Sjogren’s Syndrome and Xerostomia – An Overview Achievement & Inclusion Sjogren’s Syndrome and Xerostomia – An Overview Paul Friel August 2016

Definition of Xerostomia Achievement & Inclusion Definition of Xerostomia dry mouth <0.2ml per minute whole saliva flow

Sjogren’s Syndrome Primary – xerostomia (dry mouth) and keratoconjunctivitis (dry eyes) Secondary – as above, plus a connective tissue disorder, most commonly rheumatoid arthritis, SLE, or mixed connective tissue disorder It is a chronic, multisystem autoimmune disorder, affecting the lacrimal and salivary glands. It most commonly affects middle- aged women.

Causes of Xerostomia Drugs antidepressants (tricyclics, MAOIs and SSRIs) antihistamines antihypertensives (ACE inhibitors, B-blockers) diuretics PPIs (anti-reflux) antimuscarinics benzodiazepines opioid analgesics

Causes of Xerostomia 2. Dehydration 3. Sjogren’s Syndrome diabetes renal failure age 3. Sjogren’s Syndrome Irradiation of the head and neck Neurological (rare) Developmental (rare) Smoking

Incidence of Xerostomia 13% of UK population

Xerostomia Xerostomia can be classified as: subjective (false) – feels dry to patient but normal salivary flow e.g. mouth-breathing or objective (true) – reduced salivary flow

Related Dental/Oral Problems Caries – especially cervical/incisal caries Periodontal disease Infections – especially fungal infections Difficulty with dentures Oral discomfort Taste disturbances

Assessment History and medical history – especially regarding drug therapy Examination ‘sticking’ of mirror to mucosa ‘frothy’ saliva/lack of pooling lobulated, fissured dorsum debris interdentally ‘glazed’ gingivae denture stomatitis

Sjogren’s Syndrome Investigations 1. Unstimulated whole saliva flow rate (10 minutes) < 0.2 ml per minute indicates xerostomia 2. Stimulated parotid flow 3. Lacrimal flow (Schirmer test) 4. Parotid sialogram – shows ‘punctate sialectasis’ (snowstorm appearance) 5. Labial gland biopsy – shows focal lymphocytic sialadenitis

Management of Xerostomia Regular sips of water (not drinking it) Maintain fluid intake Avoid xerostomia-inducing drugs Artificial saliva spray (Saliva Orthana) gel (Biotene) mouthwash Oral discomfort Taste disturbances

Management of Xerostomia Use of sugar-free chewing gum/mints Pilocarpine if severe (can cause sweating, GIT problems, and facial flushing) Dietary advice non-cariogenic diet avoid use of acidic foods (e.g. citrus fruits) to stimulate saliva 8. Fluoride

Management of Xerostomia Fluoride high-fluoride toothpaste (Duraphat 2800ppm) daily fluoride mouthwash regular application of 5% NaF varnish by dental professional Chlorhexidine mouthwash Regular dental examinations and hygiene visits