Management of Salivary Hypofunction in Sjögren’s Syndrome

Abstract

The strategies to increase oral comfort and manage dental decay can be time consuming and stressful for the patient with newly diagnosed Sjogren’s syndrome who may have a host of other symptoms and regimens to manage. A conversation with the patient to assess their level of discomfort, the perceived time of most significant discomfort, and their perception of what would represent a successful outcome, combined with thorough clinical evaluation, can allow management of patient expectations and individualization of care. The goal is to keep the regimen simple. The vast majority of patients complaining of dry mouth use water as a wetting agent. If they complain of throat dryness or of water not being particularly effective, the addition of a small amount of oil (i.e., omega-3 or olive oil) to their water bottle may help the moisture adsorb to the mucosa of the oral cavity and throat. The artificial salivas and dry mouth products available on the market should ideally be of neutral pH, the choice carefully made as to whether the product is beneficial, fits into their lifestyle, and is financially feasible. Self-stimulation of saliva via sugar-free chewing gum or hard candies may be implemented as needed throughout the day. The next level of care would be represented by stimulation of saliva with a parasympathomimetic medication. For some patients, we jump to this level of care immediately because it is the most effective for their lifestyle. We will often titrate the parasympathomimetic to the minimal effective dose, especially in petite females to allow them to take the medication without experiencing side effects. The expanded option of gargling with cevimeline/pilocarpine allows individuals to experience a local saliva-producing effects without potential systemic complications, but we do not yet have a good feel for how this is working in the clinical setting. Caries can best be prevented and the caries-repair process promoted with daily application of fluoride to the teeth (1.1 % NaF dentrifice available by prescription), daily removal of plaque from the tooth surfaces, and reducing acid production in dental plaque by controlling the intake of dietary sugar. For patients at high risk of caries, the same principles are applied with greater frequency, using higher concentration of fluoride and ancillary procedures as described in this paper.