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Many patients face problems while eating, swallowing, and controlling their saliva. This blog is focused on the problem of excessive drooling.<br><br>Parkinsonu2019s disease is a progressive disorder of the nervous system that affects movement. It is estimated that 10 million people have Parkinsonu2019s disease worldwide, affecting all races and cultures. In India there are an estimated 1 Million people who suffer from Parkinsonu2019s.
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Background: Most people associate Parkinson’s disease with problems in mobility. However, PD creates results in many other symptoms, which cause problems as well as embarrassment for the patients. Many patients face problems while eating, swallowing, and controlling their saliva. This blog is focused on the problem of excessive drooling.
What is Drooling When we eat food, our mouth secrets a liquid. This liquid, called Saliva plays an important role in the digestion process. This saliva contains chemicals, which break down food and also lubricates the throat to make swallowing easier. However, many patients suffering from Parkinson’s face problem controlling their saliva that can lead to saliva coming out of their mouth involuntary? This condition is called drooling or dribbling. The medical term for drooling is “Sialorrhea”. Though not a medical problem, it creates an embarrassing situation for the patient. The problem ranges from mild wetting of the pillow during sleep to excessive outpours of saliva when the patient is involved in something and is distracted from the need to swallow the saliva. This may happen when the patient is sitting head down or when the mouth is held open involuntarily (as happens in an advanced stage of PD).
Causes of Drooling: Though not directly, but the root cause of Drooling is motor only. This is because Parkinson’s has an adverse effect on all our automatic actions, including basic actions like swallowing. The natural tendency to swallow gets slowed down in the case of a patient with PD. Our body produces a normal amount of saliva, but in the case of PD, since the patient swallows less, extra saliva gets collected in the mouth. The patient is not able to control the flow of saliva in and around the mouth. This excess saliva stored in the mouth can overflow from the corners of the mouth, which leads to drooling. Drooling happens mostly when the patient is mentally involved in some work like reading, watching TV, or doing daily work. Severe drooling is an indicator of more difficulty with swallowing. This condition is known as Dysphagia. This can cause the person to choke on food and liquids and can even lead to aspiration pneumonia.
Treatment of Drooling If a patient is facing the problem of excessive drooling, it might be a good idea to consult a speech-language pathologist. These people are experts in conducting a swallow test to diagnose any difficulties in swallowing and prescribe some strategies to help the patient to control drooling. These are not medicines, but simple tricks related to lifestyle through we can manage the drooling. One simple strategy to control drooling is to suck a hard candy or chew a piece of gum. These should preferably be sugarless. Sucking the hard candy or chewing gum helps activate the jaw muscles. The resulting swallowing reflex can help clear the saliva. This provides temporary relief from drooling. Another strategy to avoid embarrassment due to drooling is to wear a sweatband on your wrist. As and when drooling occurs, you may wipe your mouth, discretely, as a natural action. This is seen as a normal activity, and the patient is saved from embarrassment. In addition to these lifestyle strategies (or tricks), adjusting the anti PD medications may also help to swallow.
To support a patient manage drooling, there are some prescribed medications, which help a patient control drooling. The details regarding these medications are given below: • Use of anticholinergic medications: There are anticholinergic medications like Glycopyrrolate which decrease the production of saliva. In addition to this, there are some oral anticholinergic medications like trihexyphenidyl, benztropine, hycosamine as well. • Normally decrease in the saliva is seen as another side-effect of PD. But in this case, it works to our benefit. Though the use of these drugs has some other side effects like lack of concentration, drowsiness, vomiting, dizziness, blurred vision, constipation, flushing, headache, and urinary retention. Anticholinergic drugs are known to have some mental side effects, like hallucinations. So, all parameters should be considered before using them. • Scopolamine patch: This is a medicinal patch, which has to be placed on the hairless skin part of your body. Once applied, the patch releases anti-cholinergic medicine, which gets directly absorbed into the bloodstream. This slows the production of saliva in the mouth. This patch also has some side effects which are similar to eh usage of oral anticholinergic medications.
1% atropine eye drops: Though an eye-drop, but it works as an anti-cholinergic as well. 1-2 drops of Atropine eye drops are given as treatment under the tongue daily to reduce the production of saliva. The chances of any kind of systemic side-effects with local treatment is also much less. • Botulinum toxin A: Botulinum toxin is known to weaken the muscles. Botulinum toxin A, commonly known as Botox is sometimes used to decrease saliva production for people suffering from drooling. An injection of this drug directly into the salivary glands of the cheek and jaw decreases saliva production, and that too without any major side effects, except for thickening of oral mucus secretion. • Though not effective always, but when it works, its benefit lasts for several months, before requiring the next dose. Botox can prove to be a very effective treatment for patients with severe drooling. Though looking at the cost angle of treatment, it is advisable to first try using pills, patches, or mouth drops. This toxin should probably be avoided for patients, who already have deep and thick oral secretions.
Conclusion: Parkinson’s diseaseis a progressive disorder of the nervous system. There are many symptoms of the disease, which are related to mobility. However, there are some symptoms not related to mobility. Drooling is one of them. Though not a medical problem, it can become a cause of social embarrassment. Hence, it is important to control it. But trying to control saliva production may result in dry mouth, which another problem is related to Parkinson’s, hence proper care needs to be taken. There are several lifestyle techniques are medications available to manage the problem of drooling. If you want to stay updated with the latest blog on the recovery of Parkinson disease then follow: www.parkinsons.co.in
