Intervention | Advantages | Disadvantages | Common side effects/cautions | Notes |
Non-pharmacological interventions | ||||
Behavioural interventions, oral motor therapy and oral appliances288 | Non-invasive. | Intensive. Requires careful patient selection. Weak evidence base for benefit.289 | Contraindicated in posterior drooling.290 |
Medication | ||||
Hyoscine transdermal patch | Patch change every 72 hours. Shown to be equally as efficacious as glycopyrronium in treating sialorrhoea in CYP with CP.291 | Dose titration challenging. Local skin irritation. | Overly dry mouth, blurred vision, constipation, urinary retention, skin flushing or dryness. | Anticholinergic medications reduce saliva production either through direct or systemic route. Recommended as first-line therapy for sialorrhoea in CYP and adults.290 292 Can cause thick, difficult to clear secretions or mucous plugging resulting in CAP. |
Glycopyrronium liquid | Dose titration. Side effects less frequent than with hyoscine hydrobromide.291 | Typical dosing schedule three times per day. | ||
Inhaled ipratropium bromide | Can be a useful adjunct to other medications listed. Less systemic absorption. | Facemask and spacer may be poorly tolerated. Efficacy evidence base lacking. | ||
Atropine | Can be administered sublingually as drops. No reliance on gut absorption.293 | Typical dosing 3–4 times per day. Difficult to deliver accurate dosing. | ||
Salivary gland botulinum A toxin injection | Often done under local anaesthetic with ultrasound guidance.294 295 Can be repeated every 3–6 months | Invasive. Repeated injections likely to be required. | Trauma at injection site, EDS difficulties, dry mouth. | Cohort study evidence of reduced incidence of pneumonia following injection in CYP with neurological impairment.296 297 |
Surgical | ||||
Salivary gland duct ligation | Results in the atrophy in salivary glands and subsequent reduction in saliva production.298 | Invasive. Irreversible. Requires general anaesthetic. | Salivary gland stones. | Some cohort study evidence of reduced incidence of CAP and hospitalisations in CYP with neurological impairment.299 300 |
Salivary gland excision | Highly effective.298 | Invasive. Irreversible. Requires general anaesthetic. | External scarring. Dry mouth. Facial and hypoglossal nerve damage. |
CAP, community-acquired pneumonia; CP, cerebral palsy; CYP, children and young people; EDS, eating, drinking and swallowing.