Saliva problems and dysphagia are common, due to aspects such as muscle impairment affecting the jaw, tongue and swallowing, changes in saliva production, reduced ability to change posture, and diet.

The impact is an increased risk of choking and respiratory infections, with implications for taking medication as well as eating and drinking. Oral hygiene can also be affected.^1,17

Reduced ability to swallow, especially when compounded with an inability to close the mouth or with neck weakness, means normal saliva production levels can cause drooling (sialorrhoea), but MND sometimes increases saliva production (hypersalivation).¹⁷

Saliva can also thicken or become phlegmy which can be difficult to clear if the cough reflex is affected and is less lubricating for chewing food and swallowing. Dehydration, open mouth breathing, or non-invasive ventilation may be a cause.¹⁷

A speech and language therapist (SLT) or other therapist should assess the person to make recommendations about managing sialorrhoea and/or dysphagia, mechanically clearing thick mucus or supporting the posture.¹⁷

Swallowing ability may affect medication and formulation choice. If the person is already using an enteral feeding tube, advice around the medication potentially blocking or hardening the tube and pharmacokinetics/bioavailability should be considered.^17,18