Medical Term for Drooling

The medical term for drooling is "sialorrhea," which refers to excessive salivation or the involuntary spillage of saliva from the mouth. 1

Definition and Causes

Sialorrhea (drooling) is defined as the involuntary spillage of saliva from the mouth, typically resulting from dysfunction in the coordination of the swallowing mechanism 2
It is most commonly caused by poor oral and facial muscle control, leading to excess pooling of saliva in the anterior portion of the oral cavity 1
Contributing factors may include hypersecretion of saliva, dental malocclusion, postural problems, and an inability to recognize salivary spill 1

Sialorrhea is a common problem in neurologically impaired individuals, including:
- Children with mental retardation or cerebral palsy 1
- Adults with Parkinson's disease 3
- Patients who have had a stroke 1
- Individuals with progressive neuromuscular diseases and bulbar palsy 4
It is particularly common in Parkinson's disease, with more than 80% of patients developing dysphagia (which can contribute to drooling) during the course of the disease 5

Screening for sialorrhea should be performed in patients with risk factors such as:
- Parkinson's disease with Hoehn & Yahr stage above II 5
- Weight loss or low BMI 5
- Signs of dysphagia 5
- Dementia 5
Assessment methods include:
- Parkinson's disease-specific questionnaires 5
- Water swallow test with measurement of average volume per swallow 5
- Observation of passive drooling, which is the most commonly used method for saliva collection 5

Various saliva collection methods include:
- Non-absorbent-pad-based methods:
  - Direct spitting (expectoration) of saliva into a tube 5
  - Passive drooling of saliva through a funnel or straw into a tube 5
  - Oral rinsing with citric acid or saline solution 5
- Absorbent-pad-based methods using inert materials to absorb saliva 5
Passive drooling is the most commonly used method and provides whole, "mixed," resting-state saliva from all major salivary glands 5

Treatment of sialorrhea is best managed by a multidisciplinary clinical team including primary healthcare providers, speech pathologists, occupational therapists, dentists, neurologists, and otolaryngologists 1
Treatment options range from conservative to more aggressive measures:
- Conservative approaches:
  - Observation and postural changes 2
  - Biofeedback and motoric therapy of the mouth 2
  - Swallowing therapy by a speech therapist 4
- Pharmacological approaches:
  - Anticholinergic medications (glycopyrrolate, scopolamine) are effective but may be limited by side effects 1
  - Botulinum toxin type A injections into the parotid and submandibular glands provide safe and effective control for several months 1
- More aggressive interventions:
  - Radiation therapy for the salivary glands 1
  - Surgical procedures including salivary gland excision, salivary duct ligation, and duct rerouting 1
For patients with neuromuscular weakness, the American College of Chest Physicians recommends starting with a trial of anticholinergic agents, which are relatively inexpensive and readily available 5

Medication-induced sialorrhea can occur with certain drugs:
- Antipsychotics, particularly clozapine 6
- Direct and indirect cholinergic agonists used to treat Alzheimer's dementia and myasthenia gravis 6
- Heavy metal toxins (mercury and thallium) 6
- Exposure to irreversible acetylcholinesterase inhibitors 6
Silent aspiration (without reflex cough) is especially common with thin liquids and can increase the risk of respiratory complications 7
Pneumonia is the most frequent cause of death in Parkinson's disease and is substantially related to dysphagia, which often accompanies sialorrhea 5