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.


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


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.


Saliva rating scale

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
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

Last reviewed: 18 June 2019

Next review: 18 June 2021

Author(s): Palliative Care Network

Version: 3

Approved By: Policies, Procedures and Guidelines Subgroup of ADTC

Reviewer Name(s): MacMillan Palliative & Community Care Pharmacist

Document Id: TAM343