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 generally 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.
Salivary secretion is regulated by a complex reflex arch consisting of receptors and nerves which carry impulses from the mouth to a central connection (salivation center) in the brain which in turn, sends information to the salivary glands via the parasympathetic (rest and digest system) autonomic nerve bundles. The glossopharyngeal (CNIX) and vagus (CX) parasympathetic nerves innervate glands of the upper GI tract including the salivary glands. Lewy body type pathology has been found in these nerves, and this, along with autonomic nervous system dysfunction, which is common in Parkinson’s disease, may lead to increased production of saliva, and when paired with stooped posture, reduced tongue co-ordination, and reduced oral-pharyngeal sensation, results in 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.
[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)
[1] Validation and Demonstration of an Isolated Acoustic Recording Technique to Estimate Spontaneous Swallow Frequency Michael A. Crary • Livia Sura • Giselle Carnaby Dysphagia 2012
Parkinson’s disease and Swallowing Webinar June 25, 2019 7-8:30pm EDT
June is Dysphagia Awareness month, and next month, it will be my honor to provide a webinar sponsored by the National Foundation of Swallowing Disorders (NFOSD). NFOSD has a stated commitment: “to provide patient hope and improve quality of life for those suffering from all types of swallowing disorders. By enhancing direct patient support, education, research and raising public, professional and governmental awareness, our mission is to advance the prevention and treatment of swallowing disorders in our lifetime.”
You might be surprised to know that 80% of people with Parkinson’s experience dysphagia over the course of the disease, and like many symptoms of Parkinson’s, onset of a swallowing problem may be subtle and symptoms may be overlooked or under-reported by patients. As noted above, even drooling, which is bothersome for patients is not always recognized as a swallowing problem resulting in delayed referral to a speech-language pathologist.
A small, $10 registration fee will help to support the NFOSD mission. No one however will be turned away based on their ability to pay, and if needed, please use the promo code: MSPASS at the time of registration and the fee will be waived.
To register visit: https://voiceaerobicsdvd.com/featured-event/nfosd-webinar-parkinsons-disease-swallowing/
Breather +RMT Accessories kit
Visit my You Tube channel to watch an updated video learning how to measure and maintain your effort when using The Breather respiratory muscle training device. The RMT accessories kit is only $18 and adds the benefit of feedback to your training. Learn more: https://youtu.be/IyJCFvg48cs
Hi-VOLT® Shipping Update
Hi-VOLT® 4PD voice-on-light helps with daily speech practice
Due to the demand for the Hi-VOLT® voice-on-light, we sold out in April. A new order is on its way, but unfortunately got delayed at the manufacturer, who now assures us it will be ready for delivery in June. I appreciate everyone’s patience that placed an order and have extended the 10% off coupon until the end of June.
My Mission
To enlist individuals in their treatment, and help them express their personality & spirit through voice. To educate and empower.
Mary Spremulli, MA, CCC-SLP
Voice Aerobics the heART and Science of Voice Practice