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<H1 id="firstHeading" class="firstHeading" lang="en">Hypersalivation</H1>			<DIV id="bodyContent" class="mw-body-content">
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<TH colspan="2" style="text-align:center;font-size:125%;font-weight:bold;background:#ccc">Hypersalivation</TH>
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<TR>
<TH colspan="2" style="text-align:center;background:#eee;;">Classification and external resources</TH>
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<TH scope="row"><A href="/wiki/Diseases_Database" title="Diseases Database">DiseasesDB</A></TH>
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<TH scope="row"><A href="/wiki/EMedicine" title="EMedicine">eMedicine</A></TH>
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<TH scope="row"><A href="/wiki/Medical_Subject_Headings" title="Medical Subject Headings">MeSH</A></TH>
<TD><A rel="nofollow" class="external text" href="//www.nlm.nih.gov/cgi/mesh/2017/MB_cgi?field=uid&term=D012798">D012798</A></TD>
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<DIV style="text-align: right; font-size:0.9em;">[<A href="https://www.wikidata.org/wiki/Q761862" class="extiw" title="d:Q761862">edit on Wikidata</A>]</DIV>
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<P><B>Hypersalivation</B> (also called <B>ptyalism</B><SUP id="cite_ref-1" class="reference"><A href="#cite_note-1">[1]</A></SUP> or <B>sialorrhea</B><SUP id="cite_ref-2" class="reference"><A href="#cite_note-2">[2]</A></SUP>) is excessive production of <A href="/wiki/Saliva" title="Saliva">saliva</A>. It has also been defined as increased amount of saliva in the mouth, which may also be caused by decreased clearance of saliva.<SUP id="cite_ref-Brownfield_3-0" class="reference"><A href="#cite_note-Brownfield-3">[3]</A></SUP></P>
<P>Hypersalivation can contribute to <A href="/wiki/Drooling" title="Drooling">drooling</A> if there is an inability to keep the mouth closed or in <A href="/wiki/Dysphagia" title="Dysphagia">difficulty in swallowing</A> the excess saliva (dysphagia) and lead to excessive <A href="/wiki/Spitting" title="Spitting">spitting</A>.</P>
<P>Hypersalivation also often precedes <A href="/wiki/Emesis" class="mw-redirect" title="Emesis">emesis</A> (vomiting), where it accompanies <A href="/wiki/Nausea" title="Nausea">nausea</A> (a feeling of needing to vomit).<SUP id="cite_ref-4" class="reference"><A href="#cite_note-4">[4]</A></SUP></P>
<P></P>
<DIV id="toc" class="toc">
<DIV class="toctitle">
<H2>Contents</H2>
<SPAN class="toctoggle"> [<A role="button" tabindex="0" class="togglelink">hide</A>] </SPAN></DIV>
<UL>
<LI class="toclevel-1 tocsection-1"><A href="#Causes"><SPAN class="tocnumber">1</SPAN> <SPAN class="toctext">Causes</SPAN></A>
<UL>
<LI class="toclevel-2 tocsection-2"><A href="#Excessive_production"><SPAN class="tocnumber">1.1</SPAN> <SPAN class="toctext">Excessive production</SPAN></A></LI>
<LI class="toclevel-2 tocsection-3"><A href="#Decreased_clearance"><SPAN class="tocnumber">1.2</SPAN> <SPAN class="toctext">Decreased clearance</SPAN></A></LI>
</UL>
</LI>
<LI class="toclevel-1 tocsection-4"><A href="#Treatment"><SPAN class="tocnumber">2</SPAN> <SPAN class="toctext">Treatment</SPAN></A></LI>
<LI class="toclevel-1 tocsection-5"><A href="#References"><SPAN class="tocnumber">3</SPAN> <SPAN class="toctext">References</SPAN></A></LI>
</UL>
</DIV>
<P></P>
<H2><SPAN class="mw-headline" id="Causes">Causes</SPAN><SPAN class="mw-editsection"><SPAN class="mw-editsection-bracket">[</SPAN><A href="/w/index.php?title=Hypersalivation&action=edit&section=1" title="Edit section: Causes">edit</A><SPAN class="mw-editsection-bracket">]</SPAN></SPAN></H2>
<H3><SPAN class="mw-headline" id="Excessive_production">Excessive production</SPAN><SPAN class="mw-editsection"><SPAN class="mw-editsection-bracket">[</SPAN><A href="/w/index.php?title=Hypersalivation&action=edit&section=2" title="Edit section: Excessive production">edit</A><SPAN class="mw-editsection-bracket">]</SPAN></SPAN></H3>
<P>Conditions that can cause saliva overproduction include:<SUP id="cite_ref-Brownfield_3-1" class="reference"><A href="#cite_note-Brownfield-3">[3]</A></SUP></P>
<UL>
<LI><A href="/wiki/Rabies" title="Rabies">Rabies</A></LI>
<LI><A href="/wiki/Pellagra" title="Pellagra">Pellagra</A> (niacin or Vitamin B3 deficiency)<SUP id="cite_ref-5" class="reference"><A href="#cite_note-5">[5]</A></SUP></LI>
<LI><A href="/wiki/Gastroesophageal_reflux_disease" title="Gastroesophageal reflux disease">Gastroesophageal reflux disease</A>, in such cases specifically called a <B>water brash</B>, and is characterized by a sour fluid or almost tasteless saliva in the mouth<SUP id="cite_ref-6" class="reference"><A href="#cite_note-6">[6]</A></SUP></LI>
<LI><A href="/wiki/Gastroparesis" title="Gastroparesis">Gastroparesis</A> (main symptoms are nausea, vomiting, and reflux)</LI>
<LI><A href="/wiki/Pregnancy" title="Pregnancy">Pregnancy</A></LI>
<LI>Excessive starch intake</LI>
<LI>Anxiety (common sign of separation anxiety in dogs)</LI>
<LI><A href="/wiki/Pancreatitis" title="Pancreatitis">Pancreatitis</A></LI>
<LI><A href="/wiki/Liver_disease" title="Liver disease">Liver disease</A></LI>
<LI><A href="/wiki/Serotonin_syndrome" title="Serotonin syndrome">Serotonin syndrome</A></LI>
<LI><A href="/wiki/Mouth_ulcers" class="mw-redirect" title="Mouth ulcers">Mouth ulcers</A><SUP class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<I><A href="/wiki/Wikipedia:Identifying_reliable_sources_(medicine)" title="Wikipedia:Identifying reliable sources (medicine)"><SPAN title="Material near this tag needs references to reliable medical sources. (February 2015)">medical citation needed</SPAN></A></I>]</SUP></LI>
<LI><A href="/wiki/Oral_infection" class="mw-redirect" title="Oral infection">Oral infections</A></LI>
</UL>
<P>Medications that can cause overproduction of saliva include:<SUP id="cite_ref-Brownfield_3-2" class="reference"><A href="#cite_note-Brownfield-3">[3]</A></SUP></P>
<UL>
<LI><A href="/wiki/Aripiprazole" title="Aripiprazole">aripiprazole</A></LI>
<LI><A href="/wiki/Clozapine" title="Clozapine">clozapine</A></LI>
<LI><A href="/wiki/Pilocarpine" title="Pilocarpine">pilocarpine</A></LI>
<LI><A href="/wiki/Ketamine" title="Ketamine">ketamine</A></LI>
<LI><A href="/wiki/Potassium_chlorate" title="Potassium chlorate">potassium chlorate</A></LI>
<LI><A href="/wiki/Risperidone" title="Risperidone">risperidone</A></LI>
<LI>rabeprazole sodium (<A href="/wiki/Aciphex" class="mw-redirect" title="Aciphex">Aciphex</A>)</LI>
</UL>
<P>Toxins that can cause hypersalivation include:<SUP id="cite_ref-Brownfield_3-3" class="reference"><A href="#cite_note-Brownfield-3">[3]</A></SUP></P>
<UL>
<LI><A href="/wiki/Mercury_(element)" title="Mercury (element)">mercury</A></LI>
<LI><A href="/wiki/Copper" title="Copper">copper</A></LI>
<LI><A href="/wiki/Organophosphates" class="mw-redirect" title="Organophosphates">organophosphates</A> (<A href="/wiki/Insecticide" title="Insecticide">insecticide</A>)</LI>
<LI><A href="/wiki/Arsenic" title="Arsenic">arsenic</A></LI>
</UL>
<H3><SPAN class="mw-headline" id="Decreased_clearance">Decreased clearance</SPAN><SPAN class="mw-editsection"><SPAN class="mw-editsection-bracket">[</SPAN><A href="/w/index.php?title=Hypersalivation&action=edit&section=3" title="Edit section: Decreased clearance">edit</A><SPAN class="mw-editsection-bracket">]</SPAN></SPAN></H3>
<P>Causes of decreased clearance of saliva include:<SUP id="cite_ref-Brownfield_3-4" class="reference"><A href="#cite_note-Brownfield-3">[3]</A></SUP></P>
<UL>
<LI>Infections such as <A href="/wiki/Tonsillitis" title="Tonsillitis">tonsillitis</A>, <A href="/wiki/Retropharyngeal_abscess" title="Retropharyngeal abscess">retropharyngeal</A> and <A href="/wiki/Peritonsillar_abscess" title="Peritonsillar abscess">peritonsillar abscesses</A>, <A href="/wiki/Epiglottitis" title="Epiglottitis">epiglottitis</A> and <A href="/wiki/Mumps" title="Mumps">mumps</A>.</LI>
<LI>Problems with the jaw, e.g., fracture or dislocation</LI>
<LI>Radiation therapy</LI>
<LI>Neurologic disorders such as <A href="/wiki/Myasthenia_gravis" title="Myasthenia gravis">myasthenia gravis</A>, <A href="/wiki/Parkinson%27s_disease" title="Parkinson's disease">Parkinson's disease</A>, <A href="/wiki/Multiple_system_atrophy" title="Multiple system atrophy">multiple system atrophy</A>, <A href="/wiki/Rabies" title="Rabies">rabies</A>, bulbar paralysis, bilateral <A href="/wiki/Facial_nerve_palsy" class="mw-redirect" title="Facial nerve palsy">facial nerve palsy</A>, and hypoglossal nerve palsy</LI>
</UL>
<H2><SPAN class="mw-headline" id="Treatment">Treatment</SPAN><SPAN class="mw-editsection"><SPAN class="mw-editsection-bracket">[</SPAN><A href="/w/index.php?title=Hypersalivation&action=edit&section=4" title="Edit section: Treatment">edit</A><SPAN class="mw-editsection-bracket">]</SPAN></SPAN></H2>
<P>Hypersalivation is optimally treated by treating or avoiding the underlying cause.<SUP id="cite_ref-Brownfield_3-5" class="reference"><A href="#cite_note-Brownfield-3">[3]</A></SUP> Mouthwash and tooth brushing may have drying effects.<SUP id="cite_ref-Brownfield_3-6" class="reference"><A href="#cite_note-Brownfield-3">[3]</A></SUP></P>
<P>In the palliative care setting, <A href="/wiki/Anticholinergics" class="mw-redirect" title="Anticholinergics">anticholinergics</A> and similar drugs that would normally reduce the production of saliva causing a dry mouth could be considered for symptom management: <A href="/wiki/Scopolamine" class="mw-redirect" title="Scopolamine">scopolamine</A>, <A href="/wiki/Atropine" title="Atropine">atropine</A>, <A href="/wiki/Propantheline" class="mw-redirect" title="Propantheline">propantheline</A>, <A href="/wiki/Hyoscine" title="Hyoscine">hyoscine</A>, <A href="/wiki/Amitriptyline" title="Amitriptyline">amitriptyline</A>, <A href="/wiki/Glycopyrrolate" class="mw-redirect" title="Glycopyrrolate">glycopyrrolate</A>.<SUP id="cite_ref-7" class="reference"><A href="#cite_note-7">[7]</A></SUP></P>
<P>A 2008 <A href="/wiki/Systematic_review" title="Systematic review">systematic review</A> investigated the efficacy of pharmacological interventions for patients who have too much salvia due to clozapine treatment:</P>
<TABLE class="wikitable">
<CAPTION>Astemizole compared to control<SUP id="cite_ref-Sye2008_8-0" class="reference"><A href="#cite_note-Sye2008-8">[8]</A></SUP></CAPTION>
<TBODY><TR>
<TH>Summary</TH>
</TR>
<TR>
<TD>There is no well-tested treatment for this difficult problem and no data to confidently inform clinical practice.<SUP id="cite_ref-Sye2008_8-1" class="reference"><A href="#cite_note-Sye2008-8">[8]</A></SUP></TD>
</TR>
<TR>
<TD style="padding:0;">
<TABLE class="wikitable collapsible collapsed" style="width:100%;" id="collapsibleTable0">
<TBODY><TR>
<TH scope="col" style="text-align: left;"><SPAN class="collapseButton">[<A id="collapseButton0" href="#">show</A>]</SPAN>Outcome</TH>
<TH scope="col" style="text-align: left;">Findings in words</TH>
<TH scope="col" style="text-align: left;">Findings in numbers</TH>
<TH scope="col" style="text-align: left;">Quality of evidence</TH>
</TR>
<TR style="display: none;">
<TH colspan="4" style="text-align: left;">Hypersalivation</TH>
</TR>
<TR style="display: none;">
<TD>No effect / not cured / not markedly improved<BR />
Control: propantheline</TD>
<TD>Astemizole probably is probably worse than propantheline - increasing the risk of having 'no effect'. Data are based on moderate quality evidence.</TD>
<TD><A href="/wiki/Relative_risk" title="Relative risk">RR</A> 2.46 (1.63 to 3.72)</TD>
<TD><A href="/wiki/The_Grading_of_Recommendations_Assessment,_Development_and_Evaluation_(GRADE)_approach" title="The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach">Moderate</A></TD>
</TR>
<TR style="display: none;">
<TD>Change in hypersalivation scores (high = good)<BR />
Control: propantheline</TD>
<TD>On average, people receiving astemizole scored a little lower than people treated with control for clozapine-induced hypersalivation. There was a clear difference between the groups, but, at present the meaning of this in day-to-day care is unclear.</TD>
<TD><A href="/wiki/Mean_absolute_difference" title="Mean absolute difference">MD</A> 0.64 lower (1.14 lower to 0.14 lower)</TD>
<TD><A href="/wiki/The_Grading_of_Recommendations_Assessment,_Development_and_Evaluation_(GRADE)_approach" title="The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach">Low</A></TD>
</TR>
<TR style="display: none;">
<TH colspan="4" style="text-align: left;"><A href="/wiki/Adverse_event" title="Adverse event">Adverse effects</A></TH>
</TR>
<TR style="display: none;">
<TD>Tachycardia<BR />
Control: doxepin</TD>
<TD>Astemizole may increase the risk of experiencing fast heart rate, but, at present it is not possible to be confident about the difference between the two treatments because data supporting this finding are very limited.</TD>
<TD>RR 5.00 (0.25 to 99.16)</TD>
<TD><A href="/wiki/The_Grading_of_Recommendations_Assessment,_Development_and_Evaluation_(GRADE)_approach" title="The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach">Very low</A></TD>
</TR>
<TR style="display: none;">
<TD>Constipation<BR />
Control: propantheline</TD>
<TD>Astemizole may reduce constipation but there is no clear difference between people given astemizole and those receiving propanthelinecontrol for clozapine-induced hypersalivation. These findings are based on data of low quality.</TD>
<TD>RR 0.60 (0.26 to 1.39)</TD>
<TD><A href="/wiki/The_Grading_of_Recommendations_Assessment,_Development_and_Evaluation_(GRADE)_approach" title="The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach">Low</A></TD>
</TR>
<TR style="display: none;">
<TH colspan="4" style="text-align: left;">Missing outcomes</TH>
</TR>
<TR style="display: none;">
<TD></TD>
<TD>No study reported any data on outcomes such as mental state, quality of life and information relating to time in services</TD>
<TD></TD>
<TD></TD>
</TR>
</TBODY></TABLE>
</TD>
</TR>
</TBODY></TABLE>
<H2><SPAN class="mw-headline" id="References">References</SPAN><SPAN class="mw-editsection"><SPAN class="mw-editsection-bracket">[</SPAN><A href="/w/index.php?title=Hypersalivation&action=edit&section=5" title="Edit section: References">edit</A><SPAN class="mw-editsection-bracket">]</SPAN></SPAN></H2>
<DIV class="reflist" style="list-style-type: decimal;">
<DIV class="mw-references-wrap">
<OL class="references">
<LI id="cite_note-1"><SPAN class="mw-cite-backlink"><B><A href="#cite_ref-1"><SPAN class="cite-accessibility-label">Jump up </SPAN>^</A></B></SPAN> <SPAN class="reference-text"><A rel="nofollow" class="external text" href="http://medical-dictionary.thefreedictionary.com/ptyalism">thefreedictionary.com > ptyalism</A> Citing:</SPAN>
<UL>
<LI><SPAN class="reference-text">Dorland's Medical Dictionary for Health Consumers. 2007</SPAN></LI>
<LI><SPAN class="reference-text">Mosby's Medical Dictionary, 8th edition. 2009</SPAN></LI>
<LI><SPAN class="reference-text">Saunders Comprehensive Veterinary Dictionary, 3 ed. 2007</SPAN></LI>
</UL>
</LI>
<LI id="cite_note-2"><SPAN class="mw-cite-backlink"><B><A href="#cite_ref-2"><SPAN class="cite-accessibility-label">Jump up </SPAN>^</A></B></SPAN> <SPAN class="reference-text"><A rel="nofollow" class="external text" href="http://www.thefreedictionary.com/sialorrhea">thefreedictionary.com > sialorrhea</A> Citing:</SPAN>
<UL>
<LI><SPAN class="reference-text">The American Heritage Dictionary of the English Language, Fourth Edition, Updated in 2009.</SPAN></LI>
</UL>
</LI>
<LI id="cite_note-Brownfield-3"><SPAN class="mw-cite-backlink">^ <A href="#cite_ref-Brownfield_3-0"><SPAN class="cite-accessibility-label">Jump up to: </SPAN><SUP><I><B>a</B></I></SUP></A> <A href="#cite_ref-Brownfield_3-1"><SUP><I><B>b</B></I></SUP></A> <A href="#cite_ref-Brownfield_3-2"><SUP><I><B>c</B></I></SUP></A> <A href="#cite_ref-Brownfield_3-3"><SUP><I><B>d</B></I></SUP></A> <A href="#cite_ref-Brownfield_3-4"><SUP><I><B>e</B></I></SUP></A> <A href="#cite_ref-Brownfield_3-5"><SUP><I><B>f</B></I></SUP></A> <A href="#cite_ref-Brownfield_3-6"><SUP><I><B>g</B></I></SUP></A></SPAN> <SPAN class="reference-text"><A rel="nofollow" class="external text" href="http://www.medscape.com/viewarticle/477613">Medscape > Hypersalivation</A> By Erica Brownfield. Posted: 05/19/2004</SPAN></LI>
<LI id="cite_note-4"><SPAN class="mw-cite-backlink"><B><A href="#cite_ref-4"><SPAN class="cite-accessibility-label">Jump up </SPAN>^</A></B></SPAN> <SPAN class="reference-text"><CITE class="citation book">Clark], [edited by Parveen Kumar, Michael (2005). <I>Kumar & Clark clinical medicine</I> (6th ed.). Edinburgh: Elsevier Saunders. p. 266. <A href="/wiki/International_Standard_Book_Number" title="International Standard Book Number">ISBN</A> <A href="/wiki/Special:BookSources/0702027634" title="Special:BookSources/0702027634">0702027634</A>.</CITE><SPAN title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Kumar+%26+Clark+clinical+medicine&rft.place=Edinburgh&rft.pages=266&rft.edition=6th&rft.pub=Elsevier+Saunders&rft.date=2005&rft.isbn=0702027634&rft.aulast=Clark%5D&rft.aufirst=%5Bedited+by+Parveen+Kumar%2C+Michael&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHypersalivation" class="Z3988"><SPAN style="display:none;"> </SPAN></SPAN><SPAN class="citation-comment" style="display:none; color:#33aa33; margin-left:0.3em">CS1 maint: Extra text: authors list (<A href="/wiki/Category:CS1_maint:_Extra_text:_authors_list" title="Category:CS1 maint: Extra text: authors list">link</A>)</SPAN></SPAN></LI>
<LI id="cite_note-5"><SPAN class="mw-cite-backlink"><B><A href="#cite_ref-5"><SPAN class="cite-accessibility-label">Jump up </SPAN>^</A></B></SPAN> <SPAN class="reference-text"><A rel="nofollow" class="external autonumber" href="https://www.nytimes.com/health/guides/nutrition/niacin/print.html">[1]</A></SPAN></LI>
<LI id="cite_note-6"><SPAN class="mw-cite-backlink"><B><A href="#cite_ref-6"><SPAN class="cite-accessibility-label">Jump up </SPAN>^</A></B></SPAN> <SPAN class="reference-text"><A rel="nofollow" class="external text" href="http://medical-dictionary.thefreedictionary.com/water+brash">thefreedictionary.com > water brash</A> Citing: Dorland's Medical Dictionary for Health Consumers. 2007</SPAN></LI>
<LI id="cite_note-7"><SPAN class="mw-cite-backlink"><B><A href="#cite_ref-7"><SPAN class="cite-accessibility-label">Jump up </SPAN>^</A></B></SPAN> <SPAN class="reference-text">Medical Care of the Dying, 4th Edition, 2006, Edited by G.Michael Downing MD and Wendy Wainwright, MEd</SPAN></LI>
<LI id="cite_note-Sye2008-8"><SPAN class="mw-cite-backlink">^ <A href="#cite_ref-Sye2008_8-0"><SPAN class="cite-accessibility-label">Jump up to: </SPAN><SUP><I><B>a</B></I></SUP></A> <A href="#cite_ref-Sye2008_8-1"><SUP><I><B>b</B></I></SUP></A></SPAN> <SPAN class="reference-text"><CITE class="citation journal">Syed, R; Cahill, C; Duggan, L (2008). <A rel="nofollow" class="external text" href="http://www.cochrane.org/CD005579/SCHIZ_interventions-for-people-with-schizophrenia-who-have-too-much-saliva-due-to-clozapine-treatment">"Pharmacological interventions for clozapine-induced hypersalivation"</A>. <I>Cochrane Database of Systematic Reviews</I>. <B>3</B>: CD005579.pub2. <A href="/wiki/Digital_object_identifier" title="Digital object identifier">doi</A>:<A rel="nofollow" class="external text" href="//doi.org/10.1002%2F14651858.CD005579.pub2">10.1002/14651858.CD005579.pub2</A>.</CITE><SPAN title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Cochrane+Database+of+Systematic+Reviews&rft.atitle=Pharmacological+interventions+for+clozapine-induced+hypersalivation&rft.volume=3&rft.pages=CD005579.pub2&rft.date=2008&rft_id=info%3Adoi%2F10.1002%2F14651858.CD005579.pub2&rft.aulast=Syed&rft.aufirst=R&rft.au=Cahill%2C+C&rft.au=Duggan%2C+L&rft_id=http%3A%2F%2Fwww.cochrane.org%2FCD005579%2FSCHIZ_interventions-for-people-with-schizophrenia-who-have-too-much-saliva-due-to-clozapine-treatment&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHypersalivation" class="Z3988"><SPAN style="display:none;"> </SPAN></SPAN></SPAN></LI>
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question_text: what does it mean when u have a lot of saliva