Introduction:
Excessive salivation is common in babies till two years as muscular control around the mouth is underdeveloped. Few people also drool during sleep. Certain medical conditions can cause excessive salivation, which requires to be addressed. The three major pairs of salivary glands, the parotid, submandibular, and sublingual glands, are responsible for salivary secretion.
What Are the Reasons for Excessive Salivation (Drooling) In Children?
Some Infants drool too much due to teething and developing digestive systems. Drooling may worsen during colds, allergies, and when the body makes excess saliva.Drooling beyond four years can be a sign of certain medical conditions such as cerebral palsy (a condition that causes brain damage before or after birth and results in the person’s disability to move and maintain balance and posture). Poor oral control leads to hindrance in swallowing. Excessive salivation does not always mean that the salivary glands are hyperactive; a lack of control over salivary secretions can also contribute to drooling.
What Are the Types of Excessive Salivation (Drooling)?
The following are the types of excessive salivation:
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Anterior Sialorrhea: This is called drooling, and excess saliva from the mouth drips into the dress, making it wet and affecting skin care and hygiene. Older kids can find it difficult to socialize as a result of drooling.
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Posterior Sialorrhea: Instead of being swallowed, saliva enters the airway and can lead to long-term irritation of the lungs and other health issues.
What Are the Causes of Excess Salivation (Drooling)?
The following are the reasons for drooling:
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Diet: Certain foods and beverages with high acidic content, like citrus fruits and sugary foods, cause drooling.
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Age: Drooling is common in infants between three to six months, especially when teething (appearance of teeth) occurs, and can last up to two years. It is a matter of concern if it remains persistent beyond four years.
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Infections: Certain infections like mononucleosis, tonsillitis (enlarged tonsils), throat infections, sinus infections, and peritonsillar abscesses (enlarged tonsils that spread to the neck and chest due to infection) can cause excessive salivation.
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Nervous Disorders: Conditions that affect the nervous system include:
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Autism (a condition affecting brain development that makes it difficult for a person to socialize with others).
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Down Syndrome (a condition in which a child has an extra chromosome and is associated with developmental and intellectual disabilities).
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Stroke.
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Parkinson’s Disease.
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Bell’s palsy (a temporary nerve disorder that affects the facial nerve and causes facial paralysis).
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Amyotrophic lateral sclerosis (ALS- a nervous disorder that weakens muscles).
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Multiple sclerosis (a disorder wherein the body’s immune system destroys the protective covering of the nerves).
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Traumatic brain injury.
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Acid reflux.
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Structural Abnormalities: Structural abnormalities like a large tongue, improper development of the jaws, throat, crowded teeth, cleft lip, or cleft palate can cause drooling.
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Allergies: Seasonal changes can cause itchy eyes, runny nose, and sneezing, increasing salivation. Insect bites can also cause drooling.
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Medications: Pilocarpine, diazepines, and Haloperidol can cause drooling.
What Are the Symptoms of Excessive Salivation (Drooling)?
Common symptoms include
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Increased salivary flow from the mouth, resulting in wet clothes and bibs.
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Excessive salivation during sleep can wet the bedding.
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In the case of posterior sialorrhea, there can be frequent coughing or choking episodes due to aspiration of saliva in the respiratory tract.
How Is Excessive Salivation (Drooling) Diagnosed?
The health care provider will diagnose excessive salivation based on a general examination, history regarding the frequency and severity of drooling, including dental history (poor oral hygiene can cause drooling), medication history, and assessing the child's chewing, swallowing, and communicating ability. Drooling is graded based on the severity and frequency using the Thomas-Stonell and Greenberg scale as follows:
Based On Severity
Based On Frequency
How Can Excess Salivation (Drooling) Be Managed?
Management of excessive salivation requires a multi-disciplinary approach which includes doctors from various specialties like pediatricians (child specialists), pediatric dentists (child dentists), speech pathologists (experts dealing with speech-related disorders), and radiologists (experts in creating and interpreting X-rays). Various management modalities include:
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Conservative Management: Underlying conditions like nasal obstruction, dental disease, and use of medications that could cause drooling must first be resolved. Swallowing therapy, wherein a child is taught to swallow properly by teaching certain exercises for the mouth and throat. Speech therapy is given to ensure proper lip closure, position, and tongue movement. Eating and drinking techniques include prolonging lip closure and encouraging lateral movement of the tongue by placing various textures ranging from easily chewable to difficult-to-chew foods on molars. Behavioral approaches include making the child realize excessive salivation and teaching them to wipe their face and lips under such situations.
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Medications: Medications that decrease salivary secretion (called anticholinergics), like scopolamine, glycopyrrolate, and atropine sulfate, can be suggested by physicians. The side effects include thick secretions, which can cause respiratory issues, vomiting, dry mouth, dizziness, constipation, headaches, and vision issues.
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Botulinum Toxin (Botox) Injections: Botox injections are usually injected into the cheek through the parotid gland, and these injections decrease salivary production for a few months.
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At-Home Treatment: Avoiding sugary or acidic foods and chewing candies or popsicles during teething can help prevent excessive salivation. Caregivers can remind the kids to close their lips and keep their chin upwards.
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Oral Device: Dental devices like chin cups can assist with lip closure, tongue positioning, and swallowing. It is, however, not recommended in children with breathing difficulty or seizures.
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Surgery: Surgery is recommended if the above conservative measures do not work or in case of respiratory issues. This involves altering or clipping the salivary glands or redirecting the salivary ducts back to the mouth.
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Radiation Therapy: This is the last method of approach to reduce drooling. Usually, a single sitting shows a marked response.
What Happens if Excessive Salivation Is Not Treated (Drooling)?
The following can occur if excessive salivation is not treated:
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Angular cheilitis: Skin condition with painful, small cracks in one or both mouth corners.
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Pneumonia: Excess saliva can enter the lungs and cause pneumonia (inflammation of one or more air sacs of the lungs).
Conclusion:
Excessive salivation is a normal part of development and is usually not a concern. But if it persists for a long duration, then there can be underlying issues that have to be looked upon. With basic management measures, excessive salivation can be treated. However, if it affects the child's quality of life, it is advisable to consult a healthcare provider.
