Scope - Communication Resource Centre

Saliva Management

Research

Below are several examples of research recently completed, currently being undertaken both now and into the future in the areas of drooling and dry mouth.

Drooling - Australian Research
Botox Treatment

'Botulinum Toxin' (Botox) is a drug that blocks the transmission of nerve impulses to muscles, sweat glands and salivary glands. This treatment for improving saliva control is a relatively new procedure. It consists of botulinum toxin being injected into the salivary glands. It works in the same way as the medications, by blocking acetylcholine release from nerve endings but only at or near where it's injected.
The use of this drug in the reduction of saliva, is a new and emerging procedure currently being investigated at the Royal Children's Hospital.
(Royal Children's Hospital: Melbourne, 2003)

Surgery

Surgery involving reversal of the submandibular glands' ducts is currently performed around the world. The Royal Children's Hospital, Melbourne, Australia; is one of these places. A study published by the Birmingham Children's Hospital reports an overall improvement in drooling in 87% of those cases studied. 57% had complete elimination drooling whilst 13% had poor results. Those with poor results were identified as having the greatest degree of oral-motor dysfunction.

The treatment efficacy of particularly botox injections and surgical treatment of the salivary glands remain as dominant areas of research and discussion in the domain of saliva control and management.
The Saliva Clinic at the Royal Melbourne Children's Hospital (RCH) is currently carrying out both surgery and botox treatment in 2003.

For further information regarding either of these treatments, and contact details; go to the saliva control clinic web page at the RCH web site: http://www.rch.org.au/speech/index.cfm?doc_id=1221

Appliances

A recent study (in 2002) was conducted regarding the efficacy of one of a variety of intra-oral appliances called the ISMAR (Innsbruck Sensori Motor Activator and Regulator) for improving drooling in a group of children with cerebral palsy. The study also highlighted factors that might indicate a good candidate for this type of therapeutic approach.
For these children, drooling severity scores significantly improved as well as eating and drinking skills over the treatment period compared to the period of time when they did not wear the ISMAR. This appliance was thus found to be a valid treatment option for children with cerebral palsy. However more research into the issues surrounding the wearing of such an appliance is necessary for better understanding of its use.

Dry mouth
Gene Therapy - International research

Current research using gene transfer technology is being conducted which is investigating the transfer of water-transporting proteins (aquaporins) into ductal cells (normally non-saliva producing) within the salivary glands, to create more fluid producing cells. This process is hoped to help those who have undergone radiation treatment and those with auto-immune diseases, such as Sjogren's Syndrome. However, studies have so far been conducted with rodents. Human investigation is yet to be explored.

Baum, B. 2000. "Salivary Glands; Breakthrough in Gene Therapy and Tissue Engineering" : Blood Weekly. July 6, p10 Johnson, H., Reid, S., Hazard, C., Lucas, J., Desai, M., & D. Reddihough. 2002. "The effectiveness of an intra-oral appliance, the Innsbruck Sensori Motor Activator and Regulator (ISMAR) in improving saliva control in children with cerebral palsy" : Developmental Medicine & child Neurology Uppal, H. S., De, R., D'Souza, A., Pearman, K., Proops, D. 2003. "Bilateral submandibular duct relocation for drooling: an evaluation of results for the Birmingham Children's Children's Hospital" : Eur Arch Otorhinolaryngol (260): 48-51.