DROOLING

SPEECH THERAPY DEPARTMENT

NIRM

Drooling Drooling is the unintentional loss of

saliva from the mouth.

DROOLING

It is normal for babies to drool. As babies grow and mature, they are better

able to manage their saliva. Most children don't drool when awake or

asleep after the age of 4 years. Children with neurological problems have

difficulty making their muscles and nerves work properly. They have trouble swallowing saliva. Drooling is frequently seen in these children at older ages.

ALTERNATIVE NAMES

SalivationPtylasimSialorrhea,

SALIVA Saliva is almost all water. There are small

amounts of other substances, such as electrolytes (salts) and mucous which help the mouth and body in the process of eating.

Seventy percent of the 1.5 liters of saliva produced daily is from the submandibular gland; twenty-five percent is from the parotid glands and five percent is from the sublingual glands. 

SALIVA IS PRODUCED BY Saliva comes from three

pairs of salivary glands, plus many smaller glands. All of these are found in the mouth.

Two parotid glands are inside the cheek area.

The pair of sublingual glands are under the tongue.

The two submandibular glands are close to the lower jaw.

Benefits of saliva

Protect the throat and esophagus from injury during eating.

Saliva also helps recoat the teeth with calcium.

It helps keep gums healthy. It helps remove bacteria from inside the

mouth decreases breath odor. Saliva contains amylase, an enzyme that

begins the digestion of starches.

Functions of saliva

Functions of saliva Protective Swallowing Digestion Speaking

ASSESSMENT

CauseSeverityContributing factors

CAUSES Impaired oral musculature Lack of sensory awareness Lack of motor activity Improper, inefficient, or infrequent

swallowing. It is unusual for drooling to be caused

from making too much saliva.

Pathophysiology of Drooling

Primarily a defect in the oral phase of swallowing caused by: poor head control, inability to close the mouth, abnormal tongue mobility, reduced intra-oral sensation Sialorrhea can lead to drooling caused by: medications and poor fitting dentures

ASSOCIATED DISORDERS

Cerebral PalsyParkinson’s DiseaseMultiple SclerosisStroke

COMPLICATIONS

Causes functional, social, psychological, and clinical burdens on patients, their families, and caregivers.

Patients who drool often experience repeated perioral skin breakdown and infections.

Clothing and bibs become soiled and need frequent changing, which can become very laborious and limit the family's ability to be active and out of the home.

COMPLICATIONS

Teaching materials and communicative devices may become wet and damaged, impairing educational efforts.

In severe cases of drooling, dehydration may even become a problem.

Social embarrassment may make it difficult for patients who drool to interact with their peers and can lead to isolation.

SEVERITY SCALE OF DROOLING

Dry - Never drools Mild - Only lips wet Moderate - Lips and chin wet Severe - Clothing soiled Profuse - Clothing, hands, and tray

moist and wet

TREATMENT

The problem of excessive drooling can be treated in several ways:

Speech therapy Medication Surgery

SPEECH THERAPY Eating & Drinking Skills learn to close the lips, move the saliva to the back

of the mouth, and swallow. Learning to use a straw for fluids can improve

drooling. Positioning Oral Facial facilitation

Icing Brushing Vibration Manipulation Oral motor Sensory exercises

MEDICATION The salivary glands are under the control of

a part of the nervous system called the autonomic system. The medicines listed below cause the body to make less saliva by inhibiting the part of the autonomic system known as the parasympathetic system. This part of the nervous system also helps regulate urine output and stomach emptying. Robinul Artane CogentinSal-Tropine

MEDICATION

Anticholinergic - Robinul side effects - restlessness, sedation, constipation, urinary retention, blurred

vision, xerostomia Antihistamine Antireflux

SURGICAL INTERVENTION Surgery involves either changing the direction

of the ducts which lead from the salivary glands to the mouth, or removing the salivary gland tissue.

Laser surgery has recently been used. This treatment allows a quicker recovery than regular surgery. Botulinum Toxin injections are done under

anesthesia. The toxin is injected into the parotid gland. This treatment lasts up to 8 months.

Radiotherapy, or use of x-rays, to destroy part of the salivary glands is only used in severe cases and not usually used in children.

Surgical options

Submandibular duct rerouting Submandibular duct excision Parotid duct ligation Transtympanic neurectomy

Alternative Therapies

Biofeedback and hypnotherapy have been used in some patients with varying amounts of success.

Bibs Don't forget that bibs are helpful to protect

skin and clothing. The use of bandannas, or a bib that matches the shirt or dress, especially in older children, can make the bib less noticeable or add a fashion accent.

CONCLUSION

Noninvasive modalities should be attempted first

A trial of medication is warranted if noninvasive methods fail

Surgery is a final option for those patients with severe drooling problems not adequately addressed by noninvasive means or medication • •