Saliva management: sialorrhoea
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DESCRIPTION - drooling/sialorrhoea
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 |
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.
| Frequency | Points | Severity | Points |
| Never drools (Dry) | 1 | Dry (never drools) | 1 |
| Occasionally drools (not every day) | 2 | Mild (only the lips are wet) | 2 |
| Frequently drools (every day but not all the time) | 3 | Moderate (wet on lips and chin) | 3 |
| Severe (clothes get damp and need changed) | 4 | ||
| Constantly drools (always wet) | 4 | Profuse (clothes, hands and objects become wet) | 5 |
It is helpful to complete rating scales every day for 5 days, where possible at the end of the day. Longer measures (10 days) are particularly helpful if the individual's drooling varies from day to day. It is helpful if two individuals in different settings, without discussion, can complete an assessment.
| Drugs that may cause sialorrhoea: this is not necessarily a complete list, please check individual product details |
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| 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 | ||