Association between Sjögren’s Syndrome and Periodontitis: Epidemiological, Fundamental and Clinical Data: A Systematic Review

Abstract

In recent decades, researchers have investigated the bidirectional links between periodontal disease and systemic diseases, and the results have allowed the development of the concept of periodontal medicine. This concept incorporates and analyzes the mutually influential interactions that can occur between periodontitis and systemic diseases such as diabetes mellitus or cardiovascular diseases. Sjögren’s syndrome (SS) is a chronic autoimmune disorder that targets the exocrine glands of the body, such as the lacrimal and salivary glands. The amount of saliva produced may gradually decrease with the progression of the disease, which can have an impact on the structures within the oral cavity. Although the reduction in saliva flow produces negative effects in the oral cavity, a direct association between Sjögren’s syndrome and periodontal disease has not yet been demonstrated. Available studies on this topic have not identified significant differences in the periodontal status of patients with Sjögren’s syndrome and control groups at the clinical and bacteriological levels. On the other hand, other studies on this topic consider that patients with periodontitis have a higher risk of developing Sjögren’s syndrome than the general population. Therefore, the results remain inconclusive, highlighting the need for further complementary studies.

Reply to: Characterisation of crevicular fluid microbiota in primary Sjögren's disease

“…There is a significant difference in the literature about the prevalence of periodontal disease (PD) among patients with primary Sjögren's disease (SjD). The prevalence reported in several clinical studies ranges from 30% to 83.9% (2)(3)(4), in contrast to the prevalence of 7.5% recorded by the Norwegian registry (1). In our study, we observed that 97.7% of patients had PD on at least one tooth.…”

Periodontitis and Sjogren’s syndrome: a bidirectional two-sample mendelian randomization study

“…Only two studies considered that PD patients might have a different likelihood of developing newly diagnosed SS comparing to the general population, both of which reported that PD patients had higher risk of developing SS [ 18 , 46 ]. Another systematic review without meta-analysis further recognized that current evidence about the association between PD and SS or vice versa was still inconclusive [ 47 ]. Possible explanations for the discordance among these observational studies included but are not restricted to potential confounders, such as smoking and other environmental factors, different population settings, and misdiagnosis of early-stage SS with only minor clinical manifestations.…”

Sjögren’s Disease and Oral Health: A Genetic Instrumental Variable Analysis

“…Oral dryness increases the risk of infection, reduces salivary flow, impairs rinsing function, and hinders tooth remineralization. While an increased susceptibility to dental caries is well recognized, the direct link between SjD and periodontitis is a subject of controversy and requires further confirmation ( Maarse et al 2019 ; Yang, Pang, et al 2022 ; Gheorghe et al 2023 ). Given the exposed anatomical position of the teeth, it can be anticipated that changes in saliva flow or its composition have the greatest impact on dental hard tissues.…”

“…The detrimental effect of SjD on caries susceptibility is generally acknowledged in the literature (Carr et al 2012). However, the effect of SjD on periodontitis remains strongly debated (see Fig.) (Lin et al 2019; Maarse et al 2019; Yang, Pang, et al 2022; Gheorghe et al 2023). Aside from a less clear link between the cardinal symptom of xerostomia and periodontal health, this is primarily due to 2 well-known problems of conventional observational studies: confounding and reverse causation (Maarse et al 2019; Yang, Pang, et al 2022; Gheorghe et al 2023).…”

“…However, the effect of SjD on periodontitis remains strongly debated (see Fig.) (Lin et al 2019; Maarse et al 2019; Yang, Pang, et al 2022; Gheorghe et al 2023). Aside from a less clear link between the cardinal symptom of xerostomia and periodontal health, this is primarily due to 2 well-known problems of conventional observational studies: confounding and reverse causation (Maarse et al 2019; Yang, Pang, et al 2022; Gheorghe et al 2023). Given the intricate etiology of both diseases and their shared association with polyautoimmunity, the presence of (unobserved) confounding factors is suspected (Kollert and Fisher 2020; Hajishengallis and Chavakis 2021).…”