CLINICAL
Ptyalism in patients with Parkinson’s disease Ptyalism is one of the manifestations of Parkinson’s disease. So far, several pharmacological and non-pharmacological agents have been tested in the treatment of this manifestation, however, each of them has its advantages and disadvantages. This problem needs to be addressed in order to provide patients with a satisfactory quality of life.
Ana Lipovina, Montenegro
Parkinson’s disease and ptyalism
P
arkinson’s disease (PD) is a progressive disease of the central nervous system, predominantly affecting dopaminergic neurons located in the substantia nigra, in the uppermost region of the brainstem. More familiar symptoms of Parkinson’s disease that make the condition increasingly debilitating are primarily tremors in the hands, stiffness of the limbs and problems with gait and balance. The overflow of saliva from the
oral cavity - colloquially referred to as ‘drooling’ - is one of the non-motor consequences of Parkinson’s. Although the pathophysiology of excess saliva in PD has not been completely established, a study conducted by Srivanitchapoom et al. (2014) suggests the cause to be insufficient intraoral salivary clearance. It is therefore commonly referred to as a ‘pseudoptyalism’. There are no absolutely effective drugs at hand for the treatment of such patients, however, various pharmacological agents and non-pharmacological methods of treatment have been studied to alleviate the severity of this symptom. According to Parkinson’s Foundation statistics, more than 10 million people in the world live with this disease. Since their underlying disease is progressively debilitating, it is necessary to find an absolutely effective (targeted) medicine that will either have no or minimal side effects. It is very important to work on preserving the psychosocial health of the patient because all scientists involved in this discussion agree that excess
saliva in PD patients significantly endangers their quality of life, regardless of its ultimate pathophysiology.
Risk factors and morbidity
Studies assessing oral health in people with PD have reported several undesirable health consequences accompanying excess saliva such as perioral dermatitis, poor oral hygiene, halitosis, increased bacterial load, difficulty eating and speaking, and increased rates of respiratory tract infections due to the silent aspiration of saliva. Dysphagia in Parkinson’s disease arises from a number of factors but is primarily a result of reduced tongue mobility and delayed onset of the swallowing reflex. Impaired swallowing means greater pooling of saliva in the mouth, and the resulting ‘drooling’ can be mistaken for ptyalism. Interestingly, there lies strong disagreement among researchers, with some hypothesising a strong link between dysphagia and excess saliva, while others assert that the picture is not so clear. Facial muscle stiffness can
Spring 2021
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