Robert Shmerling, M.D., is associate physician and clinical chief of rheumatology at Beth Israel Deaconess Medical Center and an associate professor in medicine at Harvard Medical School. He is an active teacher in the Internal Medicine Residency Program, serving as the Robinson Firm Chief. He is also a teacher in the Rheumatology Fellowship Program and has been a practicing rheumatologist for over 25 years.

Question:

Can I control excessive salivation (sialorrhea) with medication or treatment?

Answer:

Sialorrhea can be difficult to treat. The choice of treatment often depends on the cause. There are many different causes, including:

• Neurological disease, such as cerebral palsy, Parkinson's disease or stroke

• Oral inflammation, including teething (in infants) or oral infection

• Toxin exposure, such as inhaled mercury, nerve agents or certain pesticides

• Medication side effects, such as certain anti-seizure or anti-psychosis medicines (especially clozapine)

• Anatomical abnormalities, such as tongue enlargement, orthodontic problems, surgical deformity or a complication of radiation therapy

For mild cases, no treatment may be needed. For cases that require treatment, a number of options are available, including:

• Stopping or changing medicines that may be contributing to the excessive salivation

• Dental or orthodontic care to treat inflammation, infection or to provide braces or other appliances

• Removing the tonsils (if they are repeatedly infected or clearly enlarged)

• Glycopyrrolate or a scopolamine patch — These medicines inhibit a chemical messenger that stimulates salivation. Side effects, such as constipation and blurred vision, are common and often limit the use of these drugs. Also, these drugs may make certain conditions worse, such as glaucoma.

• Acupuncture (although success has been reported only in limited studies)

• Botulinum toxin (such as Botox) — Recent studies suggest that injecting Botulinum toxin into the main salivary glands can reduce excessive salivation for many months.

• Radiation therapy — Ten or more years after radiation, the risk of cancer is increased. So, radiation treatment for sialorrhea is usually reserved for elderly people.

• Surgery to interrupt the nerve supply to the salivary glands, re-route the saliva, block the salivary ducts, or remove the salivary gland. Some combination of these options may be effective.

One risk that goes along with all of these treatments is reduced salivation and dry mouth.

Treating sialorrhea may require the help of several types of healthcare providers, including:

• Speech and swallowing therapists

• Dentists or orthodontists

• Otolaryngologists (ear, nose and throat doctors)

• Neurologists

Talk to your doctor about your symptoms and the treatments you've tried before. Considering the variety of options, I would be optimistic that one or more of them can provide you with at least some measure of relief.