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Excessive Saliva

Excessive Saliva

The production of excessive saliva could occur due to oral infections, neuromuscular conditions, or the use of certain medicines or ill-fitting dentures. The following write-up provides information on the medical conditions that may be associated with excessive production of saliva.
Dr. Sumaiya Khan
Saliva is a watery secretion that is produced by the salivary glands, which include the parotid gland, submandibular gland, sublingual glands, and minor salivary glands in the oral and buccal mucosa. Saliva consists of water, electrolytes, mucin, glycoproteins, salts, ptyalin, etc. It lubricates the oral cavity, and helps to moisten the food during mastication. The process of digestion also starts in the mouth, with the enzymes present in saliva breaking down the dietary starches and fat in the food. Antimicrobial agents that are present in the saliva reduce the risk of tooth infections. Saliva also supplies calcium and phosphate ions at the surface of teeth, thereby preventing the erosion of tooth enamel.
Under normal circumstances, the salivary glands produce up to 1.5 liters daily. Since saliva performs many vital functions, insufficient or excessive production of saliva could give rise to problems. For instance, hypersalivation could cause slurred speech and even lead to spillage of saliva. Medically referred to as ptyalism or sialorrhea, excessive saliva could either occur due to excessive production of saliva or the inability to swallow saliva.
Contributing Factors
Teething is a common reason behind excessive saliva in babies or toddlers. However, if excessive flow of saliva is seen in children older than 4 years or adults, it is not considered to be normal. Though excessive production of saliva is not a disease in itself, it could be indicative of an underlying medical condition. Here are some of the contributing factors for hypersalivation.
◘ Use of Certain Medicines
The production of saliva is controlled by the autonomic nervous system. While the parasympathetic nerves produce watery saliva, the sympathetic nerves are involved in the production of thicker saliva. The salivary glands produce more saliva when the parasympathetic nervous system releases a neurochemical called acetylcholine. This is the reason why the use of cholinergic drugs (drugs that enhance or mimic the action of acetylcholine) may cause excessive saliva. Drugs that may have ptyalism as a side effect include:

Clozapine
Pilocarpine
Ketamine
Potassium chlorate
Risperidone
Bethanechol
Lithium
Besides these drugs, certain toxins are also believed to be contributing factors for hypersalivation. These include mercury, copper, arsenic, and organophosphates.
◘ Medical Conditions
Certain medical conditions are also associated with the overproduction of saliva. These include:

Gastroesophageal reflux
Pancreatitis
Liver disease
Infections of the oral cavity
Serotonin syndrome
Rabies
Inflammation of the mucous membranes in the mouth
◘ Pregnancy
Sometimes, pregnant women may complain of having excessive saliva in the mouth. It is believed that this mostly occurs due to the change in hormone levels. Ptyalism is more likely to affect women suffering from hyperemesis gravidarum, which is a severe form of morning sickness.
◘ Dentures
Majority of people who wear dentures experience an increase in the flow of saliva on wearing new dentures. The increased production of saliva occurs as the salivary glands perceive the dentures to be a foreign body. However, the production of saliva will be restored back to normal after a few days. Wearing dentures that don't fit well can also cause excessive saliva.

Besides the aforementioned factors, excessive intake of starch could also cause excessive production of saliva.
◘ Inability to Swallow Saliva
Ptyalism could occur if the rate at which saliva is swallowed is below normal. Under normal circumstances, the saliva that is produced is swallowed on a regular basis. However, in case of people affected by certain diseases, the ability to swallow saliva is adversely affected. These conditions include:

Swollen palate
Swollen tonsils
Peritonsillar abscess
Epiglottitis
Chronic sinusitis
Enlarged adenoids
Certain medical conditions may have an adverse effect on the functioning of the muscles associated with swallowing. The ability to retain or swallow saliva in the mouth could be affected by the following neuromuscular conditions:

Facial paralysis
Bell's palsy
Amyotrophic lateral sclerosis
Parkinson's disease
Myasthenia gravis
Cerebral palsy
Treatment
At times, the increase in the production of saliva may just be a transient problem. For instance, in case of women who are affected by ptyalism during pregnancy, the issue of excessive saliva may resolve after the first trimester.
Excessive saliva often leads to drooling in babies and toddlers. It is important to note that infants have a tendency to produce excessive saliva naturally, especially when they are teething. However, medical help must be sought if hypersalivation persists in children aged 4 years or more.

The treatment would vary, depending on the underlying cause of ptyalism.
If the excessive production of saliva is due to the intake of drugs, it would be best to inform your doctor. Discontinuing that drug or reducing the dosage may prove beneficial. Since smoking can also increase the production of saliva, it would be best to quit smoking.
The use of anticholinergic drugs may be recommended in severe cases. Glycopyrrolate (Robinul) is an anticholinergic drug that has been found to be effective. However, its dosage must be controlled, as it is associated with untoward side effects.
If the excessive production of saliva is due to a medical condition, treating the underlying condition can help to resolve the problem. The administration of Botulinum toxin injections to parotid and submandibular glands is believed to be effective in treating hypersalivation and drooling to some extent.
The use of portable battery-operated suction devices may be suggested in some cases to reduce the risk of choking.
Drug therapy coupled with self-care measures can help in treating ptyalism. However, there's a need to ensure that the production of saliva doesn't decrease beyond the normal levels. Saliva performs several vital functions, and insufficient saliva can put a person at a risk of developing various health problems.
Disclaimer:
The information provided in this article is solely for educating the reader. It is not intended to be a substitute for the advice of a medical expert.