Drooling - Sialorrhoea

Drooling saliva is an involuntary dripping of saliva with reduction in the sensory awareness necessary for swallowing it. This overflow / increased flow of saliva is medically termed as sialorrhoea. Drooling is considered a normal happening in children, till they gain adequate control over neck position, oral muscle functions and coordination of muscles of face, i.e. till the age of one-and-a-half years. Children also suffer with drooling saliva in a more intensified manner while they begin to teeth, change in positions during developments, etc. in that period. Children can wear bibs for mopping up excess saliva but for adults, those circumstances are very awful. It may look awkward and make one feel guilty when saliva drips in front of others. Also, sometimes, they may develop the shameful habit and horrible environment by spitting constantly.

Saliva can drool out involuntarily on many occasions even in adults. One might experience it at one or the other occasion, spoiling pillows / bed / dresses (especially with deep sleep) with improper closure of lips, face down and also while lying in reclined positions. Drooling saliva may also be indicative of being stunned (after magical performance, mouth-watering delicious sweets, etc.) and drowsy nature where the situation goes out of control.

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Incidences – Normally, it is more common in infants with postural changes, teething and while developing speech functions. It gets controlled naturally as they grow with postures and lip control, but in case of those with developmental delays and mental retardation, the drooling process may prolong or persist continuously. It is also common in elderly people who have just lost their teeth or who wear new dentures or who suffer from paralysis, etc. Saliva secretions will also be more with any lesions in the mouth.

Causes – Saliva naturally runs down to the throat with gravity, positions / movement of tongue and jaw. Deviation from nature often brings discomfort. This is true with saliva too, i.e., when it overflows or flows out one gets embarrassed. Swallowing saliva requires good lips closure, pushing movements of tongue and jaw.

There are various reasons for saliva to drool out. They are

Increased saliva secretion / production
Non-closure / improper closure of lips
Down position of head
Lack of coordinated action of muscles of face - while eating, speaking, etc.
Lack of proper movement of tongue / jaw while eating, speaking, etc.
Difficulty in swallowing the saliva (due to congenital cricopharyngeal achalasia, paralysis of throat muscles, obstacles with mal-positions or tumours, jaw problems, mandibular joint problems, etc.)
Lack or delay in developing skills related with lifting / turning head, eating, speaking,

Generally, children suffer with drooling when there is delay in development, deficiencies, poor posture, lack of neck control, mental retardation, mumps, mouth ulcers, tonsillitis, quinsy (peritonsillar abscess), etc. In the case of adults, people commonly have dribbling saliva with dentures, structural deformities of face, mouth ulcers, epiglotitis, rabies, pancreatitis, jaundice, GERD, etc. Females have excessive salivation during pregnancy with hormonal changes. Salivation can also be in excess and go uncontrollable with nervous lesions like Extrapyramidal cerebral palsy, Bell’s palsy, facial palsy, stroke, Parkinson’s disease, myasthenia gravis, brain tumours, and benign and carcinamatous tumours of the mouth, etc.

Symptoms – Drooling itself comes as a symptom rather than a disease. It also usually accompanies with a variety of other symptoms. For example:

• Constant spitting

• Nausea and vomiting

• Discomfort and difficulty in feeding

• Difficulty in speech

Diagnosis – is very important to aim and fix the treatment. Drooling saliva should be analysed in every aspect to get it corrected soon.

• Postural analysis (wide open mouth / hanging jaw position, neck down position, etc.)

• Palpation for swellings in the salivary glands

• Sputum culture / biopsy to identify and confirm infections / disease

• X-ray / CT or MRI scan to show any pathology related with oral cavity or salivary glands and to proceed to treatment systematically.

Prevention – Postural and behaviour training can prevent drooling. In addition, one needs to

• Maintain good oral hygiene with habits of brushing and cleanliness

• Avoid highly sour and sweet foods / drinks to avoid excessive saliva secretion / production

• Develop eating and drinking skills with good posture

Complication – Drooling can bring complications when it is left untreated or when it could not be controlled with treatment. The common complications are:

• Feeling bad in the midst of a gathering (need places / tissues to spit or wipe off making one feel embarrassed)

• Dehydration and weight loss with excessive salivation

• Nausea and feeding difficulties

• Halitosis

• Depression with quality of life

General treatment – Generally, treatment involves finding any correctable causes and fixing those, if possible. According to the causes, treatment may vary i.e.:

• For glandular infections, mouth ulcers – antibiotics and anti-inflammatory drugs

• Lack of muscle tone / muscle control / nerve stimulation in face – supplements and physiotherapy

• Lack of speech or jaw movement coordination – speech therapy

• Developmental delays and neurological problems – symptomatic treatment

• Habits with positions – behaviour or postural training.

The person other than the one who suffers with infections will be directed to undergo habit or behaviour or postural or physiotherapy training to aid good lip closure and to direct saliva down to the pharynx with neck positioning. In those conditions, where training response is poor, surgical option (bilateral submandibular gland / sublingual gland excision and parotid duct repositioning) will be tried to cut down saliva production and to direct saliva straight to the pharynx.

Homeopathic treatment – Homeopathy can support one to ease the situation with comfort in addition to behaviour or postural or physiotherapy training to aid good lips closure and to direct saliva down to the pharynx with neck positioning. Homeopathy has splendid medicines to improve quality of saliva secretions. It can control (hyper functioning salivary gland) excessive saliva secretion by recovering normal glandular functions. With the most apt drug, Homeopathy can control infection, modify secretions and can streamline saliva by enhancing facial muscles tone, power and nerve stimulations.

Homeopathic medicines commonly used for drooling are Acid nit, Acid Aconite, Anti crud, Apis mel, Ars alb, Arum triphyllum, Baryta carb, Baryta iod, Baryta mur, Bryonia, Calc carb, Cocculus, Hepar sulph, Hyoscyamus, Lachesis, Merc sol, Nat mur, Onosmodium, Opium, Phosphorus, Phytolacco, Pulsastilla, Rhus tox, Sanicula, Silicea, Sulphur, Veratrum alb, etc. A few characteristic specifics are

• Viscid saliva which needs to be spit constantly or the constant desire to spit saliva – Cocculus

• Constantly spitting frothy saliva – Stramonium

• Offensive fluid saliva – Baptisia, Baryta Mur, Merc sol, Nitric acid,

• Ropy Saliva – Iris vers, Kali Bich, Picric acid,

• Offensive saliva – Baptisia, Baryta Mur, Merc sol, Nitric acid,

• Salty saliva – Cyclamen

• Sour saliva - Ignatia

• Tasteless saliva – Veratrum alb

• Sweetish saliva – Chamomilla

These medicines should be taken on the advice and diagnosis of a Qualified Homeopath.