Differential Diagnosis for Excessive Salivation in an 18-year-old Male

Single Most Likely Diagnosis

• Gastroesophageal reflux disease (GERD) with a normal EGD: Although the EGD is normal, GERD can still cause excessive salivation as a reflex to perceived esophageal irritation, even in the absence of visible mucosal damage.

Other Likely Diagnoses

• Dental or oral cavity issues: Problems such as gum disease, tooth decay, or ill-fitting dentures can stimulate excessive salivation.
• Anxiety or stress: Psychological factors can lead to increased salivation.
• Medication side effects: Certain medications, like anticholinesterases or cholinergic agonists, can cause sialorrhea (excessive salivation).

Do Not Miss Diagnoses

• Rabies: Although rare, rabies can cause excessive salivation and is almost always fatal if not promptly treated.
• Neurological disorders (e.g., Parkinson's disease, cerebral palsy): These conditions can affect the brain's ability to regulate salivation.
• Pregnancy or hormonal changes: Though less likely in a male, hormonal fluctuations can influence salivation.

Rare Diagnoses

• Sjögren's syndrome: An autoimmune disorder that can affect exocrine glands, including salivary glands, leading to excessive salivation.
• Hyperthyroidism: In some cases, an overactive thyroid gland can cause increased salivation.
• Mercury or lead poisoning: Exposure to these heavy metals can lead to a range of symptoms, including excessive salivation.