Salivation, increased
Salivation, increased: Excerpt from Signs & Symptoms: A 2-in-1 Reference for Nurses
Increased salivation (also known as polysialia or ptyalism) is an uncommon symptom that can result from a GI disorder, especially of the mouth. It also accompanies certain systemic disorders and may result from the use of certain drugs or from exposure to toxins. Saliva may also accumulate because of difficulty swallowing. (See “Dysphagia,” page 225.)
History
Ask the patient about related signs and symptoms, such as fatigue, fever, headache, or a sore throat. Also ask about exposure to industrial toxins such as mercury. Is the patient taking any medications? Note especially use of iodides, cholinergics, and miotics.
Physical assessment
A patient who complains of increased salivation may have overproductive salivary glands or difficulty swallowing. To distinguish these, first test for a gag reflex and observe the patient’s ability to swallow and chew. Is he drooling? Is his chewing uncoordinated? An impaired gag reflex, drooling, and chewing incoordination suggest difficulty swallowing.
Inspect the mouth and mucous membranes for lesions. If present, are they painful? Put on gloves and palpate the lesions, which may be suppurative or infectious. Describe them in your notes. Next, inspect the uvula, gingivae, and pharynx. Palpate the lymph nodes, and determine if the parotid glands are swollen or sore.
Medical causes
Bell’s palsy
With Bell’s palsy, paralysis of the facial nerve causes an inability to control salivation or close the eye on the affected side. The affected side of the face sags and is expressionless, the nasolabial fold flattens, and the palpebral fissure (the distance between the upper and lower eyelids) widens. The corneal reflex may be diminished or absent and the patient may have partial loss of taste or abnormal taste sensation.
Mercury poisoning
Stomatitis, characterized by increased salivation and a metallic taste, commonly occurs in those with mercury poisoning. The patient’s teeth may be loose and his gums are painful, swollen, and prone to bleeding. A blue line appears on the gingivae. The patient may also experience personality changes, memory loss, abdominal cramps, diarrhea, paresthesia, and tremors of the eyelids, lips, tongue, and fingers.
Pregnancy
In the early months of pregnancy, many women experience increased salivation, nausea, gum swelling, and breast tenderness.
Stomatitis
Mucosal ulcers may be accompanied by moderately increased salivation, mouth pain, fever, and erythema. Spontaneous healing usually occurs in 7 to 10 days, but scarring and recurrence are possible.
Syphilis
With secondary syphilis, mucosal ulcers cause increased salivation that may persist up to 1 year. Related findings include fever, malaise, headache, anorexia, weight loss, nausea, vomiting, sore throat, and generalized lymphadenopathy. A bilaterally symmetrical rash appears on the arms, trunk, palms, soles, face, and scalp. Condylomata develop in the genital and perianal areas.
Tuberculosis
Certain forms of tuberculosis may produce solitary, irregularly-shaped mouth or tongue ulcers, covered with exudate, that cause increased salivation. Other findings include weight loss, anorexia, fever, fatigue, malaise, dyspnea, cough, night sweats (a common sign), and hemoptysis.
Other causes
Drugs
Increased salivation may occur with iodide toxicity, but the earliest symptoms are a brassy taste and a burning sensation in the mouth and throat. Associated findings include sneezing, irritated eyelids, and (commonly) pain in the frontal sinus.
Pilocarpine and other miotics used to treat glaucoma may be absorbed systemically, increasing salivation. Cholinergics, such as bethanechol and neostigmine, may also cause this symptom.
Special considerations
Though annoying to the patient, increased salivation doesn’t require treatments beyond those needed to correct the underlying disorder.
Pediatric pointers
Besides stemming from conditions that affect adults, increased salivation in children may also stem from congenital esophageal atresia. With this disorder, the infant is unable to swallow seemingly excessive saliva and frothy mucus.
Geriatric pointers
Drooling is common in elderly people with Parkinson’s disease. It’s caused by a reduction in automatic or conscious swallowing rather than by excessive salivation.
Patient counseling
Teach the patient the importance of proper oral hygiene to prevent odor and dental problems. Remind him to seek regular dental care.
Pictures
Book Source Details
- Book Title: Signs & Symptoms: A 2-in-1 Reference for Nurses
- Author(s): Springhouse
- Year of Publication: 2007
- Copyright Details: Signs & Symptoms: A 2-in-1 Reference for Nurses, Copyright © 2007 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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