STUDY - Technical - New Dacian's Medicine
Drooling
(Classical / Allopathic Medicine)
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 a neuromuscular disorder or local pain
that causes dysphagia, or, less commonly, from the effects of
a drug or toxin that induces salivation. Drooling may be scant
or copious (up to 1 qt [1 L] daily) and may cause circumoral
irritation. Because it signals an inability to handle
secretions, drooling warns of potential aspiration.
HISTORY:
Ask the patient when the drooling began.
Ask the patient how much he drools. Is it scant or copious? Is his pillow wet in the morning?
Ask the patient if he's experiencing associated signs and symptoms, such as sore throat and difficulty swallowing, chewing, speaking, or breathing.
Ask the patient to describe pain, numbness, tingling, or stiffness in the face and neck and muscle weakness in the face and extremities.
Ask the patient about changes in mental status, such as drowsiness or agitation.
Ask the patient about changes in vision, hearing, and sense of taste.
Ask the patient if he has experienced anorexia, weight loss, fatigue, nausea, vomiting, or altered bowel or bladder habits.
Ask the patient whether he recently had a cold or other infection, was bitten by an animal or was exposed to pesticides.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
Ask the patient when the drooling began.
Ask the patient how much he drools. Is it scant or copious? Is his pillow wet in the morning?
Ask the patient if he's experiencing associated signs and symptoms, such as sore throat and difficulty swallowing, chewing, speaking, or breathing.
Ask the patient to describe pain, numbness, tingling, or stiffness in the face and neck and muscle weakness in the face and extremities.
Ask the patient about changes in mental status, such as drowsiness or agitation.
Ask the patient about changes in vision, hearing, and sense of taste.
Ask the patient if he has experienced anorexia, weight loss, fatigue, nausea, vomiting, or altered bowel or bladder habits.
Ask the patient whether he recently had a cold or other infection, was bitten by an animal or was exposed to pesticides.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
PHYSICAL
ASSESSMENT:
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. Also, inspect for circumoral irritation.
Note foul breath odor. Examine the tongue for bilateral furrowing (trident tongue).
Look for pallor and skin lesions and for frontal baldness. Carefully assess bite or puncture marks.
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.
Test for poor balance, hyperreflexia, and positive Babinski's reflex.
Assess sensory function for paresthesia.
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. Also, inspect for circumoral irritation.
Note foul breath odor. Examine the tongue for bilateral furrowing (trident tongue).
Look for pallor and skin lesions and for frontal baldness. Carefully assess bite or puncture marks.
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.
Test for poor balance, hyperreflexia, and positive Babinski's reflex.
Assess sensory function for paresthesia.
SPECIAL
CONSIDERATIONS:
Be alert for aspiration in a patient who drools. Position him upright or on his side, and use suction as necessary to control the drooling.
Be alert for aspiration in a patient who drools. Position him upright or on his side, and use suction as necessary to control the drooling.
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 5th month and continues until about age 2.
Excessive salivation and drooling may occur in response to hunger or anticipation of feeding and in association with nausea.
Common causes of drooling include epiglottitis, retropharyngeal abscess, severe tonsillitis, stomatitis, herpetic lesions, esophageal atresia, cerebral palsy, mental deficiency, and drug withdrawal in neonates of addicted mothers.
Drooling may also result from a foreign body in the esophagus, causing dysphagia.
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 5th month and continues until about age 2.
Excessive salivation and drooling may occur in response to hunger or anticipation of feeding and in association with nausea.
Common causes of drooling include epiglottitis, retropharyngeal abscess, severe tonsillitis, stomatitis, herpetic lesions, esophageal atresia, cerebral palsy, mental deficiency, and drug withdrawal in neonates of addicted mothers.
Drooling may also result from a foreign body in the esophagus, causing dysphagia.
PATIENT
COUNSELING:
Teach the patient exercises to help strengthen facial muscles, if appropriate.
Teach the patient exercises to help strengthen facial muscles, if appropriate.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)