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

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

3. 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.

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

5. 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

6. Incidence of Xerostomia
13% of UK population

7. 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

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

9. 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

10. 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

11. 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

12. 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

13. 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