Saliva is good for your health. Saliva provides immune protection, chemical digestion and protects the teeth from dental caries. Too little saliva is debilitating. The mouth is too dry, tongue sticks on the roof of the mouth, taste is altered, speech and swallowing is difficult. Too little saliva carries a risk of dental and oral infections. On the other hand, too much saliva is also bad. Excessive drooling is incapacitating. It causes skin infection around the lips, social embarrassment and worst of all, risk of saliva aspiration into the lungs resulting in chest infections.
Saliva is produced by thousands of minor salivary glands lining your oral mucosa and the 3 pairs of major salivary glands (Parotid glands on the sides of your face, Submandibular glands under the angles of your jaw, and Sublingual glands just under the tongue).
Xerostomia or dry mouth, occurs when too little saliva is produced. There are many causes: nasal obstruction, infections, radiation therapy, medication side effects, physiologic aging process and systemic autoimmune conditions (such as Sjogrens Disease). An ENT surgeon will investigate the possible causes of xerostomia, including tests for autoimmune conditions. In some occasions, a biopsy of the lip to study the minor salivary glands may be warranted. Treatment of xerostomia depends on the specific cause identified.
Sialendoscopy and Saliva Stones
Saliva outflow from one of the major salivary glands can be impaired due to stenosis (narrowing), stricture (scar) or stones. One of the known causes of stenosis is radioactive iodine treatment for thyroid cancer. Any narrowing or obstruction should be thoroughly investigated. This can be done either through ultrasound, sialogram (xray picture with contrast injected into the saliva ducts) or sialendoscopy (camera scope into the saliva ducts).
Sialendoscopy is the minimally invasive method of inserting a 0.9mm or 1.3mm camera into the saliva duct to visually identify the narrowing or stone obstruction. There are only a handful of ENT surgeons in Melbourne performing this procedure. During the sialendoscopy, treatment can also be performed at the same time: lavage of the saliva duct system, dilatation, or stone extraction.
We produce 1.5 litres of saliva every day. Drooling (sialorrhoea) is a social embarrassment and a health hazard. This often occurs in patients with complex neurological conditions and cerebral palsy. There are medications one can take to reduce or thicken this saliva production. However, there are significant potential side effects of these medications. Botox injection to the saliva gland is beneficial but has limited efficacy as the botox effect wears out. For definitive treatment of excess saliva drooling, several surgical options can be offered. Saliva, swallow, speech, airway, breathing and sleep are all related functions. An ENT surgeon will assess and evaluate the condition and recommend the most appropriate treatment considering all other airway functions. This treatment may include: adeno-tonsillectomy, saliva duct clipping, saliva duct re-routing, submandibular gland excision, parotidectomy, tongue coblation, etc. Dr Levi works as part of the Royal Children’s Hospital Multidisciplinary Drooling Team to ensure that the most appropriate treatment recommendation is provided for each patient.
Get in touch with Dr Levi to discuss management of saliva conditions. Dr Levi is also available to provide educational talks on this topic.