Why excessive salivation occurs? There are several causes and remedies to treat a problem of excessive saliva, among others, can be uncomfortable and inconvenient as it can cause difficulty in speaking and even diminish the sense of taste. Excessive salivation is not a disease in itself but a symptom or sign that can warn us that something is wrong in our body. Excessive saliva is known in medical terms as hypersalivation, sialosis or ptyalism.
Excessive salivation, as discussed below, can serve multiple causes and, in some cases, may appear along with difficulty for swallowing, a characteristic symptom of diseases such as Parkinson’s or achalasia (esophageal disorder that hinders the passage of food to the stomach).
Hypersalivation responds to an increase in the normal production of saliva, due to certain diseases or emotional states or other transient conditions, being able to take the bitter saliva.
What is saliva?
The saliva is an aqueous fluid, hypotonic produced by different glands in the mouth and release its secretion into the same one.
The major salivary glands are distributed in pairs symmetrically located in the mouth. These are:
- The parotid
- The submandibular or submaxillary
- The sublingual
There are also minor salivary glands in different areas of the vestibular, palatal and labial mucosa, as well as in the tongue and the sublingual and retromolar areas.
Each type of the major salivary glands produces a salivary fluid of different composition and physical characteristics. As a whole, the mixture of saliva produced by all these glands is called total saliva or mixed saliva and contains basically proteins, enzymes and salts, among other compounds.
What functions does saliva play?
The saliva plays important roles in the main body these are complimenting the lubrication of the mouth with chewing that forms bolus and swallowing as well as in the digestion of food containing carbohydrates such as starch.
Also, saliva is important in tasting foods, language, remineralization of teeth and protection against demineralization, antimicrobial protection and pH buffering, among other functions.
How much saliva does man produce?
The volume of daily saliva that an adult produces on average is approximately 1500 ML. The amount of saliva that is in the mouth at each moment of the day is variable and depends on the salivary flow which can be influenced by different factors. These include physical activity, food sighting, food contact in the mouth, food quality (acidic foods stimulate saliva production), among others. The lower production levels of saliva are produced during the act of sleeping, when salivary flow is practically zero.
An increase or decrease in the amount of adequate saliva can bring problems not only to the level of physical discomfort, but also disorders that we will see below. Do not overlook excessive salivation.
Causes of excessive salivation
There are numerous causes of drooling. First, this is a transitory problem, for example to add a denture or an orthodontic appliance. A strange body, ultimately, to which our mouth has to get used to. Once we have adapted, drooling resolves without major problems. Yes, it is inconvenient to have the mouth full of saliva.
Sialorrhea or ptyalism or hypersalivation is also associated with pregnancy. During the first trimester of pregnancy increases the production of saliva, a condition that resolves itself over the course of pregnancy. Some drugs, such as those used to control high blood pressure – may increase salivation, while others, such as benzodiazepines, reduces the ability to swallow, a symptom which can also be caused by inflammation of the mouth (caused by virus or bacteria).
Generally, sialorrhea represents one of the most common symptoms of Parkinson’s disease and other pathologies of the central nervous system. The inability to control the muscles can block swallowing of food on a voluntary basis. Finally, excessive salivation may be a symptom of the disease of gastroesophageal reflux or esophageal cancer.
The drugs that can cause salivation include muscarinic cholinergic. Clozapine, widely used in the treatment of psychiatric disorders such as schizophrenia, causes sialorrhea between 30 and 97% of the people treated, which diminishes their acceptance by these people. Pneumonia transpiration has also been reported due to sialorrhea caused by clozapine. The sialorrhea associated with the administration of clozapine appears to be genetically determined.
The poisoning by organophosphate and carbamate pesticides can also cause the drooling.
Some nutritional deficiencies can cause excessive salivation. For example, niacin vitamin deficiency produces a disease called pellagra that among its characteristics has profuse salivation.
Having a diagnosis is important not only to reveal the cause of excessive salivation, but to apply the most appropriate and effective treatment in every case, especially when we warn of health problems that they can be severe. Do not forget also that anxiety can produce from excessive salivation or dry mouth.
Remedies to control excessive salivation
In cases where excessive salivation is produced by the placement of a prosthesis or pregnancy, the remedy is provided by the time, namely only forwards. Logically, the diagnosis will suggest the best treatment. Thus, for example, in the case of Parkinson can specific drugs, although they are not suitable for all patients because of possible side effects. The gastroesophageal reflux and inflammation of mouth can also be treated with medication, but when the drugs are the cause of excessive salivation is advisable to consult the doctor to decide whether it is better to change the treatment.
What is the treatment of excessive salivation or sialorrhea?
The treatment of sialorrhea should be directed in the first place to the identification and elimination of the causes of this being possible. An example of this would be the suspension of the administration of a drug or its substitution by an alternative that does not produce sialorrhea.
Medications with an anticholinergic effect that inhibit the production and release of saliva (by inhibition of the parasympathetic nervous system) may also be used. These include atropine, glycopyrrolate, scopolamine butylbromide, amitriptyline and tropicamide.
In the case of sialorrhea induced by the use of clozapine, low-dose treatment regimens with glycopyrrolate or amisulpride have been used.
Surgical treatment is sometimes necessary. Among them is the extraction of some salivary glands, such as sublingual or submandibular glands. It is also used is the ligation of the ducts, where the saliva is released in the mouth of the salivary glands (parotid glands or submandibular glands). This causes the decrease of the size of the gland and therefore of its production of saliva.
In addition, in recent years the use of botulinum neurotoxin injection into the salivary glands has been reported with great effectiveness in the elimination of saliva production and with few adverse reactions. Some studies have questioned the efficacy and safety of this treatment in children.
In cases of postoperative sialorrhea in oral cancer involving the labial commissure, it is effective to use skin grafts.
Another therapeutic strategy under study is to cause sclerosis of the salivary glands through the use of substances such as ethanolamine oleate.
The use of hypnosis in the pregnancy treatment sialorrhea has also been reported as well as behavioral and language therapies in neurological conditions and in the sialorrhea produced by clozapine.
When other forms of treatment do not work, radiotherapy of the salivary glands can be used as a last option.
In some cases, such as in neurological conditions and in children, the treatment of sialorrhea should be carried out with a multidisciplinary approach, in which the general practitioner can participate in the choice of drugs for the most appropriate sialorrhea, the dentist, the neurologist, the psychiatrist, the physiotherapist, and the social worker, according to the characteristics of the person, the disorder that suffers and the conditions in which it develops.