Scope - Communication Resource Centre

Saliva Management

Social Implications of Drooling and Dry Mouth

Drooling or dry mouth are not dangerous; they do not cause life threatening medical complications. But drooling and dry mouth can cause problems of both the emotional and physical kind. For some individuals this can be quite serious and dilapidating, ranging from mild embarrassment to complete social alienation and adverse reactions from peers.

Drooling

There are several implications of drooling which impact upon patients socially every day, causing embarrassment, social isolation and alienation for both the individual and their family:

The constant exposure of skin to saliva can cause a rash around the mouth, chin or lips, chapping of lips and infections around the mouth. Not only are does it cause discomfort or even pain, but the sores are viewed as unsightly by the wider community.
Chronically irritated facial skin may even develop scars, adding to social exclusion.
Clothing requires several changes per day, which can become very laborious for the family or carers. They may opt for the patient to wear a bib, which results in stigmatization in the wider community.
Drooling may limit the use of electronic communication devices or teaching materials, as they can become wet and damaged.
Drool may also stain, books, furniture, carpet etc. This can not only lead to negative community feelings, but also difficulty with employment.
The embarrassment felt by the patient may result in their limit of interaction with peers, causing social isolation.
As many drooling patients have poor oro-motor control and have difficulty transporting food and saliva to the back of the mouth impacting on their ability to eat.
Smell of stale saliva

Dry mouth

When discussing social implications related to saliva management, one most often associates these issues with those who drool. However, a lack of oral secretions can also result in embarrassment or social isolation:

Saliva's natural cleansing ability is reduced, resulting in dental caries, inflammation and infection, ulcers and candidiasis (thrush). Tablets can become attached to the inside of the mouth, which if remaining for extended periods of time can cause tissue breakdown underneath the debris. Where oral hygiene is compromised, individuals with dry mouth may suffer from bad breath.
As one of the many functions of saliva is too lubricate the oral cavity, a dry mouth can cause pain in the oral cavity when eating, wearing dentures and even speaking. This can lead to avoidance of social situations such as dining out in restaurants or speaking to strangers or in public.
Saliva also contributes to taste perception, therefore sense of taste and smell can both be affected. This can again lead to avoidance of eating in public.
There may also be difficulty sleeping due to uncomfortable oral dryness.

References

Criswell, M. A., Sinha, C. K., (2001), Hyperthermic, Supersaturated Humidification in the Treatment of Xerostomia, Laryngoscope, June; 111(6); 992-996. Droolinginfo.org, (1999), Scope of the Problem, Annacle Communication Group. Inc., retrieved on 17-04-2003 from: www.droolinginfo.org Johnson,H., Scott, A., (1991), A practical approach to Saliva Control, Communication Skill Builders, Melbourne Park, A., (2003), Sialorrhea "The Drooling Patient", Department of Otolaryngology, Loyola University Website, retrieved on 12-06-2003 from: www.luhs.org/depts/otolaryn/P_peds.htm Scott, A., (2002), Issue in Saliva Management (presentation notes), Victorian Continuing Professional Development Seminar. Royal Children's Hospital, Speech Pathology Department, Saliva Control, retrieved on 17-04-2003 from: www.rch.arg.au/speech/index.cfm?doc_id+1221#problems. Webb, K., Reddihough, D., Johnson, H., Bennett, C.S., Byrt, T., (1995), Long-Term outcome of Saliva Control Surgery, Developmental Medicine and Child Neurology, 37;755-762. Xavier, G., (2000), The importance of mouth care in preventing infection, Nursing Standard, Jan; 14(18); 47-52.