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Saliva is a clear liquid produced by the salivary glands. It aids in digestion and contributes to oral health by washing bacteria and food from the mouth. The body produces about 1 to 2 liters of saliva each day, which most people swallow without noticing. But sometimes saliva doesn’t flow easily down the throat and can cause choking.

Although choking on saliva happens to everyone from time to time, repeatedly choking on saliva could indicate an underlying health problem or bad habit. Here’s what you need to know about choking on saliva, including causes and prevention.

Choking on saliva can occur if the muscles involved in swallowing weaken or stop functioning properly due to other health problems. Gagging and coughing when you haven’t been drinking or eating is a symptom of choking on saliva. You may also experience the following:

  • gasping for air
  • an inability to breathe or talk
  • waking up coughing or gagging

Occasionally choking on saliva may not be a cause for concern. But if it happens frequently, identifying the cause could prevent future occurrences. Possible causes of choking on saliva include:

1. Acid reflux

Acid reflux is when stomach acid flows back into the esophagus and mouth. As stomach contents flow into the mouth, saliva production may increase to wash away the acid.

Acid reflux can also irritate the lining of the esophagus. This can make swallowing difficult and allow saliva to pool in the back of your mouth, causing choking.

Other symptoms of acid reflux include:

Your doctor can diagnose acid reflux disease by either an endoscopy or special type of X-ray. Treatment can include over-the-counter or prescription antacids to reduce stomach acid.

2. Sleep-related abnormal swallowing

This is a disorder where saliva collects in the mouth while sleeping and then flows into the lungs, leading to aspiration and choking. You may wake up gasping for air and choking on your saliva.

An older study theorizes there may be a link between abnormal swallowing and obstructive sleep apnea. Obstructive sleep apnea is when breathing pauses while asleep due to an airway that’s too narrow or blocked.

A sleep study test can help your doctor diagnose obstructive sleep apnea and abnormal swallowing. Treatment includes use of a CPAP machine. This machine provides continuous airflow while sleeping. Another treatment option is an oral mouth guard. The guard is worn while sleeping to keep the throat open.

3. Lesions or tumors in the throat

Benign or cancerous lesions or tumors in the throat can narrow the esophagus and make it difficult to swallow saliva, triggering choking.

Your doctor can use an imaging test, like an MRI or CT scan, to check for lesions or tumors in your throat. Treatment may involve surgically removing a tumor, or radiation or chemotherapy to shrink cancerous growths. Other symptoms of a tumor can include:

  • visible lump in the throat
  • hoarseness
  • sore throat

4. Poorly fitting dentures

The salivary glands produce more saliva when nerves in the mouth detect a foreign object like food. If you wear dentures, your brain might mistake your dentures for food and increase saliva production. Too much saliva in your mouth could cause occasional choking.

Saliva production may slow down as your body adjusts to the dentures. If not, see your doctor. Your dentures may be too tall for your mouth or not fitted to your bite.

5. Neurological disorders

Neurological disorders, such as Lou Gehrig’s disease and Parkinson’s disease, can damage the nerves in the back of the throat. This can lead to difficulty swallowing and choking on saliva. Other symptoms of a neurological problem may include:

  • muscle weakness
  • muscle spasms in other parts of the body
  • difficulty speaking
  • impaired voice

Doctors use a variety of tests to check for neurological disorders. These include imaging tests, such as a CT scan and MRI, as well as nerve tests, such as an electromyography. An electromyography checks muscle response to nerve stimulation.

Treatment depends on the neurological disorder. Your doctor may prescribe medication to reduce saliva production and teach techniques to improve swallowing. Medications to reduce saliva secretion include glycopyrrolate (Robinul) and scopolamine, also known as hyoscine.

6. Heavy alcohol use

Choking on saliva can also occur after heavy alcohol use. Alcohol is a depressant. Consuming too much alcohol can slow muscle response. Being unconscious or incapacitated from consuming too much alcohol can cause saliva to pool in the back of the mouth instead of flowing down the throat. Sleeping with your head elevated can improve saliva flow and prevent choking.

7. Talking excessively

Saliva production continues as you talk. If you’re speaking a lot and don’t stop to swallow, saliva can travel down your windpipe into your respiratory system and trigger choking. To prevent choking, speak slowly and swallow in between phrases or sentences.

8. Allergies or respiratory problems

Thick mucus or saliva triggered by allergies or respiratory problems may not easily flow down your throat. While sleeping, mucus and saliva can collect in your mouth and lead to choking.

Other symptoms of allergies or a respiratory issue include:

  • sore throat
  • sneezing
  • coughing
  • runny nose

Take an antihistamine or cold medication to reduce mucus production and thin thick saliva. See your doctor if you have a fever, or if your symptoms worsen. A respiratory infection may require antibiotics.

Shop now for allergy or cold medication.

9. Hypersalivation during pregnancy

Hormonal changes during pregnancy cause extreme nausea and morning sickness in some women. Hypersalivation sometimes accompanies nausea, and some pregnant women swallow less when nauseous. Both factors contribute to excess saliva in the mouth and choking.

This problem may gradually improve. There’s no cure, but drinking water can help wash excess saliva from the mouth.

10. Drug-induced hypersalivation

Some medications can also trigger increased saliva production. These include:

  • clozapine (Clozaril)
  • aripiprazole (Abilify)
  • ketamine (Ketalar)

You may also experience drooling, difficulty swallowing, and the urge to spit.

Speak with your doctor if too much saliva production is causing you to choke. Your doctor may switch your medication, modify your dosage, or prescribe a medication to reduce saliva production.

Babies can also choke on their saliva. Speak with your child’s doctor if this happens often. Possible causes may include swollen tonsils blocking the flow of saliva or infant reflux. Try the following to reduce infant reflux in your child:

  • Keep your baby upright for 30 minutes after eating.
  • If they drink formula, try switching up the brand.
  • Give smaller but more frequent feedings.

If necessary, your child’s doctor may recommend a tonsillectomy.

Additionally, an allergy or cold can make it harder for your baby to swallow thick saliva and mucus. Your doctor may recommend remedies to thin mucus, such as saline drops or a vaporizer.

Some babies also produce more saliva when teething. This could lead to choking. The occasional cough or gag isn’t usually anything to worry about, but consult your doctor if choking doesn’t improve or if it worsens.

Prevention involves reducing saliva production, improving the flow of saliva down the throat, and treating any underlying health problems. Helpful tips include:

  • Slow down and swallow when speaking.
  • Sleep with your head propped up so that saliva can flow down the throat.
  • Sleep on your side instead of your back.
  • Raise the head of your bed by a few inches to keep stomach acid in your stomach.
  • Drink alcohol in moderation.
  • Eat smaller meals.
  • Take over-the-counter medication at the first sign of a cold, allergies, or sinus problems.
  • Sip on water throughout the day to help clear saliva from your mouth.
  • Avoid sucking on candy, which can increase saliva production.
  • Chew sugarless gum to prevent nausea during pregnancy.

If your baby chokes on saliva while sleeping on their back, talk with their doctor to see if it’s safe for them to sleep on their stomach. This allows excess saliva to drain from their mouth. Stomach or side sleeping may increase the risk of sudden infant death syndrome (SIDS), so it’s important to check in with your child’s doctor.

Choking on saliva may not indicate a serious problem. It happens to everyone at some point. Even so, don’t ignore continuous choking. This could indicate an undiagnosed health problem, such as acid reflux or a neurological disorder. Getting an early diagnosis and treatment can prevent other complications from developing.