Table 23

Investigation and management of hypersalivation

InvestigationsPotential resultsClinical management plan
Actions from history, medication and dietary assessment
History findingsProblems swallowing salivaFollow guideline for dysphagia on tables 14 and 16.
Consider referral to a speech and language therapist.
Neurological disordersRefer to neurology.
Problems closing mouthEstablish underlying cause: stroke, jaw fracture or dislocation, facial nerve palsy, Parkinson's disease.
Infection:

  •  ▸ Tonsillitis

  •  ▸ Mumps

Treat according to local guidelines.
Medication findings

  • Clozapine

  • Pilocarpine

  • Potassium

  • Risperidone

Discuss possible alternative medications.
First line
OGDGORDStart PPI or H2 antagonist. If following oesophagectomy, consider promotility agents (see p. 78).
Second line
If normal investigations/no response to intervention

  1. Advice on oral hygiene.

  2. Consider treating with an antimuscarinic mediation:10

    • Amitriptyline.

    • Glycopyrronium bromide (glycopyrrolate): oral, nebulised and subcutaneous.

    • Hyoscine hydrobromide (scopolamine hydrobromide): oral, topical, subcutaneous and nebulised.

  3. Consider referral to psychological support team.

  • GORD, gastro-oesophageal reflux disease; H2, histamine receptor 2; OGD, upper GI endoscopy (oesophago-gastroduodenoscopy); PPI, proton pump inhibitor.