These stages include oral preparatory, oral propulsive, pharyngeal, and esophageal phases ( 11). Swallowing involves multiple cranial nerves as well as voluntary and involuntary muscle movements throughout its four stages. Many of the most challenging cases of sialorrhea, however, come not from overproduction but from inability to swallow and manage secretions. Increases in production will necessarily affect some part of this arc ( 8). Through the glossopharyngeal and facial nerves, there is a direct response to oral stimulation as well as conditioned responses like to smell. While sympathetic regulation occurs primarily through noradrenaline release, parasympathetic regulation is controlled by the medulla in the brain and acetylcholine outflow ( 10). This production responds to the autonomic nervous system and thus responds to both sympathetic (restricting salivary flow) and parasympathetic (increasing salivary flow) control ( 9).
The major glands responsible for production of saliva-sublingual, parotid, and submandibular-produce, on average, between 0.5 and 1.5 L of saliva in a day ( 8). This review will provide a summary of the current epidemiology of the various forms of sialorrhea, examine the various disease states and other etiologies for the pathology, describe appropriate evaluation of the patient with hypersalivation, and, finally, provide treatment options for patients faced with these challenges.Įtiology, scope, and epidemiology of sialorrheaĪs with many involuntary functions, proper salivary flow and control is regulated by a complex combination of body systems. Treatment teams must also consider the side-effects and varying effectiveness of available treatments-pharmacologic, non-pharmacologic, surgical, and radiotherapeutic. Other causes include cancers of the head and neck and diseases such as amyotrophic lateral sclerosis (ALS). This state often results from neurologic and neuromuscular disease-most commonly Parkinson’s disease in adults ( 6) and Cerebral Palsy in children ( 7). Alternatively, inability to clear secretions and dysphagia can lead to a secondary sialorrhea. Overproduction of saliva can result from certain medications, especially of the antipsychotic type, vitamin deficiencies, and gastroesophageal reflux ( 5). Perhaps more confounding is planning a treatment strategy for sialorrhea around the wide range of disease states that can lead to this symptom. These patients require additional secretion management at baseline.įor physicians caring for patients with sialorrhea, it can be challenging to control secretions without precipitating the opposite state of xerostomia and its associated risks of oral and gastrointestinal issues. With an inability to self-manage secretions, especially in patients with poor airway control and clearance, the one or more liters of saliva produced regularly each day can result in aspiration, choking, poor oxygenation, and life-threatening pneumonias ( 4). The second, and potentially more dangerous sequelae, are those affecting the respiratory system.
Saliva in exces skin#
The first, and most obvious of these, is excess saliva spilling over the bottom lip leading to drooling, external skin irritations and breakdown, rashes, poor quality of life, and social ramifications ( 3). In either case, the saliva then poses several additional risks to the patient. Sialorrhea is precipitated by two primary mechanisms-overproduction/excessive secretion of saliva or, alternatively, poor oral clearance secondary to various forms of dysphagia. By contrast, sialorrhea, also known as hypersalivation or excessive salivary output, has garnered less attention. Namely, there have been multiple studies of xerostomia in patients taking certain medications, patients suffering from autoimmune diseases like Sjogren’s, and in patients receiving radiotherapy ( 2).
Much has been written about the relative lack or deficiency in this important secretion-also called xerostomia. Saliva provides lubrication for the mouth, helps with swallowing, distributes food to taste buds, prevents bacterial overgrowth, and aids in preventing tooth decay and oral breakdown ( 1). Normal salivary production is fundamental to good oral and gastrointestinal health.
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