and low self-esteem. It may lead to repeated infections of the oral cavity. Drooling may also suggest worsening of underlying pathological conditions.
Test and diagnosis
The doctor asks a few questions to ascertain the history of the problem. Thereafter, the diagnosis is made based on the clinical observation and evaluation. Once the diagnosis is established, the patients are assessed for the severity of the symptoms. Assessment is based on the following criteria: Number of times a dress is changed per day, difficulty to communicate with others, observation of the area around lips, observation of teeth and gums, examination of throat and nostrils, neurological examination, etc. Subsequently, the doctor may ask for a few tests to evaluate presence of any underlying pathological conditions (neurological or otolaryngologic diseases).
Treatment
Supportive treatment
Supportive treatment consists of behavioural therapy and speech therapy. Speech therapy is undertaken to improve mobility of the tongue, stability of the jaw, and closure of the lips. Dental appliances may offer some help in decreasing drooling. Behavioural therapies include cuing, positive reinforcements, etc.
Medical treatment
Drugs may be used to decrease secretion of the saliva from the glands. Most common drugs used to decrease salvation are glycopyrrolate and trihexyphenidyl. These drugs act on the salivary glands to decrease secretion of the saliva. These drugs belong to the category of anticholinergic drugs. They act on the muscarinic receptors located in the salivary glands. They inhibit the muscarinic receptors and thereby decrease salivation. Recently botulinum toxin has been found effective in decreasing salivation. Botulinum toxin is directly injected into the salivary glands. A severe form of drooling resistant to all forms of treatment may be treated with radiation, treatment with rays radiating from radioactive substances. It results in destruction of salivary glands.
Surgical treatment
Surgery is an option for severe and resistant cases of drooling. Salivary gland may be removed surgically or tied with a thread to decrease the secretion of saliva.
Drooling in adults may be of varying severity. Most commonly, it occurs due to an underlying disease. Treatment of the underlying disease is essential along with the treatment of drooling in order to decrease salivation.
