Carissa Kramer

12/4/23

DHIV Research paper

Sjogren Syndrome; An Oral Cavity Crisis

Sjorens syndrome is an autoimmune disease that is shown to light every year on July

23rd to raise awareness of this rare disease. This disease was fist discovered by Dr. Sjoren, an

optometrist in Sweden in 1929, while seeing a patient with common symptoms but not

correlated. The combonation symptoms of dry mouth, dry eyes, and joint pain was found

interesting by Dr. Sjoren. All of these symptoms were found to be due to fluid in glands

alterations. With this disease, the immune system reacts abnormally and attacks healthy tissue

and glands. These glands can become irritated and innflammed with less essential fluid

production around the body. Main fluid disruption with salivary glands causes sever xerostomia.

Many people can have early factors of the disease, but sometimes it is not identified to all be

correlated as many other disorders generally cause joint pain or xerostomia. Some patients may

have more of a mild case causing diagnosis to not be identified. Sjorens syndrome can be

diagnosed by itself or symptoms can be found easier if a person has already been diagnosed with

lupus or rheumatoid arthritis as these disorders develop Sjorens disease. It is more common to

see a person who inherits this disease due to genetics with some sort of enviornmental factor that

can disrupt the autoimmune processes bringing the disease to become more severe and

noticeable by the patient. Although many factors causes this disease their are some key factors

physitials can look at to diagnose easier. Most commonly effected is women, with symptoms
occuring after 40 years old. Race is not a determining factor with this disease. “There isn’t yet a

concrete explanation why Sjögren’s syndrome affects more women than men. Researchers are

exploring the possible role of the hormone estrogen—being postmenopausal increases a

woman’s likelihood of developing the disease, and estrogen levels drop in a woman’s body after

menopause” (Johns Hopkins Medicine). This concludes the population of the disease is shown

most ages 40 and older because of older age and being exposed to other conditions can increase

symptoms. A statement by Steven Carsons explains, “Between 400,000 and 3.1 million adults

have Sjögren's syndrome” (Steven E. Carsons). This shows the severity of this condition and

how important is is to spread awareness to older patients with Sjorens symptoms.

Symptoms of Sjorens is not easy to identify if the disease is still in its mild phases. It can

remain in ones body for many years before detected. Symptoms occur because this disease

attacks glands that make tears and saliva and also surrounding tissues. Physical side affects are

usually noticed first as glands can become larger and irritated leading to direct causes of dryness

in our senses and joints. Physical affects include drye eyes with a burning sensation, dry mouth

with difficulty swallowing, an increase in dental caries, joint pain muscle aches, acid reflux, dry

throat, and swelling of the neck and glands. If a person has a severe case of Sjorens syndrome the

symptoms can become more intense and can cause mental disturbances such as poor momory

problems, difficulty concentrating, and troubles sleeping due to aches in joints. Symptoms can

lead a patient to feel uncomoftable due to extreme dryness and joint pain. Their are some

medications that can relieve these symptoms and overall help quality of life. Artificial tears in

forms of eye drops can be taken daily to help supplement a natural amount of fluid that has been

decreased from the glands. Cholinergic agents are also recommended with patients with this

diagnosis to help with “slud” effects and activates the parasympathetic nervous system.
“Cholinergic agonists help to stimulate secretions in the body. For dry eye and dry mouth,

doctors may prescribe pilocarpine hydrochloride or cevimeline, both of which stimulate the

lacrimal glands to produce more tears and the salivary glands to create more saliva” (Patient

Care at NYU Langone Health). Other medications include daily ibuprofen medicine to reduce

inflammation, or corticosteroids for joint pain. Steroids and cholinergic drugs that are treatment

dor Sjorens disease are considered immunoserpresants and helps prevent further cell damage to

healthy cells. Although most of the treatment is healthy if an immunosurpessand is used at high

doses for long perious of time it can lead to some physical damage on the body such as high

blood pressure, diabetes, mouth sores, and thinning of the bones. Corticosteroids used for joint

inflammation can lead to more mental issues if used long term such as anxiety, depression, and

mood changes. Side effects can be avoided if a patient uses a low-dose, short-term steroid or

takes an oral corticosteroid every other day instead of daily. Their is no cure for Sjorens

syndrome but if identified early side effects can be treated easily, a person can live a long healthy

life with this syndrome if proper treatment is used to prevent side effects of the disease.

Progression of the disease is often atypical and most symtoms can take years until treated due to

most cases being mild. First symptoms that appear are dry eyes and mouth and can be easily

treatable with saliva substitutes or eye drops to keep senses moisturized especially in dry

climates. Once this disease is identified it is a lifelong terminal disease but this rare disease is

easily controlled in relation to other diseases.

The reason I chose this rare disease is the interesting idea it affects moisture in areas of

the body, especially in the oral cavity. It is important to spread awareness of this disease as

someone could have extreme dry mouth issues with multiple decayed teeth but never get

diagnosed with Sjorens disease or know the reason of their poor oral health. This disease put a
patient at higher risk for dental caries and periodontitis even if proper oral health care is

managed. The saliva composition is altered, 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” ( Cleveland Clinic). This saliva is known to dry out the oral cavity and

if not treated with proper oral care at home, keeping moisture levels balanced, and seen for

cleanings every 6 months can even lead to tooth loss. Dental caries specifically can occur on root

surfaces or tips of incisal or canine areas as it is harder for saliva to adhere to these surfaces.

Periodontal disease can also be linked to Sjorens syndrome, patients with this disease are

naturally placed at higher levels withing plaque scores and bleeding indexs because of

xerostomia not properly treated with self treatments and medications such as use of artificial

saliva products. Their are many ways to self treat this disease and can help a patient stay

motivated for good oral health stratigies at home. Patients with this disease are dried out and

need at home tricks to help moistrize the oral cavity. Avoiding dry enviornments can help with

side effects of Sjorens syndrome. Reccomend the patient uses a humidifier at home to help

moistrize skin and senses. Patient should highly consider carrying a water bottle or ice cubes to

keep mouth moistrized. Brushing 2-3 times a day as mouth is less moistrized making plaque and

buildup harder to remove. Eating softer and moist foods can help if a patient with this disease has

troubles swallowing. The patient needs to continue to eat foods with high water values or carry

around saliva inducers such as sugar free gum or a saliva supplement/gel. If a patient is at higher

risk for toothloss due to uncontrolled xerostomia, this patient is a great canidate for dental

implants to get them back on track for proper dentition and help encourage them to implement

proper oral health techniques with implants. “Sjornens synrome patients who undergo dental

implant procedures demonstrate an improvement in their periodontal status. This highlights the
importance of proactive and ongoing dental and periodontal surveillance for these patients,

aiming to decrease the risk of developing periodontal diseases. (Current health sciences jornal).

Regular dental recalls with strategies on oral care are an important topic to discuss with a

patient with Sjorens disease. This patient may feel less motivated with oral health with a natural

higher risk with dental caries. It is important to allow this patient to open up on easy tricks to

improve oral health at home and fight off xerostomia issues with natural remedies. Their is no

need for a care taker as this disease can be seen in healthy people with only few symptoms such

as dry eyes and mouth irritations. Discuss with patient how proper oral health practices with

regular recall visits can help identify trouble areas in the oral cavity and keep oral health

stabilized with this disease. During recal visits patient may need more frequent rinses and may

have high sensitivity along dentition and may be seen to have a fissued tongue. The patient

should select a soft bristled electric toothbrush to take off plaque and bacteria that is usually

flushed out with saliva. Recommend patient brushes 2-3 times a day and eats a well rounded diet.

Harder foods can also help release plaque build up such as veggies and meats. This patient would

qualify for a water flosser as this can help keep the mouth moisturized though out the day and

help with bad breath/bacteria counts. Depending on the severity of this disease a person may

need to be seen at a 3 month recall appointment for cleanings and can be prescribed sodium

fluoride prescription toothpaste to lower carious decay risks. If a patient is motivated to follow

their dental hygienists instructions the disease symptoms can became easily controlled and

regulated.
 Citations

Sjögren’s syndrome risk factors. Johns Hopkins Medicine. (2022, April 18).

https://www.hopkinsmedicine.org/health/conditions-and-diseases/sjogrens-syndrome/sjogrens-sy

ndrome-risk-factors#:~:text=A%20person%20who%20develops%20Sj%C3%B6gren’s,causes%

20it%20to%20become%20active

Carsons, S. E. (n.d.). Sjogren syndrome - statpearls - NCBI bookshelf. National Library

Of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK431049/

Medications for Sjogren’s syndrome. Patient Care at NYU Langone Health. (n.d.).

https://nyulangone.org/conditions/sjogrens-syndrome/treatments/medications-for-sjogren-s-syndr

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professional, C. C. medical. (n.d.). Immunosuppressants. Cleveland Clinic.

https://my.clevelandclinic.org/health/treatments/10418-immunosuppressants#risks-benefits

RH;, M. S. B. (n.d.). Oral manifestations of Sjögren’s syndrome. Journal of dental

research. https://pubmed.ncbi.nlm.nih.gov/18362310/

Current Health Sciences Journal. June 2023. Clinical Evaluation of Periodontal Status

and IL-6 Gingival Fluid Level in Patients with Sjogren’s Syndrome. Dimentions.

https://app.dimensions.ai/details/publication/pub.1164571948?search_mode=content&sea

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