Drooling of saliva: A review of the etiology and management options

doi:10.1016/j.tripleo.2005.08.018

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology

Volume 101, Issue 1, January 2006, Pages 48-57

https://doi.org/10.1016/j.tripleo.2005.08.018 Get rights and content

Drooling of saliva appears to be the consequence of a dysfunction in the coordination of the swallowing mechanism, resulting in excess pooling of saliva in the anterior portion of the oral cavity and the unintentional loss of saliva from the mouth. Drooling can produce significant negative effects on physical health and quality of life, especially in patients with chronic neurological disabilities. Various approaches to manage this condition have been described in the literature, including oral motor therapy, behavior modification via biofeedback, orofacial regulation therapy, drug therapy, radiotherapy, and surgical treatments. Minimally invasive modalities, such as injection of botulinum toxin, photocoagulation, and acupuncture, have also been reported. This article provides a comprehensive and thorough overview of drooling, with an emphasis on understanding its etiologies and modalities of treatment.

Section snippets

Materials and methods

Articles, from 1966 onward, were identified with Medline using key words (drooling and sialorrhea) and the “limits” function. Only original clinical studies written in English and French were retained for review. Articles were selected keeping in mind the specific experience of each author. For the table summarizing the literature on salivary duct and gland procedures, data were gathered only from series including more than 10 patients and using an assessment tool.

Many systems have been

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Cited by (133)

Radiation of parotid or submandibular glands is effective for drooling in patients with parkinsonism; a randomised double-blind placebo-controlled trial
2022, Clinical Parkinsonism and Related Disorders
Drooling is a common symptom in patients with parkinsonism, causing physical and emotional distress. It is unknown which major salivary glands are the best candidates for irradiation to reduce drooling with minimal adverse events. Therefore, this study assessed the efficacy and safety of submandibular and parotid salivary gland irradiation to reduce drooling.
A prospective, randomised, double-blind, placebo-controlled trial was conducted at the University Medical Center Groningen, the Netherlands. After informed consent, 31 patients with parkinsonism and severe drooling according to the Unified Parkinson Disease Rating Scale (UPDRS) were included in this study. Exclusion criteria consisted of the use of anticholinergic drugs, the existence of salivary gland diseases, and/or an history of (pre)malignancies of the salivary glands. Patients were randomized for parotid-, submandibular- or sham irradiation (2x6 Gy with one week interval). Patients were evaluated at 1, 3, 6 and 12 months after radiation. Primary outcome measure was drooling severity according to the UPDRS. Secondary outcomes measures consisted of stimulated glandular salivary secretion rates and adverse effects.
Overall 31 parkinsonian patients were included. Initially 11 patients were radiated on the parotid glands, 10 patients on the submandibular glands and 10 patients were sham-radiated. After 6 months, the sham-radiated patients were actively treated after a second randomisation. One patient in the parotid radiation group discontinued his participation after three months due to physical deterioration. Radiation of parotid or submandibular glands significantly improved the existing drooling, as compared to placebo radiation. Parotid- and submandibular radiation was equally effective, but more patients in the submandibular radiated group reported sticky saliva vs. patients treated by parotid radiation (33∙33% vs. 13∙33%).
Major salivary gland radiation significantly improves drooling in parkinsonian patients with few adverse effects. However, parotid gland radiation is accompanied by fewer side effects and therefore is the preferred mode of radiation in this patient population.
Primary sialorrhea and its surgical treatment with denervation of the submandibular glands in combination with sublingual gland excision
2021, Journal of Cranio-Maxillofacial Surgery
The purpose of this study was to evaluate the effectiveness of ablating postganglionic parasympathetic fibers of the submandibular ganglion in combination with sublingual gland excision in the treatment of primary sialorrhea.
Healthy volunteers were initially chosen to determine a basic saliva flow rate value by saliva collection. Next, unstimulated and stimulated saliva flow rates, and a visual analog scale index for sialorrhea were recorded in all the patients pre- and postoperatively. In addition, the generalized anxiety disorder scale was used to assess preoperative anxiety symptoms. The follow-up durations ranged from 24 to 36 months after surgery.
A total of 10 patients were included in this study. Preoperatively, the mean unstimulated saliva flow rate for the 10 patients was 11.26 ± 4.19 ml/10 min, the stimulated saliva flow rate was 16.76 ± 3.49 ml/6 min, and the visual analog scale index was 66.29 ± 14.86. Postoperatively, the mean unstimulated and stimulated saliva flow rates were significantly reduced to 5.99 ± 1.33 ml/10 min (p = 0.001) and 13.28 ± 1.86 ml/6 min (p = 0.013), respectively, and the visual analog scale index was 25.41 ± 5.6 (p < 0.001). No complications were found after operation.
This study demonstrates that ablation of postganglionic parasympathetic fibers of the submandibular ganglion in combination with sublingual gland excision by an intraoral approach is a simple, safe, and efficient approach for treating primary sialorrhea.
Efficacy of injections of botulinum toxin-A for improving drooling and quality of life in disabled patients
2020, Annals of Physical and Rehabilitation Medicine
Relationships of drooling with motor symptoms and dopamine transporter imaging in drug-naïve Parkinson's disease
2020, Clinical Neurology and Neurosurgery
Citation Excerpt :
It would be proper to underline that drooling is a cause of psycho-social impairment, being correlated to social embarrassment, isolation and worsening of depressive symptoms but also a life-threatening condition for it is correlated to a higher risk of choking or aspiration pneumonia [5]. Drooling is classified as primary drooling due to excessive production of saliva and secondary drooling caused by a decrease in the clearance of saliva due to disorders of coordinated activity of the orofacial and palatolingual muscles [6]. Since it was shown that the amount of saliva production in PD patients was actually less than that in healthy control, drooling in PD patients is presumed to be mainly secondary drooling [7,8].
The aim of the present study was to determine the relationships of drooling with motor symptoms and nigrostriatal neuron loss in drug-naïve patients with Parkinson’s disease (PD). We therefore examined the relationships of drooling with motor symptoms and striatal dopamine transporter (DAT) binding measured by [123-Iodine]-fluoropropyl-2beta-carbomethoxy-3beta-(4-iodophenylnortropane) dopamine transporter single-photon emission computed tomography(¹²³I-FP-CIT SPECT).
Thirty-five untreated PD patients (14 men and 21 women with a mean age of 71.9 ± 7.2 years) were included in this study. The patients were divided into a drooler group and non-drooler group. They underwent clinical assessments and ¹²³I-FP-CIT SPECT imaging. Motor symptoms were assessed using Unified Parkinson’s Disease Rating Scale (UPDRS).
The results showed that UPDRS motor score (p = 0.002) and akinetic-rigid score (p = 0.008) were higher and that striatal DAT availability (p = 0.03) was lower in the drooler group than in the non-drooler group. However, tremor score, age, and duration of PD showed no significant differences between the drooler group and non-drooler group.
Drooling in untreated PD is related to an increase in motor symptoms (especially bradykinesia and axial symptoms) and to reduction of striatal DAT availability.
Clinical pharmacokinetics of atropine oral gel formulation in healthy volunteers
2024, Clinical and Translational Science
Salivary Complaints in Burning Mouth Syndrome: A Cross Sectional Study on 500 Patients
2023, Journal of Clinical Medicine

View all citing articles on Scopus

: This work was supported by a grant-in-aid 2005/2006 n⁰4 for scientific research from the Fondation des Gueules Cassées.

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Oral MedicineDrooling of saliva: A review of the etiology and management options

Section snippets

Materials and methods

Lancet

J Pain Symp Manage

Int J Radiation Oncology Biol Phs

J Neurol Sci

Auris Nasus Larynx

Br J Plast Surg

Otolaryngol Head Neck Surg

Br J Plast Surg

Br J Plast Surg

Br J Plast Surg

Parkinsonism Relat Disord

Pediatr Neurol

J Oral Maxillofac Surg

Clin Neurol Neurosurg

Otolaryngol Head Neck Surg

J Neurol Sci

Pediatr Neurol

Salivary production in Parkinson's disease

Mov Disord

A study of salivary secretion in Parkinson's disease

Clin Neuropharmacol

The role of a saliva control clinic in the management of drooling

J Paediatr Child Health

Effect of botulinum toxin in the treatment of drooling: a controlled clinical trial

Pediatrics

The surgical treatment of drooling. A 10-year review

Plast Reconstr Surg

Intracellular activity of motoneurons of the rostral nucleus ambiguus during swallowing in sheep

J Neurophysiol

The role of the cerebral cortex in swallowing

Dysphagia

Management options for the drooling patients

Ear Nose Throat J

Prevalence and severity of feeding and nutritional problems in children with neurological impairment: Oxford Feeding Study

Dev Med Child Neurol

Prevalence of drooling in children with cerebral palsy attending special schools

Dev Med Child Neurol

Survey of sialorrhea in parkinsonian patients in southwestern Ontario

Can J Neurol Sci

Clinical assessment of dysphagia in early phases of Parkinson's disease

Neurol Sci

A non-surgical method of reducing drooling in cerebral-palsied patients

Dev Med Child Neurol

Biofeedback techniques and behaviour modification in the conservative remediation of drooling by children with cerebral palsy

Dev Med Child Neurol

Orofacial regulation therapy in children with Down syndrome, using the method and appliances of Castillo-Morales

ASDC J Dent Child

Regulation therapy by Castillo-Morales in children with Down's syndrome: primary and secondary orofacial pathology

ASDC J Dent Child

Moebius syndrome with oral involvement

Int J Paediatr Dent

Castillo-Morales orofacial therapy: treatment of 67 children with Down syndrome

Dev Med Child Neurol

Drooling, chewing and swallowing dysfunctions in children with cerebral palsy: treatment according to Castillo-Morales

ASDC J Dent Child

Sublingual atropine for sialorrhea secondary to Parkinsonism: a pilot study

Mov Disord

Use of atropine eye drops for clozepine-induced hypersalivation

Aust N Z J Psychiatry

Scopolamine patch for clozepine-induced sialorrhea

Psychiatr Serv

The use of transdermal scopolamine to control drooling. A case report

Am J Phys Med Rehabil

Control of drooling with transdermal scopolamine in a child with cerebral palsy

Dev Med Child Neurol

Transdermal scopolamine in drooling

J Mental Defic Res

Reduction of salivary flow with Scopoderm TTS

Ann Otol Rhinol Laryngol

Transdermal scopolamine for reduction of drooling in developmentally delayed children

Dev Med Child Neurol

A systematic review for evidence of efficacy of anticholinergic drugs to treat drooling

Arch Dis Child

Results of radiotherapy for drooling in amyotropic lateral sclerosis

Neurology

Transtympanic neurectomy: a solution to drooling problems

Dev Med Child Neurol

Oral Medicine
Drooling of saliva: A review of the etiology and management options