 4 years of age with only mild or moderate amount of drooling which may improve spontaneously
- Oral motor training-oral motor training, intended to improve motor skills, is the key non-surgical management of modality and all patients ( if appropriate ) should have a minimum of 6 months of this type of therapy format, before any surgical management is considered.
- Biofeedback – Biofeedback utilizes conditioning techniques to train you to swallow more frequently. It has been utilized in aware patients with only a modest drolling problem and who have very motivated patients.
- Removal of local factors – situational factors may contribute to drooling should be eliminated if possible that is dental disease, nasal airway obstruction, poor seating and inappropriate medications.
- Drug therapy
- The anti-cholinergic drug , atropine sulfate, has been shown to reduce the amount of resting secretion, intraoral accumulation and pharyngeal-laryngeal pooling of the saliva in more than 50 % of the patients
- The drug is a competitive antagonist of muscarinic actions of acetylcholine. It does not prevent the release of acetylcholine but antagonizes the effect of this neurotransmitter on the effector cells. This action results in drying of the mouth through reduction of salivary gland secretions.
- Atropine-induced inhibition of salivation occurs within 30 minutes to an hour. Inhibition peaks within 2 hours after oral administration but can persist up to 4 hours
- The usual dose for adults is 0.4 mg , every 4-6 hours. In children, the suggested dose is 0.01 mg/kg but generally not exceeding 0.4 mg every 4-6 hours.
- Due to potential side effects, atropine sulfate is contraindicated in patients with asthma, glaucoma or synechia ( adhesions) between the iris and the lens of the eye
- Other drugs which are used as anti-sialogogue are scopolamine (0.4-0.6 mg), methantheline (50-100 mg) and propantheline (15-30 mg)
- Surgery is primary recommendation in individuals with a cognitive delay and profuse drooling and secondarily in those that have failed to non-surgical therapy for a minimum of 6 months.