Hypersalivation: Causes, Diagnosis, and Treatment for Excess Saliva
This article provides details about what causes hypersalivation and the symptoms it can produce. It also discusses treatment options to decrease and manage excess saliva.
Hypersalivation, also known as sialorrhea or drooling, occurs when your salivary glands produce too much saliva, or you have difficulty clearing the saliva your glands produce. It can also be a combination of the two.
Your salivary glands typically produce 1–3 pints of saliva every day, and you swallow most of it. Saliva plays an important role in helping:
- digest food
- keep the mouth from drying out
- clear germs and bacteria
A range of conditions can cause hypersalivation. Some are temporary, while others are chronic conditions.
There are several possible causes of excess saliva.
Research from 2015 lists several drugs that have a link to producing excess saliva or causing drooling, including:
- antipsychotic medications, such as haloperidol and fluphenazine
- sedative medications, such as benzodiazepines and antiseizure drugs
- medications that irritate the esophagus, such as doxycycline and tetracycline
Exposure to certain toxins can also cause hypersalivation, including mercury and arsenic.
Hypersalivation is a common symptom of neurological conditions that make it difficult for a person to swallow or control the movement of their mouth.
Neurological conditions that can cause excess saliva include:
Teething and dental conditions
In infants, drooling can be a sign of teeth starting to emerge. The American Academy of Pediatrics explains that teething can begin around ages 3–6 months.
In adults, dental conditions such as cavities or a mouth infection can cause hypersalivation.
A blockage in the nasal passages can cause you to breathe through your mouth. This can result in excess saliva and drooling, particularly during sleep. You may notice dampness on your pillow when you wake up.
An anaphylactic reaction can cause swelling in the throat, making swallowing difficult. This can cause excess saliva to collect in the child’s mouth, leading to drooling.
The American Academy of Allergy, Asthma & Immunology lists other symptoms of anaphylaxis, which may include:
- getting hives or a rash
- swelling in the face, lips, and mouth
- breathing difficulty
- feeling chest tightness
- having a hoarse voice
The epiglottis is a small flap of tissue that covers the top of your windpipe when you swallow. When this tissue becomes inflamed, it is a condition called epiglottitis.
This inflammation can result from an infection or occur due to noninfectious causes, such as swallowing a foreign object.
Symptoms of epiglottitis include what doctors call the “3 Ds”:
Epiglottitis is an urgent medical situation. Often, a doctor will need to give the person a breathing tube. Once the doctor secures the airway, they will give the person antibiotics if the inflammation is due to a bacterial infection.
During pregnancy, some people may develop a condition called ptyalism gravidarum that causes hypersalivation. According to research from 2018, this condition can cause production of up to 8 cups of saliva per day.
It is unclear why hypersalivation can occur during pregnancy, but it does not pose any health risks to the birthing parent or fetus.
Can hypersalivation be a symptom of gastroesophageal reflux (GERD)?
Hypersalivation can be considered an atypical symptom of GERD. When acidic reflux is present, the body may produce more saliva in an attempt to neutralize the acidity.
Nicole Aaronson, M.D., MBA, CPE, FACS, FAAP Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.
The main symptoms of hypersalivation are excess saliva and drooling due to a difficulty swallowing the saliva that you produce or the presence of too much saliva.
Other symptoms that can develop due to hypersalivation include:
- chapped skin around the mouth
- macerated skin, which is skin that breaks down
- unpleasant odor
- aspiration or choking, when saliva enters the lungs
The diagnosis of hypersalivation may depend on the potential cause.
If you have a diagnosis of an underlying neurological condition, such as ALS or Parkinson’s disease, your doctor will assess the extent of your hypersalivation. This includes evaluating the frequency and severity of excess saliva and drooling.
If your hypersalivation may be due to another cause, your doctor may ask you about factors such as known allergies, whether you may be pregnant, or what medicines you take. Because certain drugs can cause excess saliva, your doctor may recommend stopping or changing some of your current medications.
Hypersalivation can be a difficult symptom to treat and manage. The treatment can also vary, depending on the cause of excess saliva.
If you have a temporary condition causing excess saliva, such as an oral infection or an allergic reaction, treating that condition will likely resolve hypersalivation.
For chronic hypersalivation due to a chronic condition, treatment focuses on managing the symptom and improving quality of life.
In people with neurological conditions, treatment often focuses on physical therapy to improve muscle control and swallowing.
Medical treatments for chronic hypersalivation can include:
- Anticholinergic medications: This type of medication blocks activity in the salivary glands. However, they can cause mental side effects. Talk with your doctor about the benefits and risks of anticholinergic drugs.
- Botox injections: Injecting botulism (Botox) into the salivary glands can decrease saliva production. However, the effects can wear off after a few months, and repeat treatments are necessary.
- Surgery: Doctors may reroute salivary ducts, close them off, or remove salivary glands. However, this treatment is the most invasive, and doctors often perform it when other methods are ineffective.
- Radiation: A side effect of radiation is dry mouth, which can help reduce excess saliva.
- Salivary gland ablation: This procedure involves injections of chemicals to cause salivary glands to shrink and become scar tissue.
- Tracheostomy: If choking is a concern, doctors may create an artificial airway at the front of the neck.
There are advantages and disadvantages to each of the medical treatments. Your doctor will discuss your options in the context of your individual diagnosis to find the right treatment plan for you.
These are some other questions people often ask about hypersalivation. Nicole Aaronson, M.D., MBA, CPE, FACS, FAAP, has reviewed the answers.
How can you stop hypersalivation?
The treatment for hypersalivation may vary, depending on the cause. If a temporary condition such as an oral infection is causing excess saliva, treating the underlying condition should stop hypersalivation.
For people with chronic drooling due to an underlying condition such as Parkinson’s disease, management of hypersalivation can include medications and physical therapy.
Does anxiety cause hypersalivation?
Anxiety more often links with dry mouth. Feelings of anxiety can lead to physical symptoms that are part of a survival response known as “fight or flight.” When anxiety provokes this survival response, this suppresses many typical body functions, including salivary gland activity.
Hypersalivation, or having excess saliva, can be temporary or long-term. Several conditions can cause hypersalivation, including neurological conditions associated with difficulty swallowing.
Your doctor will discuss ways to manage excess saliva through treatments such as physical therapy, medications, and surgical options.