Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Clinical Pathology
Published in: BMC Clinical Pathology 1/2005

Open Access 01-12-2005 | Research article

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

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

Published in: BMC Clinical Pathology | Issue 1/2005

Login to get access

Abstract

Background

the classification criteria for primary Sjögren'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.
Appendix
Available only for authorised users
Literature
1.
Moutsopoulos HM, Talal N: Immunological abnormalities in Sjögren's syndrome. Sjögren's syndrome. Clinical and immunological aspects. Edited by: Talal N, Moutsopoulos HM, Kassan SS. 1987, Heidelberg: Springer Verlag, 258-265.CrossRef
2.
Pedersen AM, Nauntofte B: Primary Sjögren's syndrome: oral aspects on pathogenesis, diagnostic criteria, clinical features and approaches for therapy. Expert Opin Pharmacother. 2001, 2: 1415-1436.CrossRefPubMed
3.
Daniels TE, Silverman S, Michalski JP, Greenspan JS, Path MRC, Sylvester RA, Talal N: The oral component of Sjögren's syndrome. Oral Surg Oral Med Oral Pathol. 1975, 39: 875-885.CrossRefPubMed
4.
Soto-Rojas AE, Villa AR, Sifuentes-Osornio J, Alarcon-Segovia D, Kraus A: Oral manifestations in patients with Sjögren's syndrome. J Rheumatol. 1998, 25: 906-910.PubMed
5.
Pedersen AM, Reibel J, Nordgarden H, HO Bergem, Jensen JL, Nauntofte B: Primary Sjögren's syndrome: salivary gland function and clinical oral findings. Oral Dis. 1999, 5: 128-138.CrossRefPubMed
6.
Strömbeck B, Ekdahl C, Manthorpe R, Wikström I, Jacobsson L: Health-related quality of life in primary Sjögren's syndrome, rheumatoid arthritis and fibromyalgia compared to normal population using SF-36. Scand J Rheumatol. 2000, 29: 20-28. 10.1080/030097400750001761.CrossRefPubMed
7.
Ravald N, List T: Caries and periodontal conditions in patients with primary Sjögren's syndrome. Swed Dent J. 1998, 22: 97-103.PubMed
8.
Pedersen AM, Reibel J, Nauntofte B: Primary Sjögren's syndrome: subjective symptoms and salivary findings. J Oral Pathol Med. 1999, 28: 303-311.CrossRefPubMed
9.
Christensen LB, Petersen PE, Thorn JJ, Schiødt M: Dental caries and dental health behavior of patients with primary Sjögren's syndrome. Acta Odontol Scand. 2001, 59: 116-120. 10.1080/000163501750266684.CrossRefPubMed
10.
Baudet-Pommel M, Albuisson E, Kemeny JL, Falvard F, Ristori JM, Fraysse MP, Sauvezie B.: Early dental loss in Sjögren's syndrome. Oral Surg Oral Med Oral Pathol. 1994, 78: 181-186.CrossRefPubMed
11.
Almståhl A, Wikström M, Kroneld U: Microflora in oral ecosystems in primary Sjögren's syndrome. J Rheumatol. 2001, 28: 1007-1013.PubMed
12.
Fejerskov O: Concepts of dental caries and their consequences for understanding the disease. Community Dent Oral Epidemiol. 1997, 25: 5-12.CrossRefPubMed
13.
Vitali C, Bombardieri S, Jonsson R, Moutsopoulos HM, Alexander EL, Carsons SE, Daniels TE, Fox PC, Fox RI, Kassan SS, Pillemer SR, Talal N, Weisman MH, European Study Group on Classification Criteria for Sjögren's Syndrome: Classification criteria for Sjögren's syndrome: a revised version of the European criteria proposed by the American-European Consensus Group. Ann Rheum Dis. 2002, 61: 554-558. 10.1136/ard.61.6.554.CrossRefPubMedPubMedCentral
14.
Manthorpe R, Oxholm P, Prause JU, Schiødt M: The Copenhagen criteria for Sjögren's syndrome. Scand J Rheumatol. 1986, 19-21. Suppl 61
15.
Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J: An inventory for measuring depression. Arch Gen Psychiatry. 1961, 4: 561-571.CrossRefPubMed
16.
Bardow A, Moe D, Nyvad B, Nauntofte B: The buffer capacity and buffer systems of human whole saliva measured without loss of CO2. Arch Oral Biol. 2000, 45: 1-12. 10.1016/S0003-9969(99)00119-3.CrossRefPubMed
17.
Bardow A, Madsen J, Nauntofte B: The bicarbonate concentration in human saliva does not exceed the plasma level under normal physiological conditions. Clin Oral Invest. 2000, 4: 245-253. 10.1007/s007840000077.CrossRef
18.
Van Slyke DD: On the measurement of buffer values and on the relationship of buffer value to the dissociation constant of the buffer and the concentration and reaction of the buffer solution. J Biol Chem. 1922, 52: 525-570.
19.
Schmidt-Nielsen B: The solubility of tooth substance in relation to the composition of saliva. Thesis. 1946, Copenhagen
20.
Sreebny LM, Schwartz SS: A reference guide to drugs and dry mouth – 2nd edition. Gerodontology. 1997, 14: 33-47. 10.1111/j.1741-2358.1997.00033.x.CrossRefPubMed
21.
Hunter KD, Wilson WS: The effects of antidepressant drugs on salivary flow and content of sodium and potassium ions in human parotid saliva. Arch Oral Biol. 1995, 40: 983-989. 10.1016/0003-9969(95)00079-5.CrossRefPubMed
22.
Nederfors T: Xerostomia: prevalence and pharmacotherapy. With special reference to beta-adrenoceptor antagonists. Swed Dent J. 1996, 1-70. Suppl 116
23.
Manthorpe R, Benoni C, Jacobsson L, Kirtava Z, Larsson A, Liedholm R, Nyhagen C, Tabery H, Theander E: Lower frequency of focal lip sialadenitis (focus score) in smoking patients. Can tobacco diminish the salivary gland involvement as judged by histological examination and anti-SSA/Ro and anti-SSB/La antibodies in Sjögren's syndrome?. Ann Rheum Dis. 2000, 59: 54-60. 10.1136/ard.59.1.54.CrossRefPubMedPubMedCentral
24.
Khan GJ, Mehmood R, Salah-ud-Din , Ihtesham-ul-Haq : Effects of long-term use of tobacco on taste receptors and salivary secretion. J Ayub Med Coll Abbottabad. 2003, 15: 37-39.PubMed
25.
Workshop on diagnostic criteria for Sjögren's syndrome: Clinical Exp Rheumatol. 1989, 7: 212-219.
26.
Boutsi EA, Paikos S, Dafni UG, Moutsopoulos HM, Skopouli FN: Dental and periodontal status of Sjögren's syndrome. J Clin Periodontol. 2000, 27: 231-235. 10.1034/j.1600-051x.2000.027004231.x.CrossRefPubMed
27.
Bozkurt FY, Berker E, Akkus S, Bulut S: Relationship between interleukin-6 levels in gingival crevicular fluid and periodontal status in patients with rheumatoid arthritis and adult periodontitis. J Periodontol. 2000, 71: 1756-1760. 10.1902/jop.2000.71.11.1756.CrossRefPubMed
28.
Almståhl A, Kroneld U, Tarkowski A, Wikström M: Oral microbial flora in Sjögren's syndrome. J Rheumatol. 1999, 26: 110-114.PubMed
29.
Bardow A, Nyvad B, Nauntofte B: Relationships between medication intake, complaints of dry mouth, salivary flow rate and composition, and the rate of tooth demineralization in situ. Arch Oral Biol. 2001, 46: 413-423. 10.1016/S0003-9969(01)00003-6.CrossRefPubMed
30.
Lundström IM, Lindström FD: Subjective and clinical oral symptoms in patients with primary Sjögren's syndrome. Clin Exp Rheumatol. 1995, 13: 725-731.PubMed
31.
Navazesh M, Wood GJ, Brightman V: Relationship between salivary flow rates and Candida albicans counts. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1995, 80: 284-288.CrossRefPubMed
32.
33.
Scheinin A, Pienihäkkinen K, Tiekso J, Holmberg S: Multifactorial modeling for root caries prediction. Community Dent Oral Epidemiol. 1992, 20: 35-37.CrossRefPubMed
34.
35.
Izutsu KT, Madden PR: Evidence for the presence of carbamino compounds in human saliva. J Dent Res. 1978, 57: 319-325.CrossRefPubMed
36.
Helm JP, Dodds WJ, Hogan WJ, Soergel KH, Egide MS, Wood CM: Acid neutralizing capacity of human saliva. Gastroenterology. 1982, 83: 69-74.PubMed
37.
Dawes C: Physiological factors affecting salivary flow rate, oral sugar clearance and the sensation of dry mouth in man. J Dent Res. 1987, 66: 648-53.CrossRefPubMed
38.
Sreebny LM, Banoczy J, Baum BJ, Edgar WM, Epstein JB, Fox PC: Saliva. The Working Group of the Commision on Oral Health, Research and Epidemiology (CORE). Féderation Dentaire Internationale. 1991, London: FDI World Dental Press
39.
Cook DI, Van Lennep EW, Roberts ML, Young JA: Secretion by the major salivary glands. Physiology of the Gastrointestinal Tract. Edited by: Johnson LR. 1994, New York: Raven Press, 1061-1117.
40.
41.
Atkinson JC, Travis WD, Pillemer SR, Wolff A, Bermudez D, Fox PC: Major salivary gland function in primary Sjögren's syndrome and its relationship to clinical findings. J Rheumatol. 1990, 17: 318-322.PubMed
42.
Kalk WW, Vissink A, Spijkervet FKL, Bootsma H, Nieuw Amerongen AV, Kallenberg CGM: Sialometry and sialochemistry: a non-invasive approach for diagnosing Sjögren's syndrome. Ann Rheum Dis. 2002, 61: 137-144. 10.1136/ard.61.2.137.CrossRefPubMedPubMedCentral
43.
Murer H, Biber J: [Molecular physiology and pathophysiology of renal phosphate excretion]. Schweiz Med Wochenschr. 1998, 128: 1247-1252. Article in German.PubMed
44.
Thaysen JH, Thorn NA, Schwartz IL: Excretion of sodium, potassium, chloride and carbondiozide in human parotid saliva. Am J Physiol. 1954, 178: 155-159.PubMed
45.
Stuchell RN, Mandel ID, Baurmash H: Clinical utilization of sialochemistry in Sjögren's syndrome. J Oral Pathol. 1984, 13: 303-309.CrossRefPubMed
46.
47.
Bowman SJ: Collaborative research into outcome measures in Sjögren's syndrome. Update on disease assessment. Scand J Rheumatol Suppl. 2002, 116: 23-27.CrossRefPubMed
48.
Pillemer SR, Smith J, Fox PC, Bowman SJ: Workshop Report: Outcome Measures for Sjögren's Syndrome, April 10–11, 2003, Bethesda, Maryland, USA. J Rheumatol. 2005, 32: 143-149.PubMed
49.
Chisholm DM, Waterhouse JP, Mason DK: Lymphocytic sialoadenitis in the major and minor salivary glands: A correlation in post mortem subjects. J Clin Pathol. 1970, 23: 690-694.CrossRefPubMedPubMedCentral
50.
Wise CM, Agudelo CA, Semble EL, Stump TE, Woodruff RD: Comparison of parotid and minor salivary gland biopsy specimens in the diagnosis of Sjögren's syndrome. Arthritis Rheum. 1988, 31: 662-666.CrossRefPubMed
51.
Ihrler S, Zietz C, Sendelhofert A, Lang S, Blasenbreu-Vogt S, Löhrs U: A morphogenetic concept of salivary duct regeneration and metaplasia. Virchows Arch. 2002, 440: 519-526. 10.1007/s004280100537.CrossRefPubMed
52.
Pedersen AM, Dissing S, Fahrenkrug J, Hannibal J, Reibel J, Nauntofte B: Innervation pattern and Ca2+ signalling in labial salivary glands of healthy individuals and patients with primary Sjögren's syndrome (pSS). J Oral Pathol Med. 2000, 29: 97-109. 10.1034/j.1600-0714.2000.290301.x.CrossRefPubMed
53.
Garty H, Palmer LG: Epithelial sodium channels: function, structure, and regulation. Physiol Rev. 1997, 77: 359-396.PubMed
Metadata
Title
Salivary changes and dental caries as potential oral markers of autoimmune salivary gland dysfunction in primary Sjögren's syndrome
Authors
Anne Marie Lynge Pedersen
Allan Bardow
Birgitte Nauntofte
Publication date
01-12-2005
Publisher
BioMed Central
Published in
BMC Clinical Pathology / Issue 1/2005
Electronic ISSN: 1472-6890
DOI
https://doi.org/10.1186/1472-6890-5-4

Other articles of this Issue 1/2005

BMC Clinical Pathology 1/2005 Go to the issue

Case report

Lymph node infarction – a rare complication associated with disseminated intra vascular coagulation in a case of dengue fever

Technical advance

DNA index determination with Automated Cellular Imaging System (ACIS) in Barrett's esophagus: Comparison with CAS 200

Case report

Unexpected combination of acute croup and myocarditis: Case report

Research article

Stainable hepatic iron in 341 African American adults at coroner/medical examiner autopsy

Research article

p27Kip1 is expressed in proliferating cells in its form phosphorylated on threonine 187

Research article

Id4 and FABP7 are preferentially expressed in cells with astrocytic features in oligodendrogliomas and oligoastrocytomas
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits