Objectives\u00a0 <\/b>This review is directed to dental healthcare providers (DHCP) such as dentists and dental hygienists and seeks to provide updated in\u00adformation regarding the Sj\u00f6gren\u2019s syndrome (SS) that is more com\u00admon and undetected than expect\u00aded. Indeed, DHCP have a key role in early diagnosis and manage\u00adment of oral signs, symptoms, and complications.<\/p>\n
Materials and methods\u00a0 <\/b>Scientific articles and reviews published on PubMed since 2018 were considered regarding SS early diagnosis, epidemiology and treatment of oral manifestations.<\/p>\n
Results\u00a0 <\/b>SS is a chronic progressive auto\u00adimmune disease that affects the exocrine glands, primarily salivary and lacrimal glands, that leads to their progressive destruction. SS could be primary or secondary depending on coexisting autoim\u00admune diseases. SS has also sys\u00adtemic manifestations, with higher mortality and 40-fold higher non-Hodgkin lymphoma risk.<\/p>\n
Typical oral SS feature is parotid and submandibular gland en\u00adlargement, while the characteris\u00adtic symptom is xerostomia with reduced salivary flow rate (<0.1 mL\/min) and decreased mucin production. Dry mouth leads to angular cheilitis and erythema\u00adtous petechial-type lesions on the palate particularly in denture wearers, candidiasis and in\u00adcreased yeast colonization. Oral complications are cervical caries, gingivitis, periodontitis, dental ero\u00adsion, ranula.<\/p>\n
SS may originate from a local in\u00adsult to an exocrine gland, followed by cellular necrosis, expression of SS antigens A and B (SS-A and SS-B), anti-SS-A and anti-SS-B autoantibody production, immune complexes formation, local in\u00adflammation and lymphocytic infil\u00adtration. Diagnosis is unclear with several existing criteria and lack of consensus, although the Ameri\u00adcan-European Consensus Group Classification criteria (AECG) are the most frequently used in high quality studies. This diagnostic uncertainty also produces unclear disease epidemiology. Incidence rate likely is 4-5×100,000 per year, prevalence could be 0.02- 0.7%, with almost one half of cas\u00ades undetected. Male-to-female ratio is 1:9.<\/p>\n
Conventionally, presumptive di\u00adagnosis is performed through si\u00adalography, which is invasive and exposes patients to high radia\u00adtion. Other promising imaging techniques include scintigraphy with 99mTc-pertechnetate, mag\u00adnetic resonance, ultrasonogra\u00adphy, and sialo-cone-beam com\u00adputerized tomography. Unfortu\u00adnately, SS is not curable.<\/p>\n
Nevertheless, oral symptoms and xerostomia could be controlled through cholinergic agonists (pi\u00adlocarpine and cevimeline), active electrostimulation, sialogogues, acupuncture, salivary substi\u00adtutes, toothpastes, mouthwashes and gels containing moistening agents, transcutaneous electrical nerve stimulation, intraductal irri\u00adgation, while promising results from animal studies suggest that stem cells from human exfoliated deciduous teeth could in part re\u00adstore salivary gland structure.<\/p>\n
Conclusions\u00a0 <\/b>Given that many SS cases are un\u00addetected and that SS is a chronic disease, the role of DHCP is cru\u00adcial in performing early diagnosis, alleviating oral symptoms, and treating oral complications.<\/p>\n
Clinical implications\u00a0 <\/b>On the basis of nonspecific oral symptoms and anamnesis based on the AECG criteria, DHCP may suspect SS and suggest appropri\u00adate imaging techniques for the presumptive diagnosis. Although patients are referred to other spe\u00adcialists, such as oral pathologists, immunologists, rheumatologists, DHCP must manage the oral SS manifestations using simple tools that yield only a few side and ad\u00adverse effects.<\/p>\n
Per continuare la lettura gli abbonati possono scaricare l’allegato.<\/i><\/p>\n
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