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Hypersalivation (also called ptyalism^[1] or sialorrhea^[2]) 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.^[3]

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

Hypersalivation also often precedes emesis (vomiting), where it accompanies nausea (a feeling of needing to vomit).^[4]

Causes

Excessive production

Conditions that can cause saliva overproduction include:^[3]

Rabies
Pellagra (niacin or Vitamin B3 deficiency)^[5]
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^[6]
Pregnancy
Excessive starch intake
Pancreatitis
Liver disease
Serotonin syndrome
Mouth ulcers^{[medical citation needed]}
Oral infections

Medications that can cause overproduction of saliva include:^[3]

clozapine
pilocarpine
ketamine
potassium chlorate
risperidone
rabeprazole sodium (Aciphex)

Toxins that can cause hypersalivation include:^[3]

mercury
copper
organophosphates (insecticide)
arsenic

Decreased clearance

Causes of decreased clearance of saliva include:^[3]

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.^[3] Mouthwash and tooth brushing may have drying effects.^[3]

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.^[7]

References

^ thefreedictionary.com > ptyalism Citing:
- Dorland's Medical Dictionary for Health Consumers. 2007
- Mosby's Medical Dictionary, 8th edition. 2009
- Saunders Comprehensive Veterinary Dictionary, 3 ed. 2007
^ thefreedictionary.com > sialorrhea Citing:
- The American Heritage Dictionary of the English Language, Fourth Edition, Updated in 2009.
^ ^a ^b ^c ^d ^e ^f ^g Medscape > Hypersalivation By Erica Brownfield. Posted: 05/19/2004
^ Clark], [edited by Parveen Kumar, Michael (2005). Kumar & Clark clinical medicine (6th ed.). Edinburgh: Elsevier Saunders. p. 266. ISBN 0702027634.
^ [1]
^ thefreedictionary.com > water brash Citing: Dorland's Medical Dictionary for Health Consumers. 2007
^ Medical Care of the Dying, 4th Edition, 2006, Edited by G.Michael Downing MD and Wendy Wainwright, MEd

UpToDate Contents

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1. パーキンソン病に関連する併発障害のマネージメント management of comorbid problems associated with parkinson disease
2. 緩和ケアにおける嚥下障害および誤嚥：評価およびマネージメント戦略 swallowing disorders and aspiration in palliative care assessment and strategies for management
3. 統合失調症に対するクロザピン投与のガイドライン guidelines for prescribing clozapine in schizophrenia
4. 成人における胃食道逆流症の臨床症状および診断 clinical manifestations and diagnosis of gastroesophageal reflux in adults
5. 妊娠での母体の消化管の変化 maternal gastrointestinal tract adaptation to pregnancy

English Journal

Evaluation of ethanolamine oleate sclerotherapy on the submandibular glands of canines as a potential therapy for sialorrhea.

Abbas F, Farid R, Nada I, El-Sharnouby M.SourceENT Department, Faculty of Medicine, Misr University for Science and Technology, 6th of October city, Giza, Egypt.
International journal of pediatric otorhinolaryngology.Int J Pediatr Otorhinolaryngol.2012 Dec 13. pii: S0165-5876(12)00650-7. doi: 10.1016/j.ijporl.2012.11.024. [Epub ahead of print]
BACKGROUND: Sialorrhea can have major negative effects on the physical and social well-being. Sclerotherapy may be useful in patients with sialorrhea by decreasing the amount of saliva production. The aim of this study was to test the effect of ethanolamine oleate (EO) in an experimental model as a
PMID 23246419

Nutritional risk and gastrointestinal dysautonomia symptoms in Parkinson's disease outpatients hospitalised on a scheduled basis.

Barichella M, Cereda E, Madio C, Iorio L, Pusani C, Cancello R, Caccialanza R, Pezzoli G, Cassani E.SourceParkinson Institute, Istituti Clinici di Perfezionamento (ICP), via Bignami 1, 20126 Milan, Italy.
The British journal of nutrition.Br J Nutr.2012 Dec 11:1-7. [Epub ahead of print]
Dysautonomia symptoms of nutritional interest may often occur in Parkinson's disease (PD), but the role played in affecting the risk of malnutrition still needs to be clarified. A total of 208 consecutive PD outpatients hospitalised on a scheduled basis were assessed for nutritional risk by the Maln
PMID 23228187

Japanese Journal

ボツリヌス治療の将来 : 今後の他疾患への応用の可能性 (特集ボツリヌス治療の各種疾患への応用)

Monthly book medical rehabilitation (144), 67-70, 2012-05
NAID 40019331557

皮膚, 口腔病変を認めず, 診断に苦慮した食道天疱瘡の1例

日本消化器内視鏡学会雑誌 = Gastroenterological endoscopy 52(8), 1866-1873, 2010-08-20
NAID 10026910868

Clozapine : Agonistic and Antagonistic Salivary Secretory Actions

Journal of dental research 89(3), 276-280, 2010-03-01
NAID 10027309252

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Sialorrhea; Drooling; Hypersalivation How to Pronounce Sialorrhea - YouTube Sialorrhea--A Management Challenge - American Family Physician Sialorrhea | AACPDM - American Academy for Cerebral Palsy and Developmental Medicine Handout: Sialorrhea (drooling) – Therapy Insights PDQ ORAL DISEASE: Sialorrhea (Sialosis) drugs affecting the salivary function / dental implant courses