Salivation (sialorrhea, hypersalivation) is normally observed in infants, pregnant women, and also with mechanical irritation of the receptors of the oral cavity. Common etiological factors are diseases of the gastrointestinal tract, teeth, ENT organs, damage to the central and peripheral nervous system. To diagnose the causes of salivation, saliva is examined, blood and urine tests are performed, instrumental visualization of the gastrointestinal tract and central nervous system. To stop the symptom, it is necessary to cure the underlying disease. Anticholinergics, botulinum toxin preparations are prescribed to reduce salivation.
The symptom is observed in most women in the first trimester of pregnancy. The appearance of salivation is associated with reflex irritation of the nerve centers that control the production of saliva. The intensity of manifestations is different: from single nocturnal episodes of sialorrhea to a constant and uncontrolled flow of saliva, when a woman loses up to 3-5 liters of fluid per day. Salivation is the norm in infants, children during the eruption of milk and permanent teeth.
Hypersalivation with saliva dripping from the corners of the mouth is a common problem for people who have started wearing removable dentures. Within a few months, getting used to a foreign body occurs, and the amount of saliva secreted gradually decreases. Short-term sialorrhea is observed with dental procedures, the use of chewing gum or sucking sweets. Drooling occurs in many smokers.
Sialorrhoea often develops with stomatitis, gingivitis, carious lesions of the teeth. The symptom is associated with irritation of the M-cholinergic receptors of the mucosa. Salivation is expressed moderately, more often appears at night. During the day, a slight leakage of saliva is possible, which accumulates in the corners of the mouth. In addition to increased salivation, patients complain of soreness and burning in the oral cavity, pain when chewing and swallowing, fetid breath.
Sialorrhoea is possible with damage to the stomach and the initial sections of the intestine. Its appearance is most typical in chronic pancreatitis, cholecystitis, peptic ulcer. The symptom occurs at any time of the day, often accompanied by heartburn and an unpleasant aftertaste in the mouth. A combination of salivation with abdominal pain syndrome, nausea and vomiting, and stool disorders is characteristic.
Salivation is typical for people who have nasal breathing difficulties and sleep with their mouths open. It occurs in patients with sinusitis, chronic rhinitis, in childhood - with adenoids. Salivation develops mainly during sleep. Due to the constant drying of the mucosa, viscous saliva is secreted in a small amount, accumulating on the skin of the perioral zone or leaving marks on bed linen.
The reproduction of helminths in the gastrointestinal tract causes irritation of peripheral receptors, reflexively activating the secretion of saliva. A specific sign of helminthiases is salivation, which worries at night. A person will recognize the presence of a problem by wet spots on the pillowcase and pajamas. Dried crusts of saliva are visible in the corners of the mouth after waking up. Symptoms are supplemented by abdominal pain, dyspeptic disorders, itching in the anal area.
The symptom occurs in pathological processes affecting the centers of regulation of salivation. Drooling is one of the first signs of Parkinson's disease, a cerebral tumor. In such conditions, saliva is formed in large quantities, it has to be constantly swallowed. Since problems with swallowing later join, saliva begins to drain from the corners of the mouth.
Salivation can be caused by a violation of the innervation of the facial muscles and the inability to completely close the mouth. The manifestation is pathognomonic for facial paralysis, residual effects of a stroke. Saliva always flows from one side of the mouth, where there is sagging of the muscles of the cheek and insufficient closing of the lips. Salivation increases when a person tilts his head to the side towards the affected side of the face.
With bulbar syndrome, sialorrhea is caused by swallowing disorders and the inability to keep saliva in the mouth. The functioning of the salivary glands remains at the same level or even decreases. Patients feel the saliva present in the mouth, but the automatic act of swallowing does not occur. Salivation disturbs constantly, regardless of the time of day. Later, speech disorders, difficulty swallowing solid and liquid food join.
Most often, salivation increases during treatment with M-cholinomimetics. Drugs affect peripheral receptors, stimulate the functions of the salivary glands. In this case, there is a strong uncontrolled salivation, in which saliva flows profusely down the chin. The symptom is determined from the first days of taking medication. There are other drugs that cause salivation:
With the problem of salivation, patients turn to the dentist, less often to the therapist. Given the variety of causes of pathology, the doctor is required to take a detailed history and clarify accompanying complaints. Diagnostic search begins with an examination of the oral cavity to identify signs of an inflammatory process or caries. To establish the causes of salivation, the following instrumental and laboratory diagnostic methods are used:
Moderate salivation does not pose a threat to health and does not require urgent medical measures. With nocturnal sialorrhea, patients are advised to sleep on their side so that saliva does not enter the respiratory tract. To prevent maceration of the skin around the mouth, you need to observe hygiene, use nourishing and moisturizing creams. Since there is a risk of dehydration with excessive salivation, you should increase the amount of fluid you drink per day.
To reduce the production of saliva, doctors advise giving up sweets, carbonated drinks and foods rich in extractives. Hygienic care of the oral cavity is best done with slightly foaming toothpastes. With violations of swallowing and dysfunction of the perioral muscles, motor exercises are prescribed to help control salivation. Less commonly used special massage and physiotherapy.
In most situations, salivation can be completely eliminated after the treatment of the underlying pathology. The therapeutic regimen is selected by a doctor of the appropriate profile: gastroenterologist, otolaryngologist, neurologist. If salivation is due to acute poisoning, an intensive detoxification program is performed in a hospital. With massive sialorrhea, pathogenetic therapy is required, which includes:
Surgery is recommended for severe neurological causes of drooling if other methods have failed. Surgeons use several types of operations: redirection of the excretory ducts to the back of the mouth, ligation of the ducts, partial removal of the salivary glands. The methods demonstrate a good result, but can provoke complications - facial asymmetry, chewing and swallowing disorders.