Oral manifestations and histopathology of minor salivary gland from patients with Sjögren's Syndrome and its diagnosis in a public health system

Elizângela Cristina Barbosa,Luiz Fernando Souza Passos,Jeconias Câmara,Tatiana Nayara Libório-Kimura,Sandra Lúcia Euzébio Ribeiro,Jéssica Bruna Corrêa Lindoso,Nikeila Chacon De Oliveira Conde

doi:10.18363/rbo.v73n4.p.297

Elizângela Cristina Barbosa, Luiz Fernando Souza Passos + Show 5 more

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https://doi.org/10.18363/rbo.v73n4.p.297

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Abstract

Objective: to analyze the oral manifestations, sialometry and the histopathology of the minor salivary glands of patients with Sjögren Syndrome (SS) treated in a public health system and diagnosed according to European American Consensus Group (EACG) criteria. Material and Methods: the 32 patients were submitted to Shirmer test, oral cavity exam, unstimulated and stimulated salivary flow measurement and, in some cases, to the serological testing. For certain patients a minor salivary gland biopsy was carried out. Results: 10 patients were diagnosed with Sjögren Syndrome (SS), among whom: 40% were diagnosed with primary (pSS) and 60% with secondary Sjögren Syndrome (sSS). All patients diagnosed with this condition complained of xerostomia and xeropthalmia. Besides xerostomia, the most frequent oral manifestations were difficulty in swallowing, dry lips, hyperemic gums and atrophic change in tongue papillae. The average scores of the Schirmer and salivary flow tests were lower in patients with sSS. Conclusion: the oral signs and symptoms are extremely important in the multisystem involvement of the SS, which emphasizes the dental surgeon responsibility in managing these patients. The establishment of multidisciplinary diagnostic centers is of utmost importance, as well as the ability to offer more objective exams in the public health system aiming at increasing the accuracy of Sjögren Syndrome diagnosis.

Highlights

Sjögren Syndrome (SS) is a chronic, inflammatory multisystem autoimmune disease, mainly involving the salivary and lacrimal glands
The condition is classified as primary Sjögren Syndrome, when it occurs by itself and as secondary Sjögren Syndrome, when it is associated to another autoimmune disease, among which the most frequent are Systemic Lupus Erythematosus (SLE) and Rheumatoid Arthritis (RA)
Patients suspected of SS treated at the Rheumatology Department of the Araújo Lima (AAL) outpatient unit were selected and examined by the Ophthalmology Department associated to the Federal University of Amazonas (UFAM), and referred to the UFAM School of Dentistry (FAO)

Summary

Introduction

Sjögren Syndrome (SS) is a chronic, inflammatory multisystem autoimmune disease, mainly involving the salivary and lacrimal glands. The condition is classified as primary Sjögren Syndrome (pSS), when it occurs by itself and as secondary Sjögren Syndrome (sSS), when it is associated to another autoimmune disease, among which the most frequent are Systemic Lupus Erythematosus (SLE) and Rheumatoid Arthritis (RA).. The most important manifestations of the Sjögren’s Syndrome are dry eyes (xerophthalmia) and dry mouth (xerostomia), caused by lymphocyte infiltration into the glands, destroying the acinar units and causing hypofunction. Patient history associated to oral cavity exam is extremely important to detect the signs and symptoms associated to xerostomia, as for example, filiform papillae atrophy, increased number of cavities, candidiasis, halitosis, altered sense of taste, burning feeling, difficulty in swallowing, among other.

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