Saliva management

Saliva problems in MND are most often caused by reduced ability to swallow and clear secretions.

This can lead to:

• pooling of saliva in the mouth
• drooling (sialorrhoea)
• difficulty managing oral secretions.

Some people may also experience:

• thick or sticky saliva that is difficult to clear
• a dry mouth, which may be related to reduced intake, mouth breathing or medication.

These issues can occur at any stage and may change over time.

Saliva problems may be distressing and impact daily life.

You may notice:

• drooling or saliva escaping from the mouth
• frequent wiping of the mouth or clothing
• difficulty clearing saliva or needing to spit frequently
• coughing or choking on saliva
• thick, sticky secretions in the mouth or throat
• a dry or uncomfortable mouth
• changes in speech or comfort.

Family members or carers may also notice changes and increased care needs.

People with MND may experience different types of saliva issues.

Excess saliva (sialorrhoea)
Usually caused by reduced swallowing rather than increased production. This may lead to drooling and discomfort.

Thick or tenacious secretions
Saliva may become thick and difficult to clear, which can cause discomfort, coughing and a feeling of mucus in the throat.

Dry mouth (xerostomia)
A dry mouth may occur due to reduced fluid intake, mouth breathing, or as a side effect of medication used to manage saliva. This can affect comfort, speech and oral health.

It is important to recognise the type of problem, as management approaches may differ.

Saliva problems should be assessed and managed as part of overall care.

• Consider whether swallowing difficulties are contributing.
• Consider whether medications may be affecting saliva production.
• Refer to a speech and language therapist (SLT) for assessment and advice.
• Consider the impact on comfort, communication and quality of life.
• Support family members or carers with practical strategies.

Management may need to be reviewed regularly as needs change.

A range of approaches may be used, depending on the type and severity of symptoms.

Non-pharmacological approaches may include:

• positioning to support swallowing and reduce drooling
• regular swallowing prompts or strategies
• maintaining good oral care
• supporting adequate hydration where possible
• using mouth care products to relieve dryness
• ensuring access to tissues or suction where appropriate.

Pharmacological options may include:

• medications to reduce saliva production (for drooling).

Other interventions may include:

• oral suction
• botulinum toxin injections
• radiotherapy to salivary glands in selected cases.

Choice of treatment will depend on individual needs, the type of saliva problem, and overall clinical context.

You may find the following resources helpful:

Information sheet P3 – Managing saliva problems in MND

Information sheet P9 – Oral suction

Saliva management pathway

Information on swallowing for people with or affected by MND

You can find further guidance on symptom management and support across the Management of MND section.