References: 1. Mahooney EJ, Spiegel JH. Sjögren’s disease. Otolaryngol Clin N Am. This informational pamphlet will provide you with chewing, or swallowing, a sore or cracked 2003;36:733-45. the answers to some common questions such as: tongue, dry or burning throat, a change in 2. Wall GC, Magarity ML, Jundt JW. Pharmacotherapy of xerostomia in primary Sjögren’s syndrome. Pharmacothereapy, 2002;22(5):621-29. the sense of taste or smell, increased dental 3. Fox PC, Atkinson JC, Macynski AA, Wolff A, Kung DS, Valdez IH, • What is Sjögren's Syndrome? decay, joint pain, digestive problems, dry Jackson W, Delapenha RA, Shiroky J, Baum BJ. Pilocarpine treatment of • What are some of the common salivary gland hypofunciton and dry mouth (xerostomia). Arch Int Med, nose, dry skin, and fatigue. 1991;151;1149-52. Sjögren's Syndrome symptoms of Sjögren’s? 4. Papas AS, Fernandez MM, Castano RA, Gallagher SC, Trivedi M, • How does Sjögren's syndrome Shrotriya RC. Oral pilocarpine for symptomatic relief of dry mouth and From one third to one half of patients may dry eyes in patients with Sjögrens syndrome.. Adv Exp Med Biol. Oral Health Care affect the mouth? have diffuse, firm enlargement of the major 1998;438: 973-8 • Are Sjögren's patients at a greater 5. Fife RS, Chase WF, Dore RK, Wiesenhutter CW, Lockhart PB, Tindall salivary glands during the disease. It is E, Suen JY. Cevimeline for the treatment of xerostomia n patinets with Information risk for ? usually bilateral, may be nonpainful or Sjögren’s syndrome. Arch Int Med, 2002;162:1293-1300. • What treatments are available for 6. Reich E, Petersson LG, Netuschil L, Brecx M. Mouthrinses and dental slightly tender, and may be intermittent or caries. Int Dent J.2002;52:337-45. oral dryness? persistent in nature. Consult your physician 7. Peldyak J, Makinen KK. Xylitol for caries prevention. J Dent Hyg. • Are Sjögren's patients at a greater 2002;76(4):276-85. as this may indicate a serious condition, 8. Al-Hashimi I. The management of Sjögren’s syndrome in dental risk for oral fungal “yeast” such as a . practice. JADA, 2001;132:1409-17. infections? 9. Najera MP, Al-Hashimi I, Plemons JM, Rivera-Hidalgo F, Rees TD, Haghighat N, Wright JM. Prevalence of in patients • Should Sjögren’s patients be How does Sjögren's syndrome affect with Sjögren’s syndrome. Oral Surg Oral Med Oral Pathol Oral Radiol the mouth? Endod 1997;83:453-7. evaluated for periodontal disease? 10. Jorkjend L, Johansson A, Johansson K, Bergenholtz A. Periodontitis, • Are dental implants a treatment Sjögren’s affects saliva production caries and salivary factors in Sjögren’s syndrome patients compared to in two ways: 1) generally decreasing the sex- and age-matched controls. J Oral Rehab. 2003;30:369-78. option for Sjögren's patients? 11. McCullough KB, Porter YS. Clinical and microbiological studies of amount produced and 2) altering the periodontal disease in Sjögren’s syndrome patients. J Clin Periodontol. What is Sjögren’s syndrome? proteins and components normally 2002;29:92-102. 12. Boutsi EA, Paikos S, Dafni UG, Moutsopoulos HM, Skopouli FN. Sjögren's syndrome is one of the most produced. Therefore, “dry mouth” and Dental and periodontal status of Sjögren’s syndrome. J Clin Periodontol. common autoimmune diseases affecting as many 1999;27:231-35. other oral problems may develop. 13. Radfar L, Shea Y, Steven FH, Sankar V, Leakan RA, Baum B, as 3,000,000 Americans. The disease is Without saliva, people commonly Pillemer SR. Fungal load and candidiasis in Sjögren’s syndrome. Oral characterized by the body's immune system Surg Oral Med Oral Pathol Oral Radiiol Endo 2003;96:283-7. experience oral discomfort, difficulty 14. Rosen, DS. What is thrush, and how is it treated? Health News. mistakenly attacking its own exocrine glands, eating, tooth decay, and oral infections2. 2002; 8(10):12. which include saliva and tear glands. Although The lack of saliva can also cause a dry,

Sjögren's occurs in all age groups and in both cracking tongue, and may even disrupt

sexes, the average age of onset is in the late 40s speech patterns3. The oral symptoms of Acknowledgements: University of Florida Jeffrey Dee Fleigel, III and the disease is 90% female. Sjögren's Sjögren's syndrome can disrupt a person’s Center for Autoimmune Diseases UFCD 3DN syndrome belongs to a family of autoimmune quality of life. http://www.medicine.ufl.edu/autoimmune disorders including systemic lupus Carol M. Stewart MS, DDS, MS College of Medicine erythematosus, rheumatoid arthritis, scleroderma, Are Sjögren’s patients at greater risk Co-Director, UF Center for Autoimmune Diseases Division of for “tooth decay” or dental caries? Office : 352-273-6775 dermatomyositis, and vasculitis and ranks as the email: [email protected] and Clinical Immunology second most common rheumatic disease after Yes. Because saliva functions to Office: 352-273-5340 rheumatoid arthritis1. dilute harmful , buffer acids, and Fax: 352-392-8483 remineralize to help prevent What are some of the common signs cavities, patients are at an increased risk College of Dentistry and symptoms of Sjögren’s Syndrome? for tooth decay due to lowered saliva Division of Oral Diagnostic Sciences Symptoms vary from person to person production. In order to prevent tooth Oral Medicine Clinic: 352-273-6739 but some of the most common symptoms of decay one must maintain excellent oral Fax: 352-392-2507 Sjögren’s are dry eyes (keratoconjunctivitis sicca) hygiene monitored and by a dentist. 2 and dry mouth (xerostomia) . Symptoms may Adequate oral care, use fluoride products, include but are not limited to a dry, gritty, or saliva stimulants, as well as proper diet will burning sensation in the eyes, difficulty talking, aid in reducing susceptibility to dental only be used under the care of a dentist for Cevimeline, like pilocarpine hydrochloride, has healthy controls9. However, more recent decay. prescribed periods. some contraindications for its use. Therefore, research indicates patients with Sjögren’s Fluoride Products: Frequent use of Saliva Substitutes: Saliva substitutes are also professional consultation with a physician or syndrome are not at increased risk for fluorides may control or even stop tooth available for treatment. Saliva substitutes are dentist is necessary prior to taking either drug. periodontal disease when compared with decay and repair already developed small not long lasting so they must be used frequently Diet: Sjögren's patients must remain well healthy individuals of the same age and sex cavities6. Over-the-counter (OTC) fluoride throughout the day. Some common ones are: hydrated at all times to help alleviate the or individuals with other dry mouth products can be used such as ACT, alcohol- Optimoist, Moi-Stir, Saliva Substitute, Salivart, symptoms associated with the disease. This is disorders 10,11,12. Research is ongoing. free rinse containing neutral sodium fluoride. and Mouthkote. Individuals with removable especially true in patients taking prescription However, your dentist should carry out It is important to follow the manufacturer’s dentures affected by Sjögren's also may benefit sialogogues like Salagen® and Evoxac®. periodontal assessment and monitoring. directions (or your dentist’s instructions) from the use of saliva substitutes7. Patients should drink plenty of water or sugar- when using OTC products. Saliva Stimulation: Sugar-free candies and free low acid content beverages and avoid spicy Are dental implants a treatment Daily use of a prescription fluoride product, chewing gum can stimulate saliva production. foods. Patients should avoid liquids high in option? such as Prevident gel, or Prevident 5000 Xylitol is a naturally occurring sweetener which sugar and acid, like soft drinks, due to the Yes, in selected cases. Plus toothpaste may be recommended7. does not contribute to dental decay8. When acceleration of tooth decay that can take place Conventional dentures can be intolerable Prevident gel is as a fluoride treatment at tested as a sucrose replacer, or even as a small in the mouth. Alcohol and caffeine should be for people with dry mouth. Conventional bedtime following brushing and flossing. as dietary addition, systematic xylitol use to avoided because they can irritate the tissues of crown and bridge work may also be more a fluoride treatment. Prevident 5000 Plus is impressive reductions in the incidence of dental the mouth and promote dehydration. susceptible to decay due to decreased saliva a fluoride treatment plus abrasive decay8. Therefore, implant-retained dentures or containing toothpaste, which may be used Prescription drugs: Saliva Stimulation Are Sjögren's patients at a greater risk for other implant supported dental prosthetics, one per day, preferably bedtime, in place of The two drugs currently approved for use oral yeast infections? or single-tooth implants may be a viable brushing. Both products contain 1.1% in the United States are cevimeline hydrochloride Yes. Oral yeast infections appear as red treatment option. Many factors must be neutral sodium fluoride. (Evoxac®) and pilocarpine hydrochloride or white patches in the mouth or at corners of considered in deciding who might benefit Toothpastes: A fluoride-containing (Salagen®). Pilocarpine is a potent stimulator of the mouth and may cause a burning sensation from this therapy. In individuals that meet toothpaste is generally recommended. Many exocrine secretion and has been indicated for this and altered taste. They are caused by Candida a routine criteria, implants generally succeed. OTC varieties are available. Toothpastes use for over 80 years3. Exocrine glands include yeast normally present in the mouth, but may However, extreme caution should be which contain abrasives, which are the following: sweat, saliva, lacrimal, gastric, appear at increased rates in people with Sjögren's. exercised in someone who is severely common in many whitening pastes, and pancreatic, intestinal and mucus cells of the An inverse relationship between salivary flow immune suppressed or has a history of “tartar” or plaque control products can respiratory tract. There has been a lot of rates and the level of Candida infection has been therapy. Bisphosphonate 13 sometimes be too harsh for routine use. research done on the effectiveness of this drug in described in research . Because Sjögren's related osteonecrosis of the occurring Some patients have reported increasing saliva flow indicating that it is both patients have less saliva they may have increased subsequent to surgical procedures in the hypersensitivity reactions following use of safe and effective2, 3, 4. There are several rates of oral Candida. Research has shown plain, mouth, is a growing concern. these products. contraindications for the use of pilocarpine; sugar-free yogurt can be consumed to prevent 14 Mouthrinses: When choosing a therefore it should only be taken after an and even treat oral yeast infections . In summary, with adequate management mouthrinse it is important to avoid alcohol examination by a physician or dentist. A 5mg Prescription anti-fungal mouth rinses, lozenges, and care, adverse oral concerns related to containing rinses which can sometimes dosage of Salagen® is recommended to be taken creams, and systemic medication are also Sjögren's syndrome can be minimized and a irritate and dry the mouth. Biotene® up to four times daily. available through your dentist or physician if better overall quality of life can be mouthrinse is an over the counter Cevimeline is a newer drug indicated for the desired or necessary. maintained. antimicrobial alcohol-free mouthrinse that treatment of Sjögren's. This drug works similarly can also be used to reduce the amount of to pilocarpine with different dosages and Should Sjögren's patients be evaluated harmful bacteria in the mouth. frequency. Evoxac® is taken up to three times a for periodontal disease? Prescription mouthrinses containing 0.12% day and the dosages may vary depending on your Yes. Periodontal disease is the complex gluconate, such as Peridex® physician/dentist recommendations5. Research process of loss and gum attachment loss or PerioGard®, are used to reduce harmful has shown that cevimeline therapy is highly due to bacterial infection on the surface of the bacteria for short term management of effective in improving the symptoms of dry teeth. Older research did show a 2.2 times or aphthous ulcers. These should mouth in patients with Sjögrens syndrome5. higher risk of having adult periodontitis than