Salivary changes and dental caries as potential oral markers of autoimmune salivary gland dysfunction in primary Sjogren's syndrome

Anne Marie Lynge Pedersen, Allan Bardow, Birgitte Nauntofte, Anne Marie Lynge Pedersen, Allan Bardow, Birgitte Nauntofte

Abstract

BACKGROUND: the classification criteria for primary Sjogren's syndrome (pSS) include a number of oral components. In this study we evaluated if salivary flow and composition as well as dental caries are oral markers of disease severity in pSS. METHODS: in 20 patients fulfilling the American-European Consensus criteria for pSS and 20 age-matched healthy controls whole and parotid saliva flow rates and composition, measures of oral dryness, scores of decayed, missing and filled tooth surfaces (DMFS), periodontal indices, oral hygiene, and dietary habits were examined. RESULTS: in pSS, salivary flow rates, pH, and buffer capacities were lower, and DMFS, salivary sodium and chloride concentrations higher than in the healthy controls. DMFS also correlated inversely to salivary flow rates and positively to oral dryness. Apart from slightly increased gingival index, and more frequent dental visits in pSS, the periodontal condition, oral hygiene or sugar intake did not differ between these two groups. In pSS, findings were correlated to labial salivary gland focus score (FS) and presence of serum-autoantibodies to SSA/SSB (AB). The patients having both presence of AB and the highest FS (>2) also had the highest salivary sodium and chloride concentrations, the lowest salivary phosphate concentrations, lowest salivary flow rates, and highest DMFS compared to those with normal salivary concentrations of sodium and chloride at a given flow rate. CONCLUSION: the salivary changes observed in some pSS patients reflect impaired ductal salt reabsorption, but unaffected acinar transport mechanisms, despite low salivary secretion. Our results suggest that changes in salivary flow and composition as well as dental caries may serve as potential markers of the extent of autoimmune-mediated salivary gland dysfunction in pSS. The study also indicates that the ductal epithelium is functionally affected in some pSS patients, which calls for future pathophysiological studies on the mechanisms underlying this impaired salt reabsorption.

Figures

Figure 1
Figure 1
shows the saliva composition as a function of the parotid saliva flow rate (both unstimulated and stimulated) in patients with pSS (bold circles) and healthy age-matched controls (open circles). Lines were fitted by linear (a and b) or non-linear regression (c-h) depending on the best obtainable fit judged from the R-squared values with unbroken lines representing pSS and dotted lines the controls. Figures 1a and b illustrates that the pSS patients can be divided into two subgroups with regard to salt reabsorption. One group of patients follow the reabsorption pattern of the healthy controls, whereas the other group display high sodium and chloride concentrations despite low parotid flow rates indicating differences in the degree of glandular affection by the disease of the patients studied.

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