Treatments for Excess Saliva in Pregnancy

Treatments for Excess Saliva in Pregnancy

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Note: The following information is for education only and not to be taken as medical advice. Be sure to consult your doctor for all medical decisions. 

***Trigger Warning*** 

The following blog has details that might cause a reaction in women who have Hyperemesis Gravidarum. Proceed with caution if this is you!

Treatments for Excess Saliva in Pregnancy 

AKA Pytalism, Sialorrhea and Hypersalivation

With pregnancy comes many expected changes in the body, but a mouthful of saliva often catches women by surprise. For women with HG, spitting the overflow of saliva is the only option, as swallowing the recurring mouthful can be the start of a day of non-stop vomiting. Statistics show that about half of all pregnant women experience increased salivation. This condition has many names including pytalism, sialorrhea and hypersialosis and produces up to two liters of saliva every 24 hours. The condition is so interconnected with HG that it is also known as ptyalism gravidarum. As with HG itself, there is no consistent time in the pregnancy in which this annoyance resolves, leaving women around the world wondering if there are any options to ease this problem. While pytalism is not considered a problem in the medical community, it may be one indirectly for HG sufferers as it adds vomiting episodes and social isolation that comes with having extreme nausea and vomiting.

One theory of why the body is producing increased salivation is to protect the mouth, teeth and throat from the corrosive effects of acid and to flush through bacteria. Moving bacteria from the mouth is very important, as recent studies have shown that the health of the mouth correlates to the health of the rest of the body. While excess saliva seems harmless and happens in other disease states as well, for women suffering from HG, this experience creates a vicious cycle. The cycle starts with the constant vomiting from HG which increases acid in the mouth. The acid then produces more saliva, yet the constant mouthfuls of saliva increases nausea leading to more episodes of vomiting. With HG already being an extremely debilitating and isolating condition, the constant need to spit adds to the anxiety of being in public. Take a moment to read about this nurse’s experience with it during the Covid-19 pandemic, when we were all required to wear a mask. Let me emphasize that this is what a nurse experienced at work! When medical professionals do not understand that pytalism is a medical condition, how is the rest of society supposed to care? Considering these consequences, it’s important to explore the current options for coping with pytalism and hope that more options become available in the future.

Causes

What is the underlying cause? If you Google this question, the top reason will say hormones. This is such a generic word and does not tell us much about anything!  Which hormones? Of course, even if we did know exactly which hormones and at what levels of each hormone, we are not at the point where we could adjust hormone levels to reduce saliva production. According to Jenny Leach, an author on BabyCenter, those hormones cause salivary glands to increase stimulation, but what is driving this force? Following is what we do know:

  • Hormones
    • Dopamine plays a role in increasing saliva production, and while we have medications that antagonize the D1 receptor, the adverse effects on the mother of these medications for this purpose would outweigh any benefits.
    • Estrogen is known to play a role in changing our senses when we’re pregnant. A 2012 study even looked at the estrogen levels of pregnant and non-pregnant women with periodontitis. It found that the pregnant women with low estrogen had higher levels of periodontitis. We know that some level of increased estrogen is nature’s way of protecting us, but we have yet to find a value and method to prevent this from going into overdrive.
    • Once stimulated from increased “hormones,” both the sympathetic and parasympatheic nervous systems gets to work. We do have medications that work on acetylcholine which are called anticholinergics, but we have to be very, very careful because women with HG are fighting severe dehydration on a daily basis. Anticholinergics dry out the mouth, so we would be adding fuel to the fire in a patient that is already dry. See Medication Options below to learn more about these medications.
  • Dehydration
    • Like a thermostat, our bodies have systems that auto regulate to stay balanced. Our endocrine system is an expert at self regulating, until a change throws the system out of whack. Think of your air conditioning system. Depending at what temperature you have it set, it knows that when it gets too warm, it will kick on and cool your room. In the case of HG sufferers, dehydration causes excess saliva. We then trigger the unfortunate cycle where the excess saliva then increases the nausea which leads to more vomiting which triggers increased saliva production. While the dehydration starts the cycle, once it is started, only IV therapy seems to be the solution to ending the constant vomiting and preventing rehydration. Even with that treatment, we’re battling the pytalism until it eventually dissipates at some point in the pregnancy.

Treatment Options

Most pregnant women are told, “Simply accept that excessive salivation is a side effect of being pregnant. Swallow or spit out the excess saliva.” Refusing to accept this as a final answer, I started my search for treatment options with my dentist, who seems to have a solution for every dental problem. Unfortunately she did not have any solutions to help decrease the salivation. Given that I am one who never accepts defeat, here is what I found for you…

First, the obvious and probably already tried options, from What to Expect When You’re Expecting and HG mom support groups:

  • Chewing on ice
  • Using a minty mouthwash
  • Brushing your teeth often with a minty toothpaste 
  • Chewing sugarless gum
  • Eating or drinking something sour, like sucking on lemon slices
  • Carrying tissues and a towel with you at all times, so you can blot the saliva or drool that it may cause

Next, I was happy to see that Oral B, the toothpaste and toothbrush manufacturer, actually mentions HG as a cause of excess saliva, but they made me laugh with their treatment suggestions which included: brushing teeth, drinking water and eating small frequent, low carb meals. If we could do that then we wouldn’t have HG! Maybe their last suggestion of chewing sugarless gum may help, as it was also recommended in the section above. 

Natural Remedies

[from Excessive Production in Pregnancy: Stop Spitting During Pregnancy (tandurust.com)]

  • Sucking on limes or lemons 
  • Limiting intake of sugar, as sweet and sour tastes increase saliva. Any HG survivor can tell you this is easier said than done! For an odd reason, is it’s the sugary drinks that are most likely to stay down and prevent dehydration. Case studies have  shown that a high protein diet decreases HG, but obviously it must be started before the HG overtakes the pregnancy.
  • “Use some ground coffee under your tongue. It actually absorbs the excess moisture that saliva produces and it feels like you are drinking a cup of coffee without having a cup of it in your hand.” If HG mom can do this, please let me know. Just the thought would send most HG moms into a downword spiral!
  • Sunflower seeds seem to be a popular remedy for this problem and works for a lot of pregnant women. Simply suck on sunflower seeds to help stem the need to spit.

Dental Products

  • Saliva absorption pads: 
  • Home suction: 
    • Just like the dentist would use, these machines are readily available for home use for other disease states, like ALS and tracheostomies. You can even use your HSA/FSA card for some of them. Let me know if you think this is worth trying, to avoid spitting in cup!  Take a look at options on Amazon here:https://amzn.to/3rdRLmW

Non-oral Options

  • Hypnosis
    • This study made me laugh because this patient’s “Ptyalism Gravidarum” resolved at 36 weeks, so it is questionable if it was the hypnosis or just the change in hormones in that last month. Usually excess salivation resolves long before the 36th week. That said, if you’re looking for something without risk of adverse effects and can afford it, hypnosis may be worth trying.
  • Chiroprator 
    • This study in eastern Europe with 115 women showed a 78% success rate in decreasing hypersalivation, along with a decrease in many other discomforting pregnancy symptoms. Since I am not trained in chiropractic are, I’d like to know if the methods used are the same around the world. As chiropratic care varies greatly, be sure to do your research prior to starting any treatment. Most important, do NOT try this at home!

Prescription options

These work by blocking acetylcholine, the neurotransmitter that controls nerve impulses

  • Botox
    • I saw a mom post about this treatment making a profound difference so I had to explore this option. Botox works by paralyzing the nerve and it commonly used to stop wrinkles as well as a treatment for migraines, incontinence and much else. I reached out to Abbvie/Allergan, the manufacture, about having an Ears, Nose and Throat (ENT) specialist use Botox for this condition, and while they said they have information on its safety and efficacy, what they sent me did not include this indication. Note: My dentist said NOT to use botox for this indication while you’re pregnant, yet it seems that many pregnant women are using botox for other indications with no increased risk to the mom or baby. Hopefully in the future, we’ll have more information on this option.
    • If you’re curious, here’s how the procedure is done: https://medicine.uiowa.edu/iowaprotocols/botox-injection-salivary-glands-hypersalivation. 
  • Glycopyrollate (Robinul)
    • Glycopyrollate is FDA approved for …..off label for drooling
    • The good news is that it is Pregnancy Category B. 
    • The bad news is that, as with most medications used for HG, it has many drug-drug interactions including cyclizine and phenergan, meclizine, chlorpromazine, promethazine. Why because these medication are also anticholinergics
    • If you try it, the usual dose in the hospital is…..0.1 mg/kg PO q8-12kh. Max 8 mg/day
  • Scopolamine
    • Scopolamine is a patch worn behind the ears for three days at a time. Since it is also a anticholinergic, it is not one of the medications I recommend for HG due to the fact that we do not want to cause dehydration in patient who is already dehydrated, yet I see obstetricians prescribing. Some boast about how it tremendously helped reduce their excess saliva, but others had such severe adverse effects that it took weeks for the life-threatening symptoms to alleviate. If you try it, please watch out for adverse effects and contact your doctor immediately.
  • Clonidine 
    • While this is a single case study, I was excited to come across this, as there are also other studies showing clonidine’s support in decreasing vomiting from HG. Since clonidine also lowers blood pressure, be sure to monitor your blood pressure at home. On the flip side, this study from 1985 shows clonidine as an option for women at risk for pre-eclampsia.
  • Years ago, belladonna was used since salivary glands are stimulated by the parasympathetic nervous system, but studies in the 1980s showed increased risk of congenital defects, so do NOT try this class of medications, as the risks of birth defects are still inconclusive.
    • a study in Haiti in 1992 used promethazine and belladonna to treat it, but we know now that the risks may NOT outweigh the benefits
      • Listen to a conversation on excess saliva with Danielle and Kimber McGibbon of the HER Foundation: (Thanks, Kimber for freezing me on this frame! 🤣)

       

      View this post on Instagram

       

      A post shared by HER Foundation (@hgmoms)

      • https://www.instagram.com/tv/CKu4hu2lc1D/?utm_source=ig_web_copy_link

Have you found anything to help decrease your saliva production during pregnancy that does not have other adverse effects? If so, please share at info@hgpharmacist.com or in our HG support group at https://www.facebook.com/groups/hgsolutions

 

Dr. Danielle Plummer

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