Compass is still being developed and is effectively in beta. Some content and features may be incomplete, change, or not work as expected.

Content is anchored to trusted sources where available, but Compass has not yet been clinically reviewed. It provides general information rather than medical advice.

Feedback helps us identify gaps, errors, usability problems and opportunities to improve Compass over time.

How Compass is developedGive feedback

Speech, saliva and swallowing

Pooling or drooling saliva

Saliva collecting in the mouth or escaping it, usually because swallowing has weakened rather than because more is being made.

The clinical word for this is .

Still being checked

What this is

For most people this is not about making more saliva than before. Swallowing has become less efficient, so saliva that used to be cleared without thinking now sits in the mouth or spills. That is why it often shows up alongside changes in speech or swallowing. Both practical measures and medicines are used, and a team usually starts with the practical ones.

What people often describe

  • Saliva collecting at the front of the mouth, or running out at the corner
  • Needing a tissue or a cloth to hand at all times
  • It being worse when tired, when leaning forward, or when concentrating on something else
  • Feeling self-conscious about it in company

Important distinctions

  • These are different problems and the approaches pull in opposite directions. Medicines that dry saliva are used here, so a team aims for a balance rather than for the driest mouth possible.

  • Saliva that is hard to clear and food or drink that is hard to swallow often travel together, because both depend on the same muscles. They are assessed together and managed separately.

What may help

This page lists options that are used for this problem and says where each one comes from. It is not a ranking, it is not a recommendation, and it is not personalised to you. What suits you is a decision for you and your care team.

Practical and self-management

Things people do themselves, or with whoever is helping them.

  • Positioning

    Posture and positioning are among the first measures NICE tells a team to give advice about for drooling. The recommendation is to give the advice; it does not say how much difference it makes.

    Highlighted: shows the sources for this statement

    Discuss with

    Compass explains

  • Mouth care

    Keeping the mouth clean and comfortable is part of the standard first approach, alongside posture and positioning.

    Highlighted: shows the sources for this statement

    Discuss with

    Compass explains

Allied health

What a therapist can assess, teach or adjust.

  • Speech pathology review

    A speech pathologist assesses how you are swallowing and what the saliva is like, which is the assessment NICE asks for when saliva becomes a problem.

    Highlighted: shows the sources for this statement

    Discuss with

    Compass explains

Medicines

Named here only where a guideline names them for this problem.

A medicine is named here only where a published guideline names it for this problem, and the guideline's own words are shown beside it. Compass does not advise on doses, and does not say which medicine is right for anyone.

  • An antimuscarinic medicine

    A group of medicines that reduce how much saliva the body makes. NICE names this group as the first medicine to try for drooling in ALS/MND. Which one suits you, and whether any does, is a decision for your clinician.

    Highlighted: shows the sources for this statement
    • These medicines have side effects that have to be weighed against the benefit, and they are not right for everyone.
    • Drying saliva and thick secretions pull against each other. When saliva has turned thick, NICE tells a team to review these medicines first. Your team balances the two and may adjust over time.

    Discuss with

    Compass explains

  • Glycopyrronium bromide

    One medicine from that group is named specifically by NICE as a first choice for people who have changes in thinking or memory. The guideline gives its reason as fewer central nervous system side effects. Whether it suits you is a clinical decision.

    Highlighted: shows the sources for this statement
    • You may also see this medicine written as glycopyrrolate. The two names refer to the same medicine, and which one appears on a box varies.

    Discuss with

    Compass explains

Equipment

Devices and physical aids.

  • Suction

    A small device that clears saliva from the mouth when needed. Some people use one occasionally, others keep it to hand.

    Highlighted: shows the sources for this statement

    Discuss with

    Compass explains

Procedures

Things done in a clinical setting, usually after a referral.

  • Botulinum toxin injections

    Injections into the saliva glands, given by a specialist service. NICE names botulinum toxin A, reached by referral, at first or second line. The research evidence is not the same for the two types of botulinum toxin.

    Highlighted: shows the sources for this statement

    Discuss with

    Compass explains

  • Radiotherapy to the saliva glands

    Radiotherapy to the saliva glands is used occasionally, in specific situations, and is not a routine option.

    Highlighted: shows the sources for this statement

    Discuss with

    Compass explains

When to get this looked at sooner

Saliva that is not cleared can be breathed in, and a chest infection is one of the reversible causes of worsening breathing that guidelines tell teams to treat first. If you develop a fever, more phlegm, a cough that has changed, or you feel more breathless, see a doctor as soon as possible.

Highlighted: shows the sources for this statement

Who may help

Where Compass explains this

Questions

Cards

Other problems

Words explained

About this page

This page lists options that are used for this problem and says where each one comes from. It is not a ranking, it is not a recommendation, and it is not personalised to you. What suits you is a decision for you and your care team.

Evidence for this page

The sources behind the statements on this page, and where to find them. Compass does not decide which option is right for anyone.

  1. Statement 1 of 9. Posture and positioning are among the first measures NICE tells a team to give advice about for drooling. The recommendation is to give the advice; it does not say how much difference it makes.

    • Supports this. NICE MND guideline — NICE · Clinical guideline

      NICE puts practical measures first for drooling, and names posture and positioning among them alongside advice on swallowing, diet, oral care and suctioning.

      “If a person with MND has problems with drooling of saliva (sialorrhoea), provide advice on swallowing, diet, posture, positioning, oral care and suctioning.”

      1.8.11

      Link checked August 2026

  2. Statement 2 of 9. Keeping the mouth clean and comfortable is part of the standard first approach, alongside posture and positioning.

    • Supports this. NICE MND guideline — NICE · Clinical guideline

      Oral care is one of the measures NICE names for drooling, before any medicine is considered.

      “If a person with MND has problems with drooling of saliva (sialorrhoea), provide advice on swallowing, diet, posture, positioning, oral care and suctioning.”

      1.8.11

      Link checked August 2026

  3. Statement 3 of 9. A speech pathologist assesses how you are swallowing and what the saliva is like, which is the assessment NICE asks for when saliva becomes a problem.

    • Supports this. NICE MND guideline — NICE · Clinical guideline

      NICE advises assessing the volume and thickness of the saliva alongside breathing, swallowing, diet, posture and oral care, which is the assessment a speech pathologist leads.

      “If a person with MND has problems with saliva, assess the volume and viscosity of the saliva and the person's respiratory function, swallowing, diet, posture and oral care.”

      1.8.10

      Link checked August 2026

  4. Statement 4 of 9. A group of medicines that reduce how much saliva the body makes. NICE names this group as the first medicine to try for drooling in ALS/MND. Which one suits you, and whether any does, is a decision for your clinician.

    • Supports this. NICE MND guideline — NICE · Clinical guideline

      NICE recommends trying a medicine from the antimuscarinic group first when practical measures are not enough.

      “Consider a trial of an antimuscarinic medicine as a first-line treatment for sialorrhoea in people with MND.”

      1.8.12

      Link checked August 2026

    • Qualifies this. Saliva management in MND — MND Australia · Organisation · June 2021

      These medicines have side effects that have to be weighed against the benefit, and they are not right for everyone.

      “Currently, there are a number of drugs that may be, at least partially, beneficial, but side effects need to be considered.”

      Pharmacological management:

      Link checked August 2026

    • Qualifies this. NICE MND guideline — NICE · Clinical guideline

      Drying saliva and thick secretions pull against each other. When saliva has turned thick, NICE tells a team to review these medicines first. Your team balances the two and may adjust over time.

      “If a person with MND has thick, tenacious saliva: review all current medicines, especially any treatments for sialorrhoea”

      1.8.15

      Link checked August 2026

  5. Statement 5 of 9. One medicine from that group is named specifically by NICE as a first choice for people who have changes in thinking or memory. The guideline gives its reason as fewer central nervous system side effects. Whether it suits you is a clinical decision.

    • Supports this. NICE MND guideline — NICE · Clinical guideline

      NICE names this medicine specifically as a first choice where cognitive impairment is present, on the grounds that it has fewer central nervous system side effects.

      “Consider glycopyrronium bromide as a first-line treatment for sialorrhoea in people with MND who have cognitive impairment, because it has fewer central nervous system side effects.”

      1.8.13

      Link checked August 2026

  6. Statement 6 of 9. A small device that clears saliva from the mouth when needed. Some people use one occasionally, others keep it to hand.

    • Supports this. NICE MND guideline — NICE · Clinical guideline

      Suctioning is one of the measures NICE names for drooling, alongside advice on swallowing, diet, posture, positioning and oral care.

      “If a person with MND has problems with drooling of saliva (sialorrhoea), provide advice on swallowing, diet, posture, positioning, oral care and suctioning.”

      1.8.11

      Link checked August 2026

  7. Statement 7 of 9. Injections into the saliva glands, given by a specialist service. NICE names botulinum toxin A, reached by referral, at first or second line. The research evidence is not the same for the two types of botulinum toxin.

    • Supports this. NICE MND guideline — NICE · Clinical guideline

      NICE names botulinum toxin A as an option reached by referral to a specialist service, at first or second line.

      “Consider referral to a specialist service for botulinum toxin A for first- or second-line treatment.”

      1.8.14

      Link checked August 2026

  8. Statement 8 of 9. Radiotherapy to the saliva glands is used occasionally, in specific situations, and is not a routine option.

    • Supports this. Saliva management in MND — MND Australia · Organisation · June 2021

      An Australian review lists irradiating the salivary glands among the more invasive approaches used for drooling.

      “Sialorrhoea treatments include suction, drug treatments and more invasive approaches, such as injection of botulinum toxin or irradiating the salivary glands, which may improve sialorrhoea and QoL.”

      Pharmacological management:

      Link checked August 2026

  9. Statement 9 of 9. Saliva that is not cleared can be breathed in, and a chest infection is one of the reversible causes of worsening breathing that guidelines tell teams to treat first. If you develop a fever, more phlegm, a cough that has changed, or you feel more breathless, see a doctor as soon as possible.

    • Supports this. NICE MND guideline — NICE · Clinical guideline

      Republished from the Compass answer "When should I raise saliva problems with my team?", where this statement is already mapped to this source.

      “Treat people with MND and worsening respiratory impairment for reversible causes (for example, respiratory tract infections or secretion problems) before considering other treatments.”

      1.13.1

      Link checked August 2026