Nighttime Blood in Saliva: Causes and Solutions

My mother is vomiting blood at night?

Dear Dr.
Lin,
My mother often feels an excessive amount of saliva while sleeping at night, and once she even vomited and found blood in it, which made us very anxious about what to do.
Later, we went to the hospital for examinations, including a laryngoscopy (which left her with a hoarse voice and persistent coughing), a CT scan of her neck, and a dental check-up, but everything appeared normal.
However, she still cannot sleep at night due to the large amount of bloody saliva in her mouth.
Could you please advise us on what might be causing this and what further treatments or examinations we should pursue?
P.S.
During the day, my mother has been drinking water continuously, so we are unsure if this issue occurs during the daytime as well.
Thank you for your attention.
Wishing you peace and good health!
Sincerely, May

mei, 20~29 year old female. Ask Date: 2002/05/21

Dr. Lin Mingxing reply Family Medicine

Dr.
Lin Ming-Hsing from the Tainan Hospital of the Department of Health, Executive Yuan, responded: Based on your description, your mother was evaluated in the hospital for otolaryngology and dentistry, which is an important assessment, and the examination results showed no significant abnormalities.
I recommend the following: 1.
Chest X-ray 2.
Sputum or "hemoptysis" bacterial or cellular culture 3.
Family history of lung cancer or other cancers 4.
Any severe cardiovascular or pulmonary issues, such as cardiopulmonary disease, heart failure, or chronic lung disease.
Therefore, it would be advisable to consult a pulmonologist or a family medicine specialist regarding the aforementioned recommendations.

Reply Date: 2002/05/21

More Info

Nighttime blood in saliva can be a concerning symptom, especially when it occurs frequently, as in the case of your mother. It's understandable that you and your family are worried about this situation. While you've already taken the right steps by seeking medical attention and undergoing various examinations, it's important to explore potential causes and solutions further.

Possible Causes
1. Gum Disease: One of the most common causes of blood in saliva is gum disease (gingivitis or periodontitis). If the gums are inflamed or infected, they can bleed, especially when lying down or during sleep when saliva production changes.

2. Dry Mouth: A condition known as xerostomia, or dry mouth, can lead to irritation and bleeding of the oral tissues. This can be exacerbated by medications, dehydration, or breathing through the mouth during sleep.

3. Respiratory Issues: Conditions affecting the respiratory tract, such as chronic bronchitis or even a sinus infection, can lead to blood being coughed up and mixed with saliva. If your mother has any underlying respiratory issues, this could be a contributing factor.

4. Esophageal or Gastric Issues: Sometimes, bleeding can originate from the esophagus or stomach, especially if there are ulcers or other gastrointestinal issues. This blood can then be coughed up or mixed with saliva.

5. Blood Disorders: Conditions that affect blood clotting or platelet function can lead to increased bleeding. If your mother has a history of such conditions, this could be a significant factor.

6. Cancer: Although less common, malignancies in the oral cavity, throat, or lungs can also present with blood in saliva. Given that previous examinations did not reveal any abnormalities, this may be less likely, but it should not be entirely ruled out.

Recommended Actions
1. Follow-Up with a Specialist: If the initial examinations did not yield results, it may be beneficial to consult with an ear, nose, and throat (ENT) specialist. They can conduct a thorough examination of the throat and nasal passages to identify any potential sources of bleeding.

2. Dental Evaluation: A comprehensive dental evaluation is crucial. A dentist can assess for gum disease, cavities, or other oral health issues that may be contributing to the bleeding.

3. Hydration and Humidification: Encourage your mother to stay well-hydrated throughout the day. Using a humidifier in her bedroom can help alleviate dry mouth and throat irritation during the night.

4. Monitor Symptoms: Keep a diary of when the bleeding occurs, its severity, and any accompanying symptoms. This information can be valuable for healthcare providers in diagnosing the issue.

5. Avoid Irritants: If your mother smokes or is exposed to secondhand smoke, this could exacerbate respiratory issues and lead to bleeding. Reducing exposure to irritants can help improve her overall health.

6. Consider Medication Review: If your mother is on any medications, particularly blood thinners or those that cause dry mouth, discuss these with her healthcare provider to see if adjustments can be made.

Conclusion
While the presence of blood in saliva can be alarming, understanding the potential causes and taking appropriate steps can help manage the situation. It’s essential to continue working closely with healthcare professionals to identify the underlying issue and develop a treatment plan tailored to your mother's needs. Encourage her to maintain good oral hygiene, stay hydrated, and seek further evaluations as necessary. Your proactive approach in seeking answers and support is commendable, and I wish you and your mother the best in finding a resolution to this troubling symptom.

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