How Much Saliva Is Enough for Avoidance of Xerostomia?

Xerostomia, the subjective sensation of dry mouth, occurs when the salivary flow rate is less than the rate of fluid loss from the mouth by evaporation and by absorption of water through the oral mucosa. Evaporation can only occur during mouth-breathing but could reach a maximum rate of about 0.21 ml/min at rest, although normally it would be much less. Water absorption through the mucosa can occur because saliva has one sixth the osmotic pressure of extracellular fluid, thus creating a water gradient across the mucosa. The maximum absorption rate is calculated to be about 0.19 ml/min, declining to zero as the saliva reaches isotonicity. A recent study found the residual saliva volume, the volume of saliva left in the mouth after swallowing, to be 71% of normal in patients with severe hyposalivation and whose mouths felt very dry. Saliva in the residual volume is present as a thin film which varies in thickness with site. The hard palate has the thinnest film and when this is 0.1–0.3 ml/min may be necessary for this condition to be avoided.