Drooling
Drooling — the flow of saliva from the mouth — results from a failure to swallow or retain saliva or from excess salivation. It may stem from facial muscle paralysis or weakness that prevents mouth closure, from neuromuscular disorders or local pain that causes dysphagia or, less commonly, from the effects of drugs or toxins that induce salivation. Drooling may be scant or copious (up to 1 L daily) and may cause circumoral irritation. Because it signals an inability to handle secretions, drooling warns of potential aspiration.
History and physical examination
If you observe the patient drooling, first determine the amount. Is it scant or copious? When did it begin? Ask the patient if his pillow is wet in the morning. Also, inspect for circumoral irritation.
Then explore associated signs and symptoms. Ask about sore throat and difficulty swallowing, chewing, speaking, or breathing. Have the patient describe pain or stiffness in the face and neck and muscle weakness in the face and extremities. Has he noticed mental status changes, such as drowsiness or agitation? Ask about changes in vision, hearing, and sense of taste. Also, ask about anorexia, weight loss, fatigue, nausea, vomiting, and altered bowel or bladder habits. Has the patient recently had a cold or other infection? Was he recently bitten by an animal or exposed to pesticides? Finally, obtain a complete drug history.
Next, perform a physical examination. Take the patient's vital signs. Inspect for signs of facial paralysis or abnormal expression. Examine the mouth and neck for swelling, the throat for edema and redness, and the tonsils for exudate. Note foul breath odor. Examine the tongue for bilateral furrowing (trident tongue). Look for pallor and skin lesions and for frontal baldness. Carefully assess any bite or puncture marks.
Assess cranial nerves II through VII, IX, and X. Then check pupillary size and response to light. Assess the patient's speech. Evaluate muscle strength, and palpate for tenderness or atrophy. Also, palpate for lymphadenopathy, especially in the cervical area. Observe the patient's ability to swallow, and assess his gag reflex. Test for poor balance, hyperreflexia, and a positive Babinski's reflex. Also, assess sensory function for paresthesia.
Medical causes
Bell's palsy.
With Bell's palsy, drooling accompanies the gradual onset of facial hemiplegia. 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 patient usually complains of pain in or behind the ear. Other cardinal signs and symptoms include unilateral diminished or absent corneal reflex, decreased lacrimation, Bell's phenomenon (upward deviation of the eye with attempt at lid closure), and partial loss of taste or abnormal taste sensation.
Esophageal tumor
With an esophageal tumor, copious and persistent drooling is typically preceded by weight loss and progressively severe dysphagia. Other signs and symptoms include substernal, back, or neck pain and blood-flecked regurgitation.
Ludwig's angina.
With Ludwig's angina, moderate to copious drooling stems from dysphagia and local swelling of the floor of the mouth, causing tongue displacement. Submandibular swelling of the neck and signs of respiratory distress may also occur.
Myotonic dystrophy.
Facial weakness and a sagging jaw account for constant drooling in this disorder. Other characteristic findings include myotonia (inability to relax a muscle after its contraction), muscle wasting, cataracts, testicular atrophy, frontal baldness, ptosis, and a nasal, monotone voice.
Peritonsillar abscess.
A severe sore throat causes dysphagia with moderate to copious drooling in this abscess. Accompanying signs and symptoms are a high fever, rancid breath, and enlarged, reddened, edematous tonsils that may be covered by a soft, gray exudate. Palpation may reveal cervical lymphadenopathy.
Pesticide poisoning.
Toxiceffects of pesticides may include excess salivation with drooling. Other effects are diaphoresis, nausea and vomiting, involuntary urination and defecation, blurred vision, miosis, increased lacrimation, fasciculations, weakness, flaccid paralysis, signs of respiratory distress, and coma.
Rabies
When this acute central nervous system infection advances to the brain stem, it produces drooling, or “foaming at the mouth.” Drooling stems from excessive salivation, facial palsy, or extremely painful pharyngeal spasms that prohibit swallowing. Rabies is accompanied by hydrophobia in about 50% of cases. Seizures and hyperactive deep tendon reflexes may also occur before the patient develops generalized flaccid paralysis and coma.
Seizures (generalized).
Generalized seizures are tonic-clonic muscular reactions that cause excessive salivation and frothing at the mouth accompanied by loss of consciousness and cyanosis. In the unresponsive postictal state, the patient may also drool.
Special considerations
Be alert for aspiration in the drooling patient. Position him upright or on his side. Provide frequent mouth care, and suction as necessary to control drooling. Be prepared to perform a tracheostomy and intubation, to administer oxygen, or to execute an abdominal thrust.
Help the patient cope with drooling by providing a covered, opaque collecting jar to decrease odor and prevent possible transmission of infection. Keep tissues handy and drape a towel across his chest at mealtime. Encourage oral hygiene. Also, teach the patient exercises to help strengthen facial muscles, if appropriate. Assist him with meticulous skin care, especially around the mouth and in the neck area, to prevent skin breakdown. Cornstarch may be placed on the neck to reduce the risk of maceration.
Pediatric pointers
Normally, an infant can't control saliva flow until about age 1, when muscular reflexes that initiate swallowing and lip closure mature. Salivation and drooling typically increase with teething, which begins at about the fifth month and continues until about age 2. Excessive salivation and drooling may also occur in response to hunger or anticipation of feeding and in association with nausea.
Common causes of drooling include epiglottiditis, retropharyngeal abscess, severe tonsillitis, stomatitis, herpetic lesions, esophageal atresia, cerebral palsy, mental deficiency, and drug withdrawal in neonates of addicted mothers. It may also result from a foreign body in the esophagus, causing dysphagia.
Book Source Details
- Book Title: Handbook of Signs & Symptoms (Third Edition)
- Author(s): Springhouse
- Year of Publication: 2006
- Copyright Details: Handbook of Signs & Symptoms (Third Edition), Copyright © 2006 Lippincott Williams & Wilkins.
Other Book Chapters Related to Mouth symptoms
Read excerpts from these other book chapters related to Mouth symptoms:
Medical Books Excerpts
- HALITOSIS
- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
- [ read ]
- Drooling
- "In A Page: Pediatric Signs and Symptoms" (2007)
- [ read ]
- Halitosis
- "In A Page: Pediatric Signs and Symptoms" (2007)
- [ read ]
- Drooling
- "Handbook of Signs & Symptoms (Third Edition)" (2006)
- [ read ]
- Drooling
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Halitosis
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Mouth lesions
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Throat pain
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Halitosis
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Halitosis
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
- Throat pain
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
- Sore Throat
- "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
- [ read ]
- Drooling
- "Nursing: Interpreting Signs and Symptoms" (2007)
- [ read ]
Copyright Details: Handbook of Signs & Symptoms (Third Edition), Copyright © 2008 Williams & Wilkins.
More About Causes of Mouth symptoms
» Next page: Mouth lesions (Handbook of Signs & Symptoms (Third Edition))
Rate This Website
What do you think about the features of this website?
Take our user survey and have your say:
Website User Survey
Medical Tools & Articles:
Next articles:
Tools & Services:
Medical Articles:
Forums & Message Boards
- Ask or answer a question at the Boards:
