Discovered by ophthalmologist Henrik Sjögren in the early 20th century, Sjögren's Syndrome is a systemic autoimmune rheumatic disease in which the body's immune system mistakenly thinks that exocrine glands, particularly the saliva and tear producing glands, are foreign entities invading the body. As a result, T-cells released by the immune system flood the glands in an effort to destroy them, eventually reducing the ability of the glands to produce saliva and tears due to glandular atrophy. Two major clinical consequences of suffering from Sjögren's Syndrome are xerostomia (dry mouth) and keratoconjunctivitis sicca (dry eyes).
Researchers have yet to find the exact cause of Sjögren's Syndrome but think it may involve viral infections affecting the glands that evoke a strong response from the immune system. One viral trigger being investigated as a possible culprit of Sjögren's Syndrome is the Epstein-Barr virus, a herpes family virus known to cause infectious mononucleosis and is also correlated with other autoimmune diseases such as multiple sclerosis and systemic lupus. The majority of patients suffering from Sjögren's Syndrome carry the Epstein-Barr virus in their saliva.
As a systemic autoimmune disease, Sjögren's Syndrome also causes other health problems like muscular and joint pain, extreme fatigue and various neurological issues. Less common complaints include Raynaud Phenomenon, pulmonary fibrosis and renal tubular acidosis. About one-third of Sjögren's syndrome patients experience thyroid disease as well.
Genetic Background of Sjögren's Syndrome
Geneticists believe that Sjögren's Syndrome may be an inherited condition comprised of multiple genes interacting with the environment. A distinct association with HLA-DR3 (immune response genes) has been found between the disease and the development of an autoimmune reaction to the salivary and lachrymal glands. However, twin studies need to be performed before a definite conclusion can be drawn concerning Sjögren's Syndrome and the strength of its hereditary component.
Who Gets Sjögren's Syndrome?
Ninety percent of Sjögren's Syndrome patients are female, and the average age of those with the disease is around 50 to 55. However, men and children of all age groups can be diagnosed with Sjögren's Syndrome. Rheumatic disease is the most common type of autoimmune disorder, with Sjögren's being the second most frequently seen by physicians.
Criteria Needed for Clinical Diagnosis of Sjögren's Syndrome
Assessment of tear flow is determined with a Schirmer test, which measures the amount of wetness obtained using a 30-millimeter filter strip that is placed on the lower eyelid. An abnormally deficient wetting amount is considered five millimeters or less. Another method used as part of a clinical evaluation for Sjögren's Syndrome is inspecting the eyes for any corneal abrasions due to excessive dryness that causes the eyelids to chafe the eyeball's sensitive outer layer.
Dry Mouth (xerostomia) caused by of Sjögren's Syndrome is measured by having a patient collect saliva in a vial for about 15 minutes. This saliva flow should not be stimulated and should amount to more than 1.5 milliliters to be considered within normal range. In addition, a biopsy of a minor salivary gland located near the bottom inside of the lower lip will show how many mononuclear cell aggregates exist in the gland. A positive indication of Sjögren's Syndrome usually reveals at least two aggregates of more than 50 cells per four millimeters squared.
Further clinical observations of a Sjögren's Syndrome patient may involve a tongue that is lobulated and the presence of extremely dry mouth fissures. In addition, submandibular or parotid gland swelling accompanied by soreness or pain may be evident as well.
Consequences of Saliva Gland Atrophy
When Sjögren's Syndrome remains untreated and xerostomia is allowed to continue as a chronic oral condition, the health consequences affecting the mouth and nasal passages can be serious and sometimes irreversible. These issues include:
- Severe halitosis
- Difficulties with chewing and swallowing (could cause choking)
- Increase in dental caries due to lack of the antimicrobial qualities in saliva
- Oral candidiasis
- Frequent nosebleeds
- Reduced sensitivity to tastes and smells
- Coughing spells
- Sore throat
- Chronic hoarseness
- Susceptibility to viral respiratory infections
Without a sufficient flow of saliva bathing the mouth, gum and tooth decay is expedited due to proliferation of anaerobic bacteria. Saliva is rich in oxygen, proteins, minerals, phosphate ions and calcium that are all substances necessary for the prevention of destructive, sulfurous bacteria from coating the mouth, tooth enamel, the tongue and the back of the throat.
When saliva cleans a tooth, it imparts beneficial proteins that form a protective covering called the "salivary pellicle". When anaerobic bacteria encounter this pellicle, they cannot adhere to the tooth's surface and eventually die or go elsewhere in the mouth.
Treatment for Sjögren's Syndrome
Because there is no cure for this autoimmune disease, therapy for individuals diagnosed with Sjögren's Syndrome consists mainly of reducing the severity of the symptoms by applying topical products like saliva and tear substitutes that can alleviate dryness. A chemical called pilocarpine hydrochloride sometimes helps patients by stimulating salivary secretions while local estrogens may provide relief for those experiencing severe dry skin.
Preventative Dental Care
Sjögren's Syndrome patients need to visit a dentist every three to six months in order to avoid suffering serious dental problems and reduce intense bad breath that occurs as a result of chronic xerostomia. The amount of cleanings and check-ups required every 12 months that can effectively avert cavities, abscesses, gum disease and tooth loss depends on the severity of glandular atrophy and lack of saliva flow.
In between dental check-ups, people with Sjögren's Syndrome can enhance their oral health and alleviate dry mouth by using quality oral hygiene products such as those created by Dr. Harold Katz and his line of TheraBreath mouthwashes, toothpastes, chewing gum, rinses and sprays that contain natural, oxygenating ingredients to increase saliva flow and eliminate bad breath.
In addition, TheraBreath Mouth Wetting Lozenges are especially formulated to help people suffering from severe bad breath because of dry mouth. These lozenges work in three stages by eliminating bad mouth odors, killing anaerobic bacteria and providing proprietary salivary compounds that assist in replacing the saliva that is lost due to dysfunctional salivary glands.
Ingredients in TheraBreath's Mouth Wetting Lozenges cannot be found in other similar lozenges and include a powerful combination of xylitol, zinc gluconate, rebiana and sorbitol. Sucking on two or three of these lozenges each day will ease xerostomia symptoms associated with Sjögren's Syndrome and further help reduce the risk of experiencing mouth and teeth diseases as well as chronic halitosis.
Dr. Katz Discusses White Tongue, a symptom of Sjögren's Syndrome