MANY persons after awaking find that their pillow has a wet patch of saliva. Sometimes, the corners of their mouths have white deposits from dried saliva. The condition of dribbling or what Americans call drooling is often an embarrassing one. If it is found to be a problem what can one do about it?
There are several groups of persons who suffer from the effects of chronic dribbling. The worst are those who dribble when awake and alert. These patients have neuromuscular control disorders that result in poor coordination of the swallowing mechanism. Generally, they suffer from cerebral palsy, mental retardation, cerebrovascular accidents (stroke) or Parkinson’s disease.
Patients with chronic dribbling are affected both psychologically and physically. The social stigma of dribbling can have a profoundly negative psychological impact, especially in those patients with continuously wet clothing who must wear bibs or towels around their necks in public. There is also an economic impact. The patient, guardian, or nursing home requires additional personnel as well as time, to manage the additional clothing changes and medical problems that arise. Chronic dribbling causes loss of fluids, electrolytes (charged particles), and proteins as well as alterations in the skin around the mouth. The chronically moist skin may result in hygiene problems, excoriation and infection.
The majority of persons who dribble do so when asleep. The salivary glands never really cease to secrete saliva. When we are awake, we swallow the small amount of saliva constantly secreted without being conscious of this action. But when asleep, the reflex action of swallowing does not always function effectively, and so the saliva escapes from the partially opened mouth.
Three main factors are involved in the mechanism of dribbling in normal individuals. In the first place, the position of the head plays an important role. If in the horizontal position of slumber the nose is located on the same level or below the upper surface of the neck, the person may dribble. The muscular tone of the lips also contributes to dribbling. Smokers tend not to dribble because of the muscles of their lips and from the habit, increase in tonicity and so the lips remain closed while asleep.
Then there are some whose salivary glands are naturally hyperactive. In fact, every exocrine gland in their body exhibits excess secretion. These people also perspire more, cry with copious tears, ejaculate more semen than usual, et cetera. Any drug used here for the dribbling would suppress all these excessive secretions.
Unless dribbling constitutes a critical problem an attempt should not be made to use medication or other means of treatment. In such mild cases, the individual may modify the position of his head on the pillow as described. Where the condition is moderate to severe, the drug atropine or atropine-like medication may be used. Radiation therapy over 6000 rads on the sides of the face may be used to control dribbling.
There are several surgical alternatives. Ligation of the parotid ducts alone, or in combination with excision of the submandibular glands has been employed with success. This procedure removes the contribution of the majority of major salivary glands, leaving only the sublingual and minor salivary glands for saliva production. Another approach includes rerouting the parotid glands’ ducts to the tonsillar fossa. This means that the saliva emerges deeper in the mouth and is forced to flow down the throat.
Drugs taken for mental depression can cause dribbling, as well as persons suffering from mercury poisoning, most of whom are gold miners.