Anterior Drooling Versus Posterior Drooling: A Comparative Analysis

To examine the patient population of a tertiary Interdisciplinary Saliva Control Clinic, describe management pathways and identify patients suitable for primary care.

Retrospective single-centre cohort study in a tertiary hospital reviewing patients referred to the Saliva Control Clinic over a 5-year period.

Of 361 referrals, 289 patients were seen. Age at referral ranged from 4 months to 18 years, 8 months (median 4 years, 9 months). Most referrals were from General Paediatricians (163, 58.2%). Severe neurological impairment was the most common primary diagnosis (106, 36.7%). Anterior drooling alone was present in 233 patients (83.5%), with 46 (16.5%) having posterior involvement. Prior to clinic, the most common prior intervention was medication (103, 36.1%). Many children, mostly typically developing, required no treatment (71, 24.6%). Common interventions were medications (138, 47.8%), saliva-specific surgery (74, 25.6%) and botulinum toxin (62, 21.5%). Saliva-specific surgery was more likely in patients with posterior drooling (31, 67.4%) than anterior alone (40, 17.2%).

Management of drooling depends on saliva flow and patient phenotype. Typically developing children usually require only reassurance. Anterior drooling in young children can be managed in primary care, while posterior drooling in children with neurodevelopmental disabilities should be prioritised for specialist care.