Sialorrhea (also known as ptyalism or hypersalivation) is the term given to excessive salivation 1. It is less common than xerostomia, the term for patients with hyposalivation 5.
Pathology
Etiology
It may be subdivided into true sialorrhea in which there is a real increase in salivary production/secretion, or false sialorrhea, in which there is no change in the production/secretion of saliva but an inability to swallow it 5.
True sialorrhea
- physiological: normal in infants
- pregnancy: ptyalism gravidarum 2
- also in early menstruation for some women
- vomiting
-
iatrogenic
- sialogogue administration: e.g. lemon juice
- cholinergic effects: clozapine 3, pilocarpine 5, tetrabenazine 5
- dental
- infant teething
- inflammatory oral diseases
- nasogastric intubation
False sialorrhea
Patient is unable to swallow a normal quantity of saliva.
- neurological
- cerebral palsy
- motor neuron disease
- Parkinson disease
- learning difficulties
- obstruction of the pharynx/esophagus: malignancy, etc.
- SATB2-associated syndrome (SAS) 4
Treatment and prognosis
- initially management of the primary cause 5
- specific treatments to reduce salivary production
- antisialogogues: usually anticholinergic medications, e.g. hyoscine, atropine 6
- rarely, surgical relocalisation of the salivary ducts to drain into the oropharynx 5
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