Sialorrhea (Excessive Drooling) | Baylor Scott & White Health

What is sialorrhea?

Sialorrhea, also known as excessive drooling or hypersalivation, is a condition where too much saliva builds up in the mouth and sometimes spills out past the lips. It can happen when the body produces more saliva than usual or when someone has trouble swallowing or keeping saliva in their mouth.

While it’s normal for infants and toddlers to drool, especially during teething, sialorrhea in older children or adults is usually linked to an underlying medical condition. It’s common in people with neurological disorders such as Parkinson’s disease, cerebral palsy, ALS (amyotrophic lateral sclerosis) or after a stroke.

Sialorrhea can range from mild to severe. In some cases, the excessive drooling is more of a nuisance or cosmetic concern. In others, it can interfere with daily activities, cause skin irritation, increase the risk of aspiration (when saliva enters the lungs) or lead to feeling embarrassed in social situations.

Fortunately, there are treatments that can help manage sialorrhea, including therapies, medications and in some cases, procedures or surgery. If you or a loved one is experiencing excessive drooling, talk to your doctor about the best way to manage it.

What causes excessive drooling?

Excessive drooling happens when saliva builds up in the mouth and spills out unintentionally. While it's common in babies and young children, persistent drooling in older children or adults can be a sign of an underlying condition.

Hypersalivation can happen for several reasons, including:

Neurological disorders: Conditions like cerebral palsy, Parkinson’s disease, ALS (amyotrophic lateral sclerosis), stroke or traumatic brain injury can affect the nerves and muscles that control swallowing and mouth movement. This makes it harder to manage saliva.
Swallowing disorders (dysphagia): Difficulty swallowing can cause saliva to pool in the mouth instead of being cleared regularly. This is often linked to neurological conditions but can also occur after surgery, radiation or injury.
Poor muscle control: Weakness or lack of coordination in the lips, tongue or jaw can make it difficult to keep saliva inside the mouth. This can be related to developmental delays, neuromuscular disorders or structural problems in the mouth.
Increased saliva production: Saliva may increase due to acid reflux, infections (like tonsillitis or strep throat) or reactions to certain medications.
Mouth breathing: Breathing through the mouth, especially at night, can contribute to drooling. This is often caused by allergies, sinus issues or enlarged tonsils or adenoids.
Dental problems: Issues like misaligned teeth, trouble chewing or poorly fitting dentures can affect saliva control.

When to see a doctor

If you start drooling more than usual or without a clear reason, it’s a good idea to talk to your primary care provider. It could be related to a medical issue, especially if you also have trouble swallowing, speaking or controlling facial muscles.

You should also seek care if drooling is affecting your sleep, causing skin irritation or making you feel uncomfortable or self-conscious. Your doctor can help figure out what’s causing it and suggest treatment to help you feel better.

Sialorrhea treatment

If you’re dealing with excessive drooling, there are several ways to help manage it and improve your daily comfort. The best treatment depends on what’s causing the drooling and how severe it is. Your doctor can work with you to create a plan that fits your needs.

Medication

Medication can help reduce the amount of saliva your body makes, which may ease drooling and improve daily comfort. Your doctor will work with you to find the treatment that best fits your symptoms and overall health.

Anticholinergic medications: These medicines, such as glycopyrrolate or scopolamine, slow down saliva production. They’re available as pills, liquids or skin patches. Your doctor will monitor for side effects and adjust the dosage if needed.
Botulinum toxin injections: Medication is injected into the salivary glands to temporarily reduce saliva flow. Many people notice improvement within a week or two, and results typically last a few months. It’s a quick procedure done in the doctor’s office and may need to be repeated to maintain relief.

Therapy

Therapies like speech therapy and occupational therapy can be helpful for managing drooling, especially if it’s related to muscle weakness or trouble swallowing.

Speech therapy: This type of therapy helps strengthen the muscles in your mouth and throat. A speech therapist will guide you through simple exercises that make it easier to swallow and control saliva. These exercises can also improve your speech and help reduce how often you drool.
Occupational therapy: This type of therapy focuses on practical tips and techniques to help with everyday activities. An occupational therapist might show you how to improve your posture or head position to reduce drooling. They can also suggest tools, like special cups or utensils, and ways to protect your skin if it gets irritated from saliva.

Both therapies work together to help you feel more comfortable and confident while managing symptoms in a way that fits your lifestyle.

Surgery

If other treatments don’t work and drooling is severe, surgery might be an option. Surgery can reduce saliva production or change how saliva flows in your mouth. Because surgery involves risks, it’s usually considered only after trying other treatments. Your doctor will explain what to expect and help decide if surgery is right for you.

Find specialized care for excessive drooling

At Baylor Scott & White, we offer several locations in North and Central Texas for the treatment of sialorrhea and related neurological disorders. Whether you’re seeking a diagnosis, need treatment options or looking for ongoing support, we’re here for you.

Baylor Scott & White - Plano Brain and Spine Center

4708 Alliance Blvd Pavilion I, Ste 810, Plano, TX, 75093

Baylor Scott & White - Plano Brain and Spine Center

4708 Alliance Blvd Pavilion I, Ste 810, Plano, TX, 75093

What is sialorrhea?

What causes excessive drooling?

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Surgery

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