CDM College Health Education Series

Drooling, also known as sialorrhoea, is a common but often overlooked symptom of Parkinson’s disease. It can affect confidence, communication, comfort, and quality of life. Fortunately, effective treatments and practical strategies are available to help manage this condition.

This guide explains why drooling occurs, what you can do at home, and when to seek medical advice.

---

What is Drooling?

Drooling is the unintentional loss of saliva from the mouth. Many people assume that Parkinson’s disease causes excessive saliva production, but this is usually not the case.

In most people with Parkinson’s disease, saliva production is normal. Instead, drooling occurs because swallowing becomes slower and less frequent, allowing saliva to collect in the mouth.

---

Why Does Parkinson’s Disease Cause Drooling?

Parkinson’s disease affects the muscles involved in swallowing and facial movement. Common contributing factors include:

• Reduced automatic swallowing
• Slower movement of the tongue and throat muscles
• Reduced lip closure
• Stooped posture with the head tilted forwards
• Difficulty clearing saliva from the mouth

Drooling is often more noticeable when relaxing, reading, watching television, or sleeping.

---

Common Symptoms

People with Parkinson’s disease may experience:

• Wet lips or chin
• Saliva dripping from the mouth
• Wet clothing or pillow
• Skin irritation around the mouth
• Difficulty speaking clearly
• Bad breath
• Social embarrassment
• Frequent swallowing or throat clearing

If saliva enters the airway, coughing, choking, or chest infections may occur.

---

Self-Management Strategies

Simple daily habits can significantly improve saliva control.

1. Improve Your Posture

Keeping your head upright helps saliva flow towards the throat rather than out of the mouth.

Try to:

• Sit up straight
• Keep your chin level
• Avoid prolonged forward head posture

---

2. Swallow More Frequently

Many people with Parkinson’s disease swallow less often without realising it.

Helpful reminders include:

• Swallow every few minutes
• Swallow before speaking
• Swallow before standing up
• Use phone reminders if needed

---

3. Practise Lip Closure

Strong lip muscles help keep saliva inside the mouth.

Exercise:

• Close your lips firmly together.
• Hold for 5 seconds.
• Relax.

Repeat 10 times, two to three times each day.

---

4. Facial Exercises

Gentle facial exercises may improve muscle control.

Examples include:

• Smiling widely
• Puffing out your cheeks
• Moving your tongue side to side
• Touching your tongue to each corner of the mouth

Repeat each exercise 10 times.

---

5. Stay Well Hydrated

Drinking adequate water throughout the day helps keep saliva thinner and easier to swallow.

Aim for regular fluid intake unless your doctor has advised otherwise.

---

6. Maintain Good Oral Hygiene

Good mouth care reduces the risk of infection and improves comfort.

Recommendations include:

• Brush teeth twice daily.
• Clean dentures regularly if worn.
• Attend routine dental check-ups.
• Keep lips moisturised if they become dry or cracked.

---

Speech Pathology Can Help

A speech pathologist can assess swallowing function and teach techniques to improve saliva control.

Treatment may include:

• Swallowing exercises
• Facial muscle exercises
• Safe eating and drinking strategies
• Advice for carers

Early referral can improve both swallowing and communication.

---

Medical Treatment Options

If drooling continues despite self-management, your doctor may recommend medication.

These medicines reduce saliva production but may cause side effects such as:

• Dry mouth
• Constipation
• Blurred vision
• Difficulty passing urine
• Confusion (particularly in older adults)

Medication should always be prescribed after discussing the benefits and risks with your healthcare provider.

---

Botulinum Toxin (Botox®) Injections

For moderate to severe drooling, injections of botulinum toxin into the salivary glands are an effective treatment.

Benefits include:

• Reduced saliva production
• Improved comfort
• Better quality of life
• Effects lasting approximately 3–4 months

The procedure is usually performed by a neurologist or another clinician experienced in the technique.

---

Lifestyle Tips

You may find the following helpful:

• Carry tissues or a small hand towel.
• Use absorbent clothing protectors if needed.
• Eat slowly and take small mouthfuls.
• Avoid talking while chewing.
• Sleep with your head slightly elevated.
• Review your Parkinson’s medications regularly with your doctor.

---

When Should You Seek Medical Advice?

Arrange an appointment with your healthcare provider if:

• Drooling is becoming more troublesome.
• You develop skin irritation around your mouth.
• Eating or drinking becomes difficult.
• You notice worsening swallowing.
• Drooling affects your confidence or daily activities.

Seek urgent medical attention if you experience:

• Frequent choking
• Food or drink entering the airway
• Persistent coughing during meals
• Fever with a productive cough
• Shortness of breath
• Recurrent chest infections

These symptoms may indicate aspiration and require prompt assessment.

---

Key Messages

• Drooling is common in Parkinson’s disease.
• Most people do not produce too much saliva—the problem is reduced swallowing.
• Daily swallowing exercises, improved posture, and speech pathology can make a significant difference.
• Effective medical treatments are available if symptoms persist.
• Early assessment can reduce complications and improve quality of life.

---

References

1. Parkinson’s Foundation. Drooling and Parkinson’s Disease. Available at: https://www.parkinson.org
2. Parkinson’s UK. Drooling and Excess Saliva in Parkinson’s. Available at: https://www.parkinsons.org.uk
3. National Institute for Health and Care Excellence (NICE). Parkinson’s Disease in Adults (NG71). https://www.nice.org.uk/guidance/ng71
4. International Parkinson and Movement Disorder Society. Evidence-Based Review of Treatments for Parkinson’s Disease. https://www.movementdisorders.org
5. Speech Pathology Australia. Swallowing Disorders (Dysphagia). https://www.speechpathologyaustralia.org.au
6. Australian Parkinson’s Mission. Living Well with Parkinson’s Disease. https://www.parkinsonsmission.org.au