Conditions,  Health

Sjögren’s Syndrome – Dental Caries Decay, Symptoms Management, Treatment, Diagnosis Blood Test, Rash, Considerations

Key Facts

  • Sjögren’s Syndrome is an autoimmune disorder wherein the immune system mistakenly attacks the moisture-producing glands (which produce tears and saliva)
  • Common Symptoms include dry mouth, dry eyes, joint pain, and fatigue
  • The condition can significantly affect oral health, causing dry mouth, which increases the risk of cavities and gum disease
  • Sjögren’s Syndrome affects approximately 1-4 million people in the United States and is more common in women than men
  • There is no cure, but symptoms can be managed with lifestyle changes and medication
  • This condition can affect oral health by causing dry mouth, which increases the risk of dental decay and gum disease

What is Sjögren’s Syndrome?

Sjögren’s Syndrome is a chronic autoimmune disorder in which the body’s immune system mistakenly targets and attacks its own tissues, particularly the glands that produce tears and saliva. This results in the most common symptoms – dry eyes and dry mouth. Since the disorder affects the moisture-secreting glands, it can also cause dryness in other parts of the body, such as the throat, nose, skin, and even the vaginal area in women.
Sjögren’s Syndrome can exist as a disorder on its own (primary Sjögren’s) or it can be associated with another autoimmune disorder, such as rheumatoid arthritis or lupus (secondary Sjögren’s). Though it is a progressive disorder, various management strategies can help in alleviating the symptoms.

Who Might Get Sjögren’s Syndrome?

Anyone can develop Sjögren’s Syndrome, but certain factors increase the likelihood:

  • Gender: Women are significantly more likely to develop Sjögren’s Syndrome than men. About 90% of people with Sjögren’s Syndrome are female.
  • Age: Most people are diagnosed with Sjögren’s Syndrome when they are in their 40s or older, though it can occur at any age.
  • Family History: Having a family member with an autoimmune disease increases the risk of developing Sjögren’s Syndrome.
  • Other Autoimmune Disorders: People who have other autoimmune disorders, particularly rheumatoid arthritis or lupus, are at an increased risk.

What Causes Sjögren’s Syndrome?

The exact cause of Sjögren’s Syndrome is not entirely understood. However, it’s believed to be the result of a combination of genetic and environmental factors. The immune system attacks moisture-producing glands, but why this occurs is still unclear. Some theories suggest that a viral or bacterial infection may trigger the autoimmune response in individuals who have a genetic predisposition. Hormonal factors might also play a role, considering the higher prevalence in women.
There are a number of complications associated with Sjögren’s Syndrome. Dry mouth and lack of saliva can lead to increased dental decay, mouth infections, and gum disease. Additionally, individuals with Sjögren’s Syndrome are at a higher risk of developing lymphoma, a type of cancer.

What are the Symptoms of Sjögren’s Syndrome?

Sjögren’s Syndrome primarily affects the moisture-producing glands, leading to a range of symptoms that may vary in severity.
The most common symptoms include:

  • Dry Mouth (Xerostomia): Decreased saliva production leading to a feeling of dryness in the mouth, difficulty swallowing, and altered taste.
  • Dry Eyes (Keratoconjunctivitis Sicca): Reduced tear production causing dry, gritty, or burning sensations in the eyes. This may be accompanied by sensitivity to light.
  • Fatigue: General feeling of tiredness or chronic exhaustion.
  • Joint Pain and Stiffness: Sjögren’s Syndrome may cause joint pain and stiffness, similar to rheumatoid arthritis.
  • Dry Skin: Skin may become dry, itchy, or rashes may appear.
  • Dry Nose and Throat: This can cause a persistent dry cough or hoarseness.
  • Vaginal Dryness: In women, Sjögren’s Syndrome can cause dryness of the vagina, leading to discomfort or pain during sexual intercourse.
  • Digestive Problems: Such as acid reflux or difficulty swallowing.

How is Sjögren’s Syndrome Diagnosed?

Diagnosing Sjögren’s Syndrome can be challenging because its symptoms can mimic other conditions.
Various tests and procedures may be used to confirm the diagnosis:

  • Medical History and Physical Examination: The doctor will ask about symptoms and conduct a physical examination.
  • Blood Tests: Certain autoantibodies are often present in the blood of people with Sjögren’s Syndrome.
  • Eye Tests: Tests like Schirmer’s test can help determine if the eyes are producing enough tears.
  • Salivary Gland Function Tests: These tests help assess how well the salivary glands are functioning.
  • Imaging: Imaging of the salivary glands, such as sialography or salivary scintigraphy, might be performed.
  • Biopsy: A lip biopsy, in which a small sample of salivary gland tissue is removed and examined under a microscope, can provide evidence of Sjögren’s Syndrome.

What Kind of a Doctor Treats Sjögren’s Syndrome?

Rheumatologists are often the specialists who manage and treat Sjögren’s Syndrome, as they specialize in autoimmune diseases and musculoskeletal disorders. However, because Sjögren’s Syndrome affects various parts of the body, an interdisciplinary approach may be necessary. An ophthalmologist may be involved in managing dry eye symptoms, a dentist or oral medicine specialist for dry mouth and oral health, and a gynecologist for vaginal dryness in women.
It is essential for patients with Sjögren’s Syndrome to have a coordinated care plan that addresses the full range of symptoms and helps to maintain a good quality of life.

Oral Manifestations of Sjögren’s Syndrome

Dry Mouth (Xerostomia)

One of the most significant oral manifestations of Sjögren’s Syndrome is dry mouth. Saliva plays a crucial role in oral health, aiding in digestion, preventing infection by controlling bacteria, and protecting teeth from decay.
A reduction in saliva production can lead to:

  • Difficulty in Chewing and Swallowing: A lack of saliva makes it difficult to process food.
  • Increased Risk of Dental Caries: Saliva helps neutralize acids and wash away food particles.
  • Mouth Sores and Infections: A dry mouth can become a breeding ground for bacteria.
  • Altered Taste: Dry mouth can lead to a diminished sense of taste or an unpleasant taste.

Treatment – Dental Patient Management

Saliva Substitutes and Stimulants

Saliva Substitutes: Oral moisturizers and saliva substitutes can temporarily relieve the symptoms of dry mouth.
Saliva Stimulants: Medications such as like pilocarpine (Salagen) and cevimeline (Evoxac) can help stimulate the salivary glands to produce more saliva.
Regular Dental Checkups: Regular dental visits are crucial for patients with Sjögren’s Syndrome to monitor oral health and receive professional cleanings, which can reduce the risk of cavities and gum disease.
Fluoride Treatments: Applying fluoride directly to the teeth can help strengthen the enamel and reduce the risk of cavities.

Treatment For Other Sjögren’s Syndrome Related Conditions

The management of Sjögren’s Syndrome aims to alleviate symptoms and improve the quality of life, as there is no cure for the disease. The treatment plan will vary based on the severity of symptoms and the organs affected.

Treatments for Dry Eyes

  • Artificial Tears and Lubricating Ointments: Frequent use of artificial tears can help keep the eyes moist. Lubricating ointments are also beneficial, especially during sleep.
  • Punctal Plugs: Tiny silicone plugs may be inserted into the tear ducts to reduce tear drainage, thus keeping the eye surface moist.
  • Prescription Eye Drops: Medication such as cyclosporine (Restasis) or lifitegrast (Xiidra) eye drops can help increase tear production.
  • Warm Compresses and Lid Scrubs: These can help with the relief of symptoms.

Treatments for Joint or Organ Problems

  • Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): They can alleviate joint pain and stiffness.
  • Disease-Modifying Antirheumatic Drugs (DMARDs): Medications such as hydroxychloroquine or methotrexate might be used in more severe cases to suppress the immune system.
  • Immunosuppressive Medications: In cases where internal organs are involved, stronger immunosuppressive medications may be required.

Treatments for Vaginal Dryness

  • Vaginal Moisturizers and Lubricants: These can help alleviate vaginal dryness and discomfort during intercourse.
  • Topical Estrogen Therapy: A doctor may prescribe topical estrogen creams, rings, or tablets to alleviate vaginal dryness.

In addition to the treatments mentioned, lifestyle changes such as staying hydrated, using a humidifier, wearing protective eyewear, and avoiding certain medications that can worsen dryness are often beneficial. Patient education and support are also essential components of managing Sjögren’s Syndrome. A healthcare provider may recommend joining support groups or participating in counseling to help deal with the emotional aspects of the condition. Patients with Sjögren’s Syndrome should work closely with their healthcare provider to develop a personalized treatment plan that addresses their specific symptoms and needs.

Patient Education in Sjögren’s Syndrome

  • Oral Hygiene: Educate patients on the importance of maintaining excellent oral hygiene, including brushing at least twice a day and flossing daily.
  • Diet: Advise on a diet low in sugar and acids to reduce the risk of tooth decay.
  • Hydration: Encourage frequent sipping of water throughout the day to combat dry mouth.
  • Medication: Educate patients about medications that can alleviate symptoms and discuss any side effects.

What are the Complications of Sjögren’s Syndrome?

Sjögren’s Syndrome, as an autoimmune disorder, can lead to various complications, some of which include:

  • Dental Issues: The reduction in saliva production can lead to an increase in dental cavities and gum disease.
  • Yeast Infections: Reduced saliva can also cause an increased likelihood of developing oral yeast infections such as thrush.
  • Vision Problems: The dryness of the eyes can lead to damage to the cornea and possibly impaired vision.
  • Lymphoma: People with Sjögren’s Syndrome are at a higher risk of developing lymphoma, a type of cancer that affects lymph nodes.
  • Neurological Problems: Some patients may develop peripheral neuropathy, leading to numbness and tingling in the extremities.
  • Lung, Kidney, or Liver Involvement: In severe cases, Sjögren’s can affect major organs, leading to a variety of additional complications.

How Can I Prevent Sjögren’s Syndrome?

As of now, there is no known way to prevent Sjögren’s Syndrome because the exact cause of the condition is still not completely understood.
However, for individuals diagnosed with Sjögren’s Syndrome, various measures can be taken to prevent complications:

  • Maintaining good oral hygiene to prevent dental problems
  • Regular eye exams and proper eye care
  • Regular monitoring by healthcare professionals
  • Leading a healthy lifestyle including a balanced diet and regular exercise

What is the Prognosis (Outlook) for People with Sjögren’s Syndrome?

The prognosis for individuals with Sjögren’s Syndrome varies widely. Many people experience only the mild symptoms of dry eyes and mouth, and can manage the condition effectively with lifestyle adjustments and medications.
However, for those who have systemic involvement affecting internal organs, the condition can be more challenging to manage and may require more aggressive treatment.
Early diagnosis and proper management are crucial in improving the prognosis. With regular medical care and adherence to a treatment plan, many individuals with Sjögren’s Syndrome can maintain a good quality of life.
It is also essential for patients to have open communication with their healthcare providers and to educate themselves about the condition, as managing Sjögren’s Syndrome often requires a collaborative approach to care.

Does Sjögren’s Syndrome Cause Weight Gain?

Sjögren’s Syndrome itself is not directly associated with weight gain. However, various factors related to the syndrome and its management could contribute to changes in weight.
For example:

  • Medications: Certain medications used to manage the symptoms of Sjögren’s Syndrome, such as corticosteroids, may contribute to weight gain.
  • Activity Levels: The joint pain and fatigue associated with Sjögren’s Syndrome might cause some individuals to become less physically active, which could contribute to weight gain.
  • Hormonal Changes: As an autoimmune disorder, Sjögren’s Syndrome may cause changes in hormonal balances, which might have an impact on weight.

Does Sjögren’s Syndrome Affect Ears?

Yes, Sjögren’s Syndrome can affect the ears. The symptoms related to ears may include:

  • Dryness: Just like the eyes and mouth, the ears might also experience dryness
  • Ear Infections: Individuals with Sjögren’s Syndrome might be more susceptible to ear infections
  • Hearing Problems: In some cases, people with Sjögren’s Syndrome may experience hearing difficulties
  • Tinnitus: Some individuals with Sjögren’s Syndrome report ringing in the ears, also known as tinnitus

What Should I Eat if I Have Sjögren’s Syndrome? What Foods Should I Avoid?

A balanced and nutritious diet is essential for managing Sjögren’s Syndrome.
There is no specific diet for Sjögren’s Syndrome, but here are some general recommendations:

What to Eat:

  • Water-rich Foods: Include fruits and vegetables that have high water content like cucumbers, watermelon, and oranges to help combat dryness.
  • Omega-3 Fatty Acids: Include foods rich in omega-3 fatty acids like fish, nuts, and seeds, which can help reduce inflammation.
  • Fiber: Include fiber-rich foods such as whole grains, legumes, and vegetables which can help in maintaining a healthy digestive system.

What to Avoid:

  • Sugary Foods and Drinks: These can contribute to dental problems, especially if there is reduced saliva to help clean the teeth.
  • Caffeine: Can contribute to dryness of the mouth.
  • Alcohol: Can also contribute to the dryness of the mouth and throat.
  • Spicy Foods: May cause irritation in a dry mouth.
  • Acidic Foods and Drinks: These can be harsh on tooth enamel, especially in the absence of protective saliva.

Note that individuals may have different sensitivities, so it’s essential to pay attention to how certain foods affect your symptoms. It’s also advisable to work with a nutritionist or healthcare provider to create a diet plan that suits your needs.

Is Sjögren’s Syndrome Considered a Disability?

Sjögren’s Syndrome can vary in severity among individuals. For some, the symptoms may be mild, while for others, they may be severe enough to interfere with daily life and ability to work. In cases where Sjögren’s Syndrome significantly impacts a person’s ability to perform daily activities or maintain employment, it may be considered a disability. In some countries, individuals with severe Sjögren’s Syndrome may be eligible for disability benefits. It is essential to consult with a doctor and possibly a legal adviser knowledgeable in disability laws for specific information and guidance regarding eligibility for disability status and benefits.

Does Sjögren’s Syndrome Cause Hair Loss?

Yes, Sjögren’s Syndrome can be associated with hair loss in some cases.
This could be due to a variety of factors:

  • Autoimmune Response: The autoimmune nature of Sjögren’s Syndrome can cause the body to attack hair follicles, leading to hair loss.
  • Medications: Some medications used to treat Sjögren’s Syndrome may have side effects that include hair loss.
  • Associated Disorders: People with Sjögren’s Syndrome are often more likely to have other autoimmune disorders, such as lupus, which can cause hair loss.

When Should I Call the Doctor if I Have Sjögren’s Syndrome?

It is important for individuals with Sjögren’s Syndrome to have regular check-ups with their healthcare provider to manage the condition effectively.
However, you should contact your doctor sooner if:

  • You experience new or worsening symptoms, such as increased dryness, joint pain, or fatigue
  • You notice symptoms such as hair loss, rashes, or other skin changes
  • You experience difficulty swallowing or a significant change in your ability to taste food
  • You have recurrent infections, especially in the eyes or mouth
  • You experience any symptoms that are causing you distress or significantly interfering with your quality of life

Communicating openly with your healthcare provider and seeking medical advice when needed can help in managing Sjögren’s Syndrome effectively and maintaining a better quality of life.

What Questions Should I Ask My Doctor if I Have Sjögren’s Syndrome?

If you have been diagnosed with Sjögren’s Syndrome or suspect that you may have the condition, it is important to communicate effectively with your healthcare provider to understand your condition and the options available for management and treatment.
Here is a list of questions that may be helpful to ask:

  • What is Sjögren’s Syndrome, and how does it affect the body?
  • What are the common symptoms, and what should I be monitoring in my day-to-day life?
  • Are there specific tests you recommend for diagnosing or monitoring Sjögren’s Syndrome?
  • What treatments are available, and what are the potential side effects?
  • How can I manage dry eyes and dry mouth effectively?
  • Are there any lifestyle changes that could help alleviate symptoms or prevent complications?
  • Should I be concerned about Sjögren’s Syndrome affecting other organs or systems in my body?
  • Are there any over-the-counter products that can help relieve symptoms?
  • Are there any dietary changes that may help manage the symptoms or the condition itself?
  • How can I protect my teeth and gums given the dry mouth associated with Sjögren’s Syndrome?
  • Should I see any specialists, such as a rheumatologist, ophthalmologist, or dentist, for specific aspects of Sjögren’s Syndrome?
  • Is Sjögren’s Syndrome hereditary, and should other family members be concerned?
  • What should I do if my symptoms worsen suddenly or if I experience new symptoms?
  • Are there any support groups or resources that you would recommend for patients with Sjögren’s Syndrome?
  • How will Sjögren’s Syndrome affect my long-term health, and what is the typical prognosis for someone with this condition?

Bottom Line

Sjögren’s Syndrome is an autoimmune disorder that primarily affects the glands that produce tears and saliva, causing dryness in the mouth and eyes. However, it can also affect other parts of the body. Managing Sjögren’s Syndrome effectively requires a comprehensive understanding of the condition, regular monitoring, and appropriate treatment. Communication with your healthcare provider is crucial in managing the symptoms and reducing the risk of complications. By asking informed questions and actively participating in your healthcare, you can work toward improving your quality of life despite living with Sjögren’s Syndrome.

This article is complete and was published on June 27, 2023, and last updated on August 25, 2023.

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