Dental Management of Patients with Sjogren's Syndrome

Over the years, I have had to care for quite a number of patients with Sjogren's Syndrome which has some specific impacts on oral health...


What is Sjogren's Syndrome?

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. Primary Sjogrens or Sicca syndrome - dry eyes and dry mouth
  2. Secondary Sjogrens - in association with another autoimmune condition e.g. rheumatoid arthritis,  scleroderma, SLE and other connective tissue diseases

Symptoms

1. Oral features:
  • Xerostomia
  • Burning mouth
  • Lobulated tongue
  • Opportunistic infections
2. Ocular features
  • Keroconjunctivitis sicca - visual impairment
3. Cutaneous feature
  • Xeroderma
  • Vaginal dryness
  • Raynaud's phenomenon
4. Other features
  • Fatigue/joint stiffness
  • Respiratory dryness
  • GI symptoms e.g. dysphagia
  • Haematological symptoms e.g. anaemia, leucopenia 

Diagnosis

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:
  1. Schrimer lest - to test lacrimal impairment
  2. Blood tests - to test for auto-antibodies (SS-Ro , SS- La) and rheumatoid factor
  3. Salivary flow tests
  4. Labial gland biopsy
  5. Siolography - this will only demonstrate an abnormal ultrasound appearance of salivary glands and will only inform a diagnosis

Management

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:
  • Frequent sips of water
  • Sucking on ice 
  • Sugar free chewing gum or lozenges
  • Salivary substitutes e.g. sprays, gels, pastilles
  • Humidifiers
2. Medication - pilocarpine

3. Management of other conditions 
  • Such as rheumatoid arthritis, SLE, with other systemic medications e.g. steroids and other immunosupressants 
  • Artificial tear and eye lubricants 

Impact on Dental Care

Access

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. 

Clinical Features

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. 

Side-effects of the Condition

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. 



If you have any questions about this syndrome, let me know in the comments. 

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    WhatsApp- +1 (828) 676- 9169

    ReplyDelete
  34. I always bought the idea of investing in cryptocurrency but I didn’t go through the right process and I lost all my money to a fake cryptocurrency investment platform. I didn’t do enough research and I was scammed of my hard-earned money after falling victim to a cryptocurrency investment scam. I made all efforts to get back my money but to no success, I contacted the authorities as well but they couldn’t do anything to recover my funds until I was told about Spyweb Cyber Security Services, a cryptocurrency recovery company that has helped other scam victims recover their funds. I contacted them immediately and provided all the necessary information needed to help them with their investigation. Spyweb Cyber Security Services was able to recover my cryptocurrency funds and was able to track down those scammers. I’m truly grateful for their reliable and professional service. Spyweb Cyber is the best approach if you want to recover your locked funds, and stolen cryptocurrencies. Their contact information is as follows
    Email - Spyweb @ cyberdude .com
    Whats App - +1323 (904-8824)

    ReplyDelete
  35. It's been six months now since I hired Cyber Genie Hack Pro, a team of professional Black hat hackers to gain full access to my ex-husband. It was a trying and frustrating moment for me then. Imagine my having full access to my ex-husband's device for months unknowingly to him, spying and monitoring everything that comes and goes out of his iPhone 14. I wanted to get everything I wanted to get from him, financially and evidence before I could hit him with a divorce. The plan I subscribed to with Cyber Genie's team was a 2-year spying plan, but I couldn't take it anymore after a few months, I had been dining with the devil himself. If Cyber Genie Hack Pro can help me expose my cheating ex-husband, I am sure they can help you too.
    " cybergenie (@) cyberservices (.) COM "
    W/A Numb: +1_2_5_2_5_1_2_0_3_9_1.

    ReplyDelete
  36. CONSULT ALPHA KEY LICENSED BITCOIN / USDT RECOVERY HACKER 


    Are you looking for a proficient hacker to assist you raise and hack your credit score to an exceptional level, or are you just looking to recover your stolen coins without any worries? I'm positive that working with ALPHA KEY RECOVERY will not let you down because I have firsthand experience with their incredible work. At one point, I thought there would be no way to get my stolen money back from my binary cryptocurrency investment, but I'm grateful that ALPHA KEY RECOVERY came through for me.
    Email: Alphakey@consultant.com
    Whatsapp : +15714122170
    Website: https://pantheonsite.io/dev-alpha-key
    Telegram: Alpha Key Recovery 
    Signal: +16145683873



    ReplyDelete
  37. Unfortunately, many people deal with adultery in their relationships. Technological developments have made it simpler for people to act secretively, which leaves their partners feeling uneasy and doubtful. When suspicions are raised, it is crucial to obtain hard proof in order to determine the truth. Digital technologies such as Pro Wizard Gilbert Recovery can be quite helpful in this situation.Pro Wizard Gilbert Recovery can assist you in uncovering hidden secrets within your partner's phone. By understanding the need for digital evidence, exploring the features and benefits of the software, and following a step-by-step guide, you can gain insight into your partner's activities and make informed decisions about your relationship. Pro Wizard Gilbert Recovery can help you carry out this phone hacking process without the notice of your partner to keep her wondering how you got to know about her infidelity. Communicate with Pro Wizard Gilbert Recovery with the email: prowizardgilbertrecovery(@)engineer.com WhatsApp: +1 (361) 418‑1326

    ReplyDelete
  38. S Hacker operates by using advanced methods to obtain data from a targeted phone remotely like that of your cheating spouse. It's similar to having a computer wizard use spells to reveal a relationship's truth. Before we dive into the features of S Hacker, let's take a moment to explore the signs that may indicate your partner is cheating. While these signs are not foolproof evidence, they can raise suspicions and prompt further investigation. Significant behavioral changes, such as increased secrecy, unexplained absences, or sudden defensiveness, can be red flags that something is amiss. If your partner has become more distant or secretive, it's important to address these changes and evaluate the situation. I once had a partner who I relied on but after several red flags, I sought the assistance of https://santoshihacker.godaddysites.com/ to hack into my wife's phone to clarify my skepticism. Santoshi Hacker turned out to be victorious by showing me every piece of evidence I needed to confront my wife. For a job like this also, reach Santoshi Hacker through: Email:( santoshihacker(@)hotmail(.)com,) How to catch cheating partners is sure when you consult a professional Hacker like S.H.

    ReplyDelete
  39. Thanks to Muyern Trust Hacker, I was able to recover my lost phone and all the precious memories stored in it. Their team was professional, efficient, and incredibly helpful throughout the entire process. I couldn't be happier with the outcome. Muyern Trust Hacker Email: ( muyerntrusted @ mail-me . com ) is the team to call when you need assistance with phone and Gmail hacking. They guarantee trustworthy and secure outcomes with cutting-edge equipment, moral behavior, and a dedication to your security. Take their delighted clients' word for it instead of just taking their word for it; they provide excellent services. When it comes to hacking, put your trust in Muyern Trust Hacker; they will consistently go above and beyond your expectations. In a world where digital security is paramount, Muyern Trust Hacker stands as a trusted and reliable team for all your phone and Gmail hacking requirements. With their expertise, advanced tools, and commitment to ethical practices, they ensure the highest level of service and security for their clients. Whether you need to recover lost data, regain access to a hacked account, or address any other hacking issue, Muyern Trust Hacker is the team you can rely on. Don't compromise on the safety and integrity of your personal information – trust Muyern Trust Hacker to handle your phone and Gmail hacking needs with utmost professionalism. Contact them today and let their wizardry work for you.
    Whats App; +1 (863)606-8347

    ReplyDelete
  40. What Should I Do To Recover My Lost/Stolen Bitcoin? iBolt Cyber Hacker Offers Vital Solutions for Recovery

    Understanding the Challenges of Lost or Stolen Bitcoin:
    Losing access to your Bitcoin wallet or falling victim to theft can be devastating. Traditional financial institutions do not provide the same level of assistance as they would in case of stolen fiat currency. The decentralized nature of Bitcoin means that transactions are irreversible, making it even more challenging to recover lost funds. Recognizing these challenges, iBolt Cyber Hacker offers their expertise to individuals facing such unfortunate circumstances.

    Contact Info:
    Emai: ibolt @ cyber - wizard . com
    Whtsp: +3.9.3.5.0.9.2.9.0.5.5.4.
    Web site: iboltcyberhacker . com

    ReplyDelete
  41. Email: prowizardgilbertrecovery(@)engineer.com & Telegram: @Pro_Wizard_Gilbert_Recovery



    Accessing your partner's mobile phone is usually something that requires hiring an expert to get it done for you to get your desired result. This kind of approach is mostly considered that one has lost trust in their partner. It's okay to be in such a situation and try to get over the doubt by confirming the reality. WhatsApp spying and accessing social media platforms is a piece of cake for Pro Wizard Gilbert Recovery. Initially, I thought I was just feeling insecure when my wife would just be on her phone at odd hours, until I decided to take a chance to know, knowing is better than self-doubts and that was exactly what happened. I reached Pro Wizard Gilbert Recovery a platform that's become a stress reliever. The platform understood my situation and promised to help me by taking into consideration the fact that cheating is unfair. Pro Wizard Gilbert Recovery delivered exactly what I needed and became a stress reliever. The work didn't take long and in no time my fears had been confirmed. Now I know when she’s telling the truth and how to curtail her. I think it is not drastic. The tool understood my situation and promised to help me. Finding out the truth was a stress reliever. Pro Wizard Gilbert Recovery was a shoulder to lean on for real. My life got better, I stopped using my precious time to bother about his indiscretions and channeled my energy positively. Pro Wizard Gilbert Recovery services include iPhone and Android phone calls, messages, contacts, social media, emails, and all other kinds of related services. Reach out to them via the above details.

    ReplyDelete
  42. Infidelity can leave individuals feeling lost and betrayed. Finding closure becomes essential for healing and moving forward. DANIEL MEULI  WEB RECOVERY understands this need for closure. It plays a pivotal role in providing the truth, offering a sense of resolution, and allowing individuals to begin the healing process. Amid a cheating scandal, hope can seem like a distant dream. However, DANIEL MEULI WEB RECOVERY brings that hope to the forefront. Their expertise, professionalism, and commitment to uncovering the truth offer clients the clarity they desperately seek. With DANIEL MEULI WEB RECOVERY by their side, individuals can regain control of their lives and begin the journey towards a brighter future. Finding out the truth about adultery may be a powerful and liberating experience. Countless people have been able to obtain hard proof and face the truth of an unfaithful spouse with the help of DANIEL MEULI WEB RECOVERY. DANIEL MEULI WEB RECOVERY has established itself as a reliable friend in the search for truth and closure by providing proficiency in digital forensics, cutting-edge surveillance methods, and empathetic assistance.   The discovery of a cheating scandal can unleash a storm of turmoil, leaving individuals and communities shattered and devoid of hope. Amid such chaos, rebuilding trust and finding a way forward may seem like an impossible task. DANIEL MEULI WEB RECOVERY is aware of the peculiar difficulties that follow cheating scandals, especially when they occur online. They use a diversified approach, offering comprehensive solutions by fusing state-of-the-art technology with a profound comprehension of human behavior. DANIEL MEULI WEB RECOVERY is dedicated to assisting people in rebuilding their lives, from locating online infidelity to helping with reputation management. Online cheating has become increasingly prevalent in today's interconnected world. From secret messaging apps to dating websites, individuals can easily engage in deceptive behavior. This form of cheating can have far-reaching consequences, not only in personal relationships but also in professional and academic settings. The impact of online cheating can be devastating, leaving individuals feeling violated and unsure of who to trust but DANIEL MEULI WEB RECOVERY is capable of breaching online accounts and providing good evidence. Do reach out to DANIEL MEULI WEB RECOVERY via:


                                                                            TELEGRAM:  (@) DANIELMEULI
                                                                             VIBER: + 39 351 201 3528    
    Regards.  

    ReplyDelete
  43. My name is Ashley Grandma, This year started quite well for me after my huge lost of last year just got recovered for me completely by Kingsley a hacker who was introduced to me by my grand daughter. I got defravded by these guy who claimed he worked for a crypto agency who multiplies retirement funds like 401k, after so many emails back and fourth, i innocently gave him access to my account via an investment wallet platform, It was really shocking how he made me send some of my 401k to him and he stole the remaining from my account without my permission. made multiple police reports but none could recover what i lost, not until the hacker helped me out and now i am back healthy and joyous again as i recovered everything i thought i lost from the scamming guy. It is only right for me to share his contacts just incase there is anyone with similar issue here, there is hope, below is his contacts
    E mail: refundpolici (at) gmail (dot) com
    Whats app and Tel : +1 ( 657 ) 2 6 2 4 4 8 2
    Thank you for letting me share my experience. God bless you all

    ReplyDelete
  44. A fantastic, skilled, and knowledgeable group. They enabled me to get my money back in full. Throughout the process, they kept me updated and were truthful and pragmatic on my available choices. Without a doubt, I would advise friends, family, and anybody else who has lost money on scam websites to use Cyberetrieve. Once again, I want to thank you for your much-needed and appreciated assistance. contact Cyberetrieve now via email or whatsapp

    Email: CYBERETRIEVE@MAIL.COM

    Whatsapp:+1(716) 545-4535

    ReplyDelete
  45. Be nice and don't ignore. Glory be to almighty God why made me recover my fundz and my life after i met a woman on Discord who claimed she was an lnvestment specialist and made me send her 70k few days after we started communicating. I lost alot more than that the next day after she mysteriously got access to my retirement ackount, she made away with everything. The pain was unbearable. Godswilling i met an old classmate at the local bus station who introduced me to a recovery person. we started the recovery 4 days after , it took less than 48 hours to receive the fundx in my personal ackount. Only obstacle we encountered was viruss issue which he worked on and we were perfectly back on track. My friends, if you know anyone in such situation or you yourself, kindly reach out to thesame agency who did mine, you will not be disappointed, it is very convenient. this is their contact below,
    E meil: refundpolici (at) gmail (dot) com
    Wassap and xell : +1 ( 657 ) 2 6 2 4 4 8 2
    I Love You all.

    ReplyDelete
  46. THANKS TO WIZARD WILLIAMS RECOVERY, I HAVE FINALLY RECEIVED MY LOST BITCOIN.

    Seeking assistance recovering stolen cryptocurrency wallets, recovering cryptocurrency taken by scammers, or reporting a Bitcoin scammer to recover cryptocurrency? The safest course of action is to work with a reputable Wizard Williams Recovery Expert—a specialist with cyber areas of expertise that can retrieve cash that have been embezzled by fraudsters. After losing $273,000 to a fraudulent online investment organisation, I made numerous attempts to get my money back. I tried a variety of recovery firms, most of which ended up taking additional money from me. My former colleague informed me about WIZARD WILLIAMS RECOVERY. I contacted the Expert and, upon presenting my reports, the Expert was successful in retrieving my money.
    Get in touch with Wizard Williams Recovery through;

    Email: Wizardwilliams@mail.com
    WhatsApp: +4,9,1,7,6,1,2,4,5,2,0,6,6.

    ReplyDelete
  47. Sometimes in January I lost about $455,000 to fake forex trading platform which I got lured to with the intent of earning massive profit but turned out to be a deceit. After days of depression and sadness I finally found the best and reliable cryptocurrency recovery specialist at RECOVERYBUREAUC @ GMAIL, C0M whom I hired and he was able to totally retrieve my stolen funds without hassle or hidden fees. He’s exceptional and competent
    Send a detailed mail to this specialist now for instant assistance

    RECOVERYBUREAUC @ GMAIL, C0M

    ReplyDelete
  48. Who knows about violettrading platform?? I had a really b*d experience with them in 2021, lost everything I invested with them after a lady convinced me to trade with them. If not for a hakker i met in a group chat and his wassap number +1 ( 657 ) 2 6 2 4 4 8 2 who helped me recover all I lost to the scammers just 20 hours after taking in my complain. I Hope everybody try to recover what they have lost to online predators, nobody deserves to be their victim. this is their emeil too, refundpolici (at) gmail (dot) com .

    ReplyDelete
  49. A relationship's foundation of trust can be destroyed by infidelity, leaving the other partner full of doubt and confusion. The search for the truth becomes an urgent necessity for people who suspect their partner of being unfaithful. The services offered by Pro Wizard Gilbert Recovery promise to solve the secrets surrounding an unfaithful spouse, providing a ray of hope in these vulnerable circumstances. Have you ever had that gnawing feeling in the pit of your stomach, the one that tells you something just isn't right? I certainly felt it when I began to suspect my wife might be hiding something from me. Call it intuition, call it a gut feeling, call it the desperate plea of a paranoid mind – whatever it was, it was enough to keep me up at night and fill my days with doubt. Doubt can be a relentless companion, slowly eating away at your peace of mind. It was in this state of uncertainty that I realized I needed to find answers. I needed to know the truth, whatever it may be. And that's when I stumbled upon Pro Wizard Gilbert Recovery, a name that would soon become my beacon of hope in the storm of uncertainty. Pro Wizard Gilbert Recovery is not your average investigative agency. They specialize in uncovering digital evidence and providing you with the clarity you seek. From computer forensics to cell phone and social media analysis, they have a wide range of services designed to help you gather the information you need. Now, you might be wondering, why choose Pro Wizard Gilbert Recovery over other options? Well, aside from their catchy name and cool logo, they have a proven track record of success. Their team of experts is highly skilled and experienced, and they understand the delicate nature of your situation. Plus, they offer their services with a touch of humor and personality, making the whole process a little less daunting. In my case, Pro Wizard Gilbert Recovery made her lies mock her in her face because of the evidence that I had. Once I made the decision to contact Pro Wizard Gilbert Recovery, I was greeted by a friendly voice on the other end of the line. They took the time to listen to my concerns and understand the specifics of my situation. This initial consultation reassured me that I was in capable hands. Do not wait any longer for your doubt to continue, seek Pro Wizard Gilbert Recovery aid now through: prowizardgilbertrecovery@ engineer .com
    & WhatsApp: +1 (425) 623‑3222

    Best Wishes.

    ReplyDelete
  50. HIRE THE BEST ASSETS RECOVERY TEAM AT RECOVERYBUREAUC @ GMAIL, C0M

    I’m happy I was able to recover my stolen cryptocurrency through RecoveryBureauC @ gmail c0m after falling victim to a fake cryptocurrency investment project which took about $115,000 worth BTC and USDT from my savings. This is the best service I ever got on the internet as this techie saved me from getting bankrupted. He’s awesome, send a detailed report of your case to this specialist for topnotch assistance

    Email: RECOVERYBUREAUC @ GMAIL, C0M

    Website: RecoveryBureauCapp.com

    WhatsApp: +44 7586 868096

    ReplyDelete
  51. I recently experienced a devastating setback when I fell prey to a cunning scarm that left me reeling from the loss of my cherished crypto assets. However, against all odds, I managed to turn the tables on the scammers and emerge victorious in reclaiming what was rightfully mine.
    At the outset, I was overwhelmed by a wave of frustration and despair upon realizing that I had been dupd by these unscrupulous individuals. But rather than succumb to defeat, I resolved to take decisive action and explore every possible avenue to recover my funds.
    I sought assistance from this reputable crypto recovery services renowned for their track record of success in retrieving lost funds. With their expert assistance and cutting-edge technology, we were able to trace the whereabouts of my stolen crypto and swiftly take action to recover it. It took about 18 hours and we were done, i got all my recovered funds and even a little bit more. I will like to share their reach just inscase anyone here is in, or ever finds themselves in same situation that i was. here it is Wassap : +1 ( 6 5 7 ) 2 6 2 4 4 8 2
    and REFUNDPOLICI (AT) GMAIL (DOT) COM

    ReplyDelete

  52. Hello, My name is Wendy Torres From Canada.
    I Fell victim to a Cryptocurrency Scam, Early this year. All thanks to SWIFT RECOVERY FIRM who was able to recover my lost Bitcoin. It all Started with a message pop on my phone advertising a Cryptocurrency Investment opportunity and how to yield profits from Bitcoin Investments. I got interested and after doing some research I decided to put In $237,000 worth of Crypto with the Company. All went well including my profits accumulated so fast, till it was time to make my withdrawals. My account was frozen and huge funds were requested from me which I was not able to pay. I had to Quickly look out for a solution, that’s when I came Across SWIFT RECOVERY SERVICE, A certified Bitcoin Recovery Firm. After filing my case through swiftrecoveryservice006@gmail.com, I only had to wait for 72 hours and all my Funds were recovered back to me. I heartily endorse SWIFT RECOVERY FIRM for all Bitcoin and lost funds recovery.

    MORE INFO;
    Email Address; swiftrecoveryservice006@gmail.com
    Call or WhatsApp; +1 (786) 684-0501

    ReplyDelete
  53. I owe SWIFT RECOVERY FIRM a huge debt of gratitude for their assistance in getting my Bitcoin back. I had lost every penny of my life savings after falling victim to a fraudulent investment business. I was inconsolable and unsure of what to do. After doing some internet investigation, I came across SWIFT RECOVER FIRM. They enjoy a stellar reputation and have assisted numerous clients in getting their pilfered cryptocurrency back. I’m so happy I chose to give them a shot. The SWIFT RECOVERY FIRM staff was incredibly helpful and competent. They gave me a thorough explanation of the recuperation procedure and kept me informed of their advancement at every stage. SWIFT RECOVERY FIRM was able to get back all of my Bitcoin that had been stolen in a matter of weeks! I was ecstatic to receive my money back. I strongly advise anyone who has been duped or had their cryptocurrency stolen to visit (swiftrecoveryservice006@gmail.com). They are an experienced and trustworthy FIRM that can assist you in getting your things back. You can also Whatsapp them on +1 (786) 684-0501

    ReplyDelete
  54. That was so amazing's giving a support to the poor innocent homeless boy after being found on am empty home that is almost falling apart, the boy story was a touching one that couldn’t be resist as a result of loosing both parents to online romance and online Ponzi scheme scam, meeting an ‘’alienwizbot’ Gmail first day and hearing the sudden hurried the recovery expert into speed recovery of the little homeless late boy lose to an exchange discover responsible for the incident, they were two china and 1 Pilipino girl, they both reside in one of the most popular welcoming Asia country with so much beautiful home but always with hot weather, maximum respect goes to the amazing Alienwizbot Gmail when discover the good work.

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    Email: alienwizbot (@) Gmail .com
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