How can I increase saliva production?

Methods to Increase Saliva Production

To increase saliva production, use sugar-free acidic candies, sugar-free chewing gum, or pilocarpine medication depending on the severity of your dry mouth. 1

Assessment of Salivary Function

Before starting any treatment for dry mouth, it's important to understand your baseline salivary gland function:

• Normal salivary flow rate: 0.52-1.41 mL/min (varies between resting and stimulated states) 1
• Xerostomia (dry mouth): Defined as salivary flow rate <0.1 mL/min 1

Treatment Algorithm Based on Severity

For Mild Salivary Gland Dysfunction:

1. Non-pharmacological stimulation (first-line approach):

   • Gustatory stimulants: Sugar-free acidic candies, lozenges, or xylitol products 1
   • Mechanical stimulants: Sugar-free chewing gum 1, 2
   • Chewing gum provides both gustatory and mechanical stimulation, increasing salivary flow significantly within the first minute of use 2
   • Fruit-flavored gums (strawberry, apple) may produce higher initial salivary flow rates compared to cinnamon-flavored gums 2
   • Spearmint-flavored gum may provide slightly higher sustained salivary flow after extended chewing 2

For Moderate Salivary Gland Dysfunction:

1. Pharmacological stimulation with muscarinic agonists:

   • Pilocarpine: 5-10 mg orally three times daily 3
   • Cevimeline: Available in some countries with potentially better tolerance profile 1
   • Pilocarpine is a cholinergic parasympathomimetic agent that stimulates exocrine glands 3
   • Clinical studies show 63% increase in whole saliva flow with 5 mg dose and 90% increase with 10 mg dose 3
   • Onset of action: 20 minutes; peak effect: 1 hour; duration: 3-5 hours 3

For Severe Salivary Gland Dysfunction (No Salivary Output):

1. Saliva substitution:
   • Artificial saliva products (sprays, gels, rinses) 1
   • Ideal preparations have neutral pH and contain fluoride and electrolytes to mimic natural saliva 1

Important Considerations

• Daily production: Healthy individuals produce 1.0-1.5 L of saliva every day 1
• Gender differences: Men typically have higher salivary flow rates than women 1
• Age factor: Salivary flow tends to decline with age 4
• Medication effects: Many medications (especially antidepressants) can cause dry mouth, while AChE inhibitors may increase saliva production 1

Precautions and Contraindications

• For pilocarpine:
  • Common side effects include sweating, headache, urinary frequency, and flushing
  • Use with caution in patients with cardiovascular disease, asthma, or chronic obstructive pulmonary disease
  • Dosage adjustment needed in patients with hepatic impairment (30% decrease in clearance) 3

Lifestyle Modifications to Support Salivary Function

• Avoid smoking/vaping (at least 4 hours before saliva collection) 1
• Limit alcohol consumption 1
• Stay hydrated by drinking water regularly
• Avoid caffeine and acidic beverages which can worsen dry mouth symptoms
• Maintain good oral hygiene to prevent complications of dry mouth 4

Regular use of appropriate saliva stimulants not only increases saliva flow but also helps maintain oral health by promoting oral clearance of sugars, neutralizing plaque pH, and enhancing remineralization of early caries-like lesions 5.