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Sialorrhea (Excessive Salivation)

What is Sialorrhea?

Sialorrhea or ptyalism is a medical condition that occurs when the salivary glands produce more saliva than the mouth can handle, causing the saliva to pool and drip. It may also be caused by weak neuromuscular control around the mouth.

Drooling is common in babies but is considered abnormal after age four. It can be an unpleasant and embarrassing condition that impacts health and quality of life. People with neurological disorders like motor neuron disease – MND, cerebral palsy, Parkinson’s disease, and multiple sclerosis – MS may exhibit sialorrhea. It can also affect individuals who have had a stroke or have undergone radiation therapy for head and neck cancers.

Medications may be prescribed to discourage saliva production or improve swallowing, while targeted exercises or physical therapy could bolster muscles and neurological control. For certain cases unresponsive to these conservative measures, botulinum toxin injections at Melbourne NeuroCare may provide relief by temporarily paralyzing salivary glands and reducing drooling.

Common symptoms of sialorrhea or chronic drooling include:

  • Hypersalivation or drooling that occurs frequently throughout the day
  • Difficulty swallowing saliva
  • Chin, clothing, or bed frequently wet with saliva
  • Skin irritation or chafing around the mouth from frequent drooling
  • Difficulty speaking clearly due to excess saliva
  • Social embarrassment or withdrawal
  • In severe cases, dehydration occurs if a significant amount of saliva is lost

The injections are administered directly into the salivary glands. While it’s a potent toxin, the small, controlled doses used for sialorrhea injections have a good safety profile and minimal side effects when performed by physicians experienced in this procedure

Botulinum neurotoxin works by temporarily relaxing the muscles. When injected into the salivary glands, it blocks the release of acetylcholine – a chemical messenger that stimulates saliva secretion. By reducing acetylcholine release, the toxin decreases the activation of salivary glands, resulting in less saliva production and decreased drooling.

While not necessarily a first-line option, botulinum toxin injections can be an effective way to reduce debilitating, chronic drooling for certain patients when other approaches have been unsuccessful. A neurologist may recommend botulinum toxin injections for sialorrhea if:

  • Drooling is frequent or constant, resulting in significant hygiene or social difficulties
  • All reasonable attempts at medical, behavioural or physical therapies have not been effective
  • Drooling is due to a neurological disorder such as cerebral palsy, Parkinson’s disease, and amyotrophic lateral sclerosis – ALS.

What to Expect After Treatment?

This minimally invasive outpatient procedure takes a few minutes and results in a little discomfort. Also, no recovery time is needed post-injection. A regular follow-up would monitor effectiveness and determine if repeat injections are needed to continue benefits.


Though botulinum toxin effects are not immediate, patients can expect significant drooling reduction within 3 to 7 days as the toxin takes full effect. This can significantly improve hygiene, social functioning, and quality of life. Peak effects manifest around 1 to 2 weeks post-injection, followed by a gradual waning of benefits over 3 to 4 months as the toxin wears off.

Though generally safe, possible side effects include temporary swallowing difficulties and facial muscle weakness. The neurologist can evaluate the need for adjustments to boost effectiveness or tolerability.

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For those struggling with chronic drooling beyond the early years, medical evaluation and intervention may provide relief and a chance at a higher quality of life free from the physical, social, and emotional impacts of this condition.

Melbourne NeuroCare neurologists are highly experienced in administering targeted botulinum toxin injections to efficiently minimize sialorrhea and improve your comfort and quality of life. Call or book online today to get relief from bothersome drooling.