Sjogren's is an autoimmune exocrinopathy disease which is often multi-system. It most commonly affected middle-aged women. 

The immune system begins to attack exocrine glands - specifically there is infiltration of lachrymal, salivary and other exocrine glands by lymphocytes and plasma cells. This leads to acinar destruction. It primarily affects the parotid gland but others can also be affected.

There are 2 types:

1. Oral features:

2. Ocular features

Diagnosis of Sjogren's often involves several tests and different institutes might use slightly different diagnostic criteria. But on the whole, a diagnosis is made by:

There are several ways to manage Sjogrens and patients may respond differently depending on the severity of their symptoms and their individual response. Patients will often be managed by a specialist clinic such as oral medicine department. Examples of management include:

1. Management of dry mouth symptoms:

Patients with other systemic conditions such as rheumatoid arthritis might have associated mobility issues and find getting to the dentist difficult, or have visual impairments which will create challenges. They may have lots of different medical and dental appointments to attend which can affect the ability to attend dental appointments. 

Some patients will find sitting up difficult or be at increased risk of aspiration due to their dysphagia. As dental professionals we may need to support them with dry mouth care and management as per the suggestions above and this might also make it difficult for them to tolerate removable prostheses. Dentists must also be vigilent for signs of parotid enlargement and when to escalate this due to their increased risk of non-hogkins lymphoma. 

Because of the reduced salivary flow, patients will have an increased risk of caries. Patients will need to be educated about this risk, and prevention messages delivered in terms of oral hygiene, diet advice and prescription of fluoride. Patients may also have disturbed taste so could prefer cariogenic foods. Patients will be susceptible to infections such as candida and angular chelitis, particularly if they are also on immunosupressive medications for autoimmune conditions. These medications could also have oral side effects or considerations such as steroid cover if they are on long term high doses of steroid medication. 

There might be many reasons why you decide to offer sedation for your patients depending on where you work, the needs of your patient base and the team that you work in. Some reasons might be:

Once you decide on why you want to provide sedation, you will then need to look into what technique, or techniques, you would like to be trained in. For example, if you see only children, training in inhalation sedation only might be the best method. This might also depend on the environment you work in and what is practical for your set up. For example, in inhalation sedation you will need to account for access to the gases needed as well as scavenging - although there are plenty of solutions for these if you don't have piped in gases (please contact RA medical for advice on this). The sedation techniques are split into basic techniques and advanced techniques, as per the IACSD guidelines (read about this in a previous post here):

Basic techniques:

In order to provide sedation for your patients, following the implementation of the IACSD guidelines in 2015, any new starter in sedation must complete the relevant training either;

The advantage of the first two options is that as part of these programmes you will have the theoretical and practical element of the courses provided for you i.e. direct supervision and sign off of the relevant number of cases depending on the technique you are training in. 

Some of the accredited sedation courses are only available for the employees of the relevant training provider (for example, within that Community Dental Service, as they were set up to enable services to provide in house training for their staff). Other accredited courses only provide the theoretical side of the training and you would need to find an accredited STAC trainer/supervisor to sign off your training cases. Some have blended approaches to learning, for example, theoretical online course and then signposting to a supervisor who you would have to agree with to either come to your place of work to supervise you, or go to a training centre. 

Some of the sedation courses, for example SAAD which is probably one of the longest running, have had some backlogs as a result of COVID-19, so do contact them directly to find out more. 

So you've done the relevant course... now you can do sedation by yourself?! But wait a minute, there will be ongoing requirements you will have to do as part of the guidelines that allow you to practice sedation. This includes:

Dentaid have been a charity for over 25 years, originally starting off refurbishing dental equipment to be sent overseas and then by organising voluntary trips for UK dental professionals worldwide to countries with poor access to dental care. 

The need for activities in the UK is a more recent addition to the charity, with school-based project, Bright Bites, and since 2015, free clinics and mobile dental services to vulnerable groups in the UK such as people who experience homelessness. We now run clinics up and down the UK in our fleet of 4 vehicles looking after several patient groups including:

The charity's mission statement is:

My new role is a brand new position within Dentaid: UK Clinical Director. I have been involved with Dentaid now for many years, as a volunteer and having the conversation about inclusion oral health. During my specialist training and MSc, they kindly supported me when completing my thesis looking at how we design dental services for people who experience homelessness. As I was coming towards the end of my training, we continued to have the conversation about how I could come on board to help further champion the charity's activities and expand what they were able to offer. 

The role is basically my dream job within dentistry! My first involvements within inclusion oral health were setting up a homeless dental service within a Community Dental Services, similarly using a mobile dental surgery. You can read about how I did that here. I thrived off this experience although certainly there were challenges, particularly around some of the bureaucracy that was unavoidable as part of a large NHS organisation commissioned for a very particular purpose. So when Dentaid offered me this role I couldn't say no!!!

I get asked this increasingly more so every day and it's wonderful to see the kindness and generosity of those working within our profession! Whatever your role within dentistry, there is a way you can give something back and support the work we do at Dentaid and we are grateful for everyone's help; no matter if you're a dentist, nurse, receptionist, technician, educator or work in the industry. So how can you help?

Whether you want to go abroad (we have trips now open again to countries such as Cambodia, Malawi, Uganda and Morocco), or more locally for our mobile dental clinics up and down the UK. We can find ways for all professionals to volunteer from dentists, to nurses, to technicians and hygienists and we will support you in finding the best way to use your skills. We also are happy to take other volunteers who can help with medical histories or help in other ways, just get in contact!

Contact us here to register your interest. 

Do you have any unused equipment or stock (within dates) or are refurbishing your surgeries? Are you a dental supply company who would like to help us with any equipment or stock for clinics? We would be so grateful for any donations, big or small, that we can use on overseas or UK projects. Our warehouse is based in Southampton, but donations can sometimes be dropped off at our mobile clinics up and down the UK or for large items we can arrange collection. 

Please contact us here if you would like to donate any equipment or stock. 

We'd love to support anyone who wished to fundraise for us via an event or course and we do have other events you can join such as our annual Skydives. We can help supply fundraising packs for your event, T shirts, banners etc. so if you're an individual, company, dental society or team please get in touch if you have any ideas. We also accept general donations if you wish to leave a one-off donation. 

Please contact us here.