Is Parkinson's Disease to Blame for Excessive Drooling?

If you have Parkinson's disease and drool, you are not alone

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If you have Parkinson's disease and you drool, you are not alone. Surveys show that drooling can affect up to 78 percent of people with Parkinson's.

It's not entirely clear why Parkinson's disease can cause you to drool, but the condition can affect your ability to swallow, making drool more likely. Researchers studying this issue, have found that people with Parkinson's don't produce any more saliva than other people.

In fact, Parkinson's may cause you to produce less saliva. Chances are you just don't swallow your saliva as much, most likely because you have difficulty swallowing.

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

Treating Excessive Drooling

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

Your doctor may prescribe you potent drugs known as anticholinergics, such as Artane (trihexyphenidyl hydrochloride) and Cogentin (benztropine mesylate) in an attempt to dry up any excess saliva you may have. Unfortunately, this class of drugs often causes side effects, including constipation, urinary retention, memory impairment, confusion, and even hallucinations, particularly in elderly individuals.

While they can help control drooling, they aren't always effective.

Another way you can prevent drool, as strange as it sounds, is to use prescription eye drops under your tongue. You'll want to use the eye doctors use to dilate your pupils before an eye exam: 1 percent atropine ophthalmic solution, which you'll need a prescription to obtain.

Once you have the drops, you would place several drops under your tongue twice daily, allowing the active drug—atropine—to slow your saliva production.

Botox for Excessive Drooling

Injections of Botox—botulinum toxin A—directly into your salivary glands have also been used to try to stop excessive saliva in Parkinson's disease. Although botox works for many people, the treatment carries a risk of side effects including too-dry of a mouth. Botox injections in this area can also make it difficult to swallow 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. Neurologists, pain management doctors, and physiatrists are healthcare providers with experience using botox for neurological causes. Most dermatologists use botox in their practices as well, but it is often more for cosmetic reasons.

Botox injections can also be pricey. Many insurance companies cover botox or part of the cost, but they do not cover all uses of botox.

Off-label uses are generally not covered. When botox is covered for Parkinson's it is typically for dystonia, involuntary muscle contractions. You'll want to check with your insurance company to see if they cover botox for excessive drooling related to Parkinson's. 

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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