Dentists can be first to spot Sjogren's syndrome
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Posted April 3, 2007 |
By Jennifer Garvin Hemet, Calif.—For Sjögren's syndrome patients, the symptoms are downright miserable: chronic dry eyes and dry mouth are the most common.
But for dentists, the disease may be hard to recognize early.
An autoimmune disease that attacks the salivary and tear glands, Sjögren's syndrome afflicts as many as four million Americans. The typical onset occurs in women in their 30s to 60s and, while 90 percent of patients are women, the disease also affects men, according to the Sjögren's Syndrome Foundation.
"It's important that dentists know how to incorporate recognition and management of decreased salivary function into their practices," said Dr. Troy Daniels, director of the Sjögren's clinic at the University of California at San Francisco School of Dentistry.
A decade ago, Jo Ann Snider, a registered dental hygienist, was diagnosed with primary Sjögren's syndrome.
Ms. Snider, who is married to a dentist, said it was her husband who prompted her to get tested. The SSF reports that the usual timeline from symptoms to diagnosis is six years.
"He said, 'I think you have Sjögren's syndrome,'" she recalled, and thought, " 'Good grief, I'm not old enough for that.' "
Forty-seven at the time, Ms. Snider was in the target range for the disease.
Primary Sjögren's syndrome means the disease occurs on its own, but in 50 percent of the cases, secondary Sjögren's syndrome occurs in the presence of another connective tissue disease such as rheumatoid arthritis or lupus. It may be progressive and can affect the kidneys, liver and other organ systems. In a small percentage of cases, Sjögren's progresses to malignant lymphoma.
Ms. Snider is trying to raise awareness of
the disease so that more dentists recognize the symptoms. April is National Sjögren's Syndrome Awareness Month.
Steven Taylor, chief executive officer of the Sjögren's Syndrome Foundation says, "Dental professionals are a first line of defense for the fight against Sjögren's syndrome. We are counting on them to spot the signs of the Sjögren's so that patients can receive a quicker diagnosis and be treated to slow the progression of the disease and its symptoms."
In everyday practice, Dr. Daniels notes that signs of decreased salivary function may be present that can lead a dentist to identifying Sjögren's syndrome. These include:
- multiple teeth with new or recurrent root or incisal caries;
- reduced or absent saliva pool in the mouth floor;
- reduced mucosal lubrication;
- abnormal appearing saliva expressible from parotid or submandibular gland ducts;
- signs of erythematous candidiasis;
- bilateral enlargement of major salivary glands.
If such a patient's history does not include prescription drugs or other treatment that could cause these symptoms, Sjögren's should be considered. The dentist can then consult with the patient's physician regarding blood tests and/or referral to an ophthalmologist to consider the ocular component of Sjögren's (called keratoconjunctivitis sicca).
Ms. Snider said she considers herself fortunate that she's able to work and see patients four days a week. She works alongside her husband in a practice in California.
She thinks that it's important for dentists to be educated about Sjögren's syndrome.
She's always trying to spread the word that the constant sipping of water—as many patients are advised by dentists and physicians—is not the best way to treat the dry mouth symptoms that often accompany any salivary disorder.
"This has been a real learning experience for me because the dry mouth associated with Sjögren's has been a lot more annoying that I ever imagined it would be," she said. The Sjögren's Syndrome Foundation offers a complimentary professional publication, The Sjögren's Quarterly, to all health care providers. The publication is one of the best sources of information for professionals on Sjögren's syndrome and includes clinical/practical information, new product announcements and the latest science.
Contact the SSF to receive this publication at 1-800-475-6473. For more information, visit www.sjogrens.org  .
The ADA Annual Catalog offers a brochure on xerostomia which explains the consequences of dry mouth and how patients can relieve it. The brochure, W279, may be ordered by phone at 1-800-947 4746 or by visiting www.adacatalog.org.
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