Sjogren’s syndrome is an autoimmune disease where the body’s cells that offer protection (immunity), attack the body’s own cells. This affects several organs of the body, producing a wide range of symptoms. Early diagnosis and the patient’s understanding of this ailment go a long way in improving quality of life. It can affect multiple organs, including the gut and the central nervous system. This disease is much more common in women.
Symptoms of Sjogren’s disease vary in severity; there is a triad of – dry eyes, dry mouth, fatigue and joint problems. Some patients present with brain fog, memory loss, headaches, vaginal dryness, gut disturbances like heart burn, irritable bowel, deranged liver function tests, skin rashes and photophobia.
Let’s Break This Up
What Are the Oral Symptoms of Sjogren’s Syndrome? How Does It Affect Oral Health?
Sjogren’s syndrome patients typically complain of dry mouth – reduced salivary secretion – difficulty in speaking, swallowing, chewing, wearing of dentures, oral ulcers, dryness and cracking of lips. Some patients may also have a loss of taste and smell.
Reduced saliva results in halitosis (bad breath) and increases the chances of tooth decay. Saliva is a natural lubricant in our mouth. It is a cleanser washing away food remnants and bacteria, and also has several protective proteins that help protect the lining of the mouth. Reduced saliva also results in an imbalance of microbes in the mouth, favouring fungal overgrowth, which often presents as a curd-like patch on the tongue or the insides of the cheek called thrush.
How Is Sjogren’s Syndrome Diagnosed?
Diagnosis of SS may be challenging as this condition has different presentations in different individuals. Its symptoms overlap with the presentation of menopause, and other conditions like rheumatoid arthritis, lupus, fibromyalgia, etc.
A complete history and verbalization of all symptoms to the dentist/physician/ophthalmologist will help in early diagnosis of this condition. A rheumatologist – a specialist in autoimmune disorder – is likely to correctly diagnose and better manage the disease.
Tests
- Blood Tests to Look for Autoimmune Markers – SSA (Ro), or SSB (La) or both.
- Eye Test – For tear production – Schirmer test & Rose Bengal Dye test.
- Salivary Gland Analysis – The Amount of saliva produced can be assessed by sialometry. Imaging of the salivary gland is done to see its architecture and anatomy – sialography and scintigraphy – injection of tracer dye followed by an X-ray. A salivary gland biopsy is considered – usually from the lower lip, to aid in the diagnosis of this condition.
How Can Your Dentist Contribute to Making You Feel Better?
Regular dental check-ups go a long way in ensuring oral hygiene, and early detection of tooth decay. A dental decay caught at an early stage can prevent you from having a root canal or a tooth removal. The alternative treatment to these is conservative – protecting your natural enamel and tooth tissue – which are less expensive and also many patients are less anxious with these simple remedies.
Dentist Recommendations to Manage Symptoms of SS
- Take regular sips of water to overcome mouth dryness. Keep a bottle of water always handy by your bedside at night and with you during the day time.
- Artificial saliva substitutes containing carboxymethyl cellulose are available, both in the paste form and as oral sprays to wet the mouth. Ask your dentist for these formulations.
- White patches in the mouth, thrush, can be kept in abeyance by topical antifungal preparations.
- Regular dental check-ups and brushing twice daily and flossing help.
- Do not change your toothpaste frequently; many toothpastes cause dry mouth. Do not use alcohol-based mouthwashes.
- Avoid alcohol, smoking, carbonated drinks and too much coffee or tea.
The diagnosis of any ailment often impacts our mental health and, needless to say, our physical health. Educating oneself about the condition and putting that knowledge to good use will help one cope with this condition. Consultation with a rheumatologist, a dentist and an eye specialist will help deal with the presentation of this condition.
As Kofi Annan rightly said, and I quote, “Knowledge is power. Information is liberating. Education is the premise of progress, in every society, in every family.”
This disease may seem overwhelming on diagnosis, but oral discomfort can be definitely and effectively managed with a dentist’s help and home care tips.
Keep smiling always!
Dr Preeti L Anand
Senior Dental Surgeon & Implantologist
Kauvery Hospital, Chennai
