1. DROOLING
SPEECH THERAPY
DEPARTMENT
NIRM

2. Drooling
 Drooling is the unintentional loss of saliva
from the mouth.

3. DROOLING
 It is normal for babies to drool.
 As babies grow and mature, they are better able to
manage their saliva.
 Most children don't drool when awake or asleep after
the age of 4 years.
 Children with neurological problems have difficulty
making their muscles and nerves work properly. They
have trouble swallowing saliva. Drooling is frequently
seen in these children at older ages.

4. ALTERNATIVE NAMES
Salivation
Ptylasim
Sialorrhea,

5. SALIVA
 Saliva is almost all water. There are small
amounts of other substances, such as
electrolytes (salts) and mucous which help the
mouth and body in the process of eating.
 Seventy percent of the 1.5 liters of saliva
produced daily is from the submandibular gland;
twenty-five percent is from the parotid glands
and five percent is from the sublingual glands.

6. SALIVA IS PRODUCED BY
Saliva comes from three pairs
of salivary glands, plus many
smaller glands. All of these
are found in the mouth.
 Two parotid glands are inside
the cheek area.
 The pair of sublingual glands
are under the tongue.
 The two submandibular
glands are close to the lower
jaw.

7. Benefits of saliva
 Protect the throat and esophagus from injury during
eating.
 Saliva also helps recoat the teeth with calcium.
 It helps keep gums healthy.
 It helps remove bacteria from inside the mouth
 decreases breath odor.
 Saliva contains amylase, an enzyme that begins the
digestion of starches.

8. Functions of saliva
 Functions of saliva
 Protective
 Swallowing
 Digestion
 Speaking

9. ASSESSMENT
Cause
Severity
Contributing factors

10. CAUSES
 Impaired oral musculature
 Lack of sensory awareness
 Lack of motor activity
 Improper, inefficient, or infrequent swallowing.
 It is unusual for drooling to be caused from
making too much saliva.

11. Pathophysiology of Drooling
 Primarily a defect in the oral phase of
 swallowing caused by:
 poor head control, inability to close the mouth,
 abnormal tongue mobility, reduced intra-oral
 sensation
 Sialorrhea can lead to drooling caused by:
 medications and poor fitting dentures

12. ASSOCIATED DISORDERS
Cerebral Palsy
Parkinson’s Disease
Multiple Sclerosis
Stroke

13. COMPLICATIONS
 Causes functional, social, psychological, and
clinical burdens on patients, their families, and
caregivers.
 Patients who drool often experience repeated
perioral skin breakdown and infections.
 Clothing and bibs become soiled and need
frequent changing, which can become very
laborious and limit the family's ability to be
active and out of the home.

14. COMPLICATIONS
 Teaching materials and communicative
devices may become wet and damaged,
impairing educational efforts.
 In severe cases of drooling, dehydration
may even become a problem.
 Social embarrassment may make it difficult
for patients who drool to interact with
their peers and can lead to isolation.

15. SEVERITY SCALE OF DROOLING
 Dry - Never drools
 Mild - Only lips wet
 Moderate - Lips and chin wet
 Severe - Clothing soiled
 Profuse - Clothing, hands, and tray moist and
wet

16. TREATMENT
The problem of excessive drooling can be treated
in several ways:
 Speech therapy
 Medication
 Surgery

17. SPEECH THERAPY
 Eating & Drinking Skills
learn to close the lips, move the saliva to the back of the mouth,
and swallow.
Learning to use a straw for fluids can improve drooling.
 Positioning
 Oral Facial facilitation
 Icing
 Brushing
 Vibration
 Manipulation
 Oral motor Sensory exercises

18. MEDICATION
 The salivary glands are under the control of a part of
the nervous system called the autonomic system. The
medicines listed below cause the body to make less
saliva by inhibiting the part of the autonomic system
known as the parasympathetic system. This part of the
nervous system also helps regulate urine output and
stomach emptying.
 Robinul
 Artane
 Cogentin
Sal-Tropine

19. MEDICATION
 Anticholinergic - Robinul
 side effects - restlessness, sedation,
 constipation, urinary retention, blurred
vision,
 xerostomia
 Antihistamine
 Antireflux

20. SURGICAL INTERVENTION
 Surgery involves either changing the direction of the
ducts which lead from the salivary glands to the mouth,
or removing the salivary gland tissue.
 Laser surgery has recently been used. This treatment allows a
quicker recovery than regular surgery.
 Botulinum Toxin injections are done under anesthesia.
The toxin is injected into the parotid gland. This
treatment lasts up to 8 months.
 Radiotherapy, or use of x-rays, to destroy part of the
salivary glands is only used in severe cases and not
usually used in children.

21. Surgical options
 Submandibular duct rerouting
 Submandibular duct excision
 Parotid duct ligation
 Transtympanic neurectomy

22. Alternative Therapies
 Biofeedback and hypnotherapy have been used in some
patients with varying amounts of success.
 Bibs
Don't forget that bibs are helpful to protect skin and
clothing. The use of bandannas, or a bib that matches
the shirt or dress, especially in older children, can make
the bib less noticeable or add a fashion accent.

23. CONCLUSION
 Noninvasive modalities should be attempted
first
 A trial of medication is warranted if
noninvasive methods fail
 Surgery is a final option for those patients
with severe drooling problems not
adequately addressed by noninvasive means
or medication • •