Saliva management: sialorrhoea

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DESCRIPTION - drooling/sialorrhoea

Drooling is the unintentional loss of saliva from the mouth. In the adult population it can be associated with neurological disorders such as Parkinson’s disease, motor neurone disease (MND) and stroke. Contrary to popular belief, drooling is rarely caused by hypersalivation but is more often related to neuromuscular and/or sensory dysfunction in the oral stage of the swallow.

CAUSES

Neuromuscular dysfunction/sensory dysfunction    Motor dysfunction – frequently exacerbates existing problems 
Cognitive development disorder, cerebral palsy, Parkinson’s disease (pseudo bulbar and bulbar    palsy, stroke – less common)  Enlarged tongue
 Oral incompetence
Hypersecretion – usually controlled by increased swallowing     Dental malocclusion
Inflammation (teething, dental caries, oral cavity infection, rabies)     Orthodontic problems
Medication side-effects (tranquillisers, anticonvulsants)   Head and neck surgical defects
Toxin exposure (mercury)  Gastro-oesophageal reflux

COMPLICATIONS

Drooling in the adult patient has various repercussions, ranging from physical difficulties such as dehydration, foul oral odour, perioral skin maceration and increased risk of aspiration pneumonia, to social ramifications such as embarrassment, isolation and increased dependency. As such, drooling can have a negative effect on quality of life, so much so that many patients rate drooling as their worst symptom.

Pathway

Saliva rating scale - frequency and severity (NHS Highland intranet access required)

Editorial Information

Last reviewed: 18 June 2019

Next review: 18 June 2021

Author(s): Palliative Care Network

Version: 3

Approved By: Policies, Procedures and Guidelines Subgroup of ADTC

Reviewer Name(s): MacMillan Palliative & Community Care Pharmacist