Saliva changes in Parkinson’s disease patients after injection of Botulinum neurotoxin type A

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.

A systematic review of noninvasive and invasive sialorrhoea management

“…Both botulinum toxins (BoNT) A and B are used for the management of sialorrhoea, and they have shown fewer side effects than anticholinergic medication while also decreasing aspiration pneumonia risk in people with neurological diseases (Faria, Harb, Hilton, Yacobucci, & Pizzuto, ). Studies show that botulinum injections are tolerable and effective in the management of sialorrhoea (Jackson et al, ; Jongerius et al, ; Lagalla, Millevolte, Capecci, Provinciali, & Ceravolo, ; Mancini et al, ; Martínez‐Poles et al, ; Reid, Johnstone, Westbury, Rawicki, & Reddihough, ; Tiigimäe‐Saar, Tamme, Rosenthal, Kadastik‐Eerme, & Taba, ). However, BoNT does have some side effects which relate to trauma at the injection site as well as adverse effects associated with the botulinum toxin, such as dry mouth, thickened bronchial secretion and viscous saliva, and difficulty chewing (Jackson et al, ; Jongerius et al, ; Lagalla et al, ; Mancini et al, ; Martínez‐Poles et al, ; Reid et al, ).…”

“…Trauma at the injection site can cause adverse effects such as soreness, haematoma, bleeding in the mouth and swollen salivary gland leading to difficulty in swallowing, and it might also cause facial nerve trauma when the injection is performed in the parotid gland (Reddihough et al, ). One study result did not show any adverse effect; however, the study recommended patients should be under a dentist's care more frequently due to the change in oral microflora because of the injection (Tiigimäe‐Saar et al, ).…”

“…Both botulinum toxins (BoNT) A and B are used for the management of sialorrhoea, and they have shown fewer side effects than anticholinergic medication while also decreasing aspiration pneumonia risk in people with neurological diseases (Faria, Harb, Hilton, Yacobucci, & Pizzuto, 2015). Studies show that botulinum injections are tolerable and effective in the management of sialorrhoea (Jackson et al, 2009;Jongerius et al, 2004;Lagalla, Millevolte, Capecci, Provinciali, & Ceravolo, 2006;Mancini et al, 2003;Martínez-Poles et al, 2018;Reid, Johnstone, Westbury, Rawicki, & Reddihough, 2008;Tiigimäe-Saar, Tamme, Rosenthal, Kadastik-Eerme, & Taba, 2018). However,…”

Biochemical and microbiological analysis of the saliva of institutionalized elderly: With edentulism, use of dentures and presence of biofilm

“…The presence of visible biofilm in teeth or prostheses was not associated with salivary flow. Decreasing the amount of saliva reduces self-cleaning capacity, compromising oral hygiene and changes in oral microflora and salivary composition ( 24 ). However, according to our results, although the literature attributes saliva to the mechanical cleaning factor in the oral cavity, brushing remains a major factor in biofilm control for the institutionalized elderly population.…”

The burden of sialorrhoea in chronic neurological conditions: current treatment options and the role of incobotulinumtoxinA (Xeomin®)

“…77 Patients with PD in Estonia reported thickening of saliva 1 month after injection with BoNT-A when interviewed, and a reduction in sialorrhoea severity from very intensive to moderate. 86 Retrospective analysis of patients in a movement disorders clinic showed that all patients treated with BoNT-A experienced improvements; a minimum of 50% improvement in sialorrhoea was observed using the Drooling Severity and Frequency Scale (DSFS). 87 The majority of PD outpatients completing an RCT reported satisfaction with BoNT treatment [moderate to dramatic improvement (77.7%; n = 18)] compared with placebo [no changes to mild improvement (94.4%; n = 18)].…”