DOCSLIB.ORG

Clinical Practice Guidelines for Oral Management of Sjogren Disease

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Clinical Practice Guidelines for Oral Management of Sjogren Disease PRACTICE GUIDELINES Clinical practice guidelines for oral management of Sjögren disease Dental caries prevention Domenick T. Zero, DDS, MS; Michael T. Brennan, DDS, MHS; ABSTRACT Troy E. Daniels, DDS, MS; Athena Papas, DMD, PhD; Carol Stewart, DDS, MS; Andres Pinto, DMD, MPH, MSCE; Background. Salivary dysfunction in Sjögren disease can Ibtisam Al-Hashimi, BDS, MS, PhD; Mahvash Navazesh, lead to serious and costly oral health complications. Clin- DMD; Nelson Rhodus, DMD, MPH; James Sciubba, DMD, ical practice guidelines for caries prevention in Sjögren PhD; Mabi Singh, DMD, MS; Ava J. Wu, DDS; disease were developed to improve quality and consistency Julie Frantsve-Hawley, RDH, PhD; Sharon Tracy, PhD; of care. Philip C. Fox, DDS; Theresa Lawrence Ford, MD; Methods. A national panel of experts devised clinical Stephen Cohen, OD; Frederick B. Vivino, MD, MS; questions in a Population, Intervention, Comparison, Katherine M. Hammitt, MA; for the Sjögren’s Syndrome Outcomes format and included use of fluoride, salivary Foundation Clinical Practice Guidelines Committee stimulants, antimicrobial agents, and nonfluoride remi- neralizing agents. The panel conducted a systematic search of the literature according to pre-established parameters. alivary dysfunction can have serious adverse At least 2 members extracted the data, and the panel rated effects on the oral health of patients with Sjögren the strength of the recommendations by using a variation disease (formerly known as Sjögren syndrome), of grading of recommendations, assessment, development, making it paramount that the oral clinician uses and evaluation. After a Delphi consensus panel was con- S ducted, the experts finalized the recommendations, with a every means possible to prevent complications. Patients with Sjögren disease have significantly higher levels of minimum of 75% agreement required. dental caries, require more tooth extractions, and report Results. Final recommendations for patients with higher dental expenses over their lifetime than do con- Sjögren disease with dry mouth were as follows: topical 1 fluoride should be used in all patients (strong); although no trols. Sjögren disease fl clearly is associated study results link improved salivary ow to caries preven- with a high burden tion, the oral health community generally accepts that of disease, including increasing saliva may contribute to decreased caries inci- 2 5 diminished quality of life - and increased health care dence, so increasing saliva through gustatory, masticatory, 5 7 5 costs, - especially high dental care costs. or pharmaceutical stimulation may be considered (weak); chlorhexidine administered as varnish, gel, or rinse may be Sjögren disease is the second most common auto- fl immune connective tissue disease, affecting up to 3.1 considered (weak); and non uoride remineralizing agents million Americans according to the National Arthritis may be considered as an adjunct therapy (moderate). 8 Data Workgroup, or approximately 1 in 70 people. This Conclusions and Practical Implications. The inci- dence of caries in patients with Sjögren disease can be number represents those with Sjögren disease alone fl (traditionally referred to as primary Sjögren disease); the reduced with the use of topical uoride and other pre- number affected approximately doubles if those with ventive strategies. Key Words. Sjögren syndrome; xerostomia; practice another major autoimmune or rheumatic disease in fl fl addition to Sjögren disease are included. Although guidelines; uoride; antimicrobial; salivary ow; remineralization. JADA 2016:-(-):--- http://dx.doi.org/10.1016/j.adaj.2015.11.008 Copyright ª 2016 American Dental Association. All rights reserved. JADA -(-) http://jada.ada.org - 2016 1 PRACTICE GUIDELINES Sjögren disease is a systemic disease and can affect any of this article). At least 2 TRG members extracted the body organ or system, dry mouth and dry eyes are chief data, and the TRG as a whole rated the strength of the 4 9 symptoms. , Sjögren disease causes chronic inflam- evidence, developed a draft recommendation, and rated mation and dysfunction and, ultimately, damages the the strength of the recommendation. We based grading salivary glands. of the evidence and strength of the recommendation The Sjögren’s Syndrome Foundation (SSF) set about largely on grading of recommendations, assessment, 15 establishing the first-ever clinical practice guidelines for development, and evaluation, which rates the quality Sjögren disease to improve consistency and quality of of the evidence on the basis of study limitations, care for assessing and managing the disease. It is critical inconsistency of results, indirectness of evidence, for oral health care professionals to identify patients imprecision, and publication bias (very low quality potentially having Sjögren disease and ensure that they to high quality). We rated the strength of the recom- obtain a correct diagnosis and start appropriate man- mendation on the basis of quality of evidence, balance agement to prevent caries. Care must be coordinated by a of benefits and harms, values and preferences, and costs team of health care professionals that includes a dentist, (strong or weak both for and against). For the strength rheumatologist, and ocular specialist. The SSF clinical of the recommendation, we used a variation of grading practice guidelines for caries prevention address clinical of recommendations, assessment, development, and questions pertaining to the use of fluoride, salivary evaluation that was developed by the American Society 16 stimulants, antimicrobial agents, and nonfluoride remi- of Clinical Oncology. (Appendix 4 provides defini- neralizing agents. tions used for the strength recommendations, and Appendix 5 provides the guidelines statement regarding METHODS decision on grading the quality of evidence; available The SSF followed a highly transparent and rigorous online at the end of this article). process in developing clinical practice guidelines. We followed a Delphi-type process to ascertain level Guideline protocols and principles were based on those of agreement from practitioners and other stakeholders defined by the American College of Rheumatology, the before finalizing recommendations. The TRGs sum- Institute of Medicine, and the Appraisal of Guidelines marized the data and rationale for the recommenda- for Research and Evaluation and involved participation tions they drafted, and we provided these documents by the American Dental Association (ADA) evidence- (Appendix 6, available online at the end of this article, 10 13 based dentistry staff. - Overarching methodological provides clinical rationales and evidence summaries), principles were transparency, involvement of key stake- the data extraction tables, and a summary outlining holders, and consistency. All participants completed the process to the consensus expert panel (CEP) that American College of Rheumatology conflict of interest reviewed the recommendations. The CEP, made up forms. of key stakeholders (listed in Appendix 7,available Methodological process. We established topic review online at the end of this article), voted on each groups (TRGs) for each caries prevention topic. To recommendation by using a 6-point Likert scale with reduce bias as much as possible, we predefined all the following ratings: completely agree, mostly agree, methodology elements, starting with completion of slightly agree, slightly disagree, mostly disagree, and guidelines protocol worksheets (Appendix 1, available completely disagree. Forty-two to 45 CEP members online at the end of this article) for each TRG that voted and added comments for TRG consideration. delineated clinical questions in the patient population, A minimum of 75% agreement was required and clearly intervention, comparison, outcome format and defined met with 1 round of voting for each topic. However, parameters for literature searches and data extraction for because of comments received on the strength of the all selected articles. The ADA conducted a systematic recommendation on fluoride, a second round of literature search by using predetermined terms and pa- consensuswasheldforthisspecific question, leading rameters. A minimum of 2 TRG members reviewed all to CEP agreement to increase the level for the abstracts and selected articles for further review. See the strength of the recommendation. Participants included Preferred Reporting Items for Systematic Reviews and dentists and dental hygienists from academia and 14 Meta-Analyses flow diagrams, Figures 1 through 4, for community practice, oral medicine experts, clinical literature search details; Appendix 2 (available online at researchers, and patientswithSjögrendisease. the end of this article) provides search terms. An ADA guidelines expert and librarian (S.T.) executed the sys- tematic literature search. We prepared data extraction tables that included ABBREVIATION KEY. ADA: American Dental Association. details on study characteristics, sample and disease CD-CP: Casein derivative and calcium phosphate. information, evidence, and study quality for each CEP: Consensus expert panel. SSF: Sjögren’s Syndrome publication (Appendix 3, available online at the end Foundation. TRG: Topic review group. 2 JADA -(-) http://jada.ada.org - 2016 PRACTICE GUIDELINES Records identified through searching Additional records identified through MEDLINE, PubMed, and Cochrane Library— updated literature search on first search executed March 20, 2013, April 21, 2015 and going back to January 1, 1960 (n
Load more

Recommended publications
  • Guideline # 18 ORAL HEALTH
    Guideline # 18 ORAL HEALTH RATIONALE Dental caries, commonly referred to as “tooth decay” or “cavities,” is the most prevalent chronic health problem of children in California, and the largest single unmet health need afflicting children in the United States. A 2006 statewide oral health needs assessment of California kindergarten and third grade children conducted by the Dental Health Foundation (now called the Center for Oral Health) found that 54 percent of kindergartners and 71 percent of third graders had experienced dental caries, and that 28 percent and 29 percent, respectively, had untreated caries. Dental caries can affect children’s growth, lead to malocclusion, exacerbate certain systemic diseases, and result in significant pain and potentially life-threatening infections. Caries can impact a child’s speech development, learning ability (attention deficit due to pain), school attendance, social development, and self-esteem as well.1 Multiple studies have consistently shown that children with low socioeconomic status (SES) are at increased risk for dental caries.2,3,4 Child Health Disability and Prevention (CHDP) Program children are classified as low socioeconomic status and are likely at high risk for caries. With regular professional dental care and daily homecare, most oral disease is preventable. Almost one-half of the low-income population does not obtain regular dental care at least annually.5 California children covered by Medicaid (Medi-Cal), ages 1-20, rank 41 out of all 50 states and the District of Columbia in receiving any preventive dental service in FY2011.6 Dental examinations, oral prophylaxis, professional topical fluoride applications, and restorative treatment can help maintain oral health.
    [Show full text]
  • Tooth Decay Information
    ToothMasters Information on Tooth Decay Definition: Tooth decay is the destruction of the enamel (outer surface) of a tooth. Tooth decay is also known as dental cavities or dental caries. Decay is caused by bacteria that collect on tooth enamel. The bacteria live in a sticky, white film called plaque (pronounced PLAK). Bacteria obtain their food from sugar and starch in a person's diet. When they eat those foods, the bacteria create an acid that attacks tooth enamel and causes decay. Tooth decay is the second most common health problem after the common cold (see common cold entry). By some estimates, more than 90 percent of people in the United States have at least one cavity; about 75 percent of people get their first cavity by the age of five. Description: Anyone can get tooth decay. However, children and the elderly are the two groups at highest risk. Other high-risk groups include people who eat a lot of starch and sugary foods; people who live in areas without fluoridated water (water with fluoride added to it); and people who already have other tooth problems. Tooth decay is also often a problem in young babies. If a baby is given a bottle containing a sweet liquid before going to bed, or if parents soak the baby's pacifier in sugar, honey, or another sweet substance, bacteria may grow on the baby's teeth and cause tooth decay. Causes: Tooth decay occurs when three factors are present: bacteria, sugar, and a weak tooth surface. The sugar often comes from sweet foods such as sugar or honey.
    [Show full text]
  • Msnewsletter 201809 E.Pdf
    SEPTEMBER 2018 Volume 24, Issue 3 HEALTHY A newsletter for the members of Central California Alliance for Health YOU AND YOUR HEALTH are important to us. Please call us at 1-800- 700-3874 (TTY: 1-800- 735-2929 or 7-1-1) if you have questions, need help or have concerns about your care as an Alliance member. We’re here to help! Service with a smile! Have you ever wondered who is on the ● Answer questions about your ● Send you a new Alliance ID card if other end of the phone when you call benefits you lose yours Member Services? ● Explain how you can get medical ● Assist you with concerns or Our representatives are caring, care and services complaints dedicated professionals. They are here ● Let you know which doctors and We have representatives in Santa to answer your calls Monday through clinics you can go to Cruz, Monterey and Merced counties. Friday from 8 a.m. to 5:30 p.m. ● Help you choose or change your They live and work in the communities Our representatives are ready to: Primary Care Provider we serve. What they have in common ● Help you understand how your ● Offer interpreter services if you do is that they care about our members health plan works not speak English, Spanish or Hmong and are here to help. Important notice Member Services will not be available on the following dates and times due to companywide or departmental meetings: ● November 7, all day Permit No. 1186 No. Permit ● CA Merced, December 13, from 10:45 a.m.
    [Show full text]
  • Oral Health Toolkit for Athletes
    EASTMAN DENTAL INSTITUTE CENTRE FOR ORAL HEALTH AND PERFORMANCE wwwwwww Oral Health Toolkit for Athletes 1 Contents Introduction ..................................................................................................................................... 3 How to use the toolkit ..................................................................................................................... 4 Oral health drills .............................................................................................................................. 5 Preventing dental decay ................................................................................................................. 6 Preventing gum disease ................................................................................................................. 7 Preventing dental erosion ............................................................................................................... 8 Preventing problems with wisdom teeth ......................................................................................... 9 Additional preventative methods .................................................................................................. 10 Dental check-ups .......................................................................................................................... 11 Common dental diseases ............................................................................................................. 12 References ...................................................................................................................................
    [Show full text]
  • Asthma, Allergic Rhinitis, and Tooth Decay
    EARN This course was written for dentists, 3 CE dental hygienists, CREDITS and dental assistants. Dreamstime.com | Kaspars Grinvalds © Asthma, allergic rhinitis, and tooth decay A peer-reviewed continuing education course written by Erinne Kennedy, DMD, MMSc, MPH PUBLICATION DATE: DECEMBER 2020 EXPIRATION DATE: NOVEMBER 2023 SUPPLEMENT TO ENDEAVOR PUBLICATIONS EARN 3 CE CREDITS This continuing education (CE) activity was developed by Endeavor Business Media with no commercial support. This course was written for dentists, dental hygienists, and dental assistants, from novice to skilled. Educational methods: This course is a self-instructional journal and web activity. Provider disclosure: Endeavor Business Media neither has a leadership position nor a commercial interest in any products or services discussed or shared in this educational activity. No manufacturer or third party had any input in the development of the course content. Requirements for successful completion: To obtain three (3) CE credits for this educational activity, you must pay the required fee, review the material, complete the course evaluation, and obtain an exam score of 70% or higher. CE planner disclosure: Laura Winfield, Endeavor Business Media dental group CE coordinator, neither has a leadership nor commercial interest with the products or services discussed in this educational activity. Ms. Winfield can be reached at Asthma, allergic rhinitis, [email protected]. Educational disclaimer: Completing a single continuing and tooth decay education course does not provide enough information to result in the participant being an expert in the field related to the course topic. It is a combination of many educational courses and clinical experience that allows the participant to develop ABSTRACT skills and expertise.
    [Show full text]
  • Third Molar (Wisdom) Teeth
    Third molar (wisdom) teeth This information leaflet is for patients who may need to have their third molar (wisdom) teeth removed. It explains why they may need to be removed, what is involved and any risks or complications that there may be. Please take the opportunity to read this leaflet before seeing the surgeon for consultation. The surgeon will explain what treatment is required for you and how these issues may affect you. They will also answer any of your questions. What are wisdom teeth? Third molar (wisdom) teeth are the last teeth to erupt into the mouth. People will normally develop four wisdom teeth: two on each side of the mouth, one on the bottom jaw and one on the top jaw. These would normally erupt between the ages of 18-24 years. Some people can develop less than four wisdom teeth and, occasionally, others can develop more than four. A wisdom tooth can fail to erupt properly into the mouth and can become stuck, either under the gum, or as it pushes through the gum – this is referred to as an impacted wisdom tooth. Sometimes the wisdom tooth will not become impacted and will erupt and function normally. Both impacted and non-impacted wisdom teeth can cause problems for people. Some of these problems can cause symptoms such as pain & swelling, however other wisdom teeth may have no symptoms at all but will still cause problems in the mouth. People often develop problems soon after their wisdom teeth erupt but others may not cause problems until later on in life.
    [Show full text]
  • What Every Transplant Patient Needs to Know About Dental Care
    What Every Transplant Patient Needs to Know About Dental Care International Transplant Nurses Society Should patients have that still need to be done. Taking gums each day because they don’t feel a dental exam before care of your teeth and gums (oral well. So some patients already have hygiene) is important for everyone. dental problems before they receive having a transplant? For people who are waiting for an a transplant. After transplant, you Transplant candidates should have a organ transplant and for those who may have been more concerned about dental check-up as part of the pre- have received organ transplants, problems like rejection, infection, transplant evaluation. It is helpful to maintaining healthy teeth and gums is or side effects of your medications. have an examination by your dentist an essential area of care. This booklet Because you are now taking medicines when you are being evaluated for will discuss many issues about dental to suppress your immune system, you transplant to check the health of your care and the best ways to take care of could have an increased risk of dental teeth and gums. This is important your teeth and gums. health problems. All of these factors because some medications that you can add to dental problems following take after transplant may cause you Why could I have transplant. to develop infections more easily. problems with my teeth Maintaining your dental health as best What are the most as you can while waiting for an organ and gums? will help you do better after your There are several reasons why you common dental transplant.
    [Show full text]
  • Tackling Tooth Decay
    FOR THE DENTAL PATIENT ... These substances are the building blocks of the Tackling tooth tooth’s hard enamel, and exposure to them can help the tooth repair itself. Like any treatment, decay remineralization is not always successful. Pa - tients who have the most success follow their ooth decay, usually referred to as “cavi- dentist’s recommendations closely regarding ties,” starts in the enamel, the outer pro- changes in home care. tective layer of the tooth. In some For more advanced disease, your dentist may T people, especially older adults, the gums need to remove the decay and restore the tooth. pull away from the tooth and expose the tooth If the affected area is small, he or she can place root. Decay can occur here as well. The good a filling in the tooth. When decay damages the news is that because of recent scientific advance- tooth’s structure more extensively, your dentist ments, tooth decay sometimes can be stopped. may need to place a crown over the remaining tooth. In other severe cases, not enough healthy HOW DOES TOOTH DECAY DEVELOP? tooth is left, and the tooth must be removed. Your teeth are covered with a sticky film of bac- teria called plaque. When you eat and drink, the PREVENTING TOOTH DECAY bacteria in plaque produce acids that can cause Good dental hygiene is the first step in pre- the enamel or root surface to break down. venting tooth decay. Brush your teeth twice a Plaque collects around the gumline and on the day with a fluoride-containing toothpaste and chewing surfaces of your molars in the back of clean between your teeth once a day with floss your mouth, putting these areas at higher risk or an interdental cleaner.
    [Show full text]
  • Dry Mouth QUESTIONS and ANSWERS U.S
    Dry Mouth QUESTIONS AND ANSWERS U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health What do I need to know about dry mouth? Dry mouth is the feeling that there is not enough saliva in the mouth. Everyone has a dry mouth once in a while—if they are nervous, upset or under stress. But if you have a dry mouth all or most of the time, it can be uncomfortable and can lead to serious health problems. It can also be a sign of certain diseases and conditions. Without enough saliva you can develop tooth decay or other infections in the mouth. You also might not get the nutrients you need if you cannot chew and swallow certain foods. Dry mouth is not a normal part of aging. So if you think you have dry mouth, see your dentist or physician—there are things you can do to get relief. What are the signs and symptoms? ● a sticky, dry feeling in the mouth ● trouble chewing, swallowing, tasting, or speaking ● a burning feeling in the mouth ● a dry feeling in the throat ● cracked lips ● a dry, rough tongue ● mouth sores ● an infection in the mouth The technical term for dry mouth is xerostomia (ZEER-oh-STOH-mee-ah). What causes dry mouth? People get dry mouth when the glands in the mouth that make saliva are not working properly. Because of this, there might not be enough saliva to keep your mouth wet. There are several reasons why these glands (called salivary glands) might not work right.
    [Show full text]
  • Abcs of Dental Care Oral Health Essentials
    ABCs of Dental Care Oral health essentials Achieving good oral health and preventing problems like cavities and gum disease is as easy as A-B-C: • Acquire healthy dental care habits. • Brush and floss regularly. • Conquer gum disease and tooth decay. Then, you can enjoy a healthy smile that lasts a lifetime. We keep you smiling® deltadentalins.com/enrollees Acquire healthy dental care habits Visit your dentist • Be mindful of when, how and what you eat. • Get dental checkups and cleanings. See your Holding foods (such as hard candy) in your dentist regularly to help prevent oral health mouth or eating foods that take a long time problems before they cause pain or require to chew results in longer contact with sugar, major treatment. which can damage your teeth. Avoid snacking • Share your complete medical and dental on sugary, carbohydrate-rich or acidic foods history with your dentist on your first visit. throughout the day. Eat these foods only during Then, continue to tell your dentist about any meal times or drink through a straw to minimize health changes each time you go back — even the amount of time your teeth are exposed to if the updates don’t seem related to your oral sugar and acid. health. • Drink fluoridated water. Fluoride promotes • Sit back and relax. For more stress-free dental the rebuilding of minerals in the tooth enamel, visits, choose a time when you’re not rushed, resulting in a compound that is harder bring along your favorite music and be sure to and more resistant to decay.
    [Show full text]
  • Oral Health During Pregnancy
    FOR THE DENTAL PATIENT ... delayed until after your baby is born, your den- Oral health during tist may need to obtain a radiograph as part of your dental treatment. To minimize your expo- pregnancy sure and that of the fetus to x-rays, your dentist will cover your abdomen with a protective apron and place a thyroid collar over your throat. What to expect when Talk with your dentist or physician about any concerns you may have about your treatment. expecting Good daily care is key to your oral health. To ou have so much to think about during help prevent caries (tooth decay) and gum disease, pregnancy, but don’t overlook your oral brush your teeth thoroughly twice a day with fluo- health, which can be affected by the hor- ride toothpaste to remove plaque. Be sure to clean Ymonal changes you will experience between your teeth daily during this time. with floss or another inter- For example, women are more likely to dental cleaner. Ask your develop gingivitis during pregnancy. Gingivitis dentist or hygienist to is an infection of the gingivae (gums) that can show you how to brush and cause swelling and tenderness. Your gums also floss correctly. When may bleed a little when you brush or floss. Left choosing oral care prod- untreated, gingivitis can affect the supporting ucts, look for those that tissues that hold your teeth in place. Your den- display the American tist may recommend more frequent cleanings to Dental Association’s Seal of prevent gingivitis. Acceptance, your assurance that they have met Sometimes lumps appear along the gum line ADA criteria for safety and effectiveness.
    [Show full text]
  • Oral Health in Elderly People Michèle J
    CHAPTER 8 Oral Health in Elderly People Michèle J. Saunders, DDS, MS, MPH and Chih-Ko Yeh, DDS As the first segment of the gastrointestinal system, the At the lips, the skin of the face is continuous with oral cavity provides the point of entry for nutrients. the mucous membranes of the oral cavity. The bulk The condition of the oral cavity, therefore, can facili- of the lips is formed by skeletal muscles and a variety tate or undermine nutritional status. If dietary habits of sensory receptors that judge the taste and tempera- are unfavorably influenced by poor oral health, nutri- ture of foods. Their reddish color is to the result of an tional status can be compromised. However, nutri- abundance of blood vessels near their surface. tional status can also contribute to or exacerbate oral The vestibule is the cleft that separates the lips disease. General well-being is related to health and and cheeks from the teeth and gingivae. When the disease states of the oral cavity as well as the rest of mouth is closed, the vestibule communicates with the the body. An awareness of this interrelationship is rest of the mouth through the space between the last essential when the clinician is working with the older molar teeth and the rami of the mandible. patient because the incidence of major dental prob- Thirty-two teeth normally are present in the lems and the frequency of chronic illness and phar- adult mouth: two incisors, one canine, two premo- macotherapy increase dramatically in older people. lars, and three molars in each half of the upper and lower jaws.
    [Show full text]