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Excessive Salivation (Sialorrhea) in the Elderly

Although the elderly more commonly complain of dryness of the mouth, often associated with side effects of certain drugs and chronic conditions, there may at times be an excess of saliva. Profuse salivation is known as sialorrhea. It occurs when the production of saliva is greater than the clearance of this saliva from the mouth, usually by swallowing.

The condition can lead to drooling of the saliva if the person is unable to swallow the excess saliva produced. This can be a major problem for the elderly who may have difficulty keeping their lips pursed and having swallowing problems. The secretion of the salivary glands is controlled by parasympathetic nervous system and therefore stimulation of parasympathetic nervous systems leads to increase salivation. This is often seen with the use of certain drugs, and certain neurological conditions.

Sialorrhea Symptoms in Seniors

The main symptom of sialorrhea is drooling, which may not pose a problem but is rather an embarrassment. It can lead to cracking of the lips and irritation of the skin around the lips. The skin may become infected if left untreated. Some patients may actually choke on the excess saliva which can lead to coughing. Depending on the quantity of saliva, it can also pose a problem when talking.

In the elderly with impaired gagging and swallowing reflexes, the saliva may drip into the chest and cause airway and lung irritation. These are severe complications mainly seen in the elderly. Drooling may be worse during sleep, and some patients may choke while asleep due to the excess saliva production.

What causes excess salivation?

Sialorrhea can be induced by certain types of drugs. These drugs are called as sialogogues and is at times prescribed to increase in the production of saliva can be due various side effects of these drugs. The drugs act on the parasympathetic nervous system which is the part of the nervous system that increases salivation. Few of the drugs can causes sialorrhea by direct stimulation of the brain and irritation caused in oropharyngeal region. Some of these medications include pilocarpine, potassium chlorate, risperidone, ketamine and clozapine.

A tonsillar abscess and infectious mono (infectious mononucleosis or glandular fever) are also some of the few causes leading to drooling of the saliva. At times salivation can be the only symptom until the other symptoms become prominent. The local factors causing sialorrhea include different varieties of stomatitis, acute necrotizing ulcerative gingivitis and erythema multiforme. Seniors wearing dentures (denture stomatitis) and those unable to practice good dental hygiene on their own can be at risk.

Systemic diseases involved in excess secretion of saliva include paralysis, Parkinson’s disease, epilepsy and alcoholic neuritis. The condition is also common in neuromuscular disorders or followed by a head trauma or stroke. Metallic poisons that can induce increase salivation include mercury, copper and arsenic. Organophosphorous poisoning can also lead to sialorrhea.

Treatment

Specific treatment for sialorrhea is not always necessary unless the patient is drooling excessively or choking on their saliva. Patients should be encouraged to swallow more often in order to clear the saliva from the mouth. Local factors enhancing increase salivation such as dental problems  should be corrected accordingly.

The drugs used to treat sialorrhea include anti-cholinergic drugs such as atropine sulfate. These drugs act on the parasympathetic nervous system and control the secretion of saliva. The medication is contraindicated in patient with asthma and glaucoma. Glycopyrrolate and botulinum toxin A can also be used. Surgery is considered in patients with a cognitive delay and profuse drooling.


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