Abstract

Hypersalivation (also called ptyalism or sialorrhea) is excessive production of saliva. It has also been defined as increased amount of saliva in the mouth, which may also be caused by decreased clearance of saliva.

Hypersalivation can contribute to drooling if there is an inability to keep the mouth closed or in difficulty in swallowing the excess saliva (dysphagia) and lead to excessive spitting.

Hypersalivation also often precedes emesis (vomiting), where it accompanies nausea (a feeling of needing to vomit).

Causes | Excessive production

Conditions that can cause saliva overproduction include:

- Rabies

- Pellagra (niacin or Vitamin B3 deficiency)

- Gastroesophageal reflux disease, in such cases specifically called a water brash, and is characterized by a sour fluid or almost tasteless saliva in the mouth

- Gastroparesis (main symptoms are nausea, vomiting, and reflux)

- Pregnancy

- Excessive starch intake

- Anxiety (common sign of separation anxiety in dogs)

- Pancreatitis

- Liver disease

- Serotonin syndrome

- Mouth ulcers

- Oral infections

Medications that can cause overproduction of saliva include:

- aripiprazole

- clozapine

- pilocarpine

- ketamine

- potassium chlorate

- risperidone

- rabeprazole sodium (Aciphex)

Toxins that can cause hypersalivation include:

- mercury

- copper

- organophosphates (insecticide)

- arsenic

Causes | Decreased clearance

Causes of decreased clearance of saliva include:

- Infections such as tonsillitis, retropharyngeal and peritonsillar abscesses, epiglottitis and mumps.

- Problems with the jaw, e.g., fracture or dislocation

- Radiation therapy

- Neurologic disorders such as myasthenia gravis, Parkinson's disease, multiple system atrophy, rabies, bulbar paralysis, bilateral facial nerve palsy, and hypoglossal nerve palsy

Treatment

Hypersalivation is optimally treated by treating or avoiding the underlying cause. Mouthwash and tooth brushing may have drying effects.

In the palliative care setting, anticholinergics and similar drugs that would normally reduce the production of saliva causing a dry mouth could be considered for symptom management: scopolamine, atropine, propantheline, hyoscine, amitriptyline, glycopyrrolate.

A 2008 systematic review investigated the efficacy of pharmacological interventions for patients who have too much salvia due to clozapine treatment: