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Sjögren syndrome (SS) is an inflammatory disease of the exocrine glands. signs and symptoms of dry eyes and xerostomia are characteristic features of SS. . Sjögren syndrome.
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Sjögren syndrome (SS) is an inflammatory disease of the exocrine glands. signs and symptoms of dry eyes and xerostomia are characteristic features of SS. Sjögren syndrome
There are two recognized forms of SS: primary SS, in which participation of lachrymal and salivary glands is evident but in which there is no associated autoimmune disease, and secondary SS, which is diagnosed in the presence of an autoimmune disease
Main functions of saliva are as follows: 1. Lubrication. Saliva helps soften food, bolus formation, chewing, swallowing, facilitates speech, cleans oral tissues, and prevents tooth damage. 2. Digestion and taste. Saliva contains digestive enzymes (amylase and lipase) that initiate digestion of cooked starch. Saliva allows taste perception of foods and other substances 3. Soft-tissue repair. The epidermal and transforming growth factor found in saliva promote tissue growth, differentiation, and wound healing 4. Maintenance of the ecological balance of oral microflora. Saliva contains different antibacterial, antiviral and antimycotic agents. These agents balance oral flora and inhibit bacterial colonization of teeth and soft tissues by modulating the adherence of microorganisms. The mechanical flushing action of saliva helps increase this activity.
Main functions of saliva are as follows: 5. Buffer activity. This is the capacity of saliva to lower acidic pH and maintain it at adequate levels, diminishing the risk of developing dental decay. Saliva also protects the superior gastrointestinal tract by buffering acid reflux of regurgitation from the esophagus. 6. Remineralization. Saliva protects the teeth and promotes remineralization by bringing essential minerals to the enamel surface, which enhances mineral intake into demineralizated enamel 7. Immunity and defense. Small proteins, IgA, histatins, defensins, cytokines, growth factors, hormones, mucins, and other saliva components may play a role in innate immunity and defense, based on the studies of these factors at other mucosal surfaces.
Prevalence of periodontal disease in patients with Sjiigren's Results of the study suggest that patients with Sj6gren‘s syndrome have a significantly higher plaque index score (p < 0.005), higher decayed/missing/filled surfaces scores (p < 0.05), increased alveolar bone loss (p < 0.05), deeper clinical attachment level (p < 0.05), and increased cementoenamel junction-alveolar bone crest distance (p < 0.005). Although no significant difference was found in the number of cases of "established periodontitis" between the Sj6gren's syndrome and controls, odds ratio analysis suggests that patients with Sj6gren's syndrome are at 2.2 times higher risk of having adult periodontitis than healthy controls (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997;83:453-7)
Periodontal changes Low salivary secretion promotes rapid formation of dental plaque. Saliva influences formation of dental plaque in its maturation phases and in its metabolism; therefore, calculus formation and periodontal disease are present.
Periodontal changes Risk for developing periodontal disease is 2.2 times greater than in controls. Increased plaque index score, loss of alveolar bone, increased probing depth, high bleeding index, and loss of attachment are commonly found. . Nájera, Al-Hashimi, et al, Prevalence of periodontal disease in patients with Sjögren's syndrome. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 83 (1997), pp. 453–457
Periodontal changes Conversely, some studies have found no increased risk for the development of periodontal disease The possible reason for this is that gingival fluid is not affected directly by lack of saliva but by accumulation of dental plaque Furthermore, there could be predominance of cariogenic organisms instead of periodonto-pathogens, thus exhibiting no significant difference in periodontal disease between patients with SS and controls in some studies H. Çelenligil, K. Eratalay, E. Kansu and J.L. Ebersole, Periodontal status and serum antibody responses to oral microorganisms in Sjögren's syndrome. J Periodontol 69 (1998), pp. 571–577.
Periodontal recomendation • Stimulation of saliva is preferred to the use of a substitute because of the protective effects of saliva. Therapy with sugarless chewing gum exercises may be used in patients with functional remaining salivary tissue Palliative measures may be suggested, such as occasional sucking of dry fruit slices or fruit pits M.W.J. Dodds, S.C. Hsieh and D.A. Johnson, The effect of increased mastication by daily gum-chewing on salivary gland output and dental plaque acidogenicity. J Dent Res 70 (1991), pp. 1474–1478.
Selection of appropriate brushing techniques including the use of a soft toothbrush for 5–10 min as well as use of accessories to remove plaque such as interdental brushes, dental floss, and electric toothbrushes must be recommended.
Patients with SS may have problems with effective removal of dental plaque due to oral discomfort, tooth sensitivity, and mucositis. Some prefer to use a children's dentifrice, the taste of which may be milder. I.D. Mandel, The new toothpastes. J Calif Dent AssocMar; 26 3 (1998), pp. 186–190
Denture problem It has been mentioned that dentures may not be suitable for patients with SS; however, dentures could be the only restorative choice. In edentulous patients, The tongue adheres to and dislodges the denture, causing decreased retention of partial and total removable prosthesis that results in abrasions, sore spots, ulceration, and irritation. An implant-supported denture might be recommended; however, the high cost of this denture could represent a problem for the patient. P.P. Binon and C.N. Fowler, Implant-supported fixed prosthesis treatment of a patient with Sjögren's syndrome: a clinical report. Int J Oral Maxillofac Implants8 1 (1993), pp. 54–58.
To stimulate saliva with secretagogues, pilocarpine hydrochloride is used effectively; tablets with a dose of 5 mg/3 times a day 30 min prior to meals is the recommended dose. It is necessary to be aware of possible side effects .
For the nonrespondent patient, artificial saliva is the only choice. Carboxymethylcellulose, mucin, or polyacrylic acid are the compounds used but their efficacy is questioned. The majority of patient prefer water. W.A. van der Reijden, H. van der Kwaak, A. Vissink, E.C.I. Veerman and A.V. Nieuw-Amerongen, Treatment of xerostomia with polymer-based saliva substitutes in patients with Sjögren's syndrome. Arthritis Rheum39 (1996), pp. 57–63. ts prefer water [91 and 92].
Saliva substitutes may be particularly useful when traveling, talking, or during the night. A distinction in selecting artificial saliva should be carried out; saliva substitutes with pH >6 containing fluoride are best suited for dentate patients
Salivary substitutes with a pH <5.5 and no fluoride are used in edentulous subjects; these substitutes are contraindicated in dentate patients because they may damage restorations and cause enamel erosion. C.W. Haveman and S.W. Redding, Dental management and treatment of xerostomic patients. Tex Dent J ;115 6 (1998), pp. 43–56 June.
Milk could be promoted as a salivary substitute; it provides moisture and lubrication, buffers oral acids, reduces enamel solubility, and contributes to remineralization due to its high calcium and phosphate content. Glycerin, olive oil, and margarine have been indicated to lubricate very dry tissues at night, especially if morning dryness is severe. E.L. Herod, The use of milk as saliva substitute. J Public Health Dent.;54 3 (1994), pp. 184–199 Summer.
