Sjögren’s Syndrome

We care about your overall health, and we are especially interested on how the condition of your mouth impacts overall health.  There are also systemic conditions that affect the condition of the mouth, and one of those is the focus of today’s blog.

Sjögren’s Syndrome is a disorder that has huge ramifications for the health of your mouth, in addition to its effects of the rest of the body.  This blog will highlight the dental health concerns related to this disorder.

What is Sjögren’s Syndrome?

Sjögren’s Syndrome is a chronic autoimmune disorder in which the body attacks the glands that produce moisture.  In most cases, the most obvious damage is to the salivary glands and the glands producing tears.  It can also affect other mucous glands, like those in the respiratory and GI tracts.  The damage to these glands causes them to malfunction and not produce the saliva, tears or mucous that the body constantly needs.

Sjögren’s Syndrome affects over 4 million Americans, and 90% of those affected are women.  It can occur by itself, called primary Sjögren’s, or in the presence of other connective tissue disorders like lupus or rheumatoid arthritis, called secondary Sjögren’s.

What are the Symptoms of Sjögren’s Syndrome?

No two people are exactly alike, and patients with Sjögren’s can experience one or more of these symptoms.  The disorder usually begins with a mild case of dry mouth, of which many people are unaware.  For this reason, Sjögren’s is often undiagnosed until painful symptoms are noticed by the patient.

  • Inadequate saliva – dry mouth
  • Inadequate tears – dry eyes
  • Inadequate mucous production – dry airway, esophagus
  • Joint and muscle pain

What are the Functions of Saliva?

Saliva is more than just spit.  Saliva is vital to the healthy function of your mouth in all of its capacities.  It aids chewing, tasting, digestion, swallowing, speaking, and the maintenance of a healthy oral environment.

  • Lubrication – One of saliva’s most important roles is keeping the mouth moist. Without proper lubrication, the delicate tissues lining the mouth become dry, inflamed, and sensitive.  The cheeks, lips and tongue often stick to the teeth and suffer painful sores or ulcers.  The lubrication also extends into the throat and esophagus, aiding in swallowing.
  • pH balance – Healthy saliva has a pH slightly higher than neutral; it should be slightly alkaline. This counteracts the acids in foods and drinks we regularly ingest, and it fights the acids produced by disease-causing bacteria in the mouth.
  • Digestive enzymes – Saliva is not just water. It contains many essential ingredients for healthy digestion.  The very first step in the digestive process is the exposure of food to saliva.  The enzyme amylase in healthy saliva begins breaking down food molecules.
  • Taste – Saliva has a solvent effect on food. It carries food particles to the taste buds for a greater sensation of taste.  Patients with dry mouth often experience a decreased sense of taste.

What are the Dental Consequences of Sjögren’s Syndrome?

  • Ulcers and mouth sores – Dry tissue inside the mouth is extra-sensitive to any injury, and therefore more likely to develop ulcers or sores in response to any injury. Cheeks, lips, and the tongue cannot function properly without the lubrication provided by saliva.  They are more likely to get bitten.
  • Cavities – Without saliva neutralizing the oral cavity, the bacteria that cause cavities are able to proliferate and produce more acid. This acid damages and weakens enamel, making cavities much more likely.
  • Gum disease – Saliva contains an antibacterial component, without which the bacteria that cause gum disease thrive. Patients with a dry mouth have gum disease that is more persistent and difficult to treat.
  • Bad breath – Almost all bad breath is caused by an overgrowth of bacteria. We have already discussed how a lack of saliva allows bacteria to multiply.  Most people can relate to the sensation of waking up with a “cotton mouth” feeling and extreme bad breath.  Imagine having a mouth that dry all the time!
  • Thrush infection – Thrush is a fungal infection. The fungus is naturally present in a healthy mouth without causing any concerns.  In a dry mouth, it can take over.
  • Burning sensation – The lack of lubrication makes the lining of the cheeks, lips and tongue hypersensitive to every stimulus. This often creates a burning or tingling sensation to the inside of the mouth
  • Sensitivity to harsh chemicals in toothpastes and mouthrinses – A normal healthy mouth can handle some of the harsh ingredients in many over-the-counter oral care products, like essential oils and alcohol in mouthwash or the foaming Sodium Lauryl Sulfate in toothpastes. In an extremely dry mouth, these chemicals can cause painful burning or numbing sensations.
  • Difficulty speaking – The cheeks, lips and tongue simply cannot function well when the saliva production is impaired. The position of these tissues is essential to making certain sounds, so some patients notice changes in their speech when their mouths are extremely dry.
  • Difficulty swallowing – Saliva is necessary to form food into a bolus that can be swallowed and to lubricate the throat and esophagus during the swallowing process.

What is the Treatment for Sjögren’s Syndrome?

There is no cure for Sjögren’s Syndrome at this time.  All treatments are aimed at managing the symptoms of the disorder.  Specific to dentistry, we recommend the following protocol for any patients with extreme dry mouth or impaired salivary function.

  1. Recognize your increased risk for cavities and gum disease. This means you need more frequent and more consistent visits to your dentist.  Patients with Sjögren’s Syndrome should never miss a professional teeth cleaning or dental evaluation.  Some patients need to have their teeth cleaned on a more frequent basis (for example, every three months instead of every six).
  2. Use oral care products specifically designed for patients with dry mouth. In order to prevent the burning sensation and harsh chemicals of most over-the-counter products, they should be avoided.  A great over-the-counter brand of dry-mouth-friendly products is Biotene®.  Their toothpastes and mouthrinses will not sting or burn, and their dry mouth sprays and gels are great adjuncts to keeping your mouth moist.  Chowning may also recommend prescription toothpastes or mouthrinses to decrease your risk for cavities and gum disease.
  3. Drink water throughout the day. Avoid drinks that will dehydrate you, like caffeine and alcohol.  Stay away from sodas and other high sugar drinks (they increase cavity risk).  It is essential to drink water while you eat to aid in swallowing your food.

Do You or Someone You Love have Sjögren’s Syndrome?

If you or someone you love has Sjögren’s Syndrome, call us today at 940-382-1750 to schedule a consultation with Dr. Chowning. He can assess your specific risks and needs while giving you valuable recommendations to keep your mouth healthy as you fight this difficult disorder.  For more information on Sjögren’s, click here.

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