Hypersalivation Explained

Hypersalivation
Synonyms:	Ptyalism,^[1] sialorrhea,^[2] water brash

Hypersalivation or hypersialosis is the excessive production of saliva.^[3] It has also been defined as increased amount of saliva in the mouth, which may also be caused by decreased clearance of saliva.^[4]

Hypersalivation can contribute to drooling if there is an inability to keep the mouth closed or difficulty in swallowing (dysphagia) the excess saliva, which can lead to excessive spitting.

Hypersalivation also often precedes emesis (vomiting), where it accompanies nausea (a feeling of needing to vomit).^[5]

Causes

Excessive production

Conditions that can cause saliva overproduction include:^[4]

• Rabies
• Pellagra (niacin or vitamin B₃ deficiency)^[6]
• Gastroesophageal reflux disease, in such cases specifically called a water brash (a loosely defined lay term), and is characterized by a sour fluid or almost tasteless saliva in the mouth^[7]
• Gastroparesis (main symptoms are nausea, vomiting, and reflux)
• Pregnancy
• Fluoride therapy
• Excessive starch intake
• Anxiety (common sign of separation anxiety in dogs)
• Pancreatitis
• Liver disease
• Serotonin syndrome
• Mouth ulcers
• Oral infections
• Sjögren syndrome (an early symptom in some patients)^[8]

Medications that can cause overproduction of saliva include:^[4]

• aripiprazole
• clozapine
• pilocarpine
• ketamine
• potassium chlorate
• risperidone
• pyridostigmine

Substances that can cause hypersalivation include:^[4]

• mercury
• copper
• organophosphates (insecticide)
• arsenic
• nicotine
• thallium

Decreased clearance

Causes of decreased clearance of saliva include:^[4]

• Infections such as tonsillitis, retropharyngeal and peritonsillar abscesses, epiglottitis and mumps.
• Problems with the jaw, e.g., fracture or dislocation
• Radiation therapy
• Neurologic disorders such as Amyotrophic lateral sclerosis, myasthenia gravis, Parkinson's disease, multiple system atrophy, rabies, bulbar paralysis, bilateral facial nerve palsy, and hypoglossal nerve palsy

Treatment

Hypersalivation is optimally treated by treating or avoiding the underlying cause.^[4] Mouthwash and tooth brushing may have drying effects.^[4]

In the palliative care setting, anticholinergics and similar drugs that would normally reduce the production of saliva causing a dry mouth could be considered for symptom management: scopolamine, atropine, propantheline, hyoscine, amitriptyline, glycopyrrolate.^[9]

As of 2008, it is unclear if medication for people who have too much saliva due to clozapine treatment is useful.^[10]

Notes and References

1. http://medical-dictionary.thefreedictionary.com/ptyalism thefreedictionar.com > ptyalism
2. http://www.thefreedictionary.com/sialorrhea thefreedictionary.com > sialorrhea
3. Encyclopedia: hypersalivation. 1986. Merriam-Webster's Medical Desk Dictionary. Springfield, Massachusetts. Merriam-Webster. 371. Internet Archive. registration.
4. http://www.medscape.com/viewarticle/477613 Medscape > Hypersalivation
5. Book: Clinical medicine . Elsevier Saunders . 2005 . 978-0-7020-2763-5 . Kumar . Parveen J. . 6th . Edinburgh . 266 . Clark . Michael L..
6. News: Well. The New York Times. Reynolds. Gretchen.
7. http://medical-dictionary.thefreedictionary.com/water+brash thefreedictionary.com > water brash
8. https://academic.oup.com/rheumatology/article/42/9/1113/1772287
9. Medical Care of the Dying, 4th Edition, 2006, Edited by G.Michael Downing MD and Wendy Wainwright, MEd
10. Syed . R . Au . K . Cahill . C . Duggan . L . He . Y . Udu . V . Xia . J . Rebecca . Syed . Pharmacological interventions for clozapine-induced hypersalivation . The Cochrane Database of Systematic Reviews . 16 July 2008 . 3 . CD005579 . 10.1002/14651858.CD005579.pub2 . 18646130. 4160791 .