Choking on saliva can be caused by excessive saliva production, or by some damage or illness that impacts one's ability to swallow. Sometimes it's possible to become incapacitated, such as through drinking too much alcohol, and choking on saliva may occur. Some very rare conditions, like amyotrophic lateral sclerosis (ALS) can also make swallowing more difficult, and saliva may be allowed to accumulate to the point of choking.

Nearly everyone chokes or coughs on their own saliva at some point in their life. This is usually not indicative of any medical condition, and is usually the result of forgetting to swallow often enough or talking too quickly. When it occurs only occasionally in this way, there is no cause for concern, and a doctor's advice is usually not required in these cases.

More serious issues can also cause choking on saliva. For instance, some may experience an overproduction of saliva, and they may not be able to swallow quickly enough. Treatment for this condition varies, but medication is most often used to help slow down the salivary glands.

There are also conditions which can affect one's ability to swallow. Lesions in the throat, tumors, severe arthritis of the throat, and certain neurological conditions can also affect the ability to swallow. The severity will depend on how serious the condition is. Reflux-related lesions can often heal themselves after awhile once the condition is treated, but cancer or tumors of the throat are much harder to treat.

In the case of injury or disease to the throat or esophagus itself, other symptoms are usually noticed in those areas. Pain, bleeding, heartburn, cough, and other symptoms may be present. Those with large tumors may experience a tightness in the throat, and breathing can eventually become more difficult. If any of these issues are noted, a doctor should be notified.

Some more serious diseases can also lead to trouble swallowing. ALS is a fatal neurological disorder that affects the ability to use certain muscle systems. As the nerves die, the ability to perform basic bodily functions or movements becomes impossible. The inability to swallow is usually a later symptom of the illness, and choking on saliva becomes a very real possibility during this stage. The use of suction devices to clear the throat of any excess is often needed on an ongoing basis.