Excess saliva may indicate problem


A reader recently asked about her 72-year-old mother, who complains of secreting a lot of saliva when she has a cold or viral infection.

The mother has to keep swallowing constantly to prevent drooling. The reader wanted to know whether this was caused by something specific and if it is a symptom of something that is treatable. She noted that her mother's doctor said it was nothing special and ignored it.

In normal circumstances, we produce saliva most of the time. Production can be increased by smelling, seeing or, if we're hungry enough, thinking about food. (We've all heard of "mouth-watering" food.)

Production of saliva largely is controlled by nerves that run from the brain to the salivary glands. Direct stimulation, such as sucking on a lemon drop, also can increase production and secretion.

There are three possibilities here.

First, she may be producing a normal amount of saliva but has difficulty swallowing, which makes the saliva accumulate. This is the most worrisome possibility, because it is a symptom of certain types of cancer. If she has had the problem for several years, then cancer is unlikely.

However, if the problem is a new one, I'd worry more. Does she have trouble swallowing anything else? And very importantly, does the mother smoke? If she does, the likelihood of cancer of the head and neck increases greatly and I'd probably refer her to an otorhinolaryngologist (ear-nose-and-throat doctor) for a careful evaluation.

Second, your mother could be swallowing nasal mucus that has collected in her mouth. Colds and viral infections could cause a runny nose, and she might be mistaking this for saliva.

The reader herself suggests the third possibility. This may simply be an uncommon symptom of the common cold. Colds and viral infections affect people differently, and this may be how the mother reacts.

I would like to make one observation about the comment that the mother's doctor ignores this symptom. He may have been in such a hurry that he didn't listen carefully and think about this problem.

That's bad.

On the other hand, he may have evaluated the problem thoroughly and decided that further referral or testing was unnecessary. Referral and testing are terribly expensive, and he may be doing something beneficial if he believes this is an innocent symptom.

How is one to know if he is being careful? It's hard.

First, ask yourself how you feel about the doctor; second, whether he is always in a hurry; third, where and how much training he got and how much continuing education he has done.

Answering these questions satisfactorily should determine whether to seek another opinion.

Finucane is in the Division of Geriatric Medicine at the Francis Scott Key Medical Center.

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