Ptyalism is a condition in which the salivary glands in the mouth produce excessive saliva. Saliva is essential for swallowing and digesting food and also protects the mouth and gums from infections. However, excess saliva can lead to issues such as bad breath, chapped lips, and loss of taste. Excessive swallowing, spitting, and drooling are common signs of ptyalism. It can make you develop social anxiety, low self-esteem, and speech problems. You may also have difficulties in swallowing or keeping your mouth closed. Ptyalism is usually as a result of an underlying condition rather than a disease by itself. Treating the underlying disease is, therefore, the best way to treat the condition.

Causes of Ptyalism

The most common cause of ptyalism is pregnancy. During the first semester of pregnancy, morning sickness causes many pregnant women to have hypersalivation. Ptyalism can also be a side effect of certain medications or a symptom of underlying diseases. 



Diseases that cause recurrent vomiting are commonly associated with ptyalism. Frequent vomiting irritates the throat causing salivary glands to respond to the irritation by producing excess saliva. The saliva, in turn, coats the throat to minimize irritation. Vomiting is a common symptom of conditions such as food poisoning, malaria, and gastroenteritis. Patients with these conditions are, therefore, likely to have ptyalism. Excessive acid from the stomach also causes throat irritation through acid reflux, and therefore, conditions like gastroesophageal reflux disease (GERD) and peptic ulcer disease (PUD) can cause ptyalism.



Conditions that affect neuronal muscle control, such as cerebral palsy and Parkinson’s disease, can cause ptyalism. Studies show that averagely 75 % and 10-37% of Parkinson’s disease and cerebral palsy patients, respectively, suffer from ptyalism. Down’s syndrome, stroke, and mumps also cause ptyalism. Mumps causes the salivary glands to swell and makes swallowing difficult.



Cholinergic drugs such as pilocarpine cause overproduction of body fluids like saliva and gastric acid. These drugs can, therefore, cause ptyalism either directly through increased saliva production or indirectly through acid reflux. Certain seizure medications, such as clonazepam and schizophrenic medications such as clozapine, also cause ptyalism. Studies show that clozapine-induced ptyalism occurs in 30 to 80% of patients on the drug. 



Other causes of ptyalism include infections of the throat, fake teeth in older adults, poor oral hygiene, and injuries such as a fracture to the jaw.

Diagnosis

Physicians diagnose ptyalism by checking your medical history and doing a few examinations of the mouth, tongue, posture of the head, and tonsils. A person living in Ontario, who experiences hypersalivation, can visit the Upper Hunt Club Dental Centre in Ottawa, for an examination.

Treatment

Treatment can be pharmacological (use of drugs) or nonpharmacological. A combination of the two measures is necessary for the management of ptyalism. A primary class of drug in use for pharmacological management of ptyalism is anticholinergics. Medicines in this class include atropine, glycopyrrolate, and chlorpromazine. Glycopyrrolate is the most common drug prescribed for ptyalism. It is usually given as an oral solution. 



Beta-blocker class of drugs can also be used for ptyalism. Examples of drugs in this class include atenolol and esmolol. Botulinum toxic (Botox) is an alternative to the two categories of drugs and is given as an injection to the salivary glands.For patients presenting with ptyalism who also have speech difficulties, speech therapy is helpful. 



Nonpharmacological measures include:

1. Drinking a lot of water to reduce excessive saliva formation. It also helps you keep hydrated and protects your lips from chapping any further.

2. Proper oral hygiene can get rid of any food residues in the mouth and prevent plaque formation. Brushing at least twice a day and flossing on a regular will help get rid of any acid present in the mouth after acid reflux, especially if your ptyalism is caused by GERD or vomiting.

3. A healthy diet is also relevant. A diet with a lot of starch requires a lot of saliva to digest the starch. Starch quantities should, therefore, be low in your diet if you have ptyalism. You should also avoid sugary foods in your diet. If possible, chew sugarless gum and lick sugarless candy. The two make it easy for you to swallow saliva.

If you are experiencing symptoms of ptyalism, visit the Upper Hunt Club Dental Centre in Ottawa for a dental check-up. Contact us today to schedule an appointment!