Hyper Salivation or Sialorrhea in Denture Wearing Patients – Causes and Treatment

Hyper Salivation or Increase in Saliva after wearing Complete Dentures is a very common after effect of First time denture wearers, this is considered normal because the Oral Cavity or Mouth is getting used to the new Dentures presence. The Gingiva and other Soft tissues react to the presence of a new prosthesis in the oral cavity by changing in Shape and Size of Gingiva.

Hypersalivation is also called as Sialorrhea.

Increased Saliva (Hyper Salivation) or Decreased Saliva or Dryness of mouth (Xerostomia) in first time denture wearers is very common and this is a short term problem which will mostly resolve by itself if there are no problems in the Dentures which you have prepared for the patient.  The Salivary glands are stimulated by the presence of Dentures and an increase in the blood supply to these glands Major and Minor Salivary glands leads to the problem of Increased Salivary Flow.

Your Brain increases Saliva Production whenever a foreign object is placed in your mouth thinking of it as Food, so when you use the dentures for the first time increase in salivation is seen as your Brain thinks of it as Food.

Let us now see the various Causes of Hyper Salivation in Denture Wearing Patients: (Caused due to Dentures)

  1. Increased Vertical Dimension at Occlusion – VDO: The Vertical Dimension at Occlusion can be recorded higher than usual and while the patient bites excess pressure is felt on the Soft Tissue structures of the Edentulous Ridge, here the nerve endings to the Salivary glands are present which will be in turn stimulated and lead to excess or Hyper Salivation. So
  2. Incorrect Registration of Centric Jaw Relation during Jaw relations which is commonly caused when we ask the patient to bite in his normal physiological bite position, the patient who was Edentulous finds it difficult to understand what his rest position is and mostly bites a bit forward than his normal bite. Here the Dentists expertise comes into play and we should be able to guide the patient to his Centric Relation by following the steps which are mentioned for recording Centric Jaw Relations.
  3. Anxiety and Fear of Patient towards Success of Denture: Dental Fear is very common in patients and in case of Complete denture patients they are very nervous as they are getting a new set of teeth which will be changing their appearance completely and they become Apprehensive towards the Success of it and as we all know fear is a factor in stimulating Salivation. Along with this the patient initially for a few days before he/she gets adjusted to the denture feels Anxiety fearing that the Dentures might fall off while they are talking to others or eating in front of others. This fear and Anxiety in turn leads to excess Salivation.
  4. Over Extension of Denture Borders in the Maxillary and Mandibular Dentures
  5. Increased Thickness of Denture Borders in turn stimulates excess salivation, the normal thickness of denture border should be 2mm anything more than that will lead to Hyper Salivation
  6. Increased Pressure on Gingiva, Buccal Mucosa and Nerves
  7. Initial thought of Denture as a Foreign body in the Oral cavity
  8. Hyper Salivation caused due to Clozapine, change in the drug causing increased saliva production can help in such cases.

Hypersalivation or Sialorrhea in complete Denture patients Treatment of Hyper Salivation in Complete Denture Wearing Patients:

Treatment modality of each case depends on the problem and the probable cause of hyper salivation. So first the dentist and the patient himself should diagnose the exact cause and reason for Hypersalivation.

  1. Psychological support and understanding: This is the most common treatment method which should be followed by Dentists and this is because hyper salivation is common in all denture wearers for a certain period of time and in these patients only making the patient understand and assuring him that this is normal to all Denture wearing patients is of utmost importance at the time when the denture is being delivered to the patient. Telling the patient that this is common and will subside by itself after few days when you get adjusted to the Denture will even bring down the apprehension and fear in the patient which in turn helps in decreasing Salivation.
  2. Ill fitting Denture:  Check for any variations in denture fit by recalling the patient after 2-3 days after Insertion to check for any abnormalities like sharp edges, loose denture, speech, swallowing and many other factors which will be seen by the Dentist and required corrections will be done. If the dentures are loose and falling down when you speak or eat you should visit your dentist and he/she will take your dentures and impression and do Relining Procedure to improve the fit.
  3. Ulcers on Gums below the Dentures: If you ever notice any burning sensation or the presence of Ulcers on the Gums under your Denture stop wearing the Dentures take your Dentists Appointment immediately, this might be due to excess pressure or any sharp edges on the dentures tissue surface which can also be a cause of Increased Salivation.  Your Dentist will trim or smooth the rough surface and will prescribe a numbing gel to be used on the ulcer to help relieve pain and heal faster.
  4. Check for Underlying Medical Conditions: In some medical conditions Sialorrhea is a common symptom where the patient experiences excess salivation which is not related to the presence of Denture. The diseases in which we see hyper salivation are GERD, liver disease, rabies, oral infections and some medications like Clozapine, Pilocarpine, Ketamine etc. Try to sort the problem and refer to the General physician or ask the patient to visit the Doctor who prescribed the medicines and change accordingly.
  5. Eat Lozenges or Chewing Gums (Sugar Free): Chewing on Lozenges or Chewing Gum can help in swallowing the excess saliva being produced continuously. Your brain thinks of Denture as a Food or Foreign item and increases the Saliva production. By chewing Lozenges or Chewing Gum you will be swallowing the excess saliva un consciously as this will be preventing the saliva from pooling or drooping from corner of lips and you will not feel that excess Saliva production.
  6. Medicines for Hypersalivation: There is a certain class of drugs – Antimuscarinic agents which reduce saliva secretions such as – Amitriptyline, benzatropine, atropine,  trihexyphenidyl hydrochloride, hyoscine hydrobromide (Note: These drugs should be taken under Doctor supervision only. Other medications such as Beta -Blockers can help in decreasing Saliva production. Botulinum Toxin A is also known to decrease saliva production on injecting the solution into the Salivary Glands. Other medications such as 1% atropine solution sublingually twice daily has also helped in decreasing sublingual glands hypersalivation.
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