Abstract
Backgroundthe classification criteria for primary Sjögren's syndrome (pSS) include a number of oral components. In this study we evaluated if salivary flow and composition as well as dental caries are oral markers of disease severity in pSS.Methodsin 20 patients fulfilling the American-European Consensus criteria for pSS and 20 age-matched healthy controls whole and parotid saliva flow rates and composition, measures of oral dryness, scores of decayed, missing and filled tooth surfaces (DMFS), periodontal indices, oral hygiene, and dietary habits were examined.Resultsin pSS, salivary flow rates, pH, and buffer capacities were lower, and DMFS, salivary sodium and chloride concentrations higher than in the healthy controls. DMFS also correlated inversely to salivary flow rates and positively to oral dryness. Apart from slightly increased gingival index, and more frequent dental visits in pSS, the periodontal condition, oral hygiene or sugar intake did not differ between these two groups. In pSS, findings were correlated to labial salivary gland focus score (FS) and presence of serum-autoantibodies to SSA/SSB (AB). The patients having both presence of AB and the highest FS (>2) also had the highest salivary sodium and chloride concentrations, the lowest salivary phosphate concentrations, lowest salivary flow rates, and highest DMFS compared to those with normal salivary concentrations of sodium and chloride at a given flow rate.Conclusionthe salivary changes observed in some pSS patients reflect impaired ductal salt reabsorption, but unaffected acinar transport mechanisms, despite low salivary secretion. Our results suggest that changes in salivary flow and composition as well as dental caries may serve as potential markers of the extent of autoimmune-mediated salivary gland dysfunction in pSS. The study also indicates that the ductal epithelium is functionally affected in some pSS patients, which calls for future pathophysiological studies on the mechanisms underlying this impaired salt reabsorption.
Highlights
Primary Sjögren's syndrome is a common systemic autoimmune disease that mainly affects middle-aged women
We found no significant association between the intake of medicines, including the number of medicines, the salivary flow rates, focus scores, and serum autoantibodies
In Primary Sjögren's syndrome (pSS), a significant inverse correlation was found between scores of oral dryness and the stimulated whole saliva (SWS), but only a tendency toward a relationship between the oral dryness and unstimulated whole saliva flow rate (UWS), Unstimulated parotid saliva (UPS) and stimulated parotid saliva (SPS)
Summary
Primary Sjögren's syndrome (pSS) is a common systemic autoimmune disease that mainly affects middle-aged women. The selective significance of salivary factors on dental caries in pSS remains an open question. In light of the impaired saliva formation in pSS it is noteworthy that an exact cut-off value for salivary flow and/or separate salivary constituents predicting the risk of developing dental caries has not yet been agreed on. In the diagnosis of Sjögren's syndrome (SS), an unstimulated whole saliva flow rate of ≤ 1.5 ml/15 min is currently considered pathological [13], but at this point the caries process may have been going on for years revealed by the presence of a high number of decayed, missed and filled teeth [3,7,8,9,10]
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