Too Much Saliva or Infrequent Swallowing?
Drooling, can be an embarrassing and annoying problem for individuals with a neurodegenerative disease, and a fairly common complaint I hear from patients with Parkinson’s disease (PD) is: “I have too much saliva.” Whether the problem is one of excessive saliva or impaired swallowing is not completely clear, but the impact of drooling on quality of life for patients is clear, and leaves some patients needing to constantly wipe their mouth, feeling embarrassed by saliva dripping onto their clothing, and/or experiencing vigorous coughing episodes from mis-directed saliva swallows.
Technically, drooling is defined as excessive pooling and poor control of saliva in the oral cavity that might be caused by impaired salivary clearance whereas sialorrhea refers to overflow or overproduction of saliva,[i] and in individuals with PD, both factors need to be addressed.
We normally swallow saliva all day long and rarely give much thought to its role in our body, but saliva has multiple essential functions in relation to the digestive process taking place in the upper parts of the gastrointestinal (GI) tract including: taste, chewing, bolus formation, swallowing, enzymatic digestion, and maintenance of tooth and mucosal integrity. Saliva is derived predominantly from three paired major salivary glands, the parotid, submandibular and sublingual glands, which together, account for about 90% of the fluid.[ii] The parotid and submandibular glands also become the target for Botox injections if this treatment is selected as a means of managing sialorrhea.
Lewy body type pathology has been found in the nerves that regulate salivary function, and this, along with autonomic nervous system dysfunction, which is common in Parkinson’s disease, may lead to increased production of saliva. When paired with stooped posture, reduced tongue co-ordination, and reduced oral-pharyngeal sensation, the result is often drooling.
Slower spontaneous swallow frequency rates have been reported in patients with Parkinson’s disease and changes in spontaneous or reflexive swallowing frequency have been suggested by swallowing researchers to be a sensitive index for dysphagia in at-risk populations.[iii] So, with both mechanical and neurological mechanisms at play, silent aspiration and laryngeal penetration of saliva are common features in Parkinson’s individuals.
So, you now see that drooling, in addition to being a nuisance, may very well indicate the presence of a swallowing problem that warrants further evaluation by a speech-language pathologist.
An inexpensive tennis wrist band can be more hygienic and acceptable than tissues or handkerchiefs for managing drooling. It may also serve as a visual cue to “swallow” saliva rather than wipe your mouth. Chewing gum can also be an effective way to reduce drooling, and in fact when recommending this over the last 25 years of practice, I have never yet had a patient that this didn’t help. While it might seem counterintuitive, chewing gum will increase the flow of saliva, and thereby increase the rate of swallowing.
Too Little Saliva? Dry Mouth or Xerostomia
We have probably all had an occasion of dry mouth, when very nervous, or when we have taken an over the counter cold medication. At those moment, we may find that we are sipping more water or chewing gum, but fortunately, for most of us, the moment passes in a day or so. And, while dry mouth may be a more commonly reported symptom in older adults due to medication effect, it is not a normal part of aging.
But, for many Xerostomia may be a lifelong condition associated with an underlying medical diagnosis such as scleroderma or following head-neck cancer treatment which included radiation. Unfortunately, radiation to the head-neck area destroys salivary glands and their production, and typically leaves people with severe dry mouth, making them prone to swallowing difficulties, dental disease, and reduced quality of life.
There are a variety of over the counter products which can provide some short-term relief from dry mouth, such as Biotene and also a few prescription medications. Gene therapy and other cutting edge research is also ongoing and holds promise for better options in the future. (Learn more: https://www.nidcr.nih.gov/news-events/nidcr-news/2023/turning-tap-back
Help Needed! Xerostomia Research
The NFOSD (National Foundation of Swallowing Disorders) is currently assisting a research team at Oklahoma State that is conducting xerostomia research. In order to receive their next round of funding, they need to collect 100 15-minute interviews from people who have, treat, or know about xerostomia (that can include you!).
Dr. Donna Bandy is leading this study, which includes gathering insights from healthcare providers, patients, caregivers, researchers, and industry professionals. Participation involves a brief, informal interview, and volunteers will be entered to win either a $100 or $50 Amazon gift card as a token of appreciation.
Click the link to enroll in the research:https://swallowingdisorderfoundation.com/xerostomia-research/
[i] Drooling in Parkinson’s Disease: a review Parkinsonism Relat Disord. 2014 November ; 20(11): 1109–1118. doi:10.1016/j.parkreldis.2014.08.013.
[ii] Saliva and gastrointestinal functions of taste, mastication, swallowing and digestion AM Pedersen, A Bardow, S Beier Jensen, B Nauntofte Oral Diseases (2002)
[iii] Validation and Demonstration of an Isolated Acoustic Recording Technique to Estimate Spontaneous Swallow Frequency Michael A. Crary • Livia Sura • Giselle Carnaby Dysphagia 2012
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My MissionTo enlist individuals in their treatment, and help them express their personality & spirit through voice. To educate and empower. Mary Spremulli, MA, CCC-SLP * FiTOUR® Group Exercise Instructor * Voice Aerobics® A Whole Body Approach to Voice Practice