Etiology: why hypersalivation occurs
The development of hypersialia is most commonly associated with several key factors:
- Parasympathetic stimulation: increased activity of the vagus nerve resulting from neuroses, encephalitis, or exposure to toxins and medications.
- Local inflammation: acute processes in the oral cavity, such as stomatitis and gingivitis, reflexively increase secretion.
- Intoxications: both exogenous (mercury or nicotine poisoning) and endogenous (accumulation of metabolites in uremia or coma).
- Other factors: infection of oral cavity tissues and helminthic infestations.
Impact on digestion
Excess saliva significantly alters the working conditions of the stomach:
- Alkalinization: saliva dilutes gastric juice, increasing its pH.
- Reduced protection: due to changes in acidity, the bactericidal and bacteriostatic activity of the juice drops.
- Impaired fermentation: peptic activity decreases, making protein digestion more difficult.
- Motility: evacuation of gastric contents into the duodenum is accelerated.
Complications
In addition to digestive disorders, prolonged hypersalivation is dangerous due to hypohydration. In severely ill patients, constant drooling or frequent spitting leads to significant fluid loss by the body, requiring correction of the water-electrolyte balance.
Briefly: answers to topical questions
Which neurological diseases and syndromes are accompanied by hypersalivation?
Hypersalivation/sialorrhea is indicated in sources for the following neurological diseases, forms, and syndromes:
- Parkinsonism / Parkinson's disease — external manifestations of hypersalivation are observed in parkinsonism; in Parkinson's disease, sialorrhea is associated with hyperproduction of saliva and/or swallowing impairment.
- Bulbar syndrome — may manifest as swallowing impairment, choking, nasal voice, palatal curtain paresis, and hypersalivation.
- Pseudobulbar syndrome — externally manifests as hypersalivation; true increase in saliva secretion may be absent, with saliva accumulation caused by hypokinesia of the tongue, pharyngeal muscles, and swallowing disorders.
- Bulbar and mixed forms of the lesion described in the source — belong to the most dangerous variants and manifest as bulbar syndrome with hypersalivation.
- Encephalitis stage of the disease with the triad "hydrophobia, profuse sweating, hypersalivation" — hypersalivation is indicated as part of this pathognomonic triad.
Poisoning by which exogenous poisons and toxins leads to hypersalivation?
Increased salivation/hypersalivation is indicated in sources for poisoning or intoxication by the following exogenous poisons and toxins:
- Mercury compounds — cited as the cause of exogenous intoxication in hypersalivation.
- Nicotine — cited as the cause of exogenous intoxication in hypersalivation.
- Muscarine and muscaridine — fungal toxins; their action is described as causing profuse sweating, salivation, and bronchorrhea.
- Amanitin, phalloin, phalloidin — toxic thermostable fungal alkaloids; poisoning by them is indicated as causing profuse salivation.
Which pharmacological groups of medications cause hypersalivation?
Pharmacological groups and drugs for which increased salivation or drooling is indicated in sources:
- Anticholinesterase agents — increase salivation; in case of sialorrhea, it is recommended to discontinue them or reduce the dose if possible.
- Antipsychotics (neuroleptics) — dry mouth is listed among the anticholinergic side effects of neuroleptics, occasionally accompanied by drooling.
- Specific drugs that increase salivation include quetiapine and clozapine.
P-I-V-O (Beer in Russian): Parasympathetic, Intoxication, Inflammation, Dehydration (hypohydration).
Class and exam questions
How does hypersalivation affect the bactericidal activity of gastric juice?
Excess saliva dilutes and alkalinizes gastric juice, which suppresses its natural bactericidal and bacteriostatic capacity.
Why is there a risk of dehydration in hypersalivation?
Hypohydration develops due to continuous fluid loss from frequent spitting or involuntary drooling from the mouth.
How does gastric motility change in the presence of excess saliva?
Acceleration of gastric content evacuation into the duodenum is observed.
What else to study on this topic
- Mechanisms of regulation of salivary gland secretion via the autonomic nervous system.
- Differential diagnosis of stomatitis causing hypersalivation.
- Biochemical composition of saliva in various types of intoxications.
- Pathophysiological methods for correcting water-electrolyte disturbances in chronic hypersalivation.
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