Xerostomia and Sjogren Syndrome: A Clinical Management Guide

The xerostomia is the symptom that the patient describes as the dry mouth, and the Sjogren syndrome is the systemic autoimmune condition that the clinician identifies as one of the causes that the symptom reveals. The dry mouth that the patient reports may follow the medication, the radiation, th...

The xerostomia is the symptom that the patient describes as the dry mouth, and the Sjogren syndrome is the systemic autoimmune condition that the clinician identifies as one of the causes that the symptom reveals. The dry mouth that the patient reports may follow the medication, the radiation, the diabetes, or the autoimmune disease, and the clinician who evaluates the cause rather than the symptom alone provides the management that the oral health requires. The saliva that the glands produce protects the teeth, the mucosa, and the swallowing, and the reduction that the patient experiences opens the way to the caries, the candidiasis, and the discomfort that the care must address. This article reviews the causes, the diagnosis, the oral management, the systemic care, and the maintenance that the patient maintains at home.

The Causes and the Salivary Function

The saliva that the glands produce delivers the lubrication, the buffering, the antimicrobial action, and the remineralisation that the mouth depends on, and the reduction of the flow produces the symptoms that the patient reports. The medications that the patient takes are the most common cause, and the anticholinergic, the antihypertensive, the antidepressant, and the diuretic drugs that the patient uses reduce the salivary flow more than the patient and the prescriber may recognise. The systemic diseases that the clinician considers include the Sjogren syndrome, the diabetes, the sarcoidosis, and the HIV, and the radiation to the head and the neck that the patient has received produces the irreversible damage that the management must accommodate.

The Diagnosis and the Assessment

The diagnosis that the clinician makes follows the history, the examination, the sialometry, and the biopsy where the indication exists, and the patient who presents with the persistent dry mouth receives the assessment that the cause requires. The clinical examination that the clinician performs includes the appearance of the mucosa, the pooling of the saliva, the fissuring of the tongue, and the caries that the reduced flow allows. The Sjogren syndrome that the clinician suspects receives the serology and the referral to the rheumatology, and the diagnosis that the clinician confirms guides the systemic and the oral management.

The Oral Management

The oral management that the clinician provides addresses the symptoms and the complications that the reduced flow produces, and the patient who follows the instruction preserves the teeth that the saliva no longer protects. The saliva substitute, the frequent sips of water, the sugar-free gum, and the humidifier that the patient uses reduce the discomfort, while the topical fluoride and the chlorhexidine that the clinician prescribes address the caries and the infection. The sialogogue that the clinician prescribes where the tissue remains responsive increases the flow that the patient still has the capacity to produce.

The Systemic Care and the Referral

The Sjogren syndrome that the clinician identifies requires the systemic care that the rheumatology provides, and the clinician who refers the patient participates in the team that manages the condition. The dry eye, the fatigue, the arthralgia, and the extraglandular involvement that the patient may present require the evaluation that the specialist provides, and the oral management that the clinician maintains complements the systemic care. The patient who understands the autoimmune nature of the condition cooperates with the treatment that the long-term management requires. The clinician who coordinates with the rheumatology, the ophthalmology, and the primary care delivers the care that the multisystem condition demands, and the patient who receives the coordinated management experiences the comfort and the function that the single-discipline approach cannot provide.

The Complications and the Prevention

The complications that the dry mouth produces include the caries, the candidiasis, the periodontal disease, the dysphagia, and the oral burning, and the clinician who prevents them preserves the function and the comfort that the patient requires. The caries that the reduced flow allows progresses faster than the caries that the normal saliva controls, and the frequent recall that the clinician provides detects the lesion before the restoration becomes extensive. The candidiasis that the patient develops receives the antifungal that the clinician prescribes, and the denture that the patient wears requires the hygiene that the clinician demonstrates.

The Maintenance and the Home Care

The maintenance that the patient provides at home determines the oral health that the dry mouth allows, and the routine that the clinician designs for the patient addresses the cleaning, the lubrication, and the prevention together. A soft electric brush such as the BrushO cleans the teeth and the mucosa at the gentle pressure, and the fluoride that the patient applies after the cleaning protects the enamel that the reduced saliva leaves vulnerable. The patient who keeps the recall interval and reports the change in the symptoms allows the clinician to adapt the management that the condition requires.

Clinical Key Points

- Evaluate the cause of the dry mouth rather than the symptom alone.

- Review the medication as the most common and the reversible cause.

- Assess and refer the Sjogren syndrome that the clinician suspects.

- Manage the oral symptoms with the substitute, the stimulation, and the fluoride.

- Prevent the caries, the candidiasis, and the periodontal disease with the recall and the hygiene.

Conclusion

The xerostomia is the symptom that the patient reports and the Sjogren syndrome is the condition that the clinician investigates, and the management that the clinician provides addresses the cause, the symptoms, and the complications together. The patient who follows the routine and keeps the recall maintains the oral health that the reduced saliva threatens.