Differential Diagnosis for Ptyalism

(excessive production of saliva, drooling, slobbering)

When the causes are not found, or the treatment does not stop the excessive drooling, local alopecia can develop, showing a raw inflamed skin. This condition is painful.

Secondary bacterial or fungal skin infection may develop.

Photo: courtesy of Kim Chilson

Rabbit Anna, suffering from several health problems including a runny eye that was not linked to dental problems, extraction of incisors.

Symptoms

Differential diagnosis

Ptyalism is differentiated between acute drooling or chronic drooling.

In each case, the cause of excessive production of saliva is different.

Acute ptyalism	Epiglottitis
	Neoplasia or presence of a tumor
	Presence of an abscess
	Pain

Chronic ptyalism	Neurologic trauma (e.g., stroke)
	Medication (analgesics, anticonvulsants, anticholinesterase)
	Obstruction in the nasal cavity (e.g., presence of polyps)
	Size of the tongue
	Position of the head
	Sitting or lying position
	Stress
	Diseases, e.g., rabies or tetanus

Further causes for ptyalism relate to tooth problems.

Bacterial causes	Tooth root abscess
	Inflammation of the tongue
	Cheek abscess

Oral or gastro-intestinal causes	Oral ulcerations
	Epulis, (tumor or growth on the gum)
	Stomatitis (inflammatory condition of the mouth, resulting from infection by bacteria, viruses, or fungi, from exposure to certain chemicals or drugs, from vitamin deficiency).
	Bloat, or an abnormal collection of gas in the stomach, or cecum. In this case the stomach feels swollen and the rabbit is in pain.
	Gastroesophageal reflux
	Gastric distension
	Acute gastritis (inflammation of the lining of the stomach), caused by surgery, aspirin or other drugs, by food allergens or by the presence of viral, bacterial, or chemical poisons.
	Pancreatitis (e.g., presence of gallstones, infection or medication)
	Digestive organ failure (e.g., liver disease)

Respiratory causes	Inflammation of the pharynx, bronchia and lungs (e.g., alveolar abscess)
	Pharyngitis (inflammation of the pharynx), where the compromise passage of air can lead to respiratory distress, and one symptom, among others is drooling.

Cardiovascular causes

Portosystemic shunts, a congenital or acquired vascular abnormalities that permit portal blood flow to bypass the liver and enter the systemic circulation directly. In small animal, this is characterized by drooling.

Food	Nutrient deficiency, e.g., folate deficiency, chronic fluorosis, subacute scurvy

Mechanical causes	Presence of a trapped foreign body between molars (e.g., hay, fur)
	Overgrowth of the crown of the tooth (e.g., presence of spikes)
	Malocclusion of the front teeth
	Odontoclastic lesions (small to large enamel defects right at the gum line)
	Broken tooth
	Broken maxillary bone
	Wounded or lacerated tongue and/or gums

Nervous causes	Stress
	Pain

Toxicity	Medication
	Toxins
	Poisoning

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