Sjogrens Syndrome and Xerostomia An Overview Paul Friel

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Sjogren’s Syndrome and Xerostomia – An Overview Paul Friel August 2016

Sjogren’s Syndrome and Xerostomia – An Overview Paul Friel August 2016

Definition of Xerostomia • dry mouth • <0. 2 ml per minute whole saliva

Definition of Xerostomia • dry mouth • <0. 2 ml per minute whole saliva flow

Sjogren’s Syndrome Primary – xerostomia (dry mouth) and keratoconjunctivitis (dry eyes) Secondary – as

Sjogren’s Syndrome Primary – xerostomia (dry mouth) and keratoconjunctivitis (dry eyes) Secondary – as above, plus a connective tissue disorder, most commonly rheumatoid arthritis, SLE, or mixed connective tissue disorder It is a chronic, multisystem autoimmune disorder, affecting the lacrimal and salivary glands. It most commonly affects middleaged women.

Causes of Xerostomia 1. Drugs • • antidepressants (tricyclics, MAOIs and SSRIs) antihistamines antihypertensives

Causes of Xerostomia 1. Drugs • • antidepressants (tricyclics, MAOIs and SSRIs) antihistamines antihypertensives (ACE inhibitors, B-blockers) diuretics PPIs (anti-reflux) antimuscarinics benzodiazepines opioid analgesics

Causes of Xerostomia 2. Dehydration • • • diabetes renal failure age 3. 4.

Causes of Xerostomia 2. Dehydration • • • diabetes renal failure age 3. 4. 5. 6. 7. Sjogren’s Syndrome Irradiation of the head and neck Neurological (rare) Developmental (rare) Smoking

Incidence of Xerostomia • 13% of UK population

Incidence of Xerostomia • 13% of UK population

Xerostomia can be classified as: subjective (false) – feels dry to patient but normal

Xerostomia can be classified as: subjective (false) – feels dry to patient but normal salivary flow e. g. mouth-breathing or objective (true) – reduced salivary flow

Related Dental/Oral Problems 1. Caries – especially cervical/incisal caries 2. Periodontal disease 3. Infections

Related Dental/Oral Problems 1. Caries – especially cervical/incisal caries 2. Periodontal disease 3. Infections – especially fungal infections 4. Difficulty with dentures 5. Oral discomfort 6. Taste disturbances

Assessment 1. History and medical history – especially regarding drug therapy 2. Examination •

Assessment 1. History and medical history – especially regarding drug therapy 2. Examination • • • ‘sticking’ of mirror to mucosa ‘frothy’ saliva/lack of pooling lobulated, fissured dorsum debris interdentally ‘glazed’ gingivae denture stomatitis

Sjogren’s Syndrome Investigations 1. Unstimulated whole saliva flow rate (10 minutes) < 0. 2

Sjogren’s Syndrome Investigations 1. Unstimulated whole saliva flow rate (10 minutes) < 0. 2 ml per minute indicates xerostomia 2. Stimulated parotid flow 3. Lacrimal flow (Schirmer test) 4. Parotid sialogram – shows ‘punctate sialectasis’ (snowstorm appearance) 5. Labial gland biopsy – shows focal lymphocytic sialadenitis

Management of Xerostomia 1. Regular sips of water (not drinking it) 2. Maintain fluid

Management of Xerostomia 1. Regular sips of water (not drinking it) 2. Maintain fluid intake 3. Avoid xerostomia-inducing drugs 4. Artificial saliva • • • spray (Saliva Orthana) gel (Biotene) mouthwash

Management of Xerostomia 5. Use of sugar-free chewing gum/mints 6. Pilocarpine if severe (can

Management of Xerostomia 5. Use of sugar-free chewing gum/mints 6. Pilocarpine if severe (can cause sweating, GIT problems, and facial flushing) 5. Dietary advice • • non-cariogenic diet avoid use of acidic foods (e. g. citrus fruits) to stimulate saliva 8. Fluoride

Management of Xerostomia 8. Fluoride • • • high-fluoride toothpaste (Duraphat 2800 ppm) daily

Management of Xerostomia 8. Fluoride • • • high-fluoride toothpaste (Duraphat 2800 ppm) daily fluoride mouthwash regular application of 5% Na. F varnish by dental professional 9. Chlorhexidine mouthwash 10. Regular dental examinations and hygiene visits

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