What causes excess saliva and drooling in ALS?
(Ashok Verma) In ALS, there is no problem with saliva production. Saliva production is normal; it’s the handling of saliva that is not normal. What do you mean by the handling of saliva? The saliva can’t be handled when there is weakness of the tongue and throat muscles. Drooling can be an early and significant symptom when ALS involves these muscles early, as in the bulbar type of ALS. It also depends to some extent on the anatomical structure in each person. For example, elderly patients with a small mandible [lower jawbone] and poor dental architecture may start drooling very early. Other people can handle the saliva better. How do we normally handle saliva? Saliva is normally secreted by three major pairs of salivary glands and numerous minor glands in the mouth cavity. Saliva is needed to moisten the mouth cavity and to help with swallowing and digesting food. It is poured in copiously (at about a fivefold increase) when we smell, taste, chew and swallow food. Some secretions also
