Management of Drooling of saliva. Ganesh Bavikatte, Poh Lin Sit and Ali HassoonAbstract. Drooling, also known as ptyalism or sialorrhea can be defined as salivary incontinence or the involuntary spillage of saliva over the lower lip. Drooling could be caused by excessive production of saliva, inability to retain saliva within the mouth, or problems with swallowing. O5V_DZYT4a8/hqdefault.jpg' alt='Mrcp Part 1 Books Pdf' title='Mrcp Part 1 Books Pdf' />Related links. More about Identity and Access Management OpenAthens provides a range of products and services that enable secure access to resources through. Drooling can lead to functional and clinical consequences for patients, families, and caregivers. Physical and psychosocial complication includes maceration of skin around the mouth, secondary bacterial infection, bad odour, dehydration and social stigmatisation. People with drooling problems are also at increased risk of inhaling saliva, food, or fluids into the lungs especially when bodys normal reflex mechanisms, such as gagging and coughing are also impaired. Successful management of sialorrhea can alleviate the associated hygienic problems, improve appearance, enhance self esteem, and significantly reduce the nursing care time of these sufferers. Chronic drooling can be difficult to manage this article gives overview of the causes, effects and management of drooling of saliva in general practice. Saliva is the watery and usually frothy substance produced in and secreted from the three paired major salivary parotid, submandibular and sublingual glands and several hundred minor salivary glands, composed mostly of water, but also includes electrolytes, mucus, antibacterial compounds, and various enzymes. Healthy persons are estimated to produce 0. At least 9. 0 of the daily salivary production comes from the major salivary glands while the minor salivary glands produce about 1. On stimulation olfactory, tactile or gustatory, salivary flow increases five fold, with the parotid glands providing the preponderance of saliva. Saliva is a major protector of the tissues and organs of the mouth. In its absence both the hard and soft tissues of the oral cavity may be severely damaged, with an increase in ulceration, infections, such as candidiasis, and dental decay. Saliva is composed of serous part alpha amylase and a mucus component, which acts as a lubricant. It is saturated with calcium and phosphate and is necessary for maintaining healthy teeth. The bicarbonate content of saliva enables it to buffer and produce the condition necessary for the digestion of plaque which holds acids in contact with the teeth. Abstract. Drooling, also known as ptyalism or sialorrhea can be defined as salivary incontinence or the involuntary spillage of saliva over the lower lip. Moreover, saliva helps with bolus formation and lubricates the throat for the easy passage of food. Maya Jane Coles Fabric 75. The organic and inorganic components of salivary secretion have got a protective potential. They act as barrier to irritants and a means of removing cellular and bacterial debris. Saliva contains various components involved in defence against bacterial and viral invasion, including mucins, lipids, secretory immunoglobulins, lysozymes, lactoferrin, salivary peroxidise, and myeloperoxidase. Salivary p. H is about 6 7, favouring digestive action of salivary enzyme, alpha amylase, devoted to starch digestion. Image 1. Source of this image http www. Salivary glands are innervated by the parasympathetic and sympathetic nervous system. Parasympathetic postganglionic cholinergic nerve fibers supply cells of both the secretory end piece and ducts and stimulate the rate of salivary secretion, inducing the formation of large amounts of a low protein, serous saliva. Sympathetic stimulation promotes saliva flow through muscle contractions at salivary ducts. In this regard both parasympathetic and sympathetic stimuli result in an increase in salivary gland secretions. The sympathetic nervous system also affects salivary gland secretions indirectly by innervating the blood vessels that supply the glands. Table 1 Functions of saliva. Digestion and swallowing. Initial process of food digestion. Lubrication of mouth, teeth, tongue and food boluses. Tasting food. Amylase digestion of starch. Disinfectant and protective role. Effective cleaning agent. Oral homeostasis. Protect teeth decay, dental health and oral odour. Bacteriostatic and bacteriocidal properties. Regulate oral p. HSpeaking Lubricates tongue and oral cavity. Drooling also known as driveling, ptyalism, sialorrhea, or slobbering is when saliva flows outside the mouth, defined as saliva beyond the margin of the lip. This condition is normal in infants but usually stops by 1. Sialorrhea after four years of age generally is considered to be pathologic. The prevalence of drooling of saliva in the chronic neurological patients is high, with impairment of social integration and difficulties to perform oral motor activities during eating and speech, with repercussion in quality of life. Drooling occurs in about one in two patients affected with motor neuron disease and one in five needs continuous saliva elimination. Parkinson disease. Pathophysiology Pathophysiology of drooling is multifactorial. It is generally caused by conditions resulting in. Excess production of saliva due to local or systemic causes table 2Inability to retain saliva within the mouth poor head control, constant open mouth, poor lip control, disorganized tongue mobility, decreased tactile sensation, macroglossia, dental malocclusion, nasal obstruction. Problems with swallowing resulting in excess pooling of saliva in the anterior portion of the oral cavity e. Drooling is mainly due to neurological disturbance and less frequently to hyper salivation. Under normal circumstances, persons are able to compensate for increased salivation by swallowing. However, sensory dysfunction may decrease a persons ability to recognize drooling and anatomic or motor dysfunction of swallowing may impede the ability to manage increased secretion. Table 2 Aetiology of hypersalivation. Physiological. Pregnancy. Local causes. Oral inflammation teething. Infection oral cavity infection, dental caries, tonsillitis, peritonsilar abscess. Systemic Toxin exposure pesticides, mercury, capsaicin, snake poisoning. Medication tranquilizers, anticonvulsants, anticholinesterases, lithium. Neuromuscular cerebral palsy, Parkinsons disease, motor neuron disease, bulbar pseudobulbar palsy, Stroke. Infection rabies. Gastric gastroesophageal reflux. Depending on duration of drooling, it can be classified as acute e. Symptoms Drooling of saliva can affect patient andor their carers quality of life and it is important to assess the rate and severity of symptoms and its impact on their life. Table 3 Effect of untreated Drooling of saliva. Physical. Psychological. Perioral chapping skin crackingMaceration with secondary infection. Dehydration. Foul odour. Aspiration pneumonia. Speech disturbance. Interference with feeding. Isolation. Barriers to education damage to books or electronic devicesIncreased dependency and levelintensity of care. Damage to electronic devices. Decreased self esteem. Difficult social interaction. Assessment Assessment of the severity of drooling and its impact on quality of life for the patient and their carers help to establish a prognosis and to decide the therapeutic regimen. A variety of subjective and objective methods for assessment of sialorrhoea have been described.