What is it?
Sjögren's syndrome is a connective tissue disease in which the immune system targets the glands that make your secretions. The salivary and tear glands are affected most. As saliva falls the mouth becomes dry, and as tears fall the eyes feel gritty, as though something has got into them. The two kinds of dryness together are the main clue that brings this condition to mind.
Saliva does more than wet the mouth. It buffers acid, carries minerals back to the tooth surface, holds the balance of micro-organisms in the mouth and makes swallowing easier. When that protection falls away, decay can appear in unusual places, at the gum line and on the root surfaces. Wearing a denture becomes harder, and fungal infections may keep coming back.
This syndrome is not the only cause of a dry mouth; medicines, fluid loss and radiotherapy given to the head and neck produce the same result. Dryness on its own therefore does not make the diagnosis. When dry eyes, repeated swelling of the salivary glands and joint symptoms are added, the assessment is expected to be made in rheumatology.
Signs
You will not necessarily have all of these at once.
Why does it happen?
- 01
The immune system targeting the glands
Inflammatory cells build up in the gland tissue, and the units that make the secretions are gradually replaced by other tissue. Because the process moves slowly, the dryness usually becomes obvious over years.
- 02
Going along with another rheumatic disease
The condition can be seen on its own, and it can also be found together with another disease that affects the connective tissue. Making that distinction and planning the follow-up falls to rheumatology.
- 03
Medicines that make the dryness worse
Some blood pressure, allergy, diuretic and mental health medicines lower saliva flow further. This effect adds to the effect of the disease itself; whether the medicine can be changed is decided by the doctor who prescribed it.
- 04
Habits that speed up the damage in a dry mouth
Smoking, alcohol, breathing through the mouth and taking sugary or acidic drinks through the day all make the harm greater in a mouth that has dried out. These are not the cause of the disease, but they do make its consequences worse.
How does it progress?
- Early
Dryness that goes unnoticed
Saliva becomes thicker and stringy, and the mouth feels sticky in the mornings. Because the symptoms are mild they are not dwelt on, and this period can last for years.
- Moderate
The mouth struggling to do its work
Swallowing dry food without water becomes difficult, and the tongue sticks to the palate while you speak. Cracks at the corners of the lips and a burning feeling in the tongue may be added.
- Advanced
Clear damage to the teeth and the lining
Fast-moving decay is seen at the gum line and on the root surfaces. Fungal infections recur, dentures do not sit properly, and the lining of the mouth is easily injured.
- Gland signs
Periods of swelling in a salivary gland
There may be swelling from time to time in the glands in front of the ear or under the jaw. Following these episodes and planning any tests needed is the work of rheumatology and ear, nose and throat.
How is it treated?
The diagnosis is not made in dentistry. When a dry mouth, dry eyes and repeated swelling of the salivary glands are seen together, the assessment is made in rheumatology; blood tests, measurements of eye dryness and, where needed, a sample taken from one of the small salivary glands inside the lip are all part of that process. Requesting tests and making the diagnosis are not within a dentist's remit.
Dentistry's share is protection spread over years. Because the risk of decay is raised, check-ups are brought closer together, high-fluoride toothpaste and varnish applications support the enamel and the root surfaces, and early lesions are dealt with while they are still small. When oral thrush or inflammation under a denture develops, it is treated here.
For the dryness itself, saliva substitute gels and sprays, stimulating the flow with sugar-free gum and taking water in small sips through the day all come into play. Medicines aimed at increasing the secretion depend on a doctor's decision. The dry eyes are followed up in the eye clinic, while the general treatment carries on in rheumatology.
- Swelling in a salivary gland that does not go, that hardens, or that grows on one side
- A sore in the mouth that has not healed in two weeks, or a patch that does not rub off
- Gland swelling that comes with a fever and hurts when touched
How is it prevented?
- Drink water in small sips through the day; drinking a lot at once does not meet the dryness in the same way.
- Do not spread sugary and acidic drinks through the day; in a dry mouth this habit clearly raises the risk of decay.
- Follow the programme your dentist has set for you on fluoride and on how often you are seen.
- If you wear a denture, take it out at night and clean it; on dry tissue, inflammation under a denture develops more easily.
Frequently asked questions
- If my mouth is dry, does that mean I have Sjögren's syndrome?
- You cannot reach that conclusion from a dry mouth alone. The most common cause of dryness is the medicines a person is taking; fluid loss and breathing through the mouth produce a similar picture. If dry eyes, repeated swelling of the glands and joint symptoms are added, a rheumatology assessment is requested.
- Can a dentist diagnose this disease?
- No. Your dentist sees the signs in the mouth, assesses the damage the dryness is doing to the teeth, and asks whether your eyes are drying out as well. If there is a suspicion, they refer you to rheumatology; the diagnosis, the tests and the general treatment are carried out there.
- If the dryness eases, does the risk of decay return to normal?
- If saliva production has fallen for good, the risk is not expected to return to its former level. That is why the protection programme is kept up even when the symptoms ease. Whether the interval between check-ups can be lengthened is decided by your dentist, on the basis of the signs in your mouth.
This content is for general information and does not replace an in-person examination. Symptoms overlap between conditions, and a diagnosis can only be made clinically.