Clinical-therapeutic management of drooling: Review and update

Abstract

Drooling is the uncontrolled leakage of saliva outside the mouth, generally as a result of difficulty in swallowing the saliva produced. Many factors contribute to drooling, though it is more commonly seen in children with brain paralysis -particularly those receiving anticonvulsivant medication. Drooling is also often seen in patients with lip sealing problems or malocclusions such as anterior open bite. Clinically, the affected patients can develop skin irritation or abrasions, problems of hygiene, unpleasant smell and -in the more severe presentations -the need to wear protectors or frequently change clothing. Treatment of this disorder is complex, and should be addressed from a multidisciplinary perspective, with planning on an individualized basis. Among the different existing managements, myofunctional therapy, behavioral change programs and drug treatments are the most widely used options, though there are also more invasive surgical techniques designed to reduce or cause submandibular saliva secretion to be rerouted towards posterior zones of the oral cavity. In any case, no scientific evidence-based management protocol has yet been established capable of affording favorable results in the majority of cases. The present study offers a review and update on the clinical and dental management aspects of drooling.

Challenges in managing drooling in children

“…As drooling is a multifactorial problem, it requires careful assessment by the multidisciplinary team, focusing on medical history and possible aetiology 1,5,7,13. The neurological examination should focus on the facial and hypoglossal nerves, posture, tone and motor skills 5…”

“…with Candida albicans ) 7,9,10. Drooling can also impact on speech and eating skills, and cause dehydration 5,10,11. Associated physical, psychological and practical factors (e.g.…”

A Review of Options for Treating Sialorrhea in Amyotrophic Lateral Sclerosis

“…In addition, loss of motor neurons in the spinal cord causes muscular weakness and atrophy, leading in turn to progressive respiratory dysfunction, labored communication, and decreased voluntary as well as reflexive coughing. [5][6][7][8] In ALS, sialorrhea is caused mostly by a decreased ability to swallow secretions (not by increased saliva production) due to tongue spasticity, orofacial and palatinolingual muscle control failure, facial weakness, and inability to maintain oral and buccal competence. 9,10 The progressive weakness of facial muscles and difficulty in swallowing saliva leads to drooling.…”

“…8,[18][19][20][21] Drooling also causes dermatologic problems, such as facial irritation and skin excoriation. 5 Although pulmonary aspiration syndromes are often misdiagnosed in patients with ALS, they are associated with a high mortality. 8 In a cohort of 40 consecutive patients with ALS, Sorenson et al 18 observed the occurrence of aspiration pneumonia in 5 cases (13%).…”

A bandagem elástica como recurso terapêutico para o controle da sialorreia: análise de sua eficácia

“…Desta forma, é possível que o paciente melhore alguns componentes da deglutição de forma consciente. A técnica pode ter um impacto positivo no treinamento do paciente e na melhoria da função oromotora 14 . Ao indicar um tratamento para o controle da sialorreia em crianças com PC, é necessário considerar a oportunidade de acesso dos pacientes ao método proposto, tendo em vista as condições financeiras, sociais e culturais de cada família.…”