Sjogren's Syndrome

Question 1

List some causes of a dry mouth:

Answer 1

• psychogenic - depression, anxiety, hypochondriasis
• drugs
• radiotherapy
• dehydration
• sarcoidosis
• HIV
• sjogrens syndrome

Question 2

What is sjogrens syndrome?

What are the two types?

Answer 2

• autoimmune disease, chronic inflammation of tear and saliva glands

Primary and Secondary

Secondary associated with: rheumatoid arthritis, systemic lupus erythematosus, PBC and MCTD

Question 3

How is sjogrens diagnosed?

Answer 3

• require serological markers (antibodies_

and/or

• positive labial gland biopsy

Question 4

List some oro-facial signs and symptoms of Sjogrens:

Answer 4

• obvious dryness - xerostomia
• dry eyes
• erythema and lobulation tongue
• oral discomfort
• difficulty in swallowing and talking
• altered taste
• poor retention of dentures
• oral fungal and bacterial infections
• increased incidence of lymphoma
• tiredness
• salivary gland swelling

Question 5

What are some systemic treatments for Sjogrens?

Answer 5

• Pilocarpine - oral 5mg tablets up to 4 times daily
• acupuncture

Question 6

How is xerostomia managed?

Answer 6

Artificial saliva i.e.

• orthana - oral spray
• glandosane - oral spray
• saliveze - carboxymethylcellulose
• bioxtra/biotene gel
• salinum - based on linseed oil

Salivary stimulants:

• salivix pastilles
• sugar free gum/sweets
• SS tablets

Question 7

How are fungal infections managed?

What chairside advice can be given to reduce caries risk?

Answer 7

Fungal infections: antifungal treatments

• Nystatin (rinse)
• Miconazole (gel)

Chairside Advice for caries prevention:

• fluoride applications, OHI
• dietary advice - sugar free diet
• atomiser - water

Question 8

Lack of saliva due to sjogrens syndrome will predispose to?

Answer 8

• opportunistic oral infections
• periodontal disease
• caries, particularly at cervical margin

Question 9

How to manage a sjogrens patient during dental treatment?

Answer 9

• lubricate lips with vaseline, reapply as necessary
• constant lubrication of mucosa using 3 in 1
• wet mirror aboid contact with mucosa if possible
• retract buccal mucosa with dampened swab
• offer patient water frequently
• avoid suction where possible