Parkinson's Drooling: Why It Happens and How to Stop It

If you have Parkinson's and you drool, you have almost certainly been told that you are making too much saliva. You are not. Your saliva glands are working normally. What changed is that your mouth is no longer clearing it. That single difference is why most of the things people try for drooling do not last, and it is why one free habit does.

This page is for the person with Parkinson's and for whoever sits across the table from them. Both of you have a job in this, and I will get to both.

I am a speech-language pathologist with more than ten years of clinical experience, and drooling and swallowing are what I have spent years on. What follows is the explanation my clients tell me nobody ever gave them.

Where the saliva actually comes from

Your mouth makes saliva slowly and continuously all day. It is not a faucet that opens when you eat. It is a drip that never stops, all day, every day. That was true before Parkinson's and it is still true now.

Studies that have actually measured saliva flow in people with Parkinson's find it to be normal or lower than average, not higher. That surprises almost everyone who hears it, because the mouth feels full and the chin gets wet. But the amount being made has not gone up. Something else has changed.

Why your mouth normally clears itself

Here is the part nobody explains. A healthy adult swallows somewhere between five hundred and a thousand times a day, and almost none of those swallows are on purpose. They happen automatically, in the background, in the middle of conversations and while reading and while watching television. You do not decide to swallow. Your mouth fills a little, the brain notices, and the swallow fires. That automatic swallow is the drain. The drip fills the sink, the drain empties it, and you never think about either one.

What changes in Parkinson's

Parkinson's slows down automatic movements. That is the disease in one sentence. Blinking slows, arm swing shrinks, facial expression flattens. The automatic swallow is on that same list. It does not stop. It fires less often.

So the drip is unchanged, but the drain is running less often than it used to. Saliva sits in the mouth longer. It pools behind the lower teeth and under the tongue. And in Parkinson's the head often drifts forward and down, and the lips do not close as firmly as they once did, so the pooled saliva has a short trip to the corner of the mouth. Then it is out.

That is drooling in Parkinson's. Not overproduction. Under-clearance. The clinical name is sialorrhea, and the mechanism behind it in Parkinson's is reduced swallow frequency, not increased saliva.

Why this is good news

The swallow itself still works. If you have Parkinson's and you drool, try this right now: swallow on purpose. It went down. It always does. The muscles are intact, the coordination is intact, the ability is intact. What is missing is the trigger that used to fire it for you.

Parkinson's takes some things you cannot get back. This is not one of them.

Why the usual fixes do not last

Once you understand that the problem is clearance and not production, every treatment you have tried starts to make sense, including why it helped for a while and then stopped.

Wiping. Everyone wipes. It is the reasonable move. But the wipe only removes what already got out. Everything still pooled in the mouth is exactly where it was, and the next wipe is already on its way. Wiping treats the evidence, not the cause.

Holding it in. After enough wiping, people start clamping their lips and holding the saliva in so it will not show. You cannot hold saliva in and talk at the same time, and you cannot hold it in and listen well either. This is the quiet reason people with Parkinson's go silent at the table, and it is the reason dinner invitations start getting turned down. It was never the drooling that cost you the evening. It was the holding.

Drying the mouth. Atropine drops, glycopyrrolate, scopolamine patches, and Botox to the salivary glands all do the same thing in different ways. They reduce the amount of saliva being made. And they work, in the sense that less saliva means less to pool. If your neurologist prescribed one of these, keep using it exactly as prescribed. But notice what they do not do. They do not restart the automatic swallow. The drain is still running less often. You have simply turned down the drip so the sink fills more slowly, and a dry mouth brings its own problems: cracked lips, harder chewing, more dental decay, and a swallow that has less lubrication to work with. These treatments buy time. They do not fix clearance.

Gum and hard candy. These work by forcing you to swallow more often, which is actually the right idea. But they also make more saliva, so you are increasing the drip to increase the drain, and the moment the candy is gone the swallow frequency drops right back.

Swallowing exercises. Strengthening exercises make sense when the swallow is weak. Yours is not weak. It is infrequent. Exercising a muscle that already works does not make it fire more often on its own.

None of these were wrong to try. They were the reasonable move with the information you had. Nobody told you the problem was clearance.

The free first step, written out with the reasoning behind it, is in the short guide you can get here: www.everydayslp.org. It takes about five minutes to read and there is nothing to buy.

The one free habit: wipe, then swallow

The fix has to do what the automatic swallow used to do. It has to make the swallow fire when the mouth is full, without you having to remember it.

Here is the habit. The next time you reach up to wipe, swallow. The wipe is the cue, not the fix. You are already wiping dozens of times a day. Every one of those wipes is a moment when your mouth is full and your hand is already moving. Attach the swallow to it. Wipe, then swallow, every time.

Two things happen. The wipe clears what got out, and the swallow clears what was about to. Over days, the pairing starts to feel like one motion. Over weeks, many people notice the swallow starting to arrive before the hand does. That is the automatic swallow coming back online, because you have been firing it at exactly the moments it used to fire on its own.

What done correctly feels like: you swallow with the wipe, not after you notice you forgot. If you are wiping and then remembering to swallow a few seconds later, the pairing has not formed yet. Keep going. It forms.

The job for whoever sits across the table

If you are the spouse or the adult child or the friend at the table, you will notice something before he does. The chin drops a little. The lips go tight. He stops talking mid-sentence. He has not drifted off. His mouth is full, and if he opens it, saliva comes out.

Do not fill the silence. Do not hand him the napkin. Say one word: swallow.

Early on, you will be saying it often. That is fine. You are the cue until the wipe becomes the cue. Then you can stop, and the conversation gets to be a conversation again.

Why "just swallow more" has never worked

You have probably already been told to swallow more. It is the right idea and it does not work as instructions, for the same reason "just remember to blink more" would not work. It is not a knowledge problem. You know how to swallow. It is a trigger problem. Telling someone to swallow more asks them to think about swallowing all day, and nobody can hold a thought all day. Wipe-then-swallow works because it does not ask you to remember. It attaches the swallow to something you are already doing.

Wipe-then-swallow is the free version, and it is the version you have to think about every time you wipe. There is a fuller version that attaches swallowing to the events in your day that used to trigger it automatically, so it runs in the background again and you go back to never thinking about when to swallow. That is what I teach in The Drooling Reset Private Program, a short education program delivered over three calls. It is education, not therapy, and it is not a substitute for a swallowing evaluation. If you want to find out whether it fits your situation, you can book a fit-call at www.everydayslp.org/fit-call.

When this is not the right page for you

Some swallowing problems are not clearance problems and need an in-person evaluation, not a habit. If any of these are true, please see your physician or a speech-language pathologist before trying anything here:

• You cough or choke during meals or when drinking
• Your voice sounds wet or gurgly after you swallow
• You have had pneumonia, or a doctor has mentioned aspiration
• You are losing weight without trying

Those are signs that the swallow itself may not be safe, and that is a different problem with a different answer.

So here is the whole thing

You do not make too much saliva. You can still swallow it. You are not, because the automatic swallow fires less often in Parkinson's. Wiping removes what escaped and leaves the rest. Holding it in costs you conversations. Drying agents turn down the drip without fixing the drain. The free habit is wipe, then swallow, every time. The person across the table has one word.

The drain still works. It just needs to be turned back on.

Frequently asked questions

This page is education, not medical advice. It is not a substitute for an evaluation by your own speech-language pathologist or physician. Robert is a speech-language pathologist (M.S., CCC-SLP) with more than ten years of clinical experience. EverydaySLP is where he puts the explanations his clients could never find anywhere else.