Xerostomia due to Sjögren's syndrome. Diagnostic criteria, treatment and outlines for a continuous dental care programme and an open trial with Sulfarlem

Dietary Intake, Body Composition, and Oral Health Parameters among Female Patients with Primary Sjögren's Syndrome

There is limited knowledge about dietary intake and body composition among patients with primary Sjögren’s syndrome. We assessed dietary intakes with 24-h recalls and body composition with anthropometry and bioelectrical impedance in 20 female patients. Various scoring tools were used to assess oral health. The patients had a lower energy percentage (E%) from carbohydrates (p = 0.02) and a higher E% from fat (p = 0.01) compared to a reference group. The lower intake of carbohydrates was due to a lower bread intake (p = 0.04), while the higher intake of fat was due to a higher intake of butter, margarine, and oil (p = 0.01). The patients ate more than twice (p = 0.02) as much fish as the reference group. The compliance to recommended intakes of macro- and micronutrients was good. Forty-percent of the patients were overweight/obese. Increased intake of beverages was observed in patients with severe xerostomia and/or low oral health-related quality of life, whereas reduced fat intake was found in hyposmic patients. In conclusion, the dietary intake among the patients was not much different from the reference group and complied with recommendations. Most oral health parameters were not associated with nutrient intakes. Specific dietary guidelines are probably not needed to ensure adequate nutrition among such patients.

Management of xerostomia and other complications of Sjögren's syndrome

This article provides an overview of the published literature in English in the past 63 years involving the management of xerostomia and other oral complications of Sjögren's syndrome. The evidence supporting studied interventions was evaluated using published criteria.

Periodontal disease in Thai patients with rheumatoid arthritis

AIM

To evaluate the prevalence and severity of periodontal disease in patients with rheumatoid arthritis (RA) who attended a rheumatology clinic in a university hospital.

METHODS

All consecutive patients with RA who attended the rheumatology clinic between June 2009 and January 2010 were asked to enroll in this study. All participants answered questionnaires, which included demographic data, medical history, medications used and smoking habits. A full mouth periodontal examination, including gingival index, plaque index, probing pocket depth and clinical attachment level was performed. Only cases that had at least 20 teeth were included in this study. Rheumatoid arthritis parameters, including number of tender and swollen joints, erythrocyte sedimentation rate, the presence of rheumatoid factor (RF), hand radiographs, Disease Activity Index (DAS) and health status using the Thai Health Assessment Questionnaire (HAQ), were determined. The association between RA parameters and periodontal condition was examined.

RESULTS

There were 196 participants (87.2% female) with a mean age of 51.7 ± 9.70 years, mean disease duration of 9.62 ± 7.0 years and mean DAS score of 4.64 ± 1.25. Eighty-two per cent were RF-positive. Moderate and severe periodontitis were found in 42% and 57%, respectively. Higher age, male gender, previous or current smoking and high level of plaque score were associated with severe periodontal disease. No differences in RA parameters were found between groups of patients who had moderate and severe periodontitis.

CONCLUSIONS

We found a high prevalence of periodontitis in Thai patients with RA. However, there was no association between RA parameters and periodontal conditions.

Salivary gland dysfunction: a review of systemic therapies

Xerostomia may result from salivary dysfunction secondary to a variety of conditions, including medications, autoimmune disease, and tumoricidal therapy. As the geriatric population increases, the incidence of xerostomia will increase and the oral manifestations will continue to be a challenge to the clinician. Common oral manifestations resulting from decreased salivary flow include increased dental caries, fungal infections, and dysphagia. Treatment for salivary gland dysfunction is currently limited because of a lack of controlled clinical trials. Medications that have been studied in clinical trials are emphasized in this article. The aim of this article is to briefly review salivary gland physiology and to summarize the suggested systemic treatment modalities for xerostomia that emphasize controlled clinical trials.

Role of nitric oxide in Sjögren's syndrome

OBJECTIVE

To measure levels of salivary nitrite (NO2-) and to localize nitric oxide synthases (NOS) in the labial salivary glands (LSGs) of patients with Sjögren's syndrome (SS).

METHODS

NO2- was measured by the Griess reaction. LSGs were analyzed using NADPH-diaphorase histochemical and immunohistochemical studies to determine the constitutive NOS (neuronal [ncNOS] and endothelial [ecNOS]) and inducible NOS (iNOS) isoforms.

RESULTS

The NO2- concentration (mean +/- SEM 307 +/- 51 microM versus 97 +/- 16 microM; P < 0.05) and output (166 +/- 46 nmoles/minute versus 37 +/- 7 nmoles/minute) were increased in SS patients compared with healthy control subjects. NADPH-diaphorase was found in some nerve fibers and endothelial cells, and, in SS, was found in myoepithelial, acinar, and ductal epithelial cells, but in only a few inflammatory cells. In SS, ncNOS-immunoreactive nerve fibers were sparse and ecNOS was found in a minority of the CD31-positive vascular endothelial cells and acinar cells, whereas iNOS was localized in myoepithelial, acinar, and ductal epithelial cells, often together with tumor necrosis factor alpha.

CONCLUSION

Nitrite was found in normal human saliva. NO produced by ncNOS probably acts as a nonadrenergic, noncholinergic neurotransmitter, whereas that produced by ecNOS exerts a vasodilatory effect. SS patients had increased NO2- concentrations, with most of the superfluous salivary NO being produced not by the immigrant inflammatory cells, but rather, by the resident salivary gland cells. NO may contribute to inflammatory damage and acinar cell atrophy in SS.

Proteolytic enzymes as indicators of periodontal health in gingival crevicular fluid of patients with Sjögren's syndrome

The present study characterizes the periodontal status of patients with Sjögren's syndrome (SS) and measures collagenase, elastase and gelatinase in gingival crevicular fluid (GCF) from these patients compared with adult individuals with periodontitis and healthy controls. The periodontal status was assessed by the Gingival Bleeding Index (GBI), the Visible Plaque Index (VPI), and pocket depth. Activity measurements were performed for collagenase with SDS-PAGE/laser densitometry, for elastase spectrophotometrically using a synthetic N-succinyl-Ala-Ala-Val p-nitroanilide peptide substrate, and for gelatinase with zymography. Seven of the 8 patients with SS and xerostomia showed a periodontium comparable to that seen in healthy controls. The GCF collagenase and elastase were significantly lower in patients with SS and in healthy controls than in patients with adult periodontitis. It was noteworthy that the one SS patient with periodontitis had high GCF collagenase and elastase activity. In all study groups multiple forms of gelatinases were present, indicating that they represent constitutively expressed proteinases involved in normal tissue remodeling processes. Our findings suggest that periodontal pockets/GCF form a micromilieu not affected by involvement of glandular tissue and, therefore, patients with SS show, clinically and biochemically, a periodontal status comparable to that seen in healthy controls.

Remaining teeth, oral dryness and dental health habits in middle-aged Norwegian rheumatoid arthritis patients

The aim of the study was to assess the effect of rheumatoid arthritis (RA) upon dental health. A questionnaire was mailed to all seropositive rheumatoid arthritis (RA) patients aged 44-56 yr in the files of the two main departments of rheumatology in South Eastern Norway. Data were obtained from 125 patients, constituting 91% of the target group. The number of remaining teeth in these patients was not related to disease duration or physical dysfunction, whereas a relationship to prolonged use of medication for pain relief was indicated. Factors known to affect tooth loss in the general population, such as smoking habits, dental attendance, interdental cleaning habits, previous dental disease, and place of residence were found to be important in RA patients as well. The RA patients from Oslo had a mean number of 25 remaining teeth, which is the same as reported for the general Oslo population at this age. Oral dryness was reported by more than 50% of the RA patients, but was not related to the number of teeth. The conclusion is that serious and long lasting rheumatoid arthritis had little influence on the number of remaining teeth in this middle-aged group of Norwegians.

Signs and symptoms in the masticatory system in ten patients with mixed connective tissue disease

Ten patients with mixed connective tissue disease (MCTD) were examined for signs and symptoms in the masticatory system. The study included clinical, radiological, histological and immunohistochemical examinations. The status of the teeth and periodontium did not seem to differ from that found in the general Finnish population. All 10 patients showed clinical dysfunction, and 7 had additional radiographic changes of the temporomandibular joints. Sialopenia was observed in 7 patients, and histological examination revealed sialoadenitis with a focus score exceeding 1 in the labial salivary glands in 9 patients. Only 1 patient had clinically detectable mucosal lesions. However, in 5 of 6 patients with normal-appearing mucosa, histological examination revealed chronic inflammation. Three of the 10 patients had clinically atrophic and erythematous oral mucosa; histological examination again revealed chronic inflammation. The signs and symptoms appearing in the masticatory system of these 10 MCTD patients were many and varied and indicate the importance of closely examining all oral structures. As with other connective tissue diseases, MCTD should be treated on a multidisciplinary basis.