TAM (Treatments and Medicines) NHS Highland
Drooling is the unintentional loss of saliva from the mouth. In the adult population it can be associated with neurological disorders such as Parkinson’s disease, motor neurone disease (MND) and stroke. Contrary to popular belief, drooling is rarely caused by hypersalivation but is more often related to neuromuscular and/or sensory dysfunction in the oral stage of the swallow.
Causes
| Neuromuscular dysfunction/sensory dysfunction | Motor dysfunction – frequently exacerbates existing problems |
| Cognitive development disorder, cerebral palsy, Parkinson’s disease (pseudo bulbar and bulbar palsy, stroke – less common |
Enlarged tongue |
| Oral incompetence | |
| Hypersecretion – usually controlled by increased swallowing | Dental malocclusion |
| Inflammation (teething, dental caries, oral cavity infection, rabies) | Orthodontic problems |
| Medication side-effects (tranquillisers, anticonvulsants) | Head and neck surgical defects |
| Toxin exposure (mercury) | Gastro-oesophageal reflux |
| Drugs that may cause sialorrhoea: this is not necessarily a complete list, please check individual product details |
||
| Alprazolam | Ketamine | Pentoxifylline |
| Amiodarone | Lamotrigine | Physostigmine |
| Bethanechol | Levodopa | Pilocarpine |
| Buspirone | Lithium | Risperidone |
| Clozapine | Mefenamic acid | Rivastigmine |
| Desflurane | Modafinil | Sildenafil |
| Diazoxide | Neostigmine | Tacrine |
| Digoxin | Nifedipine | Theophylline |
| Edrophonium | Nitrazepam | Tobramycin |
| Galantamine | Olanzapine | Venlafaxine |
| Impenem/Cilastatin | ||
Complications
Drooling in the adult patient has various repercussions, ranging from physical difficulties such as dehydration, foul oral odour, perioral skin maceration and increased risk of aspiration pneumonia, to social ramifications such as embarrassment, isolation and increased dependency. As such, drooling can have a negative effect on quality of life, so much so that many patients rate drooling as their worst symptom.
