Background <p>Oral submucous fibrosis (OSMF) is a premalignant condition characterized by progressive fibrosis of the oral mucosa. It may extend to involve minor salivary glands, resulting in reduced salivary secretion and xerostomia. Pharmacological sialogogues which are traditionally used to manage hyposalivation are often associated with adverse effects, limiting their long-term use. Hence, safer non-pharmacological alternatives are warranted.</p> Aim <p>To evaluate and compare salivary flow rate (SFR) in patients with OSMF before and after Transcutaneous electric nerve stimulation (TENS) therapy.</p> Methods <p>A prospective interventional study, approved by the Institutional Ethics Committee (IEC) included clinically diagnosed 60 OSMF patients. Xerostomia was evaluated subjectively using the xerostomia inventory. Unstimulated SFR was measured using the Modified Schirmer Test (MST) at baseline. TENS therapy was administered using a standard protocol and post intervention SFR values were recorded at first visit and follow-up appointments. Pre and post SFR were statistically analysed to determine the effect of TENS therapy and correlated with OSMF grading.</p> Results <p>A statistically significant improvement in SFR was seen after TENS therapy across all grades of OSMF. However, the extent of improvement varied with disease severity, with Grade I showing maximum increase, followed by Grade II and Grade III, while Grade IV showed least improvement in SFR. Progressive improvement in SFR was noted with repeated stimulation.</p> Conclusion <p>TENS seems to be a safe, non-invasive and effective modality for enhancing salivary flow in patients with OSMF and could be considered a valuable adjunctive modality for managing OSMF associated hyposalivation.</p> Trial registration <p>Clinical Trials of Registry in India (CTRI/2024/06/068807), registered on June 12 2024.</p>