Differential Diagnosis: Ptyalism & Pseudoptyalism

Following are differential diagnoses for patients presented with ptyalism/pseudoptyalism.*

• GI condition

  • Abdominal pain (eg, from visceral stretching)

  • Disease associated with nausea

  • Esophageal disease (eg, reflux esophagitis, megaesophagus, foreign body, neoplasia, stricture, spirocercosis)

  • Gastric dilatation volvulus

  • Gastric ulceration

  • Hepatic failure (eg, hepatic encephalopathy), particularly in cats

  • Hiatal hernia

  • Renal failure

• Idiopathic or nonresponsive condition

• Neurologic condition

  • Facial nerve paralysis

  • Idiopathic trigeminal neuritis

  • Infectious disease (eg, rabies,^† pseudorabies, tetanus, botulism)

  • Lesions of cranial nerves IX, X, or XII

  • Myasthenia gravis

  • Nausea from vestibular disease

  • Seizures

• Oral cavity or maxillofacial cause

  • Craniomandibular osteopathy

  • Faucitis

  • Foreign body

  • Immune-mediated disease (eg, masticatory muscle myositis, pemphigus)

  • Lip fold abnormalities

  • Mandibular fracture

  • Oropharyngeal neoplasia (eg, tonsillar squamous cell carcinoma)

  • Oropharyngeal trauma (eg, laceration)

  • Periodontal disease

  • Stomatitis (eg, calicivirus, herpesvirus, FeLV/FIV, caustic agent, electrical burn, ulceration secondary to systemic disease [eg, uremia])

  • Temporomandibular joint luxation or fracture

  • Tongue lesion (eg, linear foreign body), glossitis (eg, uremia, caustic agent, electrical burn), or tumor

• Physiologic reaction

  • Excitement

  • Hyperthermia

  • Purring

  • Response to feeding

• Reaction to medication

  • Anesthesia

  • Avermectins (eg, ivermectin, moxidectin/imidacloprid, selamectin) given topically or PO

  • Bitter drugs

  • Cholinergic drugs (eg, bethanechol), anticholinesterase drugs (eg, pyridostigmine), cholinesterase inhibitors (eg, organophosphates)

  • Pancreatic enzyme supplements

  • Pyrethrins/pyrethroids

• Salivary gland condition

  • Foreign body

  • Salivary gland neoplasia

  • Salivary mucocele

  • Sialadenitis or necrotizing sialometaplasia (ie, inflammation of the salivary glands)

  • Sialadenosis (idiopathic, noninflammatory salivary gland enlargement)

    • May be a form of limbic epilepsy 

  • Sialolithiasis

• Sepsis

• Toxicosis

  • 5-hydroxytryptophan (ie, Griffonia seed extract)

  • Bite from a venomous animal (eg, black widow spider, scorpion, toad [Bufo spp], coral snake, sea hare [Aplysia spp])

  • Household cleaner 

  • Human sleep aid (eg, zolpidem)

  • Human tricyclic antidepressant (eg, clozapine)

  • Illicit drug (eg, cocaine, amphetamine)

  • Insecticide/pesticide (eg, boric acid, aldicarb)

  • Metaldehyde

  • Mushroom (eg, Amanita muscaria)

  • Plant/tree (eg, Kentucky coffee tree, poinsettia)

  • Rodenticide (eg, zinc phosphide)

*Differentiating between ptyalism and pseudoptyalism can be challenging; some conditions (eg, oropharyngeal and CNS diseases) can result in both increased salivary production and the inability to swallow.

^†Rabies should always be considered in patients presented with drooling.