Dry mouth or xerostomia is a common oral health problem that many people experience, especially older adults. On its own, it’s not anything serious, but it may be a symptom of an underlying health condition like Sjögren’s syndrome.
Dry mouth isn’t the only symptom of Sjögren’s as it is also usually accompanied by dry eyes. These symptoms can be extremely disruptive, and timely treatment is important. Although this disorder is mild in most people, it can be severe and even life-threatening.
What Is Sjögren’s Syndrome?
Sjögren’s is an autoimmune disorder in which the body’s immune system attacks the salivary glands in the mouth and tear glands in the eyes, which results in severe dryness. It should be noted that there are two types of Sjögren’s disease:
- Primary Sjögren – When it is the only existing autoimmune disease that’s affecting the patient.
- Secondary Sjögren – When Sjögren’s coexists with other autoimmune diseases like lupus, rheumatoid arthritis, psoriatic arthritis or dermatomyositis.
Unfortunately, the exact cause of this disorder isn’t known. However, it is believed to have a genetic influence. It might also have some other risk factors, such as viral or bacterial infections, wind and low humidity. It also commonly affects people between the ages of 30 and 50 and is more prevalent in women than men.
As far as the diagnosis of this syndrome is concerned, it can take as many as 3-4 years to reach one. Its symptoms vary and mimic those of other conditions. That is why it can be hard to detect it at first. Your doctor may perform a blood test to check for its markers, do some imaging tests, biopsy, check for the flow of saliva, and ask for your medical history.
Other than dry eyes and dry mouth, a person with Sjögren’s syndrome can experience the following:
- Double vision
- Itching or burning eyes
- Damage to cornea
- Dry skin and hair
- Joint pain
- Anxiety and depression
- Sleeping difficulty
Sjögren’s syndrome can also cause damage to other organs of the body like the kidneys, liver, lungs, and nervous system.
How Is Sjögren’s Syndrome Treated?
There is no cure for Sjögren’s syndrome, but palliative care is offered, where the symptoms of the disorder are managed. For instance, artificial tears and lubricating ointments are prescribed for the eyes. The dry mouth is also managed in different ways – which we’ll soon get to – and the doctor may advise some lifestyle changes so that your symptoms don’t get worse.
As far as medications are concerned, NSAIDs can help with arthritis. Sometimes, an anti-malarial drug is also given for its treatment. And since it is an autoimmune disorder, your doctor may also prescribe immunosuppressants in more severe cases.
What Are Sjögren’s Syndrome Oral Manifestations?
The insufficient production of saliva in Sjögren’s syndrome can cause various oral health problems. That’s because saliva is responsible for protecting the teeth from infections and cavities.
Saliva also helps wash away food particles from the teeth, keeping them clean. It also plays a role in the mineralisation of the tooth by providing it with calcium, fluoride and phosphate. Of course, it also helps in the digestion and swallowing of the foods. So, without it, the mouth suffers in the following ways:
- Increased risk of cavities and tooth decay
- Accumulation of plaque and increased risk of gum disease
- Bad breath
- Canker sores
- Oral thrush
- Cracked and dry tongue
- Difficulty speaking (clicking sounds can be heard) and eating
- Taste changes
- Dry lips that stick to the teeth
- Cracked sides of the mouth
- Recurrent infection of the salivary glands
While the production of saliva is affected by Sjögren’s syndrome, research also shows that the disorder can change the composition of saliva, which increases the risk of cavities. Here, it should also be noted that even if patients with this condition maintain excellent oral hygiene, they’re still at an increased risk of oral health problems that can result in tooth loss. Loss of teeth is, in fact, quite common in those who have Sjögren’s syndrome.
What Is Sjögren’s Syndrome Dental Management?
In the case of Sjögren’s syndrome, since the mouth is already quite vulnerable to different problems, your dentist may recommend the following:
Avoid Drying Foods & Beverages
Sugary foods and alcohol can leave your mouth dry, which is why you need to avoid them. Also, cavities and tooth decay can easily occur without saliva to remove sugar from the teeth. You can consider chewing sugar-free and citrus-free candies as they can stimulate the production of saliva. For the same reason, you can consider chewing sugar-free gum.
Brush & Floss
It’s important that you brush your teeth and keep them clean. However, you need to make sure that your toothpaste contains fluoride as it can strengthen the teeth. It shouldn’t be too abrasive as that can cause further damage to the teeth.
Also, make sure to floss and use a mouthwash. With the latter, however, make sure that it doesn’t contain any alcohol as it can cause increased dryness. If you have arthritis and have difficulty brushing your teeth, you can consider using an electric toothbrush and flosser. You should maintain good oral hygiene because it can prevent a lot of problems from occurring.
Quit Using Tobacco Products
There are countless ways in which tobacco products can damage your oral and overall health. However, one thing that nicotine in tobacco does is that it decreases the production of saliva. This will only worsen your problem, which is why you need to avoid their consumption.
To deal with a dry mouth, you should make sure to sip water throughout the day. However, you should be careful about not overdoing it as it can have the opposite effect. Your brain gets the signal that saliva is not needed, and its production is reduced. Here, you should keep in mind that only water should be consumed for hydration. Coffee, colas and alcohol will further dry out the mouth, so you need to avoid them.
Artificial Saliva, Creams & Medicines
There are certain products that can act as replacements for saliva. You might be given gels, sprays, or lozenges so that the mouth is lubricated. For dry lips, you should consider using petroleum jelly or salves. Creams can also help hydrate the skin around the mouth so that it doesn’t crack.
Medications like pilocarpine and cevimeline are also prescribed to increase the production of saliva. If the patient has developed an oral infection, they may be prescribed antifungal medication. However, it’s important to note that you shouldn’t start using any of the medications and creams before consulting your doctor.
Since tooth loss is common in those with Sjögren’s syndrome, patients usually end up needing dental implants. That’s because it can become quite difficult for patients to maintain good oral hygiene. Implants act like artificial teeth and can prevent the teeth from shifting and the jawbone from deteriorating. While dentures are another option, they can be too drying. Also, without saliva, there’s not enough suction to hold them in place. That’s why you may be recommended the former.
Professional Dental Cleanings & Treatments
Accumulation of plaque is also a problem that people with Sjögren’s syndrome experience. If left untreated, it can result in gum diseases (gingivitis or the more severe periodontitis). That’s why it’s important to get a professional scaling and root planing treatment when needed. This can help prevent the loss of the tooth.
And since the enamel remineralisation function of saliva is not taking place, your dentist might also recommend a fluoride treatment. In this, the dentist applies a gel or varnish of fluoride on the teeth using cotton, rinse, or trays. Once it’s applied, you’ll have to let it stay on your teeth for half an hour so that it’s absorbed.
Other than that, you should make sure to regularly visit your dentist (twice a year). Since your teeth are already prone to more problems, your dentist might recommend more frequent visits. This will only make sure that your teeth get treated before the problem worsens.
According to The British Sjögren’s Syndrome Association, as many as 0.6% of people in the UK have this disorder. And currently, there is no cure for it. Even, its cause is not yet known. Its diagnosis can also take quite long (because of the variability of its symptoms), during which you can experience various problems. However, once it is diagnosed, it is important that you get treatment for its various symptoms to prevent them from worsening. As far as the oral health of the patient is concerned, Sjögren’s syndrome can deteriorate it in countless ways.
Even if the patients follow the best dental practices, they might end up with cavities, decay, and tooth loss. Still, that doesn’t mean that you should give up. To improve the chances of the survival of your teeth, you need to make sure that you’re taking all the measures that can help you. Scaling and root planing can protect teeth from gum disease. And if you do end up losing your tooth, you can get dental restoration. Make sure to consult a dentist for a professional diagnosis.