Scope - Communication Resource Centre

Saliva Management

Altered Secretions

As discussed previously, saliva can vary in the amount and thickness or viscosity. There are several factors that have been suggested as influencing the amount, type or rate of saliva that is produced in the oral cavity. Factors such as age, gender, chewing and more have been suggested, and researched, to determine their role in saliva production. For more information, see What is saliva and where is it made?. The contributing influence of these factors however, does not always lead to such an altered amount or viscosity of saliva that it becomes a problem.

Overproduction of saliva and thin, watery saliva

An overproduction of saliva is most often not the cause for drooling. The causes for drooling are varied, but are usually related to decreased control or swallowing of saliva while in the oral cavity (see Causes of Drooling). An overproduction of saliva leads to the mouth being constantly bathe with saliva, and may require the individual to frequently spit or swallow excess saliva. It will only result in drooling if the patient's saliva control is also inadequate.

The following are causes for an increase in saliva production, often resulting in excess watery saliva bathing the mouth:

Medications- In particular, cholinergic drugs can cause an overproduction of saliva. Discuss with your doctor if you believe your medication is causing hyper salivation.
Toxins- Poisoning from certain toxins can result in hypersalivation as one of the side affects. Your doctor should be consulted immediately if you believe you have ingested any toxins.
Lesions or infections in the oral cavity- An infection of the mucosal lining of the mouth is referred to as stomatitis. Stomatitis can result from infectious agents (bacteria, viruses, fungi), which can develop when poor oral hygiene is maintained. Physical injury or chemotherapy can also result in lesions and infections in the mouth. Your dentist or doctor can be consulted if you are experiencing any infection in the oral cavity.
Gastrointestinal causes- Ailments such as reflux, liver disease, gastric ulcers, pancreatitis or gastric distention or irritation can result in an increase of saliva production. If you are experiencing hypersalivation as a symptom of gastrointestinal complaints, please consult your doctor.
During pregnancy- Hypersalivation is one of the lesser known symptoms of pregnancy. Overproduction of saliva occurs particularly during early stages of pregnancy, when morning sickness is occurring.
Vegetable agents- Excessive starch intake, tobacco, jaborandi and muscarin are the most common vegetable products that may result in hypersalivation. Generally, the action of these agents is not long lasting. If you have any concerns regarding hypersalivation after ingestion of vegetable agents, please see your doctor.

For a full list of causes: Family Practice Notebook

Where hypersalivation is secondary to another condition, an excess amount of saliva is not usually severely limiting or even permanent. The treatment of the primary cause is often the cure for the hypersalivation3. Talk to your doctor if you are at all concerned about the cause of hypersalivation and the treatment.

Decreased saliva production and thick, ropey saliva

In most cases of where the level of saliva secreted in the oral cavity is altered, there is a decrease in the production of saliva. This results in a dry mouth, or what is referred to as xerostomia. Xerostomia can be a secondary symptom of disease, medications and chemotherapy/radiotherapy. Xerostomia can also be a primary disorder on its own. For a complete list of causes of decreased saliva production, refer to Causes of Dry Mouth.

References

Criswell, M. A., Sinha, C. K. 2001."Hyperthermic, Supersaturated Humidification in the Treatment of Xerostomia": Laryngoscope, June; 111(6); 992-996. Freeman J.J., Altieri, R.H., Baptiste, H.J., Kuo, T., Crittenden, S., Fogarty, K., Moultrie, M., Coney, E., Kanegis, K. 1994. "Evaluation and management of sialorrhea of pregnancy with concomitant hyperemesis":Journal of the National Medical Association, Sep; 86(9): 704-8 Johnson, H., and Scott, A. 1991. A practical approach to Saliva Control, Communication Sill Builders, Melbourne. Mandel, L., Tamari, K. 1995. "Sialorrhea and gastroesophageal reflux" :Journal of the American Dental Association, 126(11):1537-41 Moses, S. 2002. Drooling, Family Practice Notebook; retrieved on 12-06-2003 from: www.fpnotebook.com/ENT166.htm. Parker, A. 2003. Sialorrhea "The Drooling Patient", Department of Otolaryngology, Loyola University; retrieved on 12-06-2003 from: www.luhs.org/depts/otolaryn/P_peds.htm. Reade, P., Rich, A. 2003. Xerostomia, Medimedia, School of Dental Science, University of Melbourne, AUS. Schoofs, N. 1999. "Sjorgren's syndrome?", RN, April;62(4);45-47. Walker, P. 2001. "Management of Sialorrhea in a multi-discplinary saliva control clinic": Australian Journal of Otolaryngology, Jan; 4(1): 27-32 Xavier, G. 2000. "The importance of mouth care in preventing infection": Nursing Standard, Jan; 14(18):47-52.