Abstract
Patients with Parkinson’s disease (PD) are compromised by poor oral condition due to oropharyngeal bradykinesia, dysphagia, and the side effects of treatment. Intrasalivary gland injections of Botulinum neurotoxin type A (BNT-A) have been known to treat sialorrhea effectively in these patients. However, the decreased amount of saliva reduces self-cleaning ability that deteriorates oral hygiene and increases dental caries. The aim of this study was to determine the changes in the oral microflora and saliva in patients with PD treated for sialorrhea by means of sonography-controlled BNT-A injections into the bilateral parotid and submandibular glands. Altogether, 38 persons participated in the study: 12 PD patients who were injected with BNT-A for treatment of sialorrhea and passed salivary tests before and 1 month after the injections; and 13 PD patients and 13 healthy subjects who were not injected with BNT-A and passed salivary tests once. The condition of oral health was measured by the amount of saliva, salivary flow rate, and salivary composition. A good outcome with a significant decrease in salivary flow rate occurred at 1-month follow-up in the BNT-A-treated group while no significant change was found in salivary composition. BNT-A treatment did not change the Streptococcus mutans levels in saliva but there was statistically significant increase in levels of Lactobacilli. BNT-A injections can effectively treat sialorrhea while considering the change of oral microflora, and the patients should be under dentists’ care more frequently. EudraCT clinical trial number: 2015-000682-30.
Highlights
The clinical diagnosis of Parkinson’s disease (PD) is based upon a defined motor syndrome, non-motor features are present in most patients in the early stages of the disease already, and often can dominate among clinical manifestations [1,2,3]
By the Pearson correlation analysis, the amount of saliva was larger in patients who were treated with levodopa (p = 0.016), and less in the patients who received MAO-B treatment (p = 0.020)
The mean duration of levodopa treatment was significantly longer among patients in group 1 who received Botulinum neurotoxin type A (BNT-A) treatment for sialorrhea, compared to patients in group 2 (Table 1) that indicates to the association between levodopa treatment duration and sialorrhea
Summary
The clinical diagnosis of PD is based upon a defined motor syndrome (bradykinesia, rigidity, rest tremor), non-motor features are present in most patients in the early stages of the disease already, and often can dominate among clinical manifestations [1,2,3]. The burden of non-motor symptoms rises, affecting substantially the quality of life of patients with PD [4, 5]. Drooling is not among the most frequent non-motor symptoms with its prevalence ranging from 10 to 84% across different studies and it may affect the quality of life remarkably [7,8,9,10]. It is defined as the inability to control oral secretions, resulting in excessive saliva accumulation in the oropharynx. Based on yet unpublished data of the PD prevalence study
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