Dental Treatment (Notes for Dentists)

Dentistry aspects in the treatment of patients with Sjögren's syndrome


OA Dr. Dr. Michael Stiller

Dental Clinic of the Freie Universität Berlin



Translated from original German Language Report


Sjögren's syndrome is a common, chronic, autoimmune rheumatic disease characterized by the presence of the following features:


1. inflammation of the cornea and conjunctiva of the eye,


2. dry mouth and


3. Rheumatic disease (e.g., rheumatoid arthritis, systemic lupus erythematosus, scleroderma, etc.)



In the presence of 1st and 2nd is called a primary, in addition to a third, from a secondary Sjögren syndrome. Typical of the disease are chronic inflammatory processes in almost all the squamous glands (e.g., glandular, pancreatic, and vaginal glands). Inflammatory events in the lacrimal and salivary glands are the most frequent and most troublesome for the patient, which causes discomfort due to an often considerably restricted glandular function or even by a complete cessation of the secretion.


Of particular importance for the dentist but also the ENT specialist is the reduced production of saliva and its sequelae.


It must be said here that the human has a total of four large salivary glands (two parotid glands and two mandibular salivary glands) and a large number of small approximately pinhead-sized salivary glands in the oral mucosa and palate. In Sjogren's syndrome, all salivary glands are more or less involved and may lose much of their function. Prolonged inflammatory stimuli destroy the glands, gradually replacing normal glandular tissue with inferior tissue (no tumor tissue!). In such a case, it is then no longer possible, the salivary glands by e.g. To irritate medications and so at least to relieve the dry mouth.


OA Dr.  Dr. Michael Stiller


The saliva plays a central role in the ecology of the oral cavity and pharynx, covering the mucous membrane with a protein film, protecting it from the mechanical stress of the chewing gum, and promoting the regenerative capacity of the oral mucosa through a stable saliva filter It also contains the first phase of food digestion with digestive enzymes and contains important factors of the immune system, the so-called secretory immunoglobulins.As the oral cavity is populated with bacteria and sometimes with fungi, saliva plays a key role in the immune defense of the mouth. The saliva also contains inflammatory cells, which are mainly derived from the gingival margin, and together they minimize any impact that can damage the oral and pharyngeal mucosa, not to mention the role of saliva in remineralizing the teeth Säurebef all (cause of dental caries) and the rinsing effect "to reduce the accumulation of tooth plaque.


Is it coming, like In Sjögren's syndrome, a reduction in saliva production, a number of consequences for the patient must be expected. These can be divided into


1. Damage to the mobile and attached "oral mucosa, and


2. Damage of teeth and periodontium (periodontium).


If we look at the consequences for the oral mucosa, reddened mucous membranes often show up, since the protective saliva film is missing and thus mechanical, microbiological and chemical factors act directly on the mucous membrane. Then comes a general reduction of the immune defense of the mucous membrane, e.g. By autoaggressive processes (as in SLE) added, so you also see painful ulcerations or increased fungal growth (so-called Candida).

On the tongue, these changes usually show either by increased pleatiness or by a regression of the normal surface structure of the tongue (smooth red tongue). Especially in severe autoaggressive processes, only anti-inflammatory, immunosuppressive therapy, salivary replacement or local treatment, e.g. of ulcerations can only alleviate the problems, however, do not eliminate them.



Freie Universität Berlin



In teeth and periodontium, decreased saliva production is associated with a high tendency to decay (problem mainly in children with Sjögren's syndrome) and in adulthood the tendency to periodontal disease. In this context, hormonal influences and the often occurring in women osteoporosis play a role not to be underestimated. Since the "neutralizing" and "flushing" effect of the saliva is missing, there is accumulation of dental plaque in the cervical area, which causes the formation of periodontal pockets. With good and regular oral hygiene, these effects can be minimized but not completely eliminated. However, e.g. Inappropriate prosthetic reconstructions or protruding and not exactly matching margins of filling, one observes in these areas an increased decrease of the periodontium with the consequence of the tooth loosening and the tooth loss. Therefore, the dentist must be made aware of the Sjögren syndrome and special measures to help the patient to prevent a more pronounced dentition. This should be done by easy-to-clean prosthetic restorations and crown or filling margins, which are visible and well maintained by the patient. In addition, so-called prophylactic services should increasingly be used. 


Approximately Quarterly dental visits are therefore recommended.



What can the patient do to maintain oral health and reduce dry mouth?


Since a causal treatment of the dry mouth is not possible at the moment, only external or salivary measures remain for the treatment.  As so-called Externa are artificial salivary solutions with various also e.g.  saliva-stimulating substances available.


Stimulant measures include sugar-free chewing gums (for example Wrigley's Orbit) or sugar-free candies. The "flushing" of the oral mucosa with edible oil promotes mucosal lubricity and reduces mechanical stress.


Even if the therapeutic options for the treatment of dry mouth are generally unsatisfactory, the doctor or the dentist can make a decisive contribution to the well-being of the patient by utilizing all possibilities.