## Breadcrumb - [Home](/) - [Understanding Parkinson's](/understanding-parkinsons) - [Movement Symptoms](/understanding-parkinsons/movement-symptoms) ## Breadcrumb - [Home](/) - [Understanding Parkinson's](/understanding-parkinsons) - [Movement Symptoms](/understanding-parkinsons/movement-symptoms) # Drooling ## 💡 Quick Summary - Drooling (sialorrhea) is common in Parkinson’s due to reduced automatic swallowing, not excess saliva production. This happens when slowed or incomplete [swallowing](/understanding-parkinsons/non-movement-symptoms/speech-swallowing "Speech & Swallowing Issues") causes saliva to pool in the mouth. - It can range from mild nighttime drooling to more severe episodes and may indicate swallowing difficulties (dysphagia), which can lead to choking or aspiration pneumonia. - Management options include seeing a [speech-language pathologist](/living-with-parkinsons/finding-care/building-your-team "Building Your Care Team"), triggering swallowing, adjusting medications or using treatments. ![Daughter using napkin to wipe drool from her mom's face](/sites/default/files/styles/no_sizing/public/images/drooling.jpg?itok=6kIzSiCc) Excessive drooling, called **sialorrhea**, is a common symptom of Parkinson’s disease (PD) and can cause awkwardness in social situations. It ranges from mild wetting of the pillow during sleep to embarrassing outpourings of saliva during unguarded moments. For example, this can happen when the head is down, the mouth is held open involuntarily (as happens when PD advances) or when a person is engaged in an activity and is distracted from the need to swallow automatically. Drooling, along with [**speech and swallowing difficulties**](/understanding-parkinsons/non-movement-symptoms/speech-swallowing "Speech & Swallowing Issues"), is included among non-movement symptoms even though the root cause is motor: decreased coordination, slowness of movement ([**bradykinesia**](/understanding-parkinsons/movement-symptoms/bradykinesia "Bradykinesia (Slowness of Movement)")) and [**rigidity**](/understanding-parkinsons/movement-symptoms/rigidity "Rigidity") of the muscles of the mouth and throat. Parkinson’s causes a reduction in automatic actions, including swallowing, creating an inability to manage the flow of saliva in and around the mouth. In PD, usually the amount of saliva your body produces is normal, but swallowing issues – swallowing less often or not completely – lead to saliva pooling in the mouth. When severe, drooling is an indicator of more serious difficulty with swallowing (also known as **dysphagia**), which can cause the person to choke on food and liquids and can even lead to aspiration pneumonia. ![deanne_delehanty](/sites/default/files/styles/535x680/public/images/deanne_delehanty.jpg?h=c9aea1bc&itok=cbltvNlb) MY PD STORY: Deanne Delehanty "At age 72 we were going strong ― no need for pills, no restrictions to our diet. We were healthy and happy. So it was difficult to realize when that no longer was true for Gary. It all started with drooling. It didn’t make sense and the doctor did not see it as a symptom." [ READ Deanne's STORY ](/living-with-parkinsons/stories/deanne-delehanty) ## Managing Drooling If you are having problems with drooling, you might consider an appointment with a [**speech-language pathologist**](/living-with-parkinsons/finding-care/building-your-team "Building Your Care Team"). These professionals can perform a swallow test to diagnose any difficulties and can also give you some strategies to help with drooling. One trick is to suck on hard candy or chew gum, preferably sugarless. Candy and gum activate the jaw and the automatic swallowing reflex and can help clear saliva, providing temporary relief from drooling. Another tactic is to wear a sweatband on your wrist. This can be used to discretely wipe the mouth as necessary and is a relatively inconspicuous accessory. If these lifestyle strategies are not effective, adjusting anti-PD medications may make it easier to swallow. There are also some other prescription medication options: - ### Oral Anticholinergic Medications Glycopyrrolate and other oral [anticholinergic medications](/living-with-parkinsons/treatment/prescription-medications "Prescription Medications") (trihexyphenidyl, benztropine and hyoscyamine – medicines that can ease involuntary PD muscle movements and tremor). As a class, oral anticholinergic medications decrease saliva production. Usually this is perceived as a side effect (dry mouth), but in this case it is an advantage. Other anticholinergic side effects may be seen, including drowsiness, confusion, vomiting, dizziness, blurred vision, constipation, flushing, headache and urinary retention. Anticholinergics can also have mental side effects, so their use should be carefully considered. - ### Scopolamine Patch This patch offers anticholinergic medicine that slows production of saliva as it is absorbed into the entire bloodstream. The side effects are similar to those seen with use of oral anticholinergic medications. - ### 1% Atropine Eye Drops This anticholinergic is given as 1-2 drops under the tongue per day to dry the mouth. Systemic side effects are much less likely with this local treatment. - ### Botulinum Toxins Botulinum toxin injections are another option for treating excess saliva and drooling. Incobotulinum toxin A (Xeomin) and rimabotulinum toxin B (Myobloc) are FDA-approved for excess saliva and drooling. Onabotulinum toxin A (Botox) and abobotulinum toxin A (Dysport) are used off-label (not FDA approved for a specific condition) to decrease saliva production. An injection of botulinum toxin into the salivary glands in the cheek and jaw area can decrease saliva production with minimal side effects. Potential side effects include dry mouth, difficulty swallowing and weakness of the muscles in the jaw area. The benefit of botulinum toxin injections can last up to three months (or longer in some cases) before repeat injections are needed. Although botulinum toxin can be effective for drooling, it is costly, so doctors may recommend other treatments first. *Page reviewed by Dr. Kathryn P Moore, Movement Disorders neurologist at Duke Health, a Parkinson's Foundation Center of Excellence.* ## Related Materials Fact Sheets ### [ Pain in Parkinson's Disease ](/library/fact-sheets/pain) [Read Now](/library/fact-sheets/pain) Fact Sheets ### [ Occupational Therapy & Parkinson's ](/library/fact-sheets/occupational-therapy) [Read Now](/library/fact-sheets/occupational-therapy) Fact Sheets ### [ Managing "Off" Time in Parkinson's ](/library/fact-sheets/managing-off-time) [Read Now](/library/fact-sheets/managing-off-time) ## Related Blog Posts ![Elderly couple enjoying coffee together at home](/sites/default/files/styles/500x360/public/images/practical-pointers-blog-hero.jpg?h=ed9ce7df&itok=w7X3P7DS) Raise Awareness ### [ Six Tips for Managing Daily Life with Advancing Parkinson’s ](/blog/awareness/managing-daily-life) READ NOW ![Seniors stretching outdoors](/sites/default/files/styles/500x360/public/images/eb-1-motor-symptoms-hero.jpg?h=ed9ce7df&itok=by9QZn--) Raise Awareness ### [ Tremor, Shakes & Everything in Between: Tackling Parkinson's Motor Symptoms ](/blog/awareness/tackling-motor-symptoms) READ NOW ![gait and balance blog preview.](/sites/default/files/styles/500x360/public/images/gait%20and%20balance%20blog%20preview_1.png?h=9105c3fe&itok=Cidve2m2) Raise Awareness ### [ Finding Balance: Steps to Move Safely and Minimize Falls with Parkinson’s ](/blog/awareness/finding-balance) READ NOW ### Listen to our Podcast New episodes are released every month! 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