January 29, 2017

Sjorgen’s Syndrome

Sjorgen’s Syndrome is a fairly common autoimmune disease that is affecting up to 1% of the American population. The main characteristic of the disease is that the body’s immune system attacks your own glands that produce fluids, such as saliva or tears (the so-called exocrine glands).  

The effects are usually major and the condition affects many organs and organ systems. The disease was first described by a Swedish ophthalmologist Henrik Sjörgen, after whom the disease is named.

Its main symptoms are dry eyes and dry mouth, as these are the most obvious glands that become affected. Women are more commonly affected by men, and they usually find out symptoms of vaginal dryness, due to malfunction of glands that produce vaginal fluids. About 90% of all diagnosed patients are female and the average age of onset is in the 40s. Other symptoms include tiredness, persistent cough, muscle pains and thyroid problems.

The cause of Sjorgen’s syndrome is unknown, but it is believed to be a combination of environmental and genetic factors. Hormones might also play a role.

Generally, if the person is suffering from no other autoimmune disorders besides Sjorgen’s Syndrome, their life expectancy is unchanged and the disease can be managed by using various drugs to control the symptoms.

One of the main areas that requires attention in people with Sjorgen’s Syndrome is oral health. As Sjorgen’s Syndrome affects the salivary glands and the production of saliva, the effects are potentially very serious and warrant further examination.

Sjorgen’s Syndrome reduces saliva production and causes dry mouth (xerostomia). Both the amount of saliva produced and the proteins in saliva produced by the salivary glands are different. Saliva is important because it helps keep the pH level (acidity) inside the mouth at a neutral level and remineralizes the teeth. This prevents the minerals inside the teeth to dissolve, which may lead to cavities and other issues.

Saliva is also helpful in the digestion of food. It eases chewing and swallowing. A little known fact is that saliva itself breaks down certain simple sugars and starches even before they reach the stomach, thanks to the enzyme amylaze. Saliva is known to contain EGF (the epidermal growth factor) that helps heal various ulcers, maintains the integrity of the oral tissue and protects it from harmful effects of acid secretions such as bile or gastric acid.

It is, therefore, not surprising that those suffering from Sjorgen’s Syndrome have a higher risk of developing certain dental conditions, such as tooth decay, oral yeast infections (thrush) and periodontal disease.

However, such susceptibility to such diseases may be reduced with proper preventive measures. These include maintaining good oral hygiene habits, proper diet and the usage of fluoride products that help remineralize the enamel. Depending on the patient, prescription fluoride toothpastes and mouthwashes may be necessary. These contain higher levels of fluoride than other products available over the counter.

Various saliva substitutes and saliva stimulation agents are used. Saliva substitutes are very helpful, but must be administered frequently over the course of the day. They are not a perfect substitute for natural saliva, as they do not contain the enzymes that natural saliva contains. However, it alleviates the symptoms of dry mouth and increases comfort.

Chewing gums containing xylitol can stimulate saliva production, but prescription drugs that enhance saliva production are usually administered. Most commonly, these drugs contain cevimeline hydrochloride or pilocarpine hydrochloride. The drugs are taken 3 to 4 times a day, usually after meals. The effect lasts for some four hours, and they are generally well-tolerated.

Generally, soft drinks, alcohol and caffeine drinks should be avoided as much as possible, as they either contribute to tooth decay or irritate the mucosa and promote dehydration. It is important to stay well-hydrated, as this reduces the symptoms of the disease.

Patients suffering from Sjorgen’s Syndrome should visit their dentists more often than the general population, as they are a high-risk group. It is important to visit as soon as the symptoms appear, because as the time progresses, these cavities become less and less treatable; sometimes, a complete dental extraction is the only option. But, if spotted early, they can be treated easily and cost-effectively. However, with adequate management and lifestyle changes, life can be as close to normal as possible. Treatments generally do work and present few side-effects, and with regular hygiene, the risks of tooth decay and tooth loss decrease markedly.


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