Ovidental Editorial Team
hola@ovidentalgo.com
Sjögren's syndrome (SS) is a chronic autoimmune disorder primarily targeting the body's exocrine glands, notably the salivary and lacrimal glands, leading to symptoms such as xerostomia (dry mouth) and keratoconjunctivitis sicca (dry eyes).
These manifestations significantly impact oral health, necessitating a comprehensive dental management approach to mitigate complications and enhance patient quality of life.
Oral Manifestations of Sjögren's Syndrome
Patients with SS often exhibit:
- Xerostomia
Persistent dry mouth sensation, complicating speech, mastication, and deglutition.
- Increased Caries Risk
Salivary hypofunction diminishes the natural protective mechanisms against dental caries, leading to a higher incidence, particularly in cervical and root surfaces.
- Oral Candidiasis
The reduced salivary flow creates a favorable environment for fungal infections, notably by Candida species.
- Salivary Gland Enlargement
Patients may experience diffuse, firm enlargement of major salivary glands, such as the parotid glands.
Comprehensive Dental Management Protocol
Effective management encompasses preventive, therapeutic, and maintenance strategies:
1. Preventive Measures
- Saliva Stimulation
Encourage the use of sugar-free chewing gums or lozenges to stimulate residual salivary gland function.
Pharmacologic agents like pilocarpine or cevimeline may be prescribed to enhance salivary output.
- Topical Fluoride Application
Implement daily use of high-concentration fluoride toothpaste (e.g., 1.1% sodium fluoride) and consider in-office fluoride varnish applications to strengthen enamel and prevent caries.
- Antimicrobial Therapy
Short-term use of chlorhexidine gluconate rinses can reduce oral microbial load, aiding in caries prevention.
However, prolonged use should be monitored due to potential side effects.
- Dietary Counseling
Advise patients to limit intake of fermentable carbohydrates and acidic foods, which can exacerbate demineralization and caries risk.
2. Therapeutic Interventions
- Management of Oral Candidiasis
Diagnose and treat fungal infections with antifungal agents, such as nystatin or fluconazole, to alleviate symptoms and prevent complications.
- Restorative Dentistry
Select restorative materials that offer durability in xerostomic conditions.
Glass ionomer cements, for instance, release fluoride and may provide added protection against caries.
- Prosthodontic Solutions
For patients with significant tooth loss, consider implant-supported prostheses to improve function and comfort, as traditional dentures may be less tolerable due to dry mucosa.
3. Maintenance Phase
- Regular Dental Visits
Schedule frequent recall appointments (every 3 to 6 months) to monitor oral health, perform professional cleanings, and reinforce preventive strategies.
- Patient Education
Continuously educate patients on meticulous oral hygiene practices, including brushing with fluoride toothpaste and daily flossing, to manage their condition effectively.
- Saliva Substitutes
Recommend over-the-counter saliva substitutes or moisturizing agents to alleviate dryness and improve oral comfort.
Interdisciplinary Collaboration
Given the systemic nature of SS, collaboration with rheumatologists, ophthalmologists, and other healthcare professionals is crucial to address the multifaceted aspects of the disease and ensure comprehensive patient care.
By implementing this integrated management approach, dental professionals can play a pivotal role in mitigating oral complications associated with Sjögren's syndrome, thereby enhancing patients' oral and overall health.
References
- Sjögren Disease.
Sjögren's Foundation. Clinical Practice Guidelines.
- Mayo Clinic. Sjogren's syndrome - Diagnosis and treatment.
