Drooling When You Have Parkinson's Disease

Saliva sample results being checked after adrenal stress profile testing. Credit: Medic Image / Getty Image

If you have Parkinson's disease, you probably drool. Unfortunately, surveys show that drooling — known by doctors as "excessive pooling and spillover of saliva from your mouth" — may affect 70% to 78% of people with the condition.

To counter the drooling, you have probably learned to carry around a handkerchief in your pocket so that you can periodically wipe up the spit that seems to regularly leak out of your mouth.

Men drool more than women and it appears to be more embarrassing for men than for women, but there's little question that drooling, in general, is embarrassing for anyone who experiences it. Here are the facts about drooling in Parkinson's disease, and what you may be able to do about it.

Why All the Excess Saliva in Parkinson's Disease?

It's not entirely clear why people with Parkinson's disease tend to drool, but a major reason is they just don't swallow as much as other people.

When researchers have studied the issue, they've found that Parkinson's patients don't produce any more saliva than other people — they actually tend to produce less. They just don't swallow it as much, most likely because they have trouble swallowing.

In addition to causing embarrassment, drooling can cause sores at the corners of your mouth, and may give you bad breath. You also accidentally can breathe in a large amount of excess saliva, which can lead to pneumonia.

So What Can Be Done?

There are several drug treatments available that can address the problem of excess saliva and drooling.

Potent drugs known as anticholinergics, such as Artane (generic name: trihexyphenidyl hydrochloride) and Cogentin (generic name: benztropine mesylate) are prescribed in an attempt to “dry up” the excess saliva.

But this class of drugs often causes side effects such as constipation, urinary retention, memory impairment, confusion, and even hallucinations, particularly in elderly individuals. They also don't always work to control the drooling.

Another possibility, strange as it sounds, is to use prescription eye drops under your tongue. The eye drops used for this purpose are the ones that eye doctors use to dilate your pupils before an eye exam: 1% atropine ophthalmic solution. You place these drops under your tongue twice daily, and the active drug — atropine — can slow your saliva production.

Injections of Botox — botulinum toxin A — directly into the saliva glands have also been used to try to stop excessive saliva in Parkinson's disease. Although this works for many people, the treatment carries a risk of side effects in the form of a too-dry mouth. People who have this procedure may also have trouble swallowing food.

The effects of the Botox only last for about three to four months, after which the procedure would need to be repeated.

If you're interested in trying this, make sure to look for a doctor experienced in this specific procedure, as serious side effects — weakening your neck muscles so that you have problems swallowing — are possible.

Sources:

Merello M. Sialorrhoea and drooling in patients with Parkinson's disease: epidemiology and management. Drugs & Aging. 25(12):1007-1019, 2008.

Rezak M. The Use of Botulinum Toxin (Botox) in Parkinson's Disease. American Parkinson Disease Association. Accessed Feb. 27, 2016.

Srivanitchapoom P et al. Drooling in Parkinson's disease: a review. Parkinsonism and Related Disorders. 2014 Nov;20(11):1109-18.

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