Excessive salivation is medically known as hypersalivation, ptyalism, or sialorrhea. It occurs when saliva production exceeds the mouth’s capacity to contain it, often resulting in drooling. While saliva is necessary for digestion, oral health, and speech, an overabundance can cause discomfort, skin irritation, and social embarrassment. Understanding the underlying causes is the first step toward effective management.
Why Excessive Salivation Occurs
Excessive salivation is generally categorized into two distinct problems: a genuine increase in saliva production and a failure to clear normal amounts of saliva. True hypersalivation, or increased production, is often a side effect of certain medications. This is commonly observed with atypical antipsychotic drugs, such as clozapine, and cholinergic agonists used to treat conditions like myasthenia gravis or Alzheimer’s disease.
Certain medical conditions also stimulate the salivary glands, including infections in the mouth or throat, and gastroesophageal reflux disease (GERD). In cases of GERD, the excess saliva is sometimes called “water brash,” an involuntary reflux response to stomach acid irritating the esophagus. Exposure to heavy metal toxins or some organophosphate insecticides can also trigger a temporary, dramatic increase in saliva flow.
The more common cause of chronic sialorrhea, however, is decreased clearance due to impaired swallowing or lip control. This is frequently seen in individuals with neurological conditions that affect muscle control, such as Parkinson’s disease, stroke, cerebral palsy, or amyotrophic lateral sclerosis (ALS). In these instances, the salivary glands may be producing a normal amount of saliva, but the patient swallows less frequently, or facial and oral muscle weakness prevents effective swallowing and lip closure. The pooling of saliva is a result of this motor dysfunction, rather than overproduction, leading to unintentional leakage from the mouth.
Lifestyle and Home Management Strategies
Management of excessive saliva often begins with simple, non-pharmacological adjustments to improve oral control. Posture plays a significant role in managing saliva pooling. Maintaining an upright position with the head held straight encourages swallowing and prevents drooling. During sleep, elevating the head of the bed or using a wedge pillow can help mitigate nighttime drooling issues.
Speech-language pathologists can prescribe specific exercises to improve the strength and coordination of the oral muscles involved in swallowing and lip closure. These oral motor exercises include lip-seal practices, like pressing the lips together tightly, and jaw strengthening movements. Conscious swallowing is another valuable technique, where individuals practice a “dry swallow” on command, which helps train the body to clear saliva more often.
Dietary modifications can also reduce the stimulation of saliva production, so avoiding highly acidic foods and beverages, like citrus fruits, may be helpful. Paradoxically, sucking on a sugar-free hard candy or a piece of ice can be beneficial for some individuals. The strong flavor and cold temperature increase sensory awareness in the mouth, prompting more frequent and deliberate swallowing to clear the resulting saliva. Candies sweetened with xylitol also promote good dental health.
Professional Medical Treatment Options
When behavioral and lifestyle strategies do not provide adequate relief, medical professionals can offer several targeted treatment options. Treatment starts with a comprehensive review of current medications. If a specific drug is identified as the cause, a doctor may adjust the dosage or switch to an alternative medication. This is often the most straightforward method for resolving drug-induced sialorrhea.
Pharmacological treatments are commonly used to directly reduce the volume of saliva produced by the glands. The primary class of drugs used for this purpose is anticholinergics, which block the action of acetylcholine, a neurotransmitter that signals the salivary glands to secrete saliva. Medications such as glycopyrrolate are often prescribed because they effectively reduce secretions while having a lower risk of crossing the blood-brain barrier, minimizing central nervous system side effects like confusion.
For severe or refractory cases, more advanced interventions are available, including the targeted injection of botulinum toxin (Botox) into the major salivary glands. This neurotoxin temporarily blocks the release of acetylcholine at the nerve endings, significantly reducing saliva production. This treatment is typically effective for three to six months and can be repeated. In very rare circumstances, surgical options, such as the removal or relocation of a salivary gland duct, may be considered when all other treatments have failed.