Volume 3, Issue 5, October 2017, Page: 20-26
Primary Sjӧgren’s Syndrome and Oral Cavity Disorders
Soares Sandra Clara, Fernando Pessoa Energy, Environment and Health Research Unite/Biomedical Research Center (FP-ENAS/CEBIMED), Faculty of Health Sciences, Fernando Pessoa University, Porto, Portugal
Chapela Sara Cendon, Clinica Dental Paula González Chapela, Vigo, Spain
Received: Nov. 27, 2017;       Accepted: Dec. 11, 2017;       Published: Jan. 8, 2018
DOI: 10.11648/j.ijdm.20170305.11      View  1430      Downloads  86
Sjögren’s Syndrome (SS) is one of the three most common autoimmune diseases in the world, which affects the exocrine glands, specifically the salivary and lacrimal glands. Primary SS (pSS) particularly affects only the exocrine glands, while secondary SS is associated with other systemic autoimmune pathologies. SS is characterized, histopathologically, by an inflammatory lymphocytic infiltrate that interferes with the normal gland function. It affects 0, 5% of the world population, being more common in women (9:1 versus men), mainly around 50 years old, after the menopause. The medical dentist role is very important in the diagnosis of pSS, as in most cases he is the one who detects the first symptoms, in particular dry mouth or xerostomia. The primary syndrome doesn’t have a painful development, being dry mouth and eye dryness the most prominent clinical characteristics. The majority of the oral evidences are consequence of salivary glands hypofunction: dental caries, periodontal disease or fungal infections. Along with hyposalivation and xerostomia communication disorders can occur like dysphagia and pharyngeal dryness leading to difficulties in speech and voice fatigue. These last ones have a negative impact in the patients quality of life although a large percentage don’t seek professional help. There is a need for awareness of the voice disorders associate with pSS referring the patients to proper professional help. The treatment of pSS is empirical, symptomatic and aimed at dealing with the complications during the early-stages of the disease consisting of limiting the xerostomia and xerophthalmia damages.
Primary Sjögren’s Syndrome, Pathogenesis, Voice Disorders, Dysphagia, Oral Infections, Xerostomia
To cite this article
Soares Sandra Clara, Chapela Sara Cendon, Primary Sjӧgren’s Syndrome and Oral Cavity Disorders, International Journal of Dental Medicine. Vol. 3, No. 5, 2017, pp. 20-26. doi: 10.11648/j.ijdm.20170305.11
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Rehman, H. U. Sjögren's Syndrome. Yonsei medical journal. 2003; 44 (6), pp. 947-954.
Margaix-Muñoz M, Bagán JV, Poveda R, Jiménez Y, Sarrión G. Sjögren's syndrome of the oral cavity. Review and update. Medicina Oral Patología Oral Cirugía Bucal. 2009; 14 (7), pp. E325-30.
Moutsopoulos HM. Sjögren's syndrome: autoimmune epithelitis. Clin Immunol Immunopathol. 1994 Aug; 72 (2): 162-5.
Kassan, S. S. & Moutsopoulos, H. M. Clinical manifestations and early diagnosis of Sjögren syndrome. Archives of internal medicine. 2004; 164 (12), pp. 1275-1284.
Jonsson R, Vogelsang P, Volchenkov R, Espinosa A, Wahren-Herlenius M, Appel S. The complexity of Sjögren's syndrome: novel aspects on pathogenesis. Immunology letters. 2011; 141 (1), pp. 1-9.
Maślińska M, Przygodzka M, Kwiatkowska B, Sikorska-Siudek K. Sjögren’s syndrome: still not fully understood disease. Rheumatology international. 2015; 35 (2), 233-241.
Solans, R., Labrador, M., & Bosch, J. Á. Etiopatogenia del síndrome de Sjögren. Medicina clínica, 116 (19). 2001; pp. 750-755.
Fox, R. I. Sjögren's syndrome. The Lancet. 2005; 366 (9482), pp. 321-331.
López-Pintor, R. M., Castro, M. F. & Hernández, G. Oral Involvement in Patients With Primary Sjögren's Syndrome. Multidisciplinary Care by Dentists and Rheumatologists. Reumatología Clínica (English Edition). 2015; 11 (6), pp. 387-394.
Thoppay JR, de Rossi SS, Ciarrocca KN. Burning mouth syndrome. Dent Clin North Am. 2013; 57: 497–512.
Ruiz Allec LD, Hernandez Lopez X, Arreguin Porras JB, Velasco Ramos R, Pacheco del Valle JC, Perez Garcia AI. Alterations in voice, speech and swallowing patients with Sjogren’s syndrome. Acta Otorrinolaringol Esp. 2011; 62: 255–64.
Freeman S, Sheehan P, Thorpe M, Ruthka J. Ear, nose and throat manifestations of sjögren’s syndrome: retrospective review of a multidisciplinary clinic. J Otolaryngol. 2005; 34: 20-4.
Ogawa N, Shimoyama K, Kawanami T. Molecular mechanisms of salivary gland destruction in patients with Sjogren's syndrome. Nihon Rinsho Meneki Gakkai Kaishi.. 2005; Feb; 28 (1): 10-20.
Flescher E., Talal N. Do viruses contribute to the development of Sjogren's syndrome? Am J Med. 1991; 90: 283–5.
Yamamoto, K. Pathogenesis of Sjögren's syndrome. Autoimmunity reviews. 2003; 2 (1), pp. 13-18.
Rostron J, Rogers S, Longman L, Kaney S, Field EA. Health-related quality of life in patients with primary Sjögren's syndrome and xerostomia: a comparative study. Gerodontology. 2002; Jul; 19 (1): 53-9.
Gallardo, J. Xerostomía: Etiología, Diagnóstico y Tratamiento. Revista Médica Mexicana de Seguro Social. 2008; 46 (1), pp. 109-116.
Proctor GB. The physiology of salivary secretion. Periodontol. 2000. 2016; Feb; 70 (1): 11-25.
González S, Sung H, Sepúlveda D, González M, Molina C. Oral manifestations and their treatment in Sjögren’s syndrome. Oral diseases. 2014; 20 (2), pp. 153-161.
Samnieng P, Ueno M, Shinada K, Zaitsu T, Wright FA, Kawaguchi Y. Association of hyposalivation with oral function, nutrition and oral health in community-dwelling elderly Thai. Community Dent Health. 2012 Mar; 29 (1): 117-23.
Bergdahl M, Bergdahl J. J. Low unstimulated salivary flow and subjective oral dryness: association with medication, anxiety, depression, and stress. Dent Res. 2000; Sep; 79 (9): 1652-8.
Castro I, Sepúlveda D, Cortés J, Quest AF, Barrera MJ, Bahamondes V, Aguilera S, Urzúa U, et al. Oral dryness in Sjögren's syndrome patients. Not just a question of water. Autoimmun Rev. 2013; Mar; 12 (5): 567-74.
Carsons, S. A review and update of Sjogren's syndrome: manifestations, diagnosis, and treatment. The American journal of managed care. 2001; 7 (14 Suppl), pp. S433-43.
González S, Sung H, Sepúlveda D, González M, Molina C. Oral manifestations and their treatment in Sjögren’s syndrome. Oral Dis. 2014; 20: 153–61.
Najera MP, al-Hashimi I, Plemons JM, Rivera-Hidalgo F, Rees TD, Haghighat N et al. Prevalence of periodontal disease in patients with Sjögren’s syndrome. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997; 83 (4): 453–457.
Maria Vieira de Lima Saintrain and Eliane Helena Alvim de Souza. Impact of tooth loss on the quality of life. Gerodontology 2012; 29: e632–e636.
Nozomi Okamoto, Masayuki Morikawa, Motokazu Yanagi, Nobuko Amano, Kimiko Tomioka, Kan Hazaki, et al., Association of Tooth Loss With Development of Swallowing Problems in Community-Dwelling Independent Elderly Population: The Fujiwarakyo Study. Journals of Gerontology: MEDICAL SCIENCES, 2015, Vol. 70, No. 12.
Rhodus NL, Bloomquist C, Liljemark W, Bereuter J. Prevalence, density, and manifestations of oral Candida albicans in patients with Sjögren's syndrome. The Journal of Otolaryngology. 1997; 26 (5): 300-305.
Napenas JJ, Rouleau TS. Oral complications of Sjögren’s syndrome. Oral Maxillofac Surg Clin North Am. 2014; 26: 55–62.
Carr AJ, Ng WF, Figueiredo F, Macleod RI, Greenwood M, Staines K. Sjögren’s syndrome: an update for dental practitioners. Br Dent J. 2012; 213: 353–7.
Ship JA. Diagnosing, managing, and preventing salivary gland disorders. OralDis. 2002; 8: 77–89.
Gavaldá- Esteve C. Síndrome de Sjögren. In: Bagán-Sebastián JV, Scully C. Medicina y patología oral. Valencia: Medicina Oral S. L; 2006. p. 241-6. 2.
Jenny L. Pierce, Kristine Tanner, Ray M. Merrill, Karla L. Miller, Katherine A. Kendall, Nelson Roy. Swallowing Disorders in Sjögren’s Syndrome: Prevalence, Risk Factors, and Effects on Quality of Life, Dysphagia. 2016; 31: 49–59.
Swapan Kumar Purkait. Essentials of Oral Pathology. 3 rd Ed. JP Medical Ltd, 2011; pag 566.
Tanner K, Pierce JL, Merrill RM, Miller KL, Kendall KA, Roy N a). The Quality of Life Burden Associated With Voice Disorders in Sjögren’s Syndrome. Annals of Otology, Rhinology & Laryngology. 2015; Vol. 124 (9) 721 –727.
Tanner K, Roy N, Merrill RM, Kendall K, Miller KL, Clegg DO, et al. Comparing Nebulized Water Versus Saline After Laryngeal Desiccation Challenge in Sjogren’s Syndrome. Laryngoscope 2013; 123: 2787–2792.
Immerman S, Sulica L. Bamboo nodes. Otolaryngol-Head Neck Surg. 2007; 137: 162-3.
Niemelä RK, Hakala M. Primary Sjögren's syndrome with severe central nervous system disease. Semin Arthritis Rheum. 1999 Aug; 29 (1): 4-13.
Heller A, Tanner K, Roy N, Nissen SL, Merrill RM, Miller KL, et al. Voice, speech, and laryngeal features of primary Sjögren's syndrome. Ann Otol Rhinol Laryngol. 2014; Nov; 123 (11): 778-85.
López-López, J., Salas, E. J., & Küstner, E. C. Pronóstico y tratamiento de la boca seca. Revisión sistemática. Medicina Clínica. 2014; 142 (3), pp. 119-124.
Mavragani, C. P., & Moutsopoulos, H. M. Sjögren’s Syndrome. The Annual Review of Pathology: Mechanisms of Disease. 2014; 9, pp. 273-285.
Mavragani, C. P., & Moutsopoulos, H. M. Conventional therapy of Sjogren’s Syndrome. Clinical reviews in allergy & immunology. 2007; 32 (3), pp. 284-291.
Mathews, S. A., Kurien, B. T., & Scofield, R. H. Oral manifestations of Sjögren’s syndrome. Journal of dental research. 2008; 87 (4), pp. 308-318.
Ramos-Casals, M., & Brito-Zerón, P. Emerging biological therapies in primary Sjögren's syndrome. Rheumatology. 2007; 46 (9), pp. 1389-1396.
Corominas, H., Fíguls, R., & Riera, M. Síndrome de Sjögren. Reumatología Clínica. 2008; 4, pp. 22-27.
Tanner K, Nissen SL, Merrill RM, Miner A, Channell RW, Miller KL et al. Nebulized Isotonic Saline Improves Voice Production in Sjogren’s Syndrome Laryngoscope 2015 b; 125: 2333–2340.
Ramos-Casals, M., Tzioufas, A. G., & Font, J. Síndrome de Sjögren. Nuevas perspectivas terapéuticas. Medicina clínica. 2005; 124 (3), pp. 111-115.
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