Drooling

Daughter using napkin to wipe drool from her mom's face

Excessive drooling, called sialorrhea, is a common symptom of Parkinson’s disease (PD) and can cause awkwardness in social situations. It ranges from mild wetting of the pillow during sleep to embarrassing outpourings of saliva during unguarded moments. For example, this can happen when the head is down, the mouth is held open involuntarily (as happens when PD advances) or when a person is engaged in an activity and is distracted from the need to swallow automatically.

Drooling, along with speech and swallowing difficulties, is included among non-movement symptoms even though the root cause is motor: decreased coordination, slowness of movement (bradykinesia) and rigidity of the muscles of the mouth and throat.

Parkinson’s causes a reduction in automatic actions, including swallowing, creating an inability to manage the flow of saliva in and around the mouth. In PD, usually the amount of saliva your body produces is normal, but swallowing issues – swallowing less often or not completely – lead to saliva pooling in the mouth.

When severe, drooling is an indicator of more serious difficulty with swallowing (also known as dysphagia), which can cause the person to choke on food and liquids and can even lead to aspiration pneumonia.

MY PD STORY: Deanne Delehanty

"At age 72 we were going strong ― no need for pills, no restrictions to our diet. We were healthy and happy. So it was difficult to realize when that no longer was true for Gary. It all started with drooling. It didn’t make sense and the doctor did not see it as a symptom."

READ Deanne's STORY

Managing Drooling

If you are having problems with drooling, you might consider an appointment with a speech-language pathologist. These professionals can perform a swallow test to diagnose any difficulties and can also give you some strategies to help with drooling.

One trick is to suck on hard candy or chew gum, preferably sugarless. Candy and gum activate the jaw and the automatic swallowing reflex and can help clear saliva, providing temporary relief from drooling.

Another tactic is to wear a sweatband on your wrist. This can be used to discretely wipe the mouth as necessary and is a relatively inconspicuous accessory.

If these lifestyle strategies are not effective, adjusting anti-PD medications may make it easier to swallow. There are also some other prescription medication options:

Glycopyrrolate and other oral anticholinergic medications (trihexyphenidyl, benztropine and hyoscyamine – medicines that can ease involuntary PD muscle movements and tremor). As a class, oral anticholinergic medications decrease saliva production. Usually this is perceived as a side effect (dry mouth), but in this case it is an advantage. Other anticholinergic side effects may be seen, including drowsiness, confusion, vomiting, dizziness, blurred vision, constipation, flushing, headache and urinary retention. Anticholinergics can also have mental side effects, so their use should be carefully considered.
Botulinum toxin injections are another option for treating excess saliva and drooling. Incobotulinum toxin A (Xeomin) and rimabotulinum toxin B (Myobloc) are FDA-approved for excess saliva and drooling. Onabotulinum toxin A (Botox) and abobotulinum toxin A (Dysport) are used off-label (not FDA approved for a specific condition) to decrease saliva production.

An injection of botulinum toxin into the salivary glands in the cheek and jaw area can decrease saliva production with minimal side effects. Potential side effects include dry mouth, difficulty swallowing and weakness of the muscles in the jaw area. The benefit of botulinum toxin injections can last up to three months (or longer in some cases) before repeat injections are needed. Although botulinum toxin can be effective for drooling, it is costly, so doctors may recommend other treatments first.