Oral and salivary parameters in patients with rheumatic diseases

Abstract

We studied the presence of secondary Sjögren's syndrome (SS) and the composition of saliva, prevalence of oral pathogens, periodontitis, mouth mucosa, and teeth in patients with various rheumatic diseases and in healthy controls. The hypothesis was that different rheumatic diseases might cause differences in oral health characteristics because of the liability of secondary SS in the patients. The study involved 77 patients and 77 age-matched and sex-matched controls. Twenty patients were suffering from spondylarthropathy (SPA), 18 from ankylosing spondylitis (AS), 24 from rheumatoid arthritis (RA), and 15 from mixed connective tissue disease (MCTD). Clinical and radiographic oral health status was recorded and salivary flow rates were measured. Selected salivary proteins and immunoglobulins were analysed by routine methods. Minor salivary gland biopsy samples were taken from the patients for assessment of inflammatory focus scores. Differences between patients and controls and in between the different rheumatic diseases were analysed statistically. Secondary SS was diagnosed in 39% (30/77) of the patients. A severe periodontal condition (community periodontal index of treatment needs score 3 or 4) occurred in 58% (45/77) of the rheumatic patients compared with only 26% (20/77) of the controls (p < 0.0001). The severity of focal sialadenitis (focus score) correlated significant with salivary IgA, IgG, and IgM concentrations. Salivary albumin, total protein, IgG, and IgM concentrations were higher in all patient groups than in the controls. The number of patients with low salivary flow rates was higher in all patient groups compared to controls. Oral yeast counts were significantly higher in the patients than in the controls (p < 0.001). In a subgroup analysis, patients with SS had higher values for salivary IgA and IgM than patients without SS. Dental caries and oral lactobacilli were more frequent in patients with SS, but SS was not associated with periodontitis. No major differences were noted in other salivary biochemical parameters between these two groups. Patients with rheumatic diseases, irrespective of specific diagnosis, thus had various alterations in salivary flow and composition and oral health. The findings may reflect the autoimmune inflammation of the salivary glands frequently observed in these patients.

Salivary hypofunction: An update on aetiology, diagnosis and therapeutics

“…16,84 The American College of Rheumatology proposed, in 2012, classification criteria for Sjö gren's syndrome based on objective measures such as serum antibody titre, presence of focal lymphocytic sialadenitis and ocular staining score. 85 Besides Sjö gren, others rheumatological chronic inflammatory disorders may be associated with salivary hypofunction such as rheumatoid arthritis, 86,87 systemic lupus erythematosus, 88,89 juvenile idiopathic arthritis, 90 and primary biliary cirrhosis. 91 Autoimmune inflammation of the salivary glands is frequently observed in those patients.…”

Diagnosis and treatment of xerostomia (dry mouth)

“…25,26 Secondary SS is seen in 25%-35% of rheumatoid arthritis patients. 27,28 Systemic lupus erythematosus has been associated with a decreased unstimulated whole saliva fl ow rate, a 75% incidence of oral complaints (e.g., xerostomia, pain), and secondary SS in one-third of patients. [29][30][31] Primary biliary cirrhosis is associated with xerostomia, as 70% of patients have a coexisting autoimmune disease such as SS and 90% exhibit focal sialadenitis.…”

Saliva in perimenopausal and early postmenopausal women. A 2-year follow-up study

“…We were particularly interested in salivary albumin, the serum ultrafiltrate in saliva. Salivary albumin concentration increases in patients systemically ill and/or with mucositis [18][19][20][21]. The study design was a 2-year follow-up study of a cohort of peri-and postmenopausal women invited to a free-ofcharge community-based mammography screening [6].…”