Drooling

10/03/2011

Drooling can be an embarrassing problem for some people with Parkinson’s disease. To those with the problem it can feel as if the mouth is producing too much saliva. The term “hypersalivation” used to describe the problem reinforces this notion.  However, drooling in Parkinson’s is not caused by excessive production of saliva. Ask for a referral to a Swallowing specialist if you have this problem- as drooling can be treated.

·         Drooling in Parkinson’s is not caused by over-active production of saliva but by poor saliva management, more specifically, infrequent and/or weak swallowing.

The medical term for this poor saliva management is sialorrhea.  Individuals without Parkinson’s sense when it is appropriate to swallow their own saliva and do so hundreds of times a day. However, individuals with Parkinson’s, may not process sensory information from the mouth efficiently, and so may not realize that they need to dry swallow to clear excess saliva. To compound the problem, individuals with Parkinson’s may also have a weak swallow that does not completely remove the excess saliva and leaves a residual quantity in the mouth and throat.  A flexed head position exacerbates the problem and the backup of saliva is leaked through the mouth (drooling).  If the saliva is not leaked through the mouth, it may build up in the throat increasing the risk for aspiration of the saliva.

·         Aspiration occurs when food, liquid, and saliva “go the wrong way” and enter the larynx and the trachea. Aspiration related complications include pneumonia.  Thus, sialorrhea is an important symptom that should not be overlooked because  up to 86% of Parkinson’s’ patients who drool also have more serious swallowing problems (Eadie and Tyrer 1965). Swallowing problems (dysphagia) can lead to malnutrition, dehydration, and, as mentioned earlier, complications such as pneumonia.

Management strategies for sialorrhea include the following:

·         Therapy with a Speech-Language Pathologist which may focus on improving head posture, lip closure, and increasing volitional dry swallows

·         Anticholinergienic medications may be used to reduce saliva production. These options include but are not limited to sublingual atropine drops, scopolamine patches, and ipratropium bromide. These medications have side effects and are not appropriate for all individuals (Chou, Evatt et al. 2007). Medication options should be discussed with a physician

·         Botulinum toxin (Botox) can be injected into the salivary glands to reduce saliva production. The injections must be administered by a physician experienced in the use of Botox and may not be appropriate for those with severe dysphagia. The effects of a Botox shot may last up to 6 months. Botox is an option for those who cannot take the anticholinergic medications. Muscle weakness is a risk of this therapy and this can result in difficulty chewing or swallowing- so this therapy is not for everyone.

·         In extreme cases, surgical removal of the salivary glands may be an option

Yumi Sumida, MFA,  MS CCC-SLP,  Speech Pathology Clinical Specialist