Tips to stop drooling while sleeping: 5 ways to reduce excessive saliva

Drooling, excessive salivation, or sialorrhea is usually only a temporary nuisance, but if prolonged, this condition can significantly affect daily life, sleep, communication, and self-confidence. Medically, excessive salivation is also known as hypersalivation or sialorrhea. Notably, drooling is not always caused by the body producing too much saliva; sometimes, the cause is difficulty swallowing or poor oral motor control.

Some cases of excessive drooling may be related to GERD, nausea, dental problems, or medication side effects; while prolonged cases may be linked to neurological conditions or swallowing disorders. Therefore, instead of just constantly trying to "swallow saliva," experts recommend identifying the cause to choose appropriate treatment. This article from Tiptory helps you understand why you drool, simple home remedies, and when excessive salivation needs to be evaluated by a doctor.

Safe ways to reduce drooling

Drink enough water throughout the day

• Regular water intake helps maintain fluid balance in the body. However, drooling is not necessarily a sign of dehydration, as it can also be related to difficulty swallowing, reflux, or other medical conditions.

• Instead of drinking a lot of water at once, spread it out throughout the day and pay attention to thirst, urine color, and overall body condition.

Do not self-medicate with grape juice to treat drooling

• Some home remedies mention dark grape juice, but there is currently insufficient medical evidence to consider it an effective treatment for excessive salivation.

• Therefore, if the goal is to reduce drooling, grape juice should not be considered a primary treatment method or a substitute for finding the underlying cause.

Keep your mouth active appropriately

• Chewing gum or sucking on hard candy can increase oral muscle activity and promote swallowing saliva. However, this does not mean it reduces the amount of saliva produced.

• For children, especially young ones, hard candy should not be given without supervision due to the risk of choking. If excessive drooling persists, discuss it with an adult and a healthcare professional to determine the cause.

Adjust sleeping posture

• Drooling during sleep is quite common and can occur due to sleeping positions that allow saliva to easily flow out of the mouth. Lying on your back may help reduce this in some people, but its effectiveness varies.

• If you frequently drool at night, along with loud snoring, difficulty breathing during sleep, or persistent nasal congestion, the cause should be evaluated instead of just changing your sleeping position.

Address nasal congestion and allergies

• Nasal congestion causes some people to breathe through their mouths, which can make saliva control more difficult.

• If drooling is accompanied by nasal congestion, sneezing, or allergy symptoms, discuss with a doctor or pharmacist about appropriate ways to manage the cause. Do not self-medicate with prolonged use of drugs solely to reduce salivation.

Check current medications

• Some medications can cause excessive salivation or drooling as a side effect. Cleveland Clinic notes that some drugs, especially clozapine, can increase salivation.

• If excessive drooling begins after starting a new medication, record when the symptom appeared and discuss it with your doctor. Do not arbitrarily stop, reduce the dose, or change medication.

• If drooling is prolonged or increasing, your doctor may check for causes such as dental problems, GERD, nausea, swallowing disorders, or other medical conditions.

Part 1: Home remedies for excessive drooling

Method 1: Limit foods that cause excessive salivation

Avoid sour and overly sweet foods

• Some sour foods, especially citrus fruits, can stimulate the salivary glands. Sugary or sour foods can also make you feel like you're producing more saliva.

• If you notice drooling becoming more pronounced after a specific food, note that food down and temporarily limit it to see if the symptom improves.

• There's no need to completely eliminate fruits or healthy foods just because you're worried about excessive drooling. The goal is to identify the specific triggers that worsen your symptoms.

Prioritize simple meals when uncomfortable

• When the sensation of too much saliva in your mouth occurs, a small amount of dry, plain food like crackers or bread can help absorb excess saliva and provide temporary relief.

• However, this is only a temporary measure to alleviate discomfort, not a treatment for the cause of drooling.

• If you frequently have to eat to control this condition, you should seek the underlying cause instead of relying on dry foods.

Avoid smells that make you drool

• Not just food, food smells, especially cooking smells, can also trigger the salivary reflex. This is a normal physiological response of the body when preparing to eat.

• If you notice an increase in drooling when smelling a certain odor, limit exposure to that trigger during times when symptoms are pronounced.

• When food smells cannot be avoided, shift your attention to another activity like reading, talking, or focusing on the task at hand. This can help reduce attention to the sensation of salivation, but it does not replace treatment if symptoms persist.

Monitor triggers for drooling

• Each person may react differently to food, smells, and specific situations. Therefore, the most practical approach is to monitor when excessive salivation occurs and what factors were present just before it.

• You can record three pieces of information: what you ate or smelled, when the symptoms started, and the severity of the drooling.

• If the condition is prolonged, occurs frequently, or is accompanied by difficulty swallowing, nausea, heartburn, nasal congestion, or other unusual symptoms, you should consult a doctor to determine the cause. Excessive drooling is sometimes not due to overproduction by the salivary glands but may be related to swallowing ability or saliva control.

Method 2: Drink enough water to reduce thick saliva

Drink enough water when saliva is thick and mucousy

• When saliva becomes thick, sticky, or contains a lot of mucus, drinking enough water can help thin the secretions and make swallowing easier. This is especially helpful if you feel thick saliva stuck in your mouth or throat.

• It should not be understood that drinking more water will necessarily reduce excessive salivation. Saliva is regulated by many factors, so supplementing with water primarily helps improve dry mouth, thick secretions, and difficulty swallowing.

Divide water intake throughout the day

• Instead of drinking a large amount at once, drink water regularly throughout the day and increase intake when the weather is hot, you're exercising a lot, or your body is dehydrated.

• The amount of water needed varies from person to person. Needs also depend on age, gender, activity level, diet, and health status. Therefore, a fixed number should not be strictly applied to everyone.

• If you are looking for ways to reduce drooling, prioritize drinking just enough water so that your urine is pale yellow and your body shows no signs of dehydration.

Note when saliva has a lot of mucus

• If saliva is thick and mucousy, drinking enough water can help thin the secretions and make them easier to swallow.

• Some people find that dairy products make the sensation of mucus in the mouth or throat more pronounced. However, there is no reason for everyone to avoid dairy just because of excessive drooling. If you suspect a food is worsening your symptoms, monitor your body's reaction and discuss it with a healthcare professional when needed.

Don't just focus on saliva volume

• Drooling, excessive salivation, or sialorrhea does not always mean that the salivary glands are overactive. Some cases occur due to difficulty swallowing or difficulty controlling saliva in the mouth.

• If the condition is prolonged, recurs frequently, or is accompanied by difficulty swallowing, choking, coughing when eating or drinking, voice changes, or other unusual symptoms, you should see a doctor to determine the cause instead of just trying to drink more water.

Method 3: Chew gum to control drooling

Chewing gum can help with swallowing saliva

• For mild drooling, chewing gum can keep the mouth muscles active and encourage you to swallow more frequently. This can help limit saliva pooling in the mouth for some people.

• However, it is necessary to distinguish between reducing drooling and reducing saliva production. Chewing or sucking on candy often stimulates the salivary glands to work, so this should not be seen as a way to reduce the amount of saliva produced.

Prioritize sugar-free gum

• If you want to try this method, choose sugar-free gum to limit sugar intake and reduce the risk of affecting oral health.

• Chew for a short time and monitor your body's reaction. If you find that chewing makes you salivate more, stop using it as this method is not suitable for you.

Be cautious with hard candy

• Hard candy can stimulate saliva production and make you swallow more frequently, but it's not a suitable option for everyone. Especially, young children are at risk of choking when sucking or eating hard candy.

• If you experience excessive drooling due to difficulty swallowing or poor oral motor control, you should not use hard candy to manage symptoms yourself. Swallowing ability needs to be assessed to avoid the risk of choking.

When to seek the cause

• If drooling, excessive salivation, or sialorrhea occurs frequently and affects eating, sleeping, or communication, consult a doctor.

• Especially, if the condition is accompanied by difficulty swallowing, coughing, or choking when eating or drinking, voice changes, or the sensation of food getting stuck in the throat, finding the cause is more important than trying to control saliva with gum or hard candy.

Method 4: Grape juice is not a cure for drooling

Grape juice should not be considered a way to reduce salivation

• Dark grape juice contains tannins, a group of plant compounds that have an astringent taste and can temporarily create a dry mouth sensation. However, there is currently no strong enough clinical evidence to show that drinking grape juice can reliably treat drooling or reduce excessive salivation.

• Therefore, if you are looking for ways to reduce drooling, you should not rely on grape juice as a primary treatment method, especially when symptoms occur frequently or are prolonged.

Some beverages also contain tannins

• Tannins are found in many foods and beverages such as green tea, black tea, and coffee. They can create an astringent or dry mouth sensation after consumption but do not mean they address the underlying cause of excessive drooling.

• Red wine also contains tannins, but alcohol should not be used to control excessive salivation. Alcohol can have many adverse health effects and is not a treatment option.

Pay attention to oral health

• Grape juice, especially varieties with added sugar, can increase the risk of tooth decay if used frequently. Acidic beverages can also contribute to enamel erosion.

• If drinking fruit juice, it is best to choose unsweetened varieties, consume in moderation, and rinse your mouth with water after drinking. Maintain oral hygiene by brushing your teeth at least twice a day and flossing daily.

Don't confuse dry mouth sensation with reduced salivation

• A drink that creates an astringent or dry mouth sensation does not mean that the underlying cause of drooling, excessive salivation, or sialorrhea has been resolved.

• If you frequently have to find drinks or foods to dry your mouth, or if excessive saliva occurs along with difficulty swallowing, nausea, heartburn, or other unusual symptoms, you should consult a doctor to determine the cause and choose the appropriate method.

Method 5: Be cautious with sage and ginger

Do not self-medicate with herbs to reduce drooling

• Ginger tea or sage are often mentioned as folk remedies to create a dry mouth sensation and help control drooling. However, current scientific evidence is not strong enough to confirm that sage is effective in treating excessive salivation. NCCIH also states that research on sage is limited and cannot definitively conclude its effectiveness as an herb.

• Therefore, if you are looking for ways to reduce drooling, you should not self-medicate with herbal teas, extracts, or tinctures of sage for treatment purposes, especially when the condition is prolonged or of unknown cause.

If you want to use ginger or sage, prioritize food-level consumption

• Ginger is commonly used in food and beverages, but ginger tea should not be considered a proven method to reduce excessive drooling.

• With sage, using normal amounts in food preparation is generally safer than concentrated extracts. Some types of sage contain thujone; high or prolonged doses can cause adverse effects.

Do not self-medicate with essential oils or concentrated extracts

• You should not self-administer sage essential oil or use concentrated extracts to try to reduce excessive salivation. The risk lies not only in uncertain effectiveness but also in dosage and drug interactions.

• If you are taking medication for a condition, ask your doctor or pharmacist before using any herbal products as herbs can interact with medications.

Be especially cautious when pregnant or breastfeeding

• Sage should not be used as a dietary supplement during pregnancy. NCCIH notes that thujone in some types of sage can have adverse effects, and its safety during breastfeeding has not been clearly established.

• If drooling occurs frequently during this period, you should consult a healthcare professional instead of self-treating with herbs.

Focus on finding the cause if symptoms persist

• Prolonged drooling, excessive salivation, or sialorrhea can be related to various causes. Therefore, temporarily drying the mouth does not mean resolving the underlying cause.

• If the condition is accompanied by difficulty swallowing, choking, coughing when eating or drinking, or significantly affects daily life, you should see a doctor for appropriate evaluation instead of continuing to try various home herbal remedies.

Part 2: Causes of excessive salivation

Note 1: Reducing drooling due to nausea

Address nausea first

• Drooling can increase just before or during nausea. This is the body's protective reaction, helping to limit the effects of stomach acid on the mouth when there is a risk of vomiting. Therefore, if excessive salivation occurs with nausea, focus on controlling the cause of nausea instead of just trying to reduce salivation.

• When you start to feel nauseous, sit in a comfortable position, rest, and breathe slowly. If you notice a specific situation that often causes nausea, write it down to proactively avoid or reduce exposure to that trigger.

Avoid triggers that easily activate nausea

• Common causes include motion sickness, strong odors, certain foods, movement, stress, or digestive issues. Factors such as smell, taste, and movement can all affect feelings of nausea.

• If drooling occurs while traveling, try looking straight ahead, avoid reading or looking at screens while moving, and breathe fresh air when possible.

• If the smell of food or cooking makes you nauseous, avoid areas with strong odors or choose cold, less odorous foods. This is also a commonly recommended measure for controlling nausea during pregnancy.

Eat light when your stomach is upset

• When nauseous, try bland, easy-to-digest foods like toast, crackers, or rice, instead of greasy, spicy, or strong-smelling dishes. Eating small amounts and dividing them into several meals can be more comfortable for some people.

• If excessive drooling accompanies nausea, do not try to eat a lot to "absorb" the saliva. Prioritize small portions, eat slowly, and stop if the nausea increases.

Note if drooling during pregnancy

• Drooling during pregnancy can occur with nausea and vomiting. Hormonal changes during pregnancy can contribute to increased salivation, while nausea causes some people to swallow less saliva, making the feeling of excessive saliva in the mouth more pronounced.

• If you are pregnant, drink small sips of water frequently, get enough rest, and avoid smells or foods that make you nauseous.

Know when to see a doctor

• If drooling, nausea, or vomiting is prolonged and you cannot eat or drink normally, you should be evaluated by a healthcare professional to find the cause.

• In particular, seek medical attention early if vomiting is so severe that you cannot keep down food or drink, show signs of dehydration, dizziness, severe weakness, or urinate very little. During pregnancy, severe vomiting can lead to dehydration and malnutrition, sometimes requiring specialized treatment.

Note 2: Reducing drooling during reflux

Address reflux if it is the cause

• Drooling sometimes occurs with gastroesophageal reflux. When acid or stomach fluid flows up the esophagus and throat, the body may increase saliva production as a protective reaction. Therefore, if excessive salivation accompanies heartburn, a sour taste in the mouth, or a feeling of fluid flowing up the throat, pay attention to the possibility of reflux.

• Instead of just looking for ways to reduce drooling, prioritize controlling reflux symptoms. Some people can improve by limiting foods or drinks that worsen their symptoms, such as spicy foods, acidic foods, coffee, or fatty foods. It is not necessary to avoid all of these food groups if they do not cause symptoms for you.

Antacids can be used when needed

• Antacids do not directly reduce saliva production, but they can help quickly relieve mild symptoms of heartburn and reflux. Therefore, they are only appropriate when excessive drooling is related to reflux.

• If using over-the-counter medications, read the instructions on the package carefully and use the correct dose. Do not self-medicate with antacids daily for a long time or use them to treat severe symptoms without consulting a doctor.

Pay attention to interactions with other medications

• Antacids can affect the absorption or effectiveness of some other medications. If you are taking prescription medications, supplements, or treating chronic conditions, ask your pharmacist or doctor before use.

• Do not stop taking medication on your own just because drooling appears. Provide your doctor with a list of all medications you are taking to determine whether the symptoms are related to medication, reflux, or another cause.

See a doctor if symptoms persist

• If drooling, heartburn, or reflux does not improve after lifestyle changes and over-the-counter medications, see a doctor for evaluation of the cause.

• Seek early medical evaluation if you experience difficulty swallowing, pain when swallowing, persistent vomiting, chest pain, vomiting blood, black stools, or unexplained weight loss. These may be signs of complications or another medical condition that needs to be checked.

Note 3: Check medications that cause drooling

Talk to your doctor about the medications you are taking

• Some medications can cause excessive salivation or drooling as a side effect. This condition is especially noted with some antipsychotic medications, with clozapine being a clear example.

• If you notice excessive drooling starting after taking a new medication, record when the symptoms appeared and inform your doctor or pharmacist. This information helps them assess whether the medication is a contributing factor.

Do not stop medication on your own

• Do not reduce the dose, stop taking medication, or switch to another medication on your own just because drooling appears. With some prescription medications, sudden discontinuation can cause problems, and the medication may still be necessary to control the underlying condition.

• Your doctor may consider adjusting the medication, changing the dose, or choosing another treatment option if they find that the side effects significantly affect your daily life.

Check all medications and supplements

• When seeing a doctor for excessive salivation, provide a list of all medications you are taking, including prescription medications, over-the-counter medications, vitamins, and supplements. This helps your doctor fully assess the possible causes of the symptoms.

• Do not rely solely on online lists to self-determine which medications cause drooling. The same medication can have different effects depending on the person and the dosage.

Treat if symptoms persist

• If drooling, sialorrhea, or the feeling of too much saliva in the mouth persists, your doctor may look for the underlying cause instead of just treating the symptoms. Hypersalivation is not always due to the salivary glands producing too much; difficulty controlling or swallowing saliva can also lead to drooling.

• In some cases, your doctor may consider medications to reduce saliva production. These medications should be used under the guidance of a healthcare professional as they can cause side effects and are not suitable for everyone.

Note 4: Practice swallowing to control drooling

Swallowing exercises can help control saliva

• If drooling occurs due to difficulty controlling or swallowing saliva, restoring swallowing function can help prevent saliva from accumulating in the mouth. Clinical guidelines for excessive salivation also note that swallowing therapy may be considered when this condition results from a swallowing disorder.

• It is important to distinguish excessive salivation from ineffective swallowing of saliva. Some people do not actually produce too much saliva but still drool because saliva accumulates in the mouth and is difficult to swallow.

Appropriate swallowing exercises should be guided

• Exercises can affect the lips, tongue, jaw, pharynx, larynx, and muscles involved in swallowing. However, exercises should be chosen based on the cause and severity of the swallowing disorder for each individual.

• Do not self-perform complex swallowing exercises solely to reduce drooling. Some exercises that are not suitable for the specific condition may make swallowing less effective or increase the risk of choking. Hospital guidelines recommend that exercises be selected, guided, and monitored by a speech and swallowing therapist.

Children need separate evaluation

• If a child frequently drools, has difficulty controlling saliva, coughs, or chokes when eating or drinking, they should not simply be told to swallow repeatedly. These may be signs that feeding, drinking, and swallowing functions need to be evaluated.

• A speech therapist can evaluate oral motor skills, the swallowing process, and guide strategies appropriate for the child.

Special considerations for neurological or muscular diseases

• People with diseases or injuries affecting motor skills and swallowing, such as Parkinson's, nerve damage, or some muscle diseases, may experience poor saliva control.

• In these cases, the goal is not only to reduce drooling but also to ensure that the patient swallows safely and to minimize the risk of food, water, or saliva entering the airway.

Know when to see a doctor

• If excessive drooling is accompanied by coughing or choking when eating or drinking, a wet voice after swallowing, food getting stuck in the mouth or throat, difficulty breathing after eating or drinking, or recurrent respiratory infections, a swallowing disorder should be evaluated.

• A doctor or speech and swallowing therapist can evaluate the cause, check the safety of swallowing, and develop an appropriate rehabilitation program. For swallowing disorders, professional evaluation is more important than self-trying home remedies to reduce drooling.

Note 5: Treat nasal congestion to reduce drooling

Treat nasal congestion and allergies

• Drooling can occur with sinusitis, colds, or allergies. Cleveland Clinic notes that sinus infections and allergies are factors that may be related to drooling.

• If drooling is accompanied by nasal congestion, runny nose, sneezing, itchy nose, or post-nasal drip, focus on treating the rhinosinusitis rather than just trying to reduce saliva.

Reduce nasal congestion appropriately

• For mild symptoms, you can rest, drink plenty of fluids, and use saline solution to clear your nasal passages. Nasal irrigation with saline can help reduce nasal congestion and symptoms related to allergies or sinusitis.

• If performing nasal irrigation, use distilled water, sterile water, or boiled and cooled water, do not use untreated tap water directly to avoid introducing microorganisms into the sinuses.

Use medication when indicated

• For allergies, a doctor or pharmacist can recommend appropriate antihistamines or nasal sprays. For sinusitis, treatment depends on the cause and duration of symptoms; not all cases require antibiotics.

• Do not self-medicate solely to reduce excessive salivation. The primary goal is to control nasal congestion, allergies, or sinusitis if that is the factor causing the symptoms.

Monitor if drooling persists

• If nasal and sinus symptoms are controlled but excessive drooling still persists, other causes need to be considered. Drooling is not always due to overproduction of saliva; difficulty swallowing or poor control of oral muscles can also cause this condition.

• If nasal congestion or sinus symptoms are prolonged, recurrent, facial pain increases, fever, or unusual nasal discharge occurs, seek medical attention for evaluation. Persistent symptoms may require a specialized ear, nose, and throat doctor to examine.

Part 3: When to see a doctor

Note 1: Treat oral diseases to reduce drooling

Check for problems in the oral cavity

• Drooling or excessive salivation is sometimes related to oral problems. Untreated tooth decay can stimulate the salivary glands to work more, while oral and throat infections can also be accompanied by drooling.

• If excessive drooling occurs with toothache, gum pain, swelling, bad breath, an unpleasant taste in the mouth, or pus, you should be examined by a dentist or doctor instead of just trying to reduce drooling at home.

Treat the cause instead of just alleviating symptoms

• Schedule a dental appointment if you suspect tooth decay, gingivitis, dental abscess, or oral infection. Dental abscesses do not heal on their own and require treatment by a dentist to prevent the infection from spreading.

• Do not self-medicate with antibiotics or other medications solely to control drooling. The treatment method must be based on the specific cause identified through examination.

Pay attention when wearing braces or oral appliances

• Braces, dentures, or some oral appliances can alter sensations in the oral cavity and affect saliva control in some people.

• If excessive salivation begins after fitting an appliance or is accompanied by difficulty swallowing, pain, swelling, or persistent irritation, inform your dentist for examination and adjustment if necessary.

Maintain oral hygiene

• Regular brushing, cleaning between teeth, and routine dental check-ups help reduce the risk of tooth decay, gum disease, and problems that can affect oral health.

• However, good oral hygiene does not always eliminate excessive drooling. If symptoms persist, other causes such as reflux, nausea, allergies, current medications, or swallowing problems need to be investigated.

Seek early medical attention if there are signs of infection

• Seek medical attention if drooling, pain, or swelling in the mouth persists, especially if accompanied by fever, swelling in the jaw or neck area, difficulty opening the mouth, unusual foul odor, or pus. These may be signs of an infection that requires treatment.

• If swelling in the mouth, jaw, or neck causes severe difficulty breathing or swallowing, seek emergency medical care immediately, as some infections can spread to deep tissues in the neck and affect the airway.

Note 2: Medications to reduce saliva require a doctor's prescription

Only use medication when prescribed by a doctor

• When excessive drooling significantly affects daily life, a doctor may consider some anticholinergic medications to reduce nerve signals stimulating the salivary glands. Some medications like glycopyrrolate and scopolamine have been used to control drooling, but their effectiveness must be weighed against the risk of side effects.

• This is not a group of medications that should be bought and used on your own to reduce saliva production. The choice of medication depends on the cause, age, underlying conditions, current medications, and swallowing ability of each individual.

Discuss side effects thoroughly

• Anticholinergic drugs can cause dry mouth, constipation, urinary retention, blurred vision, dizziness, drowsiness, or confusion. Some people have to stop taking the medication due to side effects.

• Individuals with certain medical conditions such as narrow-angle glaucoma, urinary retention, or gastrointestinal motility disorders need to be especially cautious when using this class of drugs.

Do not self-adjust dosage or change medication

• If you are taking medication for another condition and experience drooling, inform your doctor instead of reducing the dose or stopping the medication yourself.

• Your doctor can assess whether the medication you are taking is related to the excessive salivation and consider changing the treatment plan if appropriate.

Other treatment methods may be needed

• If drooling persists and medication is unsuitable or causes many side effects, your doctor may consider other methods depending on the cause, such as injecting botulinum toxin into the salivary glands in some cases. This procedure must be performed by a qualified healthcare professional.

• Especially for individuals with neurological conditions or swallowing disorders, treatment should simultaneously consider swallowing ability and saliva control, rather than just trying to dry the mouth.

When to see a doctor

• If you experience excessive drooling, profuse salivation, or saliva frequently pooling in your mouth, affecting eating, communication, or sleep, you should be evaluated by a doctor to determine the cause.

• If the condition is accompanied by difficulty swallowing, coughing or choking while eating or drinking, voice changes after swallowing, or difficulty breathing, seek early medical evaluation as the problem may be related to a swallowing disorder rather than simply excessive saliva production.

Note 3: Atropine should only be used when prescribed by a doctor

Do not self-administer atropine eye drops

• Atropine is an anticholinergic drug that can reduce saliva production. Some studies show that sublingual atropine can help improve drooling in some people, especially in cases related to neurological conditions or swallowing disorders. However, this is often an off-label use and requires physician guidance.

• Therefore, you should not self-administer atropine 1% eye drops sublingually or apply them to treat excessive salivation. The concentration and dosage must be chosen by a doctor based on age, medical conditions, current medications, and swallowing status.

Effective but risks need to be considered

• Systematic reviews and meta-analyses show that atropine can reduce drooling, with sublingual administration yielding notable results. However, studies show significant differences in medical conditions, dosages, and effectiveness assessment methods, so a general formula cannot be applied to everyone.

• Research on post-stroke patients also noted that sublingual atropine can reduce the extent of drooling when combined with swallowing rehabilitation. This suggests that the drug is most suitable when used within a specific treatment plan, rather than as a self-care trick at home.

Pay attention to atropine's side effects

• Atropine can cause anticholinergic side effects such as excessive dry mouth, blurred vision, flushing, drowsiness, rapid heartbeat, or urinary retention. The risk of systemic effects still exists even when the drug is used topically.

• Therefore, if your doctor prescribes atropine to control excessive drooling, follow the instructions correctly and report any unusual symptoms immediately.

Do not substitute with other medications

• Some other anticholinergic drugs can also be used to treat drooling, but the choice of drug depends on the cause and the individual's health condition. Do not self-switch to hyoscyamine, amitriptyline, ipratropium, or similar drugs based solely on information found online.

• If drooling, excessive salivation, or sialorrhea persists, especially when accompanied by difficulty swallowing, coughing, or choking while eating or drinking, you should be evaluated by a doctor before taking any medication.

Note 4: Botox can reduce drooling

Consider Botox for severe drooling

• For prolonged excessive drooling that significantly affects daily life, your doctor may consider injecting botulinum toxin into certain salivary glands when other methods are not effective enough. Studies show that this method can reduce the severity and frequency of drooling, especially in people with certain neurological conditions.

• This is a specialized treatment method, not a self-care solution at home. The suitability of this option needs to be based on the cause of excessive salivation, swallowing ability, and overall health status.

Effectiveness is only temporary

• Botulinum toxin reduces salivary gland activity for a certain period. The effect is not permanent and may require repeat injections as evaluated by the doctor. A follow-up study on repeated treatment showed that effectiveness can be maintained with appropriate treatment cycles.

• Since the response time varies between individuals, do not self-determine a fixed injection schedule, such as injecting every few months. The doctor will decide the next treatment time based on the severity of drooling and the response from the previous session.

Risk assessment required before injection

• Botulinum toxin can cause dry mouth or make existing swallowing difficulties more pronounced. This is particularly important for individuals who already have dysphagia.

• Before treating excessive drooling, the doctor needs to assess swallowing ability, aspiration risk, and the cause of saliva production. Professional guidelines emphasize multidisciplinary assessment when hypersalivation is related to dysphagia or neurological conditions.

Only performed at a medical facility

• Injecting botulinum toxin into the salivary glands must be performed by a qualified healthcare professional, using appropriate techniques and localization methods. This should not be considered a routine cosmetic procedure when the goal is to treat drooling.

• If you or a loved one experiences prolonged drooling or excessive salivation, discuss it with a doctor to determine the cause first. When intensive treatment is needed, the doctor may refer you to the appropriate specialist and develop a safe treatment plan.

Note 5: Surgery only for severe drooling

Consider surgery only when other methods are ineffective

• Surgery to reduce drooling is not the first option. Recent guidelines and reviews recommend a step-by-step approach, usually starting with postural adjustments, oral motor and swallowing therapy, medication, or botulinum toxin; surgery is reserved for severe cases of excessive drooling or those unresponsive to other methods.

• The goal of surgery is not merely to reduce the amount of saliva but to control excessive salivation that significantly affects quality of life or poses health risks, such as in individuals with neurological conditions accompanied by severe swallowing disorders.

The doctor will choose the appropriate method

• Depending on the case, the doctor may consider techniques such as salivary duct ligation, salivary duct redirection, or salivary gland surgery. The choice depends on the cause, severity of drooling, swallowing ability, and overall health status.

• Some studies show that surgery can provide more long-term effectiveness compared to temporary methods. However, surgery also carries risks of complications, so a careful balance between benefits and risks needs to be considered.

Assess swallowing ability before surgery

• Before treating excessive drooling with surgery, the doctor needs to assess swallowing ability and the risk of saliva entering the airway. This is an important step because excessive reduction of saliva in individuals who already have difficulty swallowing can exacerbate dry mouth or swallowing difficulties.

• In some cases, the patient may need to be evaluated by multiple specialties, such as ENT, neurology, dentistry, and speech-language pathologists to determine the appropriate course of action.

Surgery should not be considered a common cure

• If you only occasionally drool, especially during sleep, when nauseous, or when you have a stuffy nose, surgery is usually not the appropriate option. First, the underlying cause of the symptoms needs to be identified and addressed.

• If drooling, excessive salivation, or sialorrhea persists, affecting eating, communication, sleep, or quality of life, seek medical evaluation for a step-by-step assessment instead of trying to self-treat.

Surgery is the last step in treatment

• Current evidence supports a personalized approach: start with less invasive measures, assess the response, and then move to more intensive methods. A systematic review in 2026 also showed that surgical interventions tend to provide more sustainable benefits in severe or refractory cases, but should be reserved for appropriate cases.

• Therefore, if you are looking for ways to reduce drooling, do not consider salivary gland surgery a quick fix. The doctor needs to first determine whether the problem lies in excessive saliva production, swallowing ability, or oral motor control.

When drooling causes coughing or choking

Seek early medical attention if drooling is accompanied by coughing or choking

• If excessive drooling is accompanied by coughing, clearing the throat, or a feeling of choking, do not just look for ways to reduce drooling at home. These signs may be related to difficulty swallowing and need to be evaluated to determine if saliva is entering the airway.

• Prolonged drooling can also be a sign of a swallowing disorder, especially when accompanied by food or drink being held in the mouth, a gurgly voice after swallowing, or difficulty controlling secretions in the mouth.

Recognize aspiration risk

• Aspiration occurs when saliva, food, or liquid enters the airway instead of going down the esophagus. If this happens repeatedly, the patient may be at increased risk of lung infections, including aspiration pneumonia.

• Notable signs include:

  • Coughing or throat clearing during or after swallowing.

  • Choking or difficulty breathing.

  • Voice becoming wet or gurgly after eating or drinking.

  • Food or water frequently retained in the mouth.

  • Drooling or difficulty controlling saliva.

Do not self-adjust saliva-reducing medications

• If your doctor has prescribed medication to control excessive salivation, take it exactly as directed. Do not increase the dose yourself with the expectation of reducing drooling faster.

• If side effects or unusual symptoms occur after taking the medication, inform your doctor or pharmacist for guidance. Some saliva-reducing medications can cause dry mouth or other side effects, so a balance between effectiveness in controlling saliva and safety is needed.

Evaluate swallowing ability if symptoms persist

• Not all cases of excessive drooling are due to overproduction by the salivary glands. Some people drool because they cannot swallow or control saliva effectively. Clinical guidelines recommend a multidisciplinary assessment to determine the cause and choose the appropriate treatment method.

• If a swallowing disorder is suspected, the doctor may refer you to a speech and swallowing therapist to evaluate swallowing function. In some cases, specialized swallowing tests may be indicated.

Seek emergency care if unable to swallow or have difficulty breathing

• If drooling is accompanied by difficulty breathing, inability to swallow saliva, severe choking, or rapidly worsening symptoms, seek emergency care immediately. The NHS considers drooling accompanied by inability to swallow or difficulty breathing as a sign requiring urgent treatment.

• In these situations, do not continue to try home remedies to reduce drooling. Prioritize airway safety and seek timely medical attention.

References

1. American Speech-Language-Hearing Association. (n.d.). Adult dysphagia: Practice portal. American Speech-Language-Hearing Association.
2. Cleveland Clinic. (2022). Drooling: Definition & causes. Cleveland Clinic.
3. National Institute of Dental and Craniofacial Research. (2024). Saliva and salivary gland disorders. National Institutes of Health, U.S. Department of Health and Human Services.
4. National Institute of Dental and Craniofacial Research. (2024). Oral hygiene. National Institutes of Health, U.S. Department of Health and Human Services.
5. National Institute of Dental and Craniofacial Research. (2024). Dry mouth. National Institutes of Health, U.S. Department of Health and Human Services.
6. National Institute of Diabetes and Digestive and Kidney Diseases. (2024). Eating, diet, & nutrition for GER & GERD. National Institutes of Health, U.S. Department of Health and Human Services.
7. National Institute of Diabetes and Digestive and Kidney Diseases. (2024). Symptoms & causes of GER & GERD. National Institutes of Health, U.S. Department of Health and Human Services.
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12. Møller, E., Pedersen, S. A., & others. (2024). Management of sialorrhea in neurological disorders: A systematic review and meta-analysis. Journal of Neurology.
13. Nóbrega, P. R., Rodrigues, B., & others. (2024). Sublingual atropine for sialorrhea: A systematic review and meta-analysis. Journal of Neurology.
14. Scott, R. B., et al. (2019). Botulinum toxin type A for the treatment of sialorrhea: A systematic review and meta-analysis. Clinical Neurology and Neurosurgery, 177, 82–90.
15. McCarty, E. B., & Chao, T. N. (2021). Dysphagia and aspiration in patients with neurological disease. Otolaryngologic Clinics of North America, 54(1), 127–143.
16. Speyer, R., Cordier, R., Kertscher, B., & Heijnen, B. J. (2019). Diagnosis and management of oropharyngeal dysphagia and aspiration. Clinical Interventions in Aging, 14, 175–187.

Content edited by: Ashley Wright Nguyen.

Information reviewed and verified by expert: William Harris.