Sjogren's syndrome

Question 1

Describe Sjogren’s syndrome, the glands it affects, who it affects and define secondary disease

Answer 1

Description:
• Autoimmune disease where lymphocytes attack and replace functional epithelium

The glands it affects:
• Primarily affects exocrine glands by decreasing the salivary and lacrimal gland secretion

Who it affects:
• Mainly affects females (40 - 50)

Secondary disease:
• Can be caused as a secondary disease.
• This is determined when symptoms occur in the presence of diagnosed systemic connective tissue disease. Examples are lupus and biliary cirrhosis

Question 2

State the aetiology of Sjogren’s syndrome

Answer 2

• Precise cause of the autoimmune attack unknown

Theory: disease results from complications of viral infection with Epstein–Barr virus infection (EBV):
• Exposure to or reactivation of EBV triggers activation of the human lymphocyte antigen (HLA) complex
• This results in the release of cytokines TNF, IL- 2, IFN-γ and others
• Chronic inflammation, infiltration of lymphocytes, and ultimate destruction of exocrine gland tissue follows

Question 3

List the general signs of Sjogren’s syndrome (4)

Answer 3

• Keratoconjunctivitis sicca (dry eyes)
• Xerostomia
• Salivary gland dysfunction
• Connective tissue disease (usually when SS is caused as a secondary disease)

Question 4

List the oral signs and symptoms of Sjogren’s syndrome (10)

Answer 4

• Hyposalivation
• Glossitis
• Mucositis
• Parotid gland hypertrophy
• Candidiasis
• Angular cheilosis
• Taste dysfunction
• Secondary infection
• Periodontitis
• Significantly increased caries rate

Question 5

Explain the goals of medical management of Sjogren’s syndrome (4)

Answer 5

• No cure for SS is known
• Patient management is traditionally palliative and preventive
• Relief of the primary symptoms of dryness (oral and ocular) and the burning / discomfort is the main goal
• Restoration and maintenance of a normal homeostatic oral environment is a secondary goal

Question 6

Explain the dental management of Sjogren’s syndrome (3)

Answer 6

• Provision of moisture and lubrication by stimulation or simulation
• Treatment of secondary mucosal conditions such as mucositis or candidiasis
• Prevention of oral disease, provision of maintenance and general support