Symptom Finder - Ptyalism
PTYALISM
The mnemonic MINT will facilitate the recall of the most important causes of ptyalism.
M—Malformation would prompt the recall of congenital esophageal atresia.
I—Inflammation ought to suggest herpes simplex, aphthous stomatitis, and peritonsillar abscess. Syphilis and tuberculosis rarely cause ptyalism.
N—Neurologic disorders that cause ptyalism include bulbar palsy (as in amyotrophic lateral sclerosis and poliomyelitis) and pseudobulbar palsy (as in multiple sclerosis and brain stem gliomas). They should also suggest myasthenia gravis, Parkinsonism, and ptyalism associated with dementia.
T—Toxic disorders that cause ptyalism include iodine medications, mercury poisoning, pilocarpine, and other parasympathomimetic drugs.
Approach to the Diagnosis
The most important thing to do is look for ulcerations or other abnormalities of the mouth and oropharynx. Dental cares and gingivitis may cause ptyalism as may an ill-fitted dental plate. If local conditions can be excluded, a thorough neurologic examination should be done to rule out bulbar and pseudobulbar palsy. A Tensilon test or serum acetylcholine receptor antibody titer can be done to exclude myasthenia gravis. The busy physician will want to consult a neurologist to do this. Although a CT scan or MRI may be needed, a neurologic consult is more cost-effective. Do not hesitate to consult a dentist or oral surgeon if the diagnosis is in doubt.
The mnemonic MINT will facilitate the recall of the most important causes of ptyalism.
M—Malformation would prompt the recall of congenital esophageal atresia.
I—Inflammation ought to suggest herpes simplex, aphthous stomatitis, and peritonsillar abscess. Syphilis and tuberculosis rarely cause ptyalism.
N—Neurologic disorders that cause ptyalism include bulbar palsy (as in amyotrophic lateral sclerosis and poliomyelitis) and pseudobulbar palsy (as in multiple sclerosis and brain stem gliomas). They should also suggest myasthenia gravis, Parkinsonism, and ptyalism associated with dementia.
T—Toxic disorders that cause ptyalism include iodine medications, mercury poisoning, pilocarpine, and other parasympathomimetic drugs.
Approach to the Diagnosis
The most important thing to do is look for ulcerations or other abnormalities of the mouth and oropharynx. Dental cares and gingivitis may cause ptyalism as may an ill-fitted dental plate. If local conditions can be excluded, a thorough neurologic examination should be done to rule out bulbar and pseudobulbar palsy. A Tensilon test or serum acetylcholine receptor antibody titer can be done to exclude myasthenia gravis. The busy physician will want to consult a neurologist to do this. Although a CT scan or MRI may be needed, a neurologic consult is more cost-effective. Do not hesitate to consult a dentist or oral surgeon if the diagnosis is in doubt.
