Drooling of Saliva or Hypersialorrhea

Unfortunately excessive drooling of saliva or hypersialorrhea is a commonproblem in neurodegenerative disorders. We've both seen in it our own lovedones in the later stages of HD. It is usually caused by swallowingdysfunction and can facilitate choking, aspiration, and chest infections.This problem may also be attributable to eating problems, choking, andinfections as well lead to such complications as dehydration, a reddeningaround the mouth, chin, and neck. Just as important, socially this problemis embarrassing therefore affects the persons social interactions. It is said that drooling is caused by a defect in the oral or voluntaryphase of swallowing, resulting in a buildup of saliva in the front of themouth; poor head control; constant open mouth; poor lip control; ordecreased tactile sensation. In addition, adverse drug reactions involvingtranquilizers and anticonvulsants can cause hypersecretion of saliva.Although drool can be very undesirable itself, has several specific andimportant functions: it lubricates food for swallowing; it helps in thedigestion of starch; it is crucial for oral hygiene; it maintains toothstructure and integrity; and it has various immunologic and nonimmunologicproteins that destroy intra-oral bacteria. Detailed evaluations can help determine how bad the problem may be.

Countingthe number of bibs or shirts soiled each day provides a subjective estimateof the severity of the condition. Physical findings such as skin macerationon the neck, chest, and hands due to dampness and constant wiping confirminitial impressions of severity and indicate the need for treatment. In the earlier to mid-stages of HD the management of sialorrhea is usuallybetter helped using a team approach including an otolaryngologist, a speechpathologist, and a dentist. The speech pathologist determines theprobability of improvement of oral-motor skills with time, therapy, or both.The dentist assesses structural abnormalities and health of the teeth andgums. The otolaryngologist examines for head and neck pathology, looks forupper airway obstruction, and determines the severity of the droolingproblem.

Once the team has evaluated the person, the type of treatment to be used is decided, however, it typically consists of a combination approach.During this stage the current treatments available are behavioral therapy,oral-motor therapy, medication, and surgery. Speech therapy and behaviormodification techniques are said to show only modest improvements and do nothave long-term effects, whereas, medications and surgery have a much higherrate of success. In the later stages of HD, we've talked about using a couple of differentmedications for excessive salvia on this list. Medications used for managingsialorrhea work by drying up the secretions, however, their use oftenresults in a dry mouth, causing swallowing difficulties and poor oralhygiene. These drugs most often contain atropine sulfate, scopolamine, orglycopyrrolate, which, in themselves, are used to treat a variety ofdifferent conditions.

While these medications have been shown to decreasethe amount of saliva production, they have side-effects that should be givengreat consideration before the decision is made to begin using medication asa method to control drooling. The goal of treatment is to reduce drooling but maintain a moist, healthyoral cavity. No single therapy has been documented to resolve sialorrheasatisfactorily in all patients. If anyone does consider a saliva treatment,it is important that the advantages outweigh the disadvantages of decreasingsaliva in the mouth. More specifically, whatever saliva management method ischosen, it is important that the mouth be kept moist. To completelyeliminate drooling risks the significant complication of xerostomia [drymouth]. I.e. it's another one of those situations where a decision needs tobe made to weigh whether the side effects from a potential medication take aback seat to improving the persons overall quality of life!