From the Research
Management of hypersalivation (ptyalism) in the first trimester of pregnancy should begin with non-pharmacological approaches, and if necessary, anticholinergic medications like glycopyrrolate may be considered under close medical supervision, as supported by the most recent and highest quality study 1.
Non-Pharmacological Approaches
- Frequent small sips of water
- Chewing sugar-free gum or sucking on ice chips to help manage excess saliva
- Maintaining good oral hygiene and using alcohol-free mouthwash for temporary relief
- Dietary modifications to avoid starchy and spicy foods that may stimulate saliva production
Pharmacological Interventions
- Antihistamines like diphenhydramine (25-50mg every 4-6 hours) or meclizine (25mg every 4-6 hours) may help reduce secretions, though they should be used cautiously during pregnancy
- For severe cases, a short course of anticholinergic medications like glycopyrrolate (1-2mg twice daily) might be considered under close medical supervision, as it has been shown to reduce saliva flow with limited risk 1
Importance of Ruling Out Other Causes
- Other causes of excessive salivation, such as gastroesophageal reflux disease, should be ruled out and may require separate treatment approaches
- A thorough diagnostic evaluation, including transnasal swallowing endoscopy and radiologic assessments, may be necessary to determine the underlying cause of hypersalivation and guide treatment decisions 1
Consideration of Recent Guidelines
- Recent guidelines suggest that glycopyrrolate bromid is an effective and approved treatment option for children and adolescents, and Incobotulinum toxine is an approved therapy for chronic hypersalivation in adults 1
- Surgical approaches, such as salivary duct relocation, are recommended less often due to invasiveness and failure, and radiotherapy is reserved mainly for neurodegenerative diseases 1