From the Guidelines
A specialist who can help with excess saliva (hypersalivation or sialorrhea) is an otolaryngologist (ENT doctor) or a neurologist, depending on the underlying cause, and they may consider botulinum toxin (BT) therapy to salivary glands for patients with inadequate response or intolerance to anticholinergic therapy, as suggested by the American College of Chest Physicians clinical practice guideline and expert panel report 1. When evaluating and treating hypersalivation, it is essential to consider the underlying cause, which could be medication side effects, neurological conditions like Parkinson's disease, stroke, cerebral palsy, or anatomical issues affecting swallowing.
- Treatment options may include:
- Anticholinergic medications to block nerve signals that stimulate saliva production
- Botulinum toxin (Botox) injections into the salivary glands, which can reduce saliva production for 3-6 months, with doses varying depending on the formulation and individual patient needs, as noted in the study 1
- Surgical options like salivary gland removal or duct relocation for severe cases
- Speech therapy techniques to improve swallowing frequency and oral motor control The choice of treatment depends on the cause of hypersalivation and the patient's response to initial therapies, with botulinum toxin therapy being a suggested option for patients with inadequate response or intolerance to anticholinergic therapy, as per the guideline 1.
- A thorough evaluation is necessary to determine the underlying cause before starting treatment, and the decision to use botulinum toxin therapy or other treatments should be based on individual patient needs and local expertise, as noted in the study 1.
From the FDA Drug Label
Glycopyrrolate oral solution was evaluated for chronic severe drooling in patients aged 3-16 years with neurologic conditions associated with problem drooling.
The specialist that treats hypersalivation (excessive saliva production) is likely a neurologist or an oral medicine specialist, as glycopyrrolate is used to treat chronic severe drooling in patients with neurologic conditions. However, the FDA label does not explicitly state which specialist treats hypersalivation. 2
From the Research
Specialist for Hypersalivation Treatment
The treatment of hypersalivation (excessive saliva production) often requires a multidisciplinary approach, involving various specialists. Some of the specialists who may be involved in the treatment of hypersalivation include:
- Primary health care providers
- Speech pathologists
- Occupational therapists
- Dentists
- Orthodontists
- Neurologists
- Otolaryngologists (ENT specialists) 3
- Palliative care specialists 4
Treatment Options
The treatment options for hypersalivation may vary depending on the underlying cause and severity of the condition. Some of the treatment options include:
- Non-pharmacologic interventions, such as postural changes and biofeedback
- Pharmacologic interventions, such as anticholinergic medications (e.g., glycopyrrolate and scopolamine) 5, 3
- Botulinum toxin injections into the salivary glands 5, 3, 6
- Surgical interventions, such as salivary gland excision, salivary duct ligation, and duct rerouting 3
- Radiotherapeutic interventions, which may be considered as a last resort 5