Hypersalivation

Hypersalivation
Classification and external resources
DiseasesDB	20764
MedlinePlus	003048
eMedicine	ent/629
MeSH	D012798

Hypersalivation (also called ptyalism^[1] or sialorrhea^[2]) is excessive production of saliva. It has also been defined as increased amount of saliva in the mouth, which may also be caused by decreased clearance of saliva.^[3]

Hypersalivation can contribute to drooling if there is an inability to keep the mouth closed or in difficulty in swallowing the excess saliva (dysphagia).

Hypersalivation also often precedes emesis (vomiting), where it accompanies nausea (a feeling of needing to vomit).^[4]

Causes

Excessive production

Conditions that can cause saliva overproduction include:^[3]

• Rabies
• Pellagra (niacin or Vitamin B3 deficiency)^[5]
• Gastroesophageal reflux disease, in such cases specifically called a water brash, and is characterized by a sour fluid or almost tasteless saliva in the mouth^[6]
• Pregnancy
• Excessive starch intake
• Pancreatitis
• Liver disease
• Serotonin syndrome
• Mouth ulcers
• Oral infections

Medications that can cause overproduction of saliva include:^[3]

• clozapine
• pilocarpine
• ketamine
• potassium chlorate
• risperidone
• rabeprazole sodium (Aciphex)

Toxins that can cause hypersalivation include:^[3]

• mercury
• copper
• organophosphates (insecticide)
• arsenic

Decreased clearance

Causes of decreased clearance of saliva include:^[3]

• Infections such as tonsillitis, retropharyngeal and peritonsillar abscesses, epiglottitis and mumps.
• Problems with the jaw, e.g., fracture or dislocation
• Radiation therapy
• Neurologic disorders such as myasthenia gravis, Parkinson's disease, multiple system atrophy, rabies, bulbar paralysis, bilateral facial nerve palsy, and hypoglossal nerve palsy.

Treatment

Hypersalivation is optimally treated by treating or avoiding the underlying cause.^[3] Mouthwash and tooth brushing may have drying effects.^[3]

In the palliative care setting; anticholinergics and similar drugs that would normally reduce the production of saliva causing a dry mouth could be considered for symptom management: scopolamine, atropine, propantheline, hyoscine, amitriptyline, glycopyrrolate.^[7]

References

1. thefreedictionary.com > ptyalism Citing:
   • Dorland's Medical Dictionary for Health Consumers. 2007
   • Mosby's Medical Dictionary, 8th edition. 2009
   • Saunders Comprehensive Veterinary Dictionary, 3 ed. 2007
2. thefreedictionary.com > sialorrhea Citing:
   • The American Heritage Dictionary of the English Language, Fourth Edition, Updated in 2009.
3. Medscape > Hypersalivation By Erica Brownfield. Posted: 05/19/2004
4. Clark], [edited by Parveen Kumar, Michael (2005). Kumar & Clark clinical medicine (6th ed.). Edinburgh: Elsevier Saunders. p. 266. ISBN 0702027634.
6. thefreedictionary.com > water brash Citing: Dorland's Medical Dictionary for Health Consumers. 2007
7. Medical Care of the Dying, 4th Edition, 2006, Edited by G.Michael Downing MD and Wendy Wainwright, MEd