Evaluation of palatal saliva flow rate and oral manifestations in patients with Sjögren's syndrome

Objective: The purpose of this study was to describe the oral properties of Sjögren's syndrome (SS), including the determination of palatal saliva (PS) flow rate. Subjects and methods: Forty‐nine SS patients and 43 healthy controls participated. Subjective symptoms were recorded and clinical assessments of the oral mucosal, dental and periodontal status were made. Unstimulated whole saliva (WS) and PS flow rates, the number of decayed, missing and filled teeth (DMF‐T number), the gingival bleeding index (GBI) and the periodontal probing depth (PPD) were determined. Results: Despite the decrease in the flow rate of WS in SS patients, PS was not different from those of the controls (1.57 ± 1.02 and 1.35 ± 2.5 μl cm^?2 min^?1, respectively). GBI (20.0% vs. 10.5%, respectively), DMF‐T (27.1 ± 6.12 vs. 23.0 ± 6.99, respectively) and PPD (2.28 ± 1.09 mm vs. 1.82 ± 0.73 mm, respectively) were higher in SS compared with the controls (P < 0.05). DMF‐T and PPD showed a positive correlation with anti‐SSA and/or anti‐SSB antibody positivity in the serum (P < 0.05). Conclusions: Data of the present study suggest that the subjective feeling of xerostomia in SS patients is the result of a decrease in the volume of the whole saliva, and not of the viscous PS. Correlation of DMF‐T and PPD with autoantibody positivity reveals that the oral health status of SS patients may be associated with the general autoimmune process.     

Oral findings in coeliac disease and Sjögren's syndrome

OBJECTIVE: Both coeliac disease (CD) and Sjogren's syndrome (SS) have an autoimmune background and increased risk of oral mucosal and dental abnormalities. Individuals suffering concomitantly from CD and SS could even be at a higher risk. STUDY DESIGN: Oral mucosal and dental abnormalities were examined in 20 patients with CD + SS (mean age 61 years) and compared with age- and sex-matched controls with either CD or SS. RESULTS: Oral mucosal changes were most common in SS (80%), followed by CD + SS (65%) and CD (40%). Coeliac-type dental enamel defects were found in 89% in CD + SS and in 88% in CD compared with only 25% in SS (P < 0.001). The median number of teeth was six in the CD + SS, 24 in the CD and 22 in the SS group. The DMF index was higher (P < 0.005) in the CD + SS than in the CD group. CD + SS was characterized by higher salivary flow rate (P < 0.001) and lower inflammatory focus score in the salivary glands (P < 0.01) than SS. CONCLUSIONS: The co-occurrence of CD and SS should be recognized because of its effects on dental and oral mucosal health. A lower salivary gland inflammatory focus score and higher salivary flow rate in CD + SS than in SS suggests that a gluten-free diet treatment may alleviate autoimmune inflammation.     

Elevated blood pressure is not related to saliva flow in patients with Sjögren's syndrome

OBJECTIVE: The extent to which Fusobacterium nucleatum is recovered from root canals of teeth that present with an interappointment flare-up following endodontic instrumentation was investigated. STUDY DESIGN: Included in the study were 28 patients that sought emergency treatment after initiation of root canal therapy. Only non-painful teeth that had been treated because of a necrotic pulp and periapical inflammatory lesion were studied. Root canal samples for bacterial analysis were taken, transported to a bacteriological laboratory, and processed for a semiquantitative assessment of bacterial isolates. Bacterial findings were correlated with self-assessed pain intensity as recorded by means of a Visual Analogue Scale. Clinical presentation of swelling and presence of exudate in the treated root canals were also linked. RESULTS: Bacteria were recovered from all teeth examined. Gram-negative anaerobic coccoid rods (Prevotella species and Porphyromonas species) were frequent isolates. All teeth in patients who were reported to be in severe pain (Visual Analogue Scale > or = 6) displayed F nucleatum. Nine out of 10 of these teeth also had swelling and exudate in the root canals. Samples from the remaining patients that had teeth with less pain score showed a variable bacterial recovery. None of these teeth displayed F nucleatum. CONCLUSION: F nucleatum appears to be associated with the development of the most severe forms of interappointment endodontic flare-ups.     

Oral manifestations of Sjögren's syndrome

Sj?gren's syndrome is a common autoimmune rheumatic disease. The most common symptoms of Sj?gren's syndrome are extreme tiredness, along with dry eyes (keratoconjunctivitis sicca) and dry mouth (xerostomia). Saliva plays an essential role in numerous functions of the mouth. Xerostomia can be caused by medications, chronic diseases like Sj?gren's syndrome, and medical treatments, such as radiation therapy and bone marrow transplant. Xerostomia can eventually lead to difficulty in swallowing, severe and progressive tooth decay, or oral infections. Despite having excellent oral hygiene, individuals with Sj?gren's syndrome have elevated levels of dental caries, along with the loss of many teeth, early in the disease. Sj?gren's syndrome alters the protein profile and brings about a change in the composition of saliva. There is an increase in the levels of lactoferrin, beta(2)-microglobulin, sodium, lysozyme C, and cystatin C, and a decrease in salivary amylase and carbonic anhydrase. Up to 90% of individuals with Sj?gren's syndrome have antibodies targeting the Ro 60 and La autoantigens. Natural aging, regardless of Sj?gren's syndrome, is also another factor that brings about a significant change in the composition of saliva. The most prevailing cause of xerostomia in elderly persons is the use of anticholinergic medications. Currently, there is no cure for Sj?gren's syndrome, and treatment is mainly palliative.     

Oral and dental aspects of Sjögren's syndrome

Sj?gren's syndrome is a common condition which can result in significant physical and emotional debility. Dentists can play a pivotal role in the prompt diagnosis, investigation and management of patients with Sj?gren's syndrome. A sound understanding of the pathogenesis, presentation and current management of Sj?gren's syndrome, will enable the general dental practitioner to make a significant contribution to the oral health and general well-being of those affected by the disease. This article aims to provide the general dental practitioner with a comprehensive and practical guide to current developments and best practise in the care of these individuals.     

Cytokine concentrations in stimulated whole saliva among patients with primary Sjögren's syndrome, secondary Sjögren's syndrome, and patients with primary Sjögren's syndrome receiving varying doses of interferon for symptomatic treatment of the condition: a preliminary study

Sj?gren's syndrome is an autoimmune disorder which causes diminished salivary flow due to autoimmune sialoadenitis. This decrease in saliva flow is the result of inflammation and atrophy of the salivary glands. Most treatment regimens are palliative in nature, but treatment with interferon (IFN) holds promise for Sj?gren's syndrome sufferers. Several studies have investigated cytokine concentrations in the salivary glandular tissues from Sj?gren's syndrome patients; however, there is little information concerning cytokine expression in saliva. This is especially true with respect to treatment modalities and their effects on local cytokines. A clinical study was conducted to determine salivary interleukin (IL)-6, IFN, and IL-2, concentrations among subjects diagnosed with primary and secondary Sj?gren's syndrome and a healthy control group. The primary Sj?gren's syndrome showed significantly higher salivary IL-2 and salivary IL-6 than the control and secondary Sj?gren's groups. There were no between group differences for salivary IFN concentrations. In addition, the study assessed salivary IL-6, IFN, and IL-2 concentrations among 18 Sj?gren's syndrome patients before and after administration of IFN via the oral mucosal route. The results of the study showed that the mean values for the pre- and post-treatment groups for stimulated whole saliva flow rates were 3.15 and 3.74 ml/5 min, respectively. The post-treatment group exhibited a 16.8% increase in stimulated whole saliva flow rates. The salivary IL-6 concentration was 53.3% lower for the post-treatment group (17.79) as compared to the baseline value (33.35). The values for salivary IFN and salivary total protein were virtually unchanged from their baseline values. Salivary IL-2 values, however, were 50% lower in the post-treatment group (3.07) when compared to their respective baseline values (6.10). The results of this study suggest that healthy individuals exhibit lower salivary IL-2 and IL-6 as compared to individuals suffering from primary and secondary Sj?gren's syndrome. The results also suggest that administration of IFN via the oral mucosal route may increase salivary flow rates and depress certain cytokines (IL-2, IL-6) associated with inflammatory destruction of salivary glandular tissues in Sj?gren's syndrome patients.     

Different proteomic protein patterns in saliva of Sjögren's syndrome patients

Objective:  To investigate the salivary protein profile in patients with Sjögren's syndrome (SS), and healthy control subjects.
Materials and methods:  Unstimulated whole saliva samples were collected from 16 age-matched females; eight healthy subjects and eight patients diagnosed with SS (six primary SS, one incomplete SS and one primary SS associated with B cell lymphoma). Proteins were extracted and separated individually by 2D sodium dodecyl sulphate–polyacrylamide gel electrophoresis. Selected protein spots of interest were analysed by electrospray ionization – tandem mass spectrometry. Obtained data were searched against the Swiss-Prot and NCBI non-redundant protein databases using Mascot software.
Results:  Two groups of patterns of protein expression were observed in the eight SS patients: a major group (six patients) with significant expression differences from the healthy subjects and the second group (two patients) with a pattern similar to the eight healthy subjects.
Conclusion:  In this preliminary study, protein expression differences were found between SS patients and healthy subjects. Individual analysis of SS patients exhibited two patterns of protein expression with no direct relation to the clinical, serological or histological severity of disease. This study emphasizes the difficulty of the present proteomic knowledge to diagnose and monitor the sequel of SS development.     

Impact of Sjögren's syndrome on oral health-related quality of life in southern Chinese

summary The effect of oral symptoms of Sjögren's syndrome (SS) on health‐related quality of life is presently uncertain. This study aimed to investigate oral health‐related quality of life (OHRQOL) among southern Chinese people with SS. Twenty‐six primary SS cases, 25 secondary cases and 29 matched controls took part in this cross‐sectional study. Each participant completed a SF‐36 questionnaire, the Oral Health Impact Profile and a dry mouth measure, assisted by a trained interviewer. Data on socio‐demographic variables were also collected. The dry mouth measure revealed that people with primary and secondary SS had significant problems associated with subjective symptoms of dry mouth generally, and dry mouth when eating and speaking (P < 0·01). Sticky saliva and coughing were also problems in some primary SS cases. OHIP summary and sub‐scale scores did not reveal differences in negative impacts between groups. Mean SF‐36 sub‐scale scores were significantly different between groups (P < 0·05). In physical function, role‐physical and general health domains, primary and secondary SS sufferers had lower scores indicating poorer health. Oral symptoms of SS, notably xerostomia, had a negative effect on OHRQOL. Health‐related quality of life in general was also impaired in SS sufferers. The OHIP did not appear to discriminate oral problems of concern to SS sufferers.     

Sjögren's syndrome

Sjögren's syndrome (SS) is a chronic autoimmune disease affecting the exocrine glands, primarily the salivary and lacrimal glands. It has been suggested that exogenous agents may trigger SS in genetically predisposed individuals. However, at present, the etiology of SS is far from being understood, and no direct evidence for any of these triggers has been presented. The salivary and lacrimal glands from patients with SS harbor unique and highly selected T‐ and B‐cell populations. Disturbance in glandular cell apoptosis may be one possible explanation for the sicca symptoms in SS. However, discrepancies between glandular destruction and salivary flow give rise to processes causing glandular dysfunction preceding or triggering glandular cell destruction. Recent reports suggested autoantibodies inhibiting neuronal innervation of acinar cells and defective water transport to be implicated in salivary secretion deficiency observed in SS. Several types of autoantibodies have been suggested to contribute to the pathogenesis of SS. However, how the tolerance to these structures is broken down is unknown at present. Studies on B‐cell activating factor indicated that diminished apoptosis and disturbed B‐cell maturation could be responsible for the occurrence of autoreactive B‐cells and B‐cell hyperreactivity. B‐cell activation may also provide a basis for lymphoma development observed in up to 5% of the patients with SS.     

Oral and periodontal status in Sj?gren's syndrome.

Sj?gren's syndrome is a multi-system chronic inflammatory disease of the exocrine glands. Inflammation of the salivary glands leads to reduction in salivary output, which imposes a significant impact on oral health. Dentists and dental hygienists are the primary healthcare providers to identify early signs and symptoms of Sj?gren's syndrome. Early diagnosis of Sj?gren's syndrome is fundamental for effective management of the disease.     

Fungal load and candidiasis in Sjögren's syndrome

OBJECTIVE: We sought to investigate the prevalence of Candida carriage and the relationships between salivary flow rates and oral Candida load in patients with Sj?gren's syndrome (SS). METHODS: The oral Candida load of patients with SS was evaluated by culturing oral rinse (swish and spit) samples. Culture, Gram stain, and wet-mount test results were reported. RESULTS: One hundred three patients (96 women) met European criteria for SS (91 with primary SS and 12 with secondary SS). The mean age (95% confidence interval) was 55 years (range, 51-57 years). Oral rinse cultures were positive in 77% of subjects. The total stimulated salivary flow rate was inversely correlated with oral Candida load (r = -0.47; P 相似文献   

A comparison of two clinical methods for measuring saliva in patients with Sjögren's syndrome

Abstract

Objective. The aim of the present study was to evaluate two different ways of measuring unstimulated and stimulated whole salivary output in the dental clinic, namely by volume (mL/min) and by weight (g/min). Materials and methods. Thirty-one patients diagnosed with Secondary Sjögren's syndrome (SSS) participated in the study. Results. The results showed a large discrepancy between the measurements performed by volume and by weight (p < 0.001) and additionally when taking into account density calculation, especially in individuals with low salivary secretion rate. Conclusion. It is suggested that weight measurement of saliva should be more routinely implemented, especially in patients with reduced salivary secretion.     

Current issues in Sjögren's syndrome

Sjögren's syndrome is a chronic autoimmune and rheumatic disorder with prominent sicca complaints from the mucous membranes because of lack of proper exocrine secretions. There is no straightforward and simple diagnostic test for Sjögren's syndrome, although several classification criteria have been designed including several oral diagnostic tests. A new set of classification criteria in a joint effort by research groups in Europe and USA has recently been presented. A large number of autoantibodies have been reported in Sjögren's syndrome where, in some cases, the antibodies are correlated with the extent and severity of disease. The finding of serum autoantibodies directed against the muscarinic M3 receptor is an important advance in understanding the pathogenesis of not only the impaired glandular function but also associated features of autonomic dysfunction in some patients. The treatment of primary Sjögren's syndrome is still mainly symptomatic.     

Sjögren's syndrome. Consequences for oral health

Sj?gren's syndrome is an auto-immune disease involving exocrine glands causing amongst others xerostomia and dry eyes. Many other tissues may be affected as well. Early recognition of this disease may help to alleviate signs and symptoms and is, thus, important. The aim of this paper is to provide the dentist with knowledge to enable him to timely diagnose the oral component of Sj?gren's syndrome as well as to give guidelines for the treatment.     

Primary Sjögren's syndrome

Columbia University's Salivary Gland Center (SGC) has examined more than 6,000 patients with a variety of concerns stemming from salivary gland disease and/or salivary secretory dysfunction. Not unexpectedly, the most common patient complaint centers around symptoms associated with dry mouth. Such patients are usually first seen by the dental practitioner. Because Sj?gren's syndrome (SS) causes dry mouth, and because it is a relatively common entity--encountered in about three million Americans--and because the dental profession has become aware of its classic manifestation of xerostomia, patients experiencing SS are referred in increasing numbers to the SGC for evaluation. Therefore, the authors wish to call attention to the methodology used in accurately diagnosing SS and to illustrate its signs and symptoms with a case report.     

Quality of life in patients with Sjögren's syndrome and sicca complex

Summary To investigate the general and oral quality of life in patients with Sjögren’s syndrome (SS) and sicca complex. Forty‐four patients with SS were studied consecutively, 33 were primary SS and 11 secondary SS, classified in accordance with the Vitali European criteria. The Spanish version of the Medical Outcome Short Form (36) Health Survey questionnaire (SF‐36) was used to evaluate general quality of life and the Oral Health Impact Profile (OHIP‐49) Spanish version to study oral quality of life. Regarding general quality of life using the SF‐36, when comparing the SS and the control groups, lower scores were obtained in the SS groups in all domains and on comparing primary and secondary SS, lower scores were found for primary SS in all the subscales. With respect to oral quality of life using the OHIP‐49 (all items), we found lower scores for the primary SS group with respect to the control group. Patients with primary SS present lower scores for both oral and general quality of life.     

Prevalence of periodontal disease in patients with Sjögren's syndrome

The periodontal status of 25 patients with Sjögren's syndrome was compared with that of an age-, sex-, and race-matched healthy controls. Clinical evaluation included determination of number of teeth, decayed/missing/filled surfaces, probing pocket depth, clinical attachment level, plaque index, gingival index, bleeding on probing, and measurement of alveolar bone level (examined with radiography). Results of the study suggest that patients with Sjögren's syndrome have a significantly higher plaque index score (p < 0.005), higher decayed/missing/filled surfaces scores (p < 0.05), increased alveolar bone loss (p < 0.05), deeper clinical attachment level (p < 0.05), and increased cementoenamel junction-alveolar bone crest distance (p < 0.005). Although no significant difference was found in the number of cases of “established periodontitis” between the Sjögren's syndrome and controls, odds ratio analysis suggests that patients with Sjögren's syndrome are at 2.2 times higher risk of having adult periodontitis than healthy controls.