The Management of Drooling in Children and Patients With Mental and Physical Disabilities: A Literature Review

Abstract

Amongst the duties of the paediatric dentist is the provision of oral care to patients with the problem of drooling. Many, but certainly not all, of these patients have physical and/or learning disabilities. Various methods have been advocated for the management of drooling in the paediatric patient and older patients with disabilities, including behavioural programmes, biofeedback techniques, physiotherapy, biofunctional oral appliances, medication and surgery. It is of paramount importance that the patients and/or carers understand the advantages and disadvantages of any treatment method being considered. The paediatric dentist has an important role to play in explaining the different options to the patients and carers, and in implementing some treatment modalities, particularly non-surgical approaches. Referral to surgical specialists should be seen as 'a last resort' and suggested only if other treatment methods have been exhausted. If pharmacological or surgical treatment is carried out, careful monitoring for the development of dental caries and other problems is essential. The aim of this paper is to provide the paediatric dentist with concise overall knowledge of the causes of drooling and treatment options available.

Botulinum toxin A: a new option for treatment of drooling in children with cerebral palsy. Presentation of a case series

“…The treatment of drooling has been extensively described in the literature. The methods available for the management of drooling comprise both surgical and nonsurgical options [1,2,4,6,12,13,15]. Surgical options in the treatment of drooling are denervation of the salivary glands by transtympanic neurectomy, rerouting or ligation of the salivary duct of either the submandibular or parotid gland, and excision of one or more salivary glands [1,7,9,11,12,16].…”

“…Anticholinergic drugs can be used to decrease saliva secretion. Unfortunately, due to the systemic application of the drugs, a wide range of side-eects are known [2,4,6,13,15]. No treatment option is universally successful and each method has potential complications [4].…”

Advances in the diagnosis and management of chronic pulmonary aspiration in children

“…These organisms can cause recurrent pneumonia or pulmonary abscess if aspirated in sufficient quantity [23]. Most neurologically impaired children who aspirate their saliva do so because of severe swallowing incoordination and absent laryngeal sensation rather than excess production of saliva [24]. In children who continue to have symptoms of aspiration despite cessation of oral feeding and treatment or diagnostic exclusion of GOR, an evaluation for salivary aspiration is warranted.…”

The Experience of Treating Drooling with Repeated Botulinum Toxin Injections

“…At rest, the submandibular and sublingual glands produce 70% of saliva. Stimulated salivary flow increases up to fivefold when the parotid glands produce most of the saliva [5]. …”