dhypersalivation

dhypersalivation, commonly termed hypersalivation or sialorrhea, describes excessive saliva production and/or reduced ability to manage saliva. In clinical practice, the problem is often due to impaired clearance of saliva rather than true overproduction. The term ptyalism is also used, and distinctions between hypersalivation and drooling due to swallowing impairment are made to guide evaluation and treatment.

Etiology falls into several categories. Increased saliva production (ptyalism) can occur with mucosal irritation, oral infections, gastroesophageal reflux, pregnancy, and certain medicines with cholinergic activity. More frequently, hypersalivation results from diminished swallow or clearance in neurological conditions such as Parkinson's disease, amyotrophic lateral sclerosis, cerebral palsy, stroke, or severe intellectual disability. Dental problems, mouth breathing, and exposure to toxins (organophosphates) can contribute. Some medications may cause sialorrhea, including clozapine.

Clinical features include persistent drooling, moisture around the lips, skin irritation, and potential aspiration, particularly in children and older adults with reduced protective reflexes. Evaluation includes medical history, medication review, dental assessment, and swallow evaluation; imaging or ENT or speech-language pathology consultation may be necessary to determine swallow function and airway risk.

Management aims to reduce saliva production or improve clearance and may involve nonpharmacologic strategies (oral motor therapy, saliva control devices), and pharmacologic treatments such as oral or injectable anticholinergic agents (glycopyrrolate, scopolamine patch), botulinum toxin injections into the salivary glands, or, rarely, radiation therapy. When refractory, surgical options such as duct ligation or partial gland excision may be considered. Addressing underlying neurological or systemic conditions is essential.