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SALIVARY GLANDS - SIALORRHEA DEC. 1997 Sialorrhea is defined as a persistent or episodic increase in salivary flow that is usually managed by an increased swallowing rate. It differs from drooling. Patients who drool produce a normal salivary volume but because of some neuromuscular dysfunction (cerebral palsy, Parkinson's, mental retardation), their saliva is not controlled effectively. Saliva accumulates in the anterior mouth floor and drools out. These are multiple known causes of hypersalivation. Nevertheless, the Salivary Gland Center (SGC) has noted that the problem is most often perceptual (somatoform) in origin. An emotional disturbance manifests itself via a perceived physical complaint, which frequently is initiated by an oral event (dental care) that focuses attention on the mouth. Calibration of salivary volume and chemistry in these patients by the SGC demonstrates no abnormalities. Many medications can cause sialorrhea and include psychotherapeutic agents (clozapine, lithium), pilocarpine (myasthenia gravis therapy), isoproterenol (asthma therapy) and antihypertensives (reserpine). Chemical agents such as insecticides can inhibit cholinesterase and lead to salivation. Local irritating factors (teething, dentures, smoking) also serve as salivary stimulants.
Episodic hypersalivation occurs with gastroesophageal reflux (GER). Gastric irritants enter the esophagus and lead to erosions and premalignant disease (Barrett's). Clearance of the irritants is facilitated through the esophagosalivary reflex mediated by vagal afferents. A salivary hypersecretion, with its bicarbonate buffering system, results. Pregnant patients and those with a hiatus hernia are particularly susceptible to GER disease. Some seizure (benign childhood epilepsy) and bipolar affective disorders are also reported to cause episodic sialorrhea. Treatment is aimed at the causative process but options include anticholinergic agents (transdermal scopalamine) and antidepressants (amitryptiline). Omeprazole to inhibit gastric secretions is prescribed for the GER patient. When conservative methods fail and drooling is a concern, surgery (duct transposition, tympanic neurectomy) can be performed. The Salivary Gland Center (SGC) was developed because a void existed in the diagnostic and comprehensive care of patients with salivary gland problems and/or secretory dysfunction. Since the diversity of these salivary conditions presents challenges to the clinician, the SGC is available for referrals. Louis Mandel, DDS Director, Salivary Gland Center (212) 305-9982
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SGC has examined many patients with asymptomatic bilateral enlargement
of the parotid glands (sialadenosis). This condition is usually
associated with alcoholism, diabetes, or malnutritional syndromes.
Hypertrophy of individual secretory cells with increased salivation
results from the autonomic neuropathy which is the common denominator
uniting these disparate pathologic entities. The bilateral parotid
enlargement associated with HIV disease can also demonstrate hypersalivation.
The swollen HIV gland reflects the presence of lymphoepithelial
cysts and/or a CD8 lymphocyte infiltration.