Sjögren Syndrome: Reduced Quality of Life as an Oral-Systemic Consequence

July 29, 2010

Surveillance Spotlight: Current Concepts in Oral–Systemic Health

The International Centre for Oral–Systemic Health, based at the University of Manitoba's faculty of dentistry, was launched in January 2008. The centre is proud to partner with JCDA to provide summaries of contemporary literature and news in oral–systemic health that may affect modern dental practice.

The majority of discussion surrounding oral-systemic connections involves examining the linkages between chronic inflammatory diseases and specific negative health outcomes such as increased severity of disease or overall disease burden.1 This includes consideration of morbidity and mortality associated with the synergistic influences of oral and systemic diseases. Within the context of increased morbidity, one can specifically discuss quality of life issues. Decreased quality of life is arguably just as devastating as more overt outcomes of disease (i.e., myocardial infarction, stroke, kidney failure or premature birth) as it affects activities of daily living and one's overall ability to enjoy life.

A recent study examined quality of life issues in patients with Sjögren syndrome.2 This investigation is important because it addresses the unique contribution of oral health and integrity of oral function to more general measures of health and well-being, including activities of daily living and social functioning.

Sjögren syndrome is a common chronic autoimmune disorder, characterized by persistent oral and ocular dryness. Symptoms may be limited to local effects on the salivary and lacrimal glands or can extend to include widespread involvement of multiple organ systems.3 The disorder may occur alone or in combination with other rheumatic diseases (i.e., systemic lupus erythematosus or rheumatoid arthritis). The disease affects women more frequently than men (female-to-male ratio is 9:1) and the onset of symptoms occurs most often during middle age. Patients present with dryness of the mouth and eyes and symptoms include extreme fatigue, myalgia, arthralgia and psychological distress.

Hyposalivation and dryness of the oral mucosa puts these patients at high risk for poor oral health. Therefore maintaining oral health is a significant issue for this population. Patients can also experience changes in the composition of saliva that increases the susceptibility to dental caries and periodontal disease, increases incidence of oral candidiasis and ulceration, causes changes in taste sensation and complicates wearing dentures. Patients frequently experience difficulty chewing and swallowing food, difficulty speaking, and suffer embarrassment or self-consciousness in social situations as a result of xerostomia.

In another study, investigators used a survey tool (Oral Health Impact Profile) to assess oral health-related quality of life in patients with Sjögren syndrome.4 The tool measures aspects of quality of life directly related to oral health and function independent of the other problems associated with Sjögren syndrome. It is a powerful predictor of self-rated psychological variables such as depression, self-esteem and overall life satisfaction. The results indicate that oral health and function have an independent influence on general quality of life in these patients.

The study findings indicate that xerostomia and hyposalivation have a considerably negative effect on activities of daily living and social relationships. In fact, the results demonstrate that oral disease and poor oral function may have serious social and psychological consequences.

This reaffirms the critical importance of the dental team in the co-management of patients with systemic diseases such as Sjögren syndrome. Dentists and physicians must work collaboratively to maintain oral health and quality of life for patients with Sjögren syndrome. The dentist should communicate effectively with the medical team (e.g., primary care physician, rheumatologist and ophthalmologist) to address patient concerns related to xerostomia and hyposalivation in an aggressive manner.

Oral management by the dental team should be based on an individualized treatment plan that addresses the severity of the salivary dysfunction. To minimize oral problems such as recurrent decay, oral ulcers and candidiasis, clinicians should recommend that patients undergo examination and prophylaxis every 4 months with a customized fluoride use program and use of sugar-free lozenges and xylitol chewing gum to enhance salivary flow. The dental team is in a key position to identify initial signs and symptoms of Sjögren syndrome and to refer patients for a complete medical evaluation.

Dr. Iacopino is dean and professor of restorative dentistry, and director of the International Centre for Oral–Systemic Health, at the faculty of dentistry, University of Manitoba, Winnipeg, Manitoba. Email: iacopino@cc.umanitoba.ca.

References

  1. Iacopino AM. Relationship between periodontal disease and general health: role of inflammation. J Can Dent Assoc. 2008;74(8):695-96.
  2. Stewart CM, Berg KM, Cha S and Reeves WH. Salivary dysfunction and quality of life in Sjögren syndrome: a critical oral-systemic connection. J Am Dent Assoc. 2008;139(3):291-99.
  3. Delaleu N, Jonsson R and Koller MM. Sjögren's syndrome. Eur J Oral Sci. 2005;113(2):101-13.
  4. Slade GD. Derivation and validation of a short-form oral health impact profile. Community Dent Oral Epidemiol. 1997;25(4):284-90.

The views expressed are those of the author and do not necessarily reflect the opinions or official policies of the Canadian Dental Association.

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