Excessive salivation in pregnancy: Ptyalism

She kept spitting saliva into a plastic cup almost every 10 to 15 minutes with occasional belching. “Doc, I feel so miserable that I keep spitting the excess saliva. If I don’t spit it out, I feel choked in my throat, If I swallow it, I feel very nauseated. Is there any solution?”

T, 30, a first-time mum, was 8 weeks pregnant. She had morning sickness earlier on which was aggravated by the excessive production of saliva a week ago. T was suffering from ptyalism, a rare condition in which there is increased salivation during pregnancy.

Ptyalism in Pregnancy Ptyalism is an uncommon condition in pregnancy. The incidence varies significantly worldwide, from 0.08% of pregnancies , reported in the United States, to up to 0.3%, reported in Japan. Cause of Ptyalism Ptyalism usually occurs in women who are suffering from severe morning sickness called hyperemesis gravidarum.

The exact cause remains unclear. It is speculated that changes in various pregnancy hormones may play a role. Some researchers believe there may be a psychological component as ptyalism is more common in psychotic women.

Also, women who feel nauseous tend to swallow less, which allows saliva to build up in the mouth. The frequent vomiting may stimulate the salivary glands to produce more saliva to protect the irritation by the gastric juice on the mouth and throat. Symptoms of Ptyalism

Symptoms include · Massive saliva volumes (up to 2 litre per day) · Swollen salivary glands · Sleep deprivation · Emotional distress · Social embarrassment Ptyalism usually resolves during the second trimester. But in some cases, it persists throughout the pregnancy. Treatment of Ptyalism There is no definitive treatment for ptyalism. Treatment modalities ranging from medications, hypnosis to dietary and lifestyle changes have not been successful. However, the following strategies aimed at helping patients swallow might help. These include: · Eating frequent small meals · Avoiding starchy foods · Frequent sips of water · Maintain good oral hygiene

I reassured T that this disorder did not have any negative impact on the development of the baby and the obstetric outcome. She was able to cope with the inconvenience of frequent spitting as the pregnancy progressed. Fortunately, the symptoms stopped at 30 weeks and she delivered a healthy baby boy at term.

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