How to Cope with Excessive Salivation

Drooling Too Much? A Definitive Guide to Managing Excessive Salivation

Excessive salivation, medically known as hypersalivation or sialorrhea, is more than just an inconvenience; it can significantly impact quality of life. From social embarrassment and skin irritation to challenges with speech and eating, the constant presence of too much saliva can be a distressing experience. While often perceived as a minor issue, persistent hypersalivation warrants attention, as it can be a symptom of underlying health conditions or a side effect of medications. This comprehensive guide will delve deep into the world of excessive salivation, providing a clear, actionable roadmap to understanding, managing, and ultimately coping with this often-misunderstood condition.

Understanding the Root of the Problem: Why Do We Salivate Excessively?

Before we can effectively cope with excessive salivation, it’s crucial to understand why it occurs. Saliva plays a vital role in our oral health, aiding in digestion, lubricating the mouth, and protecting against bacteria. Our salivary glands, located in and around our mouths, produce approximately 1 to 1.5 liters of saliva daily. Hypersalivation arises when there’s an imbalance in this delicate system, leading to an overproduction of saliva or an inability to effectively clear it.

The causes of excessive salivation are diverse and can range from temporary, easily resolved issues to more complex, chronic conditions. Identifying the specific cause is the first critical step towards effective management.

1. Transient Causes: When Hypersalivation is Temporary

Sometimes, excessive salivation is a fleeting phenomenon, triggered by specific circumstances or short-term issues. These are often easier to identify and manage.

• Oral Irritation and Inflammation: Any irritation or inflammation within the mouth can stimulate increased saliva production as the body attempts to wash away irritants and promote healing.
  • Examples:
    • Teething in Infants: The eruption of new teeth can cause significant gum irritation, leading to copious drooling in babies. This is a natural, temporary phase.

    • Mouth Ulcers or Canker Sores: Painful sores in the mouth often lead to an increase in saliva as a protective mechanism.

    • Gingivitis or Periodontitis: Inflammation of the gums due to poor oral hygiene can trigger heightened salivary flow.

    • Oral Infections: Fungal infections like oral thrush or bacterial infections can cause irritation and subsequent hypersalivation.

    • Ill-fitting Dentures or Orthodontic Appliances: New braces or poorly fitting dentures can rub against the gums and cheeks, leading to irritation and increased saliva production as the mouth tries to adapt.

• Acid Reflux (GERD): The presence of stomach acid in the esophagus can irritate the lining, and the body’s natural response is to produce more saliva to neutralize the acid and protect the esophageal wall.

  • Examples: Experiencing heartburn or a sour taste in the mouth along with excessive drooling, especially after meals or at night, could indicate GERD.
• Nausea and Vomiting: The body often produces more saliva as a protective mechanism before or during episodes of nausea and vomiting. This helps to lubricate the throat and protect the esophagus from stomach acid.
  • Examples: The sudden urge to salivate profusely before a bout of motion sickness or morning sickness.
• Certain Foods and Beverages: Some highly acidic, spicy, or pungent foods can stimulate salivary glands.
  • Examples: Sucking on a lemon, eating extremely spicy chili, or consuming very sour candies can cause a temporary surge in saliva.
• Dental Procedures: During and immediately after certain dental procedures, the mouth may produce more saliva as a response to the manipulation and healing process.
  • Examples: Following a tooth extraction or root canal, it’s common to experience a temporary increase in salivation.
• Allergic Reactions: In some cases, an allergic reaction, particularly to certain foods or airborne allergens, can manifest with increased salivation as part of a broader immune response.
  • Examples: Experiencing excessive drooling alongside hives, swelling, or difficulty breathing after consuming a new food.
• Drug Side Effects: A surprising number of medications can have hypersalivation as a side effect.
  • Examples: Certain antipsychotics (e.g., clozapine), cholinergic agonists, some anticonvulsants, and even some medications for Alzheimer’s disease can increase saliva production. Always review medication side effects with your doctor or pharmacist.
• Pregnancy: Hormonal fluctuations during pregnancy, particularly in the first trimester, can lead to increased saliva production (ptyalism gravidarum). This is usually temporary and resolves as the pregnancy progresses.
  • Examples: A pregnant individual experiencing significant morning sickness alongside an noticeable increase in saliva.

2. Chronic Causes: When Hypersalivation Persists

When excessive salivation becomes a persistent issue, it often points to a more chronic underlying condition that requires medical attention.

• Neurological Conditions: Many neurological disorders can impair the ability to swallow effectively, leading to saliva pooling in the mouth and subsequent drooling. The issue isn’t always overproduction but rather impaired clearance.
  • Examples:
    • Parkinson’s Disease: Individuals with Parkinson’s often have difficulty with spontaneous swallowing, leading to saliva accumulation.

    • Cerebral Palsy: Muscle control issues in individuals with cerebral palsy can affect swallowing reflexes.

    • Stroke: Damage to brain regions controlling swallowing can result in dysphagia (difficulty swallowing) and hypersalivation.

    • Amyotrophic Lateral Sclerosis (ALS): Progressive muscle weakness, including those involved in swallowing, is a hallmark of ALS.

    • Bell’s Palsy: Temporary facial paralysis can affect lip closure and swallowing, leading to drooling on one side of the mouth.

    • Intellectual Disabilities: Some individuals with intellectual disabilities may have impaired oral motor control.

• Glandular Problems: Although less common, issues directly with the salivary glands can sometimes lead to excessive production.

  • Examples:
    • Sialadenitis (Salivary Gland Infection): Inflammation and infection of a salivary gland can sometimes lead to increased output, though it’s more often associated with swelling and pain.

    • Salivary Gland Tumors: Rarely, a tumor in a salivary gland could potentially alter its function, though this is not a primary cause of generalized hypersalivation.

• Structural Abnormalities: Physical obstructions or abnormalities in the mouth or throat can impede normal saliva flow and swallowing.

  • Examples:
    • Enlarged Adenoids or Tonsils: These can narrow the airway and affect tongue position, making swallowing more difficult.

    • Oral or Pharyngeal Tumors: Growths in the mouth or throat can physically obstruct the swallowing pathway.

• Psychological Factors: While not a direct physiological cause, anxiety or stress can sometimes indirectly influence salivary production.

  • Examples: Some individuals report increased salivation during periods of extreme stress or panic attacks, though this is usually temporary.

The Impact of Excessive Salivation: More Than Just a Nuisance

The effects of hypersalivation extend beyond the immediate discomfort. Understanding these impacts can underscore the importance of seeking solutions.

• Social Embarrassment and Isolation: Constant drooling can lead to significant self-consciousness, impacting social interactions, professional life, and overall confidence. Individuals may withdraw from social situations to avoid perceived judgment.

• Skin Irritation and Breakdown: Constant moisture around the mouth, chin, and neck can lead to maceration (softening and breakdown of the skin), rashes, and infections, particularly fungal infections. This is especially prevalent in infants and individuals who are less mobile.

• Chapping and Cracking of Lips: Paradoxically, constant wetness can lead to chapped and cracked lips as saliva evaporates, drawing moisture from the skin.

• Dental Problems: While saliva is protective, excessive amounts can sometimes be associated with increased tartar buildup if oral hygiene is not meticulous, or in some cases, could be a sign of underlying issues that contribute to dental problems (like GERD).

• Speech Difficulties (Dysarthria): Excessive saliva can interfere with articulation, making speech unclear and difficult to understand. This can further exacerbate social challenges.

• Eating and Drinking Challenges (Dysphagia-Related): If hypersalivation is due to swallowing difficulties, it can make eating and drinking challenging, increasing the risk of aspiration (inhaling food or liquid into the lungs), which can lead to pneumonia.

• Dehydration (Paradoxical): While the mouth is constantly wet, the body can still become dehydrated if the excess saliva is not effectively managed, as fluid is lost rather than retained.

• Sleep Disturbances: Drooling during sleep can be uncomfortable, leading to disrupted sleep and wet bedding.

• Hygiene Issues: The need for constant wiping can lead to an increased laundry burden and can be inconvenient.

Practical Strategies for Immediate Relief: Coping Day-to-Day

While seeking professional help for underlying causes is paramount, several practical strategies can offer immediate relief and help manage the symptoms of excessive salivation in daily life.

1. Oral Hygiene and Care:

Maintaining impeccable oral hygiene is crucial, both to prevent irritation that can worsen salivation and to protect the skin.

• Frequent Wiping and Patting: Gently patting the mouth and chin dry with a soft cloth or tissue throughout the day is essential. Avoid rubbing, which can irritate the skin.
  • Example: Carry a supply of soft, absorbent handkerchiefs or small, gentle facial cloths. For children, use specialized drool bibs designed to absorb moisture and protect clothing.
• Barrier Creams: Apply a protective barrier cream (e.g., petroleum jelly, zinc oxide cream) around the mouth and on the chin to prevent skin irritation and breakdown.
  • Example: Before bedtime, apply a thin layer of Vaseline to the affected areas. Reapply during the day as needed, especially after wiping.
• Lip Balm: Regularly apply a moisturizing lip balm to prevent chapping and cracking.
  • Example: Keep a hydrating lip balm handy and apply it several times a day.
• Gentle Cleansing: Wash the face and around the mouth with a mild, non-irritating cleanser and lukewarm water. Avoid harsh soaps or cleansers.
  • Example: Use a baby wash or a sensitive skin cleanser for daily face washing.

2. Dietary Modifications:

What you eat and drink can influence saliva production. Making conscious dietary choices can sometimes help.

• Limit Acidic and Spicy Foods: These can stimulate saliva production.
  • Example: If you notice increased drooling after eating citrus fruits, tomatoes, or hot peppers, try to reduce your intake.
• Avoid Excessive Sugary Drinks: Sugary beverages can sometimes contribute to a feeling of more saliva, and also contribute to dental issues if not properly managed.
  • Example: Opt for plain water over sugary sodas or fruit juices.
• Stay Hydrated: While it seems counterintuitive, dehydration can sometimes make saliva thicker and more bothersome. Sipping small amounts of water regularly can help keep saliva consistency manageable.
  • Example: Carry a water bottle and take frequent, small sips throughout the day.
• Chewing Gum or Sucking on Hard Candy (with caution): For some, stimulating saliva through chewing gum or sucking on sugar-free hard candy can actually help in managing the saliva by making it easier to swallow, provided the individual has good swallowing function. This is more effective for intermittent, rather than constant, hypersalivation.
  • Example: If you find you drool more when concentrating, try sugar-free gum to encourage swallowing. However, if swallowing is impaired, this can worsen the problem.

3. Posture and Positioning:

Gravity can be your friend! Strategic positioning can help manage saliva flow.

• Upright Posture: Maintaining an upright posture, especially during and after meals, can help gravity drain saliva downwards and facilitate swallowing.
  • Example: Sit up straight while eating and remain upright for at least 30 minutes after finishing a meal.
• Head Position: For individuals with neurological conditions, specific head positions (e.g., slight chin tuck) recommended by a speech-language pathologist can improve swallowing efficiency.
  • Example: A therapist might instruct a patient with dysphagia to slightly tuck their chin when swallowing to protect the airway.
• Elevate Head of Bed: If drooling is significant during sleep, elevating the head of the bed (not just using extra pillows) can help reduce pooling.
  • Example: Use a wedge pillow or elevate the bed frame slightly at the head.

4. Speech and Swallowing Exercises (Under Guidance):

For individuals with swallowing difficulties, targeted exercises can strengthen oral motor muscles and improve swallowing reflexes.

• Tongue Exercises: Exercises to strengthen the tongue can improve its ability to clear saliva.
  • Example: Pushing the tongue against the roof of the mouth, moving it side to side, or trying to touch the nose with the tongue (if able).
• Lip Closure Exercises: Strengthening lip muscles can help prevent saliva from escaping the mouth.
  • Example: Holding a button between the lips (without using teeth) or practicing pursing the lips.
• Swallowing Maneuvers: A speech-language pathologist can teach specific swallowing techniques (e.g., Mendelsohn maneuver, effortful swallow) to improve clearance.
  • Example: Practicing a “hard swallow” where you imagine swallowing a large pill.

5. Environmental Adaptations:

Making small changes to your environment can also ease the burden.

• Keep Tissues Handy: Strategically place tissue boxes in frequently used areas (e.g., nightstand, desk, living room).
  • Example: Always have a small pack of tissues in your pocket or bag when leaving the house.
• Protective Coverings: Use waterproof pillowcases or mattress protectors if nocturnal drooling is an issue.
  • Example: Place a towel or absorbent pad on the pillow at night.

Medical and Therapeutic Interventions: When Professional Help is Needed

When lifestyle adjustments and practical strategies aren’t enough, medical and therapeutic interventions can provide more significant relief. It’s crucial to consult a healthcare professional to determine the underlying cause and appropriate treatment plan.

1. Medical Consultation and Diagnosis:

The first step is always a thorough medical evaluation.

• General Practitioner (GP): Your GP can conduct an initial assessment, review your medical history, and rule out common causes like medication side effects or GERD.
  • Example: Schedule an appointment with your family doctor to discuss your concerns. Be prepared to describe when the hypersalivation started, what makes it worse or better, and any other symptoms you’re experiencing.
• Referral to Specialists: Depending on the suspected cause, your GP may refer you to a specialist.
  • Neurologist: If a neurological condition is suspected (e.g., Parkinson’s, stroke, cerebral palsy).

  • Gastroenterologist: If GERD or other digestive issues are a likely cause.

  • Ear, Nose, and Throat (ENT) Specialist (Otolaryngologist): To rule out structural abnormalities, salivary gland issues, or if oral cancers are a concern.

  • Dentist: To address dental problems, gum disease, or ill-fitting prosthetics.

  • Speech-Language Pathologist (SLP): To assess swallowing function (dysphagia) and develop a personalized therapy plan.

2. Pharmacological Treatments:

Medications are often used to reduce saliva production, particularly for chronic or severe hypersalivation. These medications primarily work by blocking the parasympathetic nervous system, which controls saliva secretion.

• Anticholinergics: These medications reduce saliva production by blocking acetylcholine, a neurotransmitter that stimulates salivary glands.
  • Examples:
    • Glycopyrrolate (Robinul): Often a first-line treatment, available in oral and transdermal patch forms. It generally has fewer central nervous system side effects than some other anticholinergics.

    • Scopolamine (Transderm Scop): A transdermal patch that can be effective, but often has more systemic side effects like drowsiness or confusion, especially in the elderly.

    • Atropine: Sometimes used in eye drop form, placed under the tongue for local effect, or as an oral solution.

    • Benztropine (Cogentin): Used for Parkinson’s-related drooling.

  • Important Considerations: Anticholinergics can have side effects such as dry mouth (the desired effect, but can be excessive), blurred vision, constipation, urinary retention, and cognitive impairment, particularly in older adults. Dosage must be carefully titrated.

• Botulinum Toxin (Botox) Injections: Botox can be directly injected into the major salivary glands (parotid and submandibular glands) to temporarily paralyze them and reduce saliva production.

  • How it Works: Botox blocks the release of acetylcholine from nerve endings, thus reducing glandular secretion.

  • Duration: The effects typically last for 3-6 months, after which repeat injections are necessary.

  • Examples: Used in cases of severe, persistent hypersalivation, especially in neurological conditions where other treatments are ineffective or poorly tolerated.

  • Important Considerations: Injections must be performed by an experienced clinician to avoid complications like temporary facial weakness or difficulty swallowing if too much toxin spreads to adjacent muscles.

3. Speech-Language Pathology (SLP) Interventions:

An SLP plays a crucial role, especially when hypersalivation is linked to swallowing difficulties.

• Swallowing Assessments: Comprehensive evaluations (e.g., modified barium swallow study, fiberoptic endoscopic evaluation of swallowing – FEES) to identify the exact nature of the swallowing impairment.

• Oral Motor Exercises: Targeted exercises to improve lip closure, tongue control, and jaw strength.

• Sensory Stimulation: Techniques to increase sensory awareness in the mouth and throat to trigger more efficient swallowing.

• Swallowing Strategies: Teaching compensatory strategies and maneuvers (e.g., chin tuck, effortful swallow, multiple swallows) to improve safety and efficiency.

• Saliva Management Techniques: Coaching on how to better manage saliva, including frequent small swallows or using external aids.

4. Surgical Interventions (Rare and Reserved for Severe Cases):

Surgery for hypersalivation is typically a last resort, considered only for very severe and intractable cases where all other treatments have failed.

• Salivary Gland Excision: Removal of one or more major salivary glands (e.g., submandibular gland excision). This is an irreversible procedure with potential risks, including nerve damage.

• Salivary Duct Ligation/Repositioning: Procedures to redirect or block the flow of saliva from the ducts.

  • Example: Submandibular duct relocation, where the duct is rerouted to a less sensitive area.

  • Important Considerations: Surgical options carry risks such as infection, scarring, nerve damage (leading to facial weakness or numbness), and the potential for residual drooling if other glands compensate.

5. Radiation Therapy (Extremely Rare):

Low-dose radiation therapy to the salivary glands can reduce saliva production, but this is an extremely rare treatment choice due to the long-term risks, including dry mouth (xerostomia) and potential for secondary cancers. It is almost exclusively considered in severe, life-limiting cases where no other option is viable.

Psychological and Emotional Support: Addressing the Hidden Burden

Living with excessive salivation can take a significant toll on mental and emotional well-being. Addressing these aspects is as important as managing the physical symptoms.

• Counseling or Therapy: A therapist can help individuals cope with the social anxiety, embarrassment, and frustration associated with hypersalivation. Cognitive Behavioral Therapy (CBT) can be particularly effective in addressing negative thought patterns and behaviors.
  • Example: Attending sessions with a therapist to develop coping mechanisms for social situations where drooling might be a concern.
• Support Groups: Connecting with others who understand the challenges of excessive salivation can provide invaluable emotional support, shared strategies, and a sense of community.
  • Example: Joining online forums or local support groups for individuals with chronic health conditions that cause hypersalivation (e.g., Parkinson’s support groups).
• Educating Others: Openly and calmly explaining the condition to close friends, family, and colleagues can reduce misunderstandings and foster empathy.
  • Example: “I have a medical condition that sometimes causes me to produce more saliva than normal. It’s not contagious, and I’m managing it as best I can.”
• Self-Compassion: It’s vital to practice self-kindness and remind yourself that this is a medical condition, not a personal failing.
  • Example: Acknowledging that it’s okay to feel frustrated, but also focusing on the steps you are taking to manage the condition.
• Stress Reduction Techniques: Since stress can sometimes exacerbate symptoms, incorporating stress-reducing activities can be beneficial.
  • Example: Practicing mindfulness, meditation, yoga, or engaging in hobbies that bring joy and relaxation.

Living Well with Excessive Salivation: A Holistic Approach

Coping with excessive salivation is often a journey of trial and error, requiring patience, persistence, and a multi-faceted approach. There’s no single magic bullet, but by combining various strategies, individuals can significantly improve their quality of life.

1. Consistent Management Routine:

Establishing a consistent daily routine for managing saliva is key.

• Scheduled Wiping/Care: Integrate skin care and wiping into your daily schedule, just like brushing your teeth.
  • Example: Wipe your mouth and apply barrier cream first thing in the morning, before meals, and before bed.
• Medication Adherence: If prescribed medications, take them consistently as directed by your doctor.
  • Example: Set reminders on your phone to ensure you don’t miss doses of anticholinergics.
• Regular Follow-ups: Maintain regular appointments with your healthcare team to monitor your condition and adjust treatment plans as needed.
  • Example: Schedule follow-up visits with your neurologist or ENT every few months to assess the effectiveness of treatment and discuss any new concerns.

2. Adaptations for Specific Situations:

Think ahead about how to manage hypersalivation in different contexts.

• Public Speaking/Presentations: Keep a discreet tissue or cloth handy. Practice pauses to allow for swallowing or wiping.
  • Example: If giving a presentation, have a water bottle on the podium and use sips of water as a natural way to manage saliva.
• Dining Out: Choose foods that are less likely to stimulate excessive saliva. Be prepared with tissues.
  • Example: Avoid very acidic sauces or extremely spicy dishes if these trigger your salivation.
• Travel: Pack extra supplies of bibs, tissues, barrier creams, and any necessary medications.
  • Example: When traveling by air, ensure all liquid medications and creams comply with TSA regulations.
• Social Gatherings: Focus on engaging in conversation and enjoying the company, rather than fixating on the drooling.
  • Example: Remind yourself that most people are more focused on the interaction than on minor physical details.

3. Advocating for Yourself:

Be proactive in your care and don’t hesitate to seek second opinions or ask questions.

• Educate Yourself: Learn as much as you can about your specific cause of hypersalivation.

• Communicate Clearly: Articulate your symptoms and concerns to your healthcare providers.

• Be Patient and Persistent: Finding the right combination of treatments can take time. Don’t get discouraged if the first approach isn’t completely effective.

4. Focusing on Overall Health:

A healthy lifestyle can indirectly support better management of any chronic condition.

• Balanced Diet: Support overall health and immune function.

• Regular Exercise: Can improve mood, reduce stress, and improve general well-being.

• Sufficient Sleep: Important for physical and mental restoration.

• Avoid Irritants: If you smoke or consume excessive alcohol, these can irritate the oral cavity and potentially worsen symptoms.

Empowering Yourself: Taking Control

Excessive salivation can be a challenging condition, but it is not insurmountable. By understanding its causes, implementing practical coping strategies, seeking appropriate medical and therapeutic interventions, and nurturing your emotional well-being, you can significantly reduce its impact on your life. This guide aims to empower you with the knowledge and actionable steps needed to navigate this condition with confidence and ultimately, regain control.