Sjögren's syndrome

Oral health effects

• Severe dry mouth (xerostomia)

  Autoimmune destruction of salivary glands produces marked, chronic dry mouth, a defining feature of the condition.

  Mechanism: Lymphocytic infiltration and destruction of exocrine (salivary/lacrimal) glands.

  Clinical management: Aggressive caries prevention, salivary stimulants (e.g., pilocarpine where appropriate), substitutes, fluoride, frequent recall, candidiasis monitoring.

• Rapid decay at the gumline and on roots (cervical/root caries)

  Loss of salivary protection leads to rapidly progressing caries.

  Clinical management: High-fluoride regimens, dietary counseling, close monitoring.

• Oral thrush and cracked mouth corners (oral candidiasis / angular cheilitis)

  Loss of saliva greatly raises the risk of Candida infection (about 10-fold) and angular cheilitis (about 6-fold); it often presents as a red, burning, depapillated tongue rather than white plaques.

  Clinical management: Inspect the tongue dorsum, palate and commissures every visit; refer for antifungal treatment; advise cleaning dentures nightly; recommend sugar-free saliva substitutes and avoiding alcohol-containing rinses.

• Altered taste (dysgeusia)

  Many people with Sjögren's report altered or reduced taste because saliva is needed to carry tastants to taste buds.

  Clinical management: Ask about taste changes; screen for candidiasis (a reversible cause); counsel against compensating with sugary or acidic foods and drinks.

• Difficulty chewing and swallowing (dysphagia)

  Dryness makes it hard to form and swallow a food bolus; swallowing difficulty is far more common than in people without Sjögren's.

  Clinical management: Keep water at hand during appointments; use high-volume suction and avoid leaving debris or dry powders in the mouth; seat upright; ask about choking episodes.